Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part I - Definitions › Section 12VAC5-200-10 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
The following words and terms when used in this chapter
					 have the following meanings unless the context clearly indicates
					 otherwise:
"Applicant" means the person requesting medical care
					 services for himself or on whose behalf a request is made.
"Board" means the State Board of Health.
"Child" means a person under 18 years of age and includes
					 any biological or adopted child, and any child placed for adoption or foster
					 care unless otherwise treated as a separate unit for the purposes of
					 determining eligibility and charges under these regulations.
"Commissioner" means the Commissioner of Health.
"Department" means the state Department of Health and
					 includes the central office, regional offices, health districts, and local
					 health departments.
"Eligibility determination" means the process of obtaining
					 required information regarding family size, income, and other related data in
					 order to establish charges to the applicant.
"Extraordinary financial hardship" includes hardship due to
					 such events as natural disasters, damage to or the loss of uninsured real or
					 personal property, unpaid legal liabilities, and obligatory and unavoidable
					 expenditures for close relatives outside the family unit.
"Family" or "family unit" means the applicant and other
					 such household members who together constitute one economic unit. An economic
					 unit is one or more individuals who generally reside together and share income.
					 The economic unit shall count in its income any contributions to the unit from
					 persons not necessarily living with the unit.
A parent may be a biological, adoptive, or
					 stepparent.
A woman who is pregnant may be counted as a multiple
					 beneficiary when the pregnancy has been verified by a physician or a nurse
					 practitioner working under the supervision of a physician.
A husband and wife who are separated and are not living
					 together shall be considered to be separate family units.
"Flat rate charges" means charges for specified goods or
					 services that are to be charged to all clients regardless of income and with no
					 eligibility determination.
"Gross income" means total cash receipts before taxes from
					 all sources. These include money wages and salaries before any deductions, but
					 do not include food or rent in lieu of wages. These receipts include net
					 receipts from nonfarm or farm self-employment (e.g., receipts from an
					 applicant's own business or farm expenses) income, plus any depreciation shown
					 on income tax forms. They include regular payments from social security or
					 railroad retirement, unemployment and workers' compensation, strike benefits
					 from union funds, veterans' benefits, training stipends, alimony, child
					 support, and military family allotments or other regular support from an absent
					 family member or someone not living in the household; private pensions,
					 government employee pensions (including military retirement pay), and regular
					 insurance or annuity payments; and income from dividends, interest, net rental
					 income, net royalties, or periodic receipts from estates or trusts, lump sum
					 settlements, and net gambling or lottery winnings.
"Gross income" does not include the value of food stamps,
					 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
					 checks, fuel assistance payments, housing assistance, money borrowed, tax
					 refunds, gifts, withdrawal of bank deposits from earned income, earnings of
					 minor children, money received from the sale of property, general relief from
					 the Department of Social Services, or college or university scholarships,
					 grants, fellowships, and assistantships when provided to pay for, or in the
					 form of, tuition, fees, other direct educational expenses, housing, or
					 meals.
"Income scales" means scales based on individual or family
					 gross income. They shall be based on the official federal poverty guidelines
					 updated annually by the U.S. Department of Health and Human Services in
					 accordance with §§ 652 and 6763(2) of the Omnibus Reconciliation Act
					 of 1981 ( Public Law 97-35 ). There shall be two income scales: one for
					 Northern Virginia and one for the remainder of the Commonwealth as
					 follows:
Income Level A - those clients with incomes up to and
					 including 100% of the federal poverty income guidelines will qualify as Income
					 Level A clients, except for Northern Virginia where the Income Level A will be
					 up to and including 110% of the federal poverty income guidelines.
Income Level B - those clients with incomes above 100% and
					 no more than 110% of the federal poverty guidelines will qualify as Income
					 Level B clients, except for Northern Virginia where the Income Level B will be
					 above 110% and no more than 133.3% of the federal poverty income
					 guidelines.
Income Level C - those clients with incomes above 110% and
					 no more than 133.3% of the federal poverty income guidelines will qualify as
					 Income Level C clients, except for Northern Virginia where the Income Level C
					 will be above 133.3% and no more than 166.6% of the federal poverty income
					 guidelines.
Income Level D - those clients with incomes above 133.3%
					 and no more than 166.6% of the federal poverty income guidelines will qualify
					 as Income Level D clients, except for Northern Virginia where the Income Level
					 D will be above 166.6% and no more than 200% of the federal poverty income
					 guidelines.
Income Level E - those clients with incomes above 166.6%
					 and less than 200% of the federal poverty income guidelines will qualify as
					 Income Level E clients, except for Northern Virginia where the Income Level E
					 will be above 200% and less than 233.3% of the federal poverty income
					 guidelines.
Income Level F - those clients with incomes equal to or
					 above 200% and less than 250% of the federal poverty income guidelines will
					 qualify as Income Level F clients, except for Northern Virginia where the
					 Income Level F will be equal to or above 233.3% and less than 283.3% of the
					 federal poverty income guidelines.
Income Level G - those clients with incomes equal to or
					 above 250% of the federal poverty level guidelines will qualify as Income Level
					 G clients, except for Northern Virginia where income level G will be equal to
					 or above 283.3% of the federal poverty income guidelines.
"Medical care services" means clinical medical, dental, and
					 nursing services provided to patients by physicians, dentists, nurses, and
					 other health care providers employed by health districts or contracted by
					 health districts to provide these services. It does not include laboratory
					 tests, pharmaceutical and biological products, radiological or other imaging
					 studies, other goods or products, or other medical services that a health
					 district does not directly provide.
"Medically indigent" means applicants whose individual or
					 family gross income is defined as Income Level A.
"Minor" means a person less than 18 years of age whose
					 parents are responsible for his care. A minor will be considered a separate
					 family unit when married or not living with any relative or deemed an
					 adult.
A minor shall be deemed an adult for the purposes of
					 consenting to:
1. Medical or health
				  services needed to determine the presence of or to treat venereal disease or
				  any infectious or contagious disease which the State Board of Health requires
				  to be reported.
2. Medical and
				  health services required for birth control, pregnancy, or family planning
				  except for the purposes of sexual sterilization.
"Nonchargeable services" means the medical care and related
					 goods and services that the department has determined will be provided without
					 charge and without an eligibility determination to all citizens regardless of
					 income.
"Northern Virginia" means the area which includes the
					 cities of Alexandria, Fairfax, Falls Church, Manassas, Manassas Park, and the
					 counties of Arlington, Fairfax, Loudoun, and Prince William.
"Venereal disease" is synonymous with "sexually transmitted
					 infection."
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.