Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.1 - Handicapped Children's Services Program › Rule 37.57.102 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
Unless otherwise indicated, the following definitions apply
				  throughout this subchapter:
(1)
				"Applicant" means a child or youth with special health care needs (CYSHCN) who
				has applied or whose parent or guardian has applied on the child's behalf to
				receive children's special health service (CSHS) financial assistance from the
				department.
(2) "Child or Youth
				with Special Health Care Needs" (CYSHCN) means a child or youth, under the age
				of 22, who has or is at increased risk for chronic physical, developmental,
				behavioral, or emotional condition and who also requires health and related
				services of a type or amount beyond that required by children
				generally.
(3) "Client" means a
				CYSHCN who is eligible to receive CSHS financial assistance as determined by
				the department under this subchapter.
(4) "CSHS" means the children's special
				health services program of the department, authorized by
				50-1-202,
				MCA, that serves children and youth with special health care needs.
(5) "Department" means the Montana Department
				of Public Health and Human Services.
(6) "Disability" or "disabling condition"
				means a chronic physical, developmental, behavioral or emotional condition
				requiring health and related services of a type or amount beyond that required
				by children generally.
(7)
				"Disabled" means having any physical defect or characteristic, congenital or
				acquired, that prevents or restricts normal growth or capacity for activity.
(8) "Eligibility year" means the
				federal fiscal year in which a CYSHCN receives CSHS direct payment financial
				assistance.
(9) "Enabling services"
				means nonclinical services that enable individuals to access health care and
				improve health outcomes. Enabling services include, but are not limited to:
				case management, care coordination, referrals, home visiting, respite care,
				specialized daycare or preschool, translation/interpretation, transportation,
				eligibility assistance, health education for individuals or families, and
				outreach.
(10) "Family" means a
				group of related or non-related individuals who are living together as a single
				economic unit.
(11) "Federal fiscal
				year" means the period beginning October 1 and ending the following September
				30.
(12) "Financial Assistance"
				means payment by the department for CSHS-authorized treatment and enabling
				services for a CYSHCN eligible for the CSHS program.
(13) "HMK" means Healthy Montana Kids
				(Children's Health Insurance Program or CHIP) insurance plan administered by
				the department.
(14) "HMK Plus"
				means Healthy Montana Kids Plus (children's Medicaid) plan administered by the
				department.
(15) "Initial diagnosis
				and evaluation" means taking a medical history and performing a physical
				examination, medical procedures, laboratory tests, hearing and other diagnostic
				tests, or other procedures necessary for the diagnosis of a
				condition.
(16) "Poverty income
				guidelines" means the poverty income guidelines published in 2018 in the
				Federal Register by the U.S. Department of Health and Human Services. The
				department adopts and incorporates by reference the federal poverty guidelines
				that establish income thresholds according to family unit size for purposes of
				determining eligibility for government assistance or services and that are
				published in the January 2018, Federal Register. A copy of the 2018 poverty
				guidelines may be obtained from the Department of Public Health and Human
				Services, Public Health and Safety Division, Children's Special Health Services
				Program, 1400 Broadway, Rm A-116, Helena, MT 59620, telephone (406)
				444-3617.
(17) "Program" means the
				department's children's special health services program for a CYSHCN,
				authorized by
				50-1-202,
				MCA.
(18) "Provider" means a
				supplier of medical care or services, enabling services, interventions, medical
				appliances, prescribed medications, formula or foods, and
				consultations.
(19) "Risk category"
				means any condition of a child or youth's life which qualifies them as being at
				an increased risk for chronic physical, development, behavioral, or emotional
				condition, further qualifying them as a CYSHCN. This may include but is not
				limited to: living in poverty, in the foster care or Child Protective Services
				system, having a parent with a disabling condition, multiple adverse childhood
				experiences, or homelessness.
(20)
				"Services" means enabling or treatment services covered by the rule.
(21) "Special Health Care Need" means a
				chronic condition that requires health and related services of a type or amount
				beyond that generally required by children.
(22) "Third-party payer" means a public or
				private entity that is or may be liable to pay all or part of the medical costs
				for a client.
(23) "Treatment"
				means medical, corrective, and/or surgical intervention to alleviate a
				disabling condition or as recommended by a provider based on a CYSHCN's risk
				category, including for initial testing and diagnosis. This includes
				medications and medical equipment.
AUTH:
					 50-1-202,
					 MCA; IMP:
					 50-1-202,
					 MCA