Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 20 - KIDNEY DISEASE PROGRAM › Chapter 10.20.01 - General Regulations › Section 10.20.01.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Applicant" means an individual who has
				  applied for, or is in the process of applying for, Kidney Disease Program
				  enrollment and has not yet been certified as an eligible recipient.
(2) "Certification period" means the 12-month
				  period during which an individual is certified as eligible to receive Kidney
				  Disease Program benefits.
(3)
				  "Certified facility" means a hospital, dialysis facility, or transplantation
				  center which the Department certifies meets the standards that the Commission
				  adopts for providing services to recipients and which is certified by
				  Medicare.
(4) "Commission" means
				  the State Commission on Kidney Disease.
(5) "Department" means the State Department
				  of Health and Mental Hygiene.
(6)
				  "Dialysis" means chronic hemodialysis or chronic peritoneal dialysis provided
				  in a certified facility or a facility approved by the Commission or in the
				  patient's home under the auspices of a certified facility or home dialysis
				  program approved by the Commission.
(7) "End stage renal disease (ESRD)" means
				  that stage of renal impairment that appears irreversible and permanent, and
				  requires a regular course of maintenance dialysis or kidney transplantation to
				  maintain life.
(8) "Family" means
				  the recipient and all of the following individuals sharing the same household
				  with the recipient:
(a) The recipient's
				  spouse;
(b) The recipient's natural
				  or adopted children who are younger than 21 years old;
(c) The recipient's natural or adoptive
				  parent, if the recipient is a child younger than 21 years old; and
(d) The recipient's stepchildren or
				  grandchildren for which the recipient has legal or presumed
				  guardianship.
(9)
				  "Liquid assets" means cash or an asset that can readily be converted to
				  cash.
(10) "Medical Assistance"
				  means the State program of comprehensive medical and other health-related care
				  for indigent and medically indigent persons.
(11) "Medicare" means the insurance program
				  administered by the federal government under Title XVIII of the Social Security
				  Act, 42 U.S.C. §
												1395 et seq.
(12) "Poverty income guidelines" means the
				  federal poverty income guidelines contained in the most recent annual update of
				  the Department of Health and Human Services poverty income guidelines as
				  published in the Federal Register.
(13) "Preauthorization" means an approval
				  required from the Program before services are rendered to a
				  recipient.
(14) "Primary Adult Care
				  Program (PAC)" has the meaning stated in COMAR
				  10.09.60.02B.
(15) "Program" means the Kidney
				  Disease Program of Maryland.
(16)
				  "Program participation fee" means an annual premium which may be assessed by
				  the Program and is based on family income or liquid assets, or both.
(17) "Provider" means an individual,
				  association, partnership, corporation, or unincorporated group licensed or
				  certified to provide health care services for Program recipients.
(18) "Qualified alien" means an alien who:
(a) Has been fully admitted for permanent
				  residence in the United States under the Immigration and Nationality Act
				  (INA);
(b) Has been granted asylum
				  in the United States under § 208 of the INA;
(c) Has been admitted into the United States
				  as a refugee under § 207 of the INA;
(d) Has been paroled into the United States
				  under § 212(d)(5) of the INA for a period of at least 1 year;
(e) Has had deportation withheld under §
				  243(h) of the INA; or
(f) Has been
				  granted conditional entry into the United States under § 203(a)(7) of the
				  INA in effect before April 1, 1980.
(19) "Quarterly amount" means the quarterly
				  installment payment which is equal to 25 percent of a recipient's annual
				  Program participation fee.
(20)
				  "Recipient" means an individual who is certified for enrollment in the Kidney
				  Disease Program of Maryland.
(21)
				  "Reimbursable drug list" means the Kidney Disease Program formulary of
				  medications approved for payment.
(22) "Representative" means an individual
				  who, because of an applicant's or a recipient's mental or physical incapacity
				  or youth, or specified dialysis or transplant facility personnel who have been
				  so designated by virtue of the applicant's or recipient's voluntarily signed
				  authorization form, is authorized, in accordance with State law, to complete,
				  sign, or withdraw an application for enrollment in the Program or to activate a
				  hearing process.
(23) Resident.
(a) "Resident" means an individual
				  permanently living in Maryland whose temporary absence from the State does not
				  interrupt continuity of residence.
(b) "Resident" does not mean:
(i) Members or their families, or both, of
				  the United States armed services temporarily stationed in Maryland;
				  or
(ii) Foreign nationals employed
				  in embassies of their native country.