Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-500 - Medical definitions › Section 182-500-0070 - Definitions-M

Current through Register Vol. 24-14, July 15, 2024
"Managed care organization (MCO)"
see WAC
				  182-538-050.
"Medicaid"
means the federal medical aid program
				  under Title XIX of the Social Security Act that provides health care to
				  eligible people.
"Medicaid agency"
means the state agency that
				  administers the medicaid program. The Washington state health care authority
				  (HCA) is the state's medicaid agency.
"Medicaid transformation project"
refers to the
				  demonstration granted to the state by the federal government under section 1115
				  of the Social Security Act. Under this demonstration, the federal government
				  allows the state to engage in a five-year demonstration to support health care
				  systems, to implement reform, and to provide new targeted medicaid services to
				  eligible clients with significant needs.
"Medical assistance"
is the term the agency and
				  its predecessors use to mean all federal or state-funded health care programs,
				  or both, administered by the agency or its desig-nees. Medical assistance
				  programs are referred to as Washington apple health.
"Medical care services (MCS)"
means the limited
				  scope health care program financed by state funds for clients who are eligible
				  for the aged, blind, or disabled (ABD) cash assistance (see WAC
				  388-400-0060
				  ) or the housing and essential needs (HEN) referral program (see WAC
				  388-400-0065
				  ) and not eligible for other full-scope programs due to their citizenship or
				  immigration status.
"Medical consultant"
means a physician employed
				  by or contracted with the agency or the agency's designee.
"Medical facility"
means a medical institution
				  or clinic that provides health care services.
"Medical institution"
See "institution" in WAC
				  182-500-0050.
"Medical services card"
or
"services
				  card"
means the card the agency issues at the initial approval of a
				  person's Washington apple health benefit. The card identifies the person's name
				  and medical services identification number but is not proof of eligibility. The
				  card may be replaced upon request if it is lost or stolen, but is not required
				  to access health care through Washington apple health.
"Medically necessary"
is a term for describing
				  requested service which is reasonably calculated to prevent, diagnose, correct,
				  cure, alleviate or prevent worsening of conditions in the client that endanger
				  life, or cause suffering or pain, or result in an illness or infirmity, or
				  threaten to cause or aggravate a handicap, or cause physical deformity or
				  malfunction. There is no other equally effective, more conservative or
				  substantially less costly course of treatment available or suitable for the
				  client requesting the service. For the purposes of this section, "course of
				  treatment" may include mere observation or, where appropriate, no medical
				  treatment at all.
"Medically needy (MN)"
or
"medically needy
				  program (MNP)"
means the state and federally funded health care program
				  available to specific groups of people who would be eligible as categorically
				  needy (CN), except their monthly income is above the CN standard. Some
				  long-term care clients with income or resources above the CN standard may also
				  qualify for MN.
"Medically needy income level (MNIL)"
means the
				  standard the agency uses to determine eligibility under the medically needy
				  program. See WAC
				  182-519-0050.
"Medicare"
is the federal government health
				  insurance program under Titles II and XVIII of the Social Security Act. For
				  additional information, see
www.Medicare.gov
.
"Medicare assignment"
means the process by which
				  a provider agrees to provide services to a medicare beneficiary and accept
				  medicare's payment for the services.
"Medicare cost-sharing"
means out-of-pocket
				  medical expenses related to services provided by medicare. For clients enrolled
				  in medicare, cost-sharing may include Part A and Part B premiums, co-insurance,
				  deductibles, and copay-ments for medicare services. See chapter 182-517
				  WAC.
"Minimum essential coverage"
means coverage
				  under 26 U.S.C. Sec. 5000A(f).
"Modified adjusted gross income (MAGI)"
means
				  the adjusted gross income as determined by the Internal Revenue Service under
				  the Internal Revenue Code of 1986 (IRC) increased by:
(a) Any amount excluded from gross income under 26 U.S.C.
				  Sec. 911;
(b) Any amount of interest received or accrued by the client
				  during the taxable year which is exempt from tax; and
(c) Any amount of Title II Social Security income or Tier 1
				  railroad retirement benefits excluded from gross income under 26 U.S.C. Sec.
				  86. See chapter 182-509 WAC for additional rules regarding MAGI.
Statutory Authority:
					 RCW
					 41.05.021,
					 74.09.035, and
					 2011 1st sp.s. c
					 36 . 12-19-051, §
											182-500-0070, filed 9/13/12,
					 effective 10/14/12. 11-14-075, recodified as §
											182-500-0070, filed 6/30/11,
					 effective 7/1/11. Statutory Authority:
					 RCW
					 74.08.090 and 2011 1st sp. sess. c 15.
					 11-14-053, § 388-500-0070, filed 6/29/11, effective
					 7/30/11.