Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Authorized representative"
means an
				  individual or organization authorized by a competent applicant or member,
				  authorized by a responsible person acting for an incompetent applicant or
				  member pursuant to subrule 76.9(2), or with other legal authority to represent
				  the applicant or member in the application process, renewal of eligibility and
				  other ongoing communications with the department.
"Electronic account"
means a Web-based
				  account established by the department for an applicant or member for
				  communication between the department and the applicant or member.
"Electronic case record"
means an electronic
				  file that includes all information collected and generated by the department
				  regarding each individual's Medicaid eligibility and enrollment.
"Health insurance marketplace "
means an
				  American health benefit exchange established pursuant to 42 U.S.C. §
				  18031.
"Medicare savings program"
refers to the
				  limited Medicaid coverage groups that provide payment of Medicare premiums,
				  coinsurance, and deductibles for low-income elderly or disabled individuals.
				  Those groups are qualified disabled and working people (QDWP) pursuant to 42
				  U.S.C. § 1396a (a)(10)(E)(ii), qualified Medicare beneficiaries (QMB)
				  pursuant to 42 U.S.C. § 1396a (a)(10)(E)(i), specified low-income Medicare
				  beneficiaries (SLMB) pursuant to 42 U.S.C. § 1396a (a)(10)(E)(iii), and
				  expanded specified low-income Medicare beneficiaries (ESLMB) pursuant to 42
				  U.S.C. § 1396a (a)(10)(E)(iv).
"Member"
means an individual who has been
				  determined eligible for medical assistance pursuant to 441-Chapter 75 and has
				  been enrolled to receive assistance. For the medically needy program, "member"
				  shall mean an individual who has been determined eligible for medical
				  assistance under the medically needy program, has been enrolled, and has
				  countable income at or below the medically needy income level (MNIL) or has
				  reduced countable income to the MNIL during the certification period through
				  spenddown.
"Modified adjusted gross income"
means the
				  methodology to determine income eligibility prescribed by 1902(e)(14) of the
				  Social Security Act ( 42 U.S.C. § 1396a (e)(14)).
"Presumptive eligibility"
means that a
				  person is presumed to be eligible on a temporary basis based on information
				  provided.
"Qualified entity"
is an entity that is
				  described in Paragraphs (1) through (10) of
				  42 CFR
				  435.1101 relating to coverage groups for
				  children, 42 CFR 435.1110b relating to hospitals determining eligibility,
				  U.S.C. § 1396r-1 relating to coverage groups for pregnant women, or 42
				  U.S.C. § 1396r-1b relating to the breast and cervical cancer coverage
				  group, that has been determined by the department to be capable of making
				  presumptive Medicaid eligibility determinations, and that has signed an
				  agreement with the department as a qualified entity.
"Responsible person"
means an individual
				  recognized by the department pursuant to subrule 76.9(1) as acting for an
				  applicant or member who is unable to act on the applicant's or member's own
				  behalf because the applicant or member is a minor or is incompetent,
				  incapacitated, or deceased.
"Supplemental security income"
or
"SSI"
is a federally administered program established by Title
				  XVI of the Social Security Act to provide supplemental income to individuals
				  who have attained the age of 65 or are blind or disabled.
"WIC"
is the Special Supplemental Nutrition
				  Program for Women, Infants, and Children established by 42 U.S.C. §
				  1786.