7 Alaska Admin. Code § 100.990

Current through September 25, 2024

Section 7 AAC 100.990 - Definitions

In this chapter, unless the context requires otherwise,

(1) "AB" means aid to the blind under former 42 U.S.C. 1201 (Title X of the Social Security Act);

(2) "adoption" means the establishment of a parent-child relationship between a child and an adult who is not the child's birth parent and that is recognized by law, including an adoption established by order of a state court, an adoption established by order of a tribal court with respect to an "Indian child" within the meaning given in 25 U.S.C. 1903 (Indian Child Welfare Act), and an adoption under tribal custom;

(3) "adoptive" means a relationship that exists as a result of an adoption;

(4) "Adult Public Assistance" means the program under AS 47.25.430-47.25.615 that provides monthly cash assistance to eligible aged, blind, and disabled persons in need; for purposes of this chapter, "Adult Public Assistance" does not include interim assistance under AS 47.25.455;

(5) "advanced nurse practitioner" means an individual

(A) licensed under AS 08.68 as an advanced nurse practitioner; or

(B) who is authorized by federal law to practice as an advanced nurse practitioner without a license issued under AS 08.68, including federal employees and individuals working under contract with the United States;

(6) "APA" means the Adult Public Assistance program;

(7) "applicant" means an individual who has submitted an identifiable application in accordance with 7 AAC 100.004 and whose eligibility for Medicaid has not been approved or denied; "applicant" includes

(A) a parent or legal guardian who submits an application on behalf of a minor child in the custody of that parent or legal guardian; and

(B) an individual, alive or deceased, who is not a minor and whose application is submitted through an authorized representative or a person acting responsibly for the individual;

(8) "APTD" means aid to the permanently and totally disabled under former 42 U.S.C. 1351 (Title XIV of the Social Security Act);

(9) "assisted living home" has the meaning given in AS 47.33.990;

(10) "business property" means property used to operate a business or generate income;

(11) "caretaker relative"

(A) means any of the following individuals who, for purposes of the eligibility categories in 7 AAC 100.002(a) and (c), provide the care and control of a dependent child:

(i) a biological or legally adoptive relative of the dependent child to the fifth degree of consanguinity; a biological relative must be of full or half blood; a biological relative may be a caretaker relative even though the legal relationship has been terminated;

(ii) a stepfather, stepmother, stepbrother, or stepsister of the dependent child;

(iii) the spouse of an individual described in (i) or (ii) of this subparagraph, even after the marriage is terminated by death or divorce; and

(B) does not include

(i) a legal guardian;

(ii) a friend or neighbor;

(iii) an unrelated godparent;

(iv) a second cousin of a dependent child; or

(v) an individual who has been given a dependent child to take care of;

(12) "child support services agency" means the child support services agency of the Department of Revenue;

(13) "commissioner" means the commissioner of health and social services;

(14) "community spouse" means an individual who

(A) is living outside of a long-term care facility;

(B) is not receiving home and community-based waiver services; and

(C) is the spouse of an applicant or recipient who is living in a long-term care facility or receiving home and community-based waiver services;

(15) "continuous period of institutionalization" means at least 30 consecutive days of residing in a medical institution or receiving home and community-based waiver services;

(16) "countable resource" means a nonexcluded and nonexempt resource of a household that is included in the total of a household's resources for purposes of determining if the household has resources at or below the resource limit for the applicable eligibility category;

(17) "department" means the Department of Health and Social Services;

(18) "dependent" means an individual who derives the individual's main support from another individual;

(19) "district office" means the office of the department that is responsible for determining Medicaid eligibility under this chapter;

(20) "Family Medicaid" means medical assistance provided under 7 AAC 100.100 - 7 AAC 100.199;

(21) "fee agent" means a department-paid volunteer who is authorized by the department to conduct a face-to-face interview with an applicant or recipient and assist an applicant or recipient in completing an application and related forms;

(22) "home and community-based waiver services" means services provided under AS 47.07.045 and 7 AAC 130;

(23) "household" means those individuals whose financial need, income, and resources are used to determine Medicaid eligibility under this chapter;

(24) "inpatient" means an individual who has been admitted to a medical institution as an inpatient by a physician or dentist and who

(A) receives room, board, and professional services in the institution for a 24-hour period or longer; or

(B) is expected by the medical institution to receive room, board, and professional services in the institution for a 24-hour period or longer even if the individual

(i) dies, is discharged, or is transferred to another facility; and

(ii) does not actually stay in the medical institution for 24 hours;

(25) "intermediate care facility for the mentally retarded" means a facility described in 7 AAC 12.300;

(26) "long-term care facility" means an establishment that is

(A) regulated by the department under AS 18.20 as a skilled nursing facility or intermediate care facility; or

(B) owned or operated as a skilled nursing facility or intermediate care facility by the United States, an Indian tribe, or a tribal organization and exempt from state licensure under applicable law;

(27) "long-term care services" means

(A) services provided in a long-term care facility;

(B) services provided in an intermediate care facility for the mentally retarded;

(C) home and community-based waiver services; and

(D) any other services received in a medical institution by a recipient who is an institutionalized individual required to pay a portion of that individual's income toward the cost of care under 7 AAC 100.550 - 7 AAC 100.579;

(28) "mandatory state supplement" means the payment made by a state that supplements the federal payment made to recipients of the APTD program and that was made a mandatory payment under P.L. 93-66;

(29) "Medicaid" means the medical assistance program administered by the department under 42 U.S.C. 1396 - 1396 v and AS 47.07;

(30) "medical institution"

(A) means a facility that provides medical care, including nursing and convalescent care, and that is

(i) licensed or certified by the department to provide that care; or

(ii) owned or operated by the United States, an Indian tribe, or a tribal organization and exempt from state licensure or certification under applicable law; and

(B) includes a hospital, skilled nursing facility, intermediate care facility, intermediate care facility for the mentally retarded, residential psychiatric treatment center, and assisted living home that provides residential supported living and habilitation services;

(31) "Medicare" means the medical assistance program administered by the federal government through private insurance companies under 42 U.S.C. 1395 - 1395 hhh;

(32) "Medicare Part A" means that portion of the Medicare program providing coverage for hospital care under 42 U.S.C. 1395 c - 1395i-5;

(33) "Medicare Part B" means that portion of the Medicare program providing coverage for physician and outpatient care under 42 U.S.C. 1395 j - 1395w-4;

(34) "mental health professional" has the meaning given in AS 47.30.915;

(35) "month" means a calendar month unless otherwise specified in this chapter;

(36) "motor vehicle" means a motorized vehicle used to provide transportation of individuals or goods; "motor vehicle"

(A) includes a car, truck, recreational vehicle, all-terrain vehicle, boat, snowmachine, airplane, helicopter, superlight or ultralight aircraft, and hovercraft; and

(B) does not include a pickup truck shell or camper that is designed to be mounted on a car or truck;

(37) "newborn" means an infant under one year of age;

(38) "nonfinancial eligibility requirement" means an eligibility requirement other than one relating to income or resources;

(39) "OAA" means old age assistance under former 42 U.S.C. 301 (Title I of the Social Security Act);

(40) "OASDI" means old age, survivors, and disability insurance under 42 U.S.C. 401 - 434 (Title II of the Social Security Act);

(41) "parent" means a child's natural or adoptive father or mother;

(42) "physician" means an individual

(A) licensed as a physician under AS 08.64; or

(B) who is authorized by federal law to practice as a physician without a license issued under AS 08.64, including federal employees and individuals working under contract with the United States;

(43) "physician assistant" means an individual

(A) licensed as a physician assistant under AS 08.64; or

(B) who is authorized by federal law to practice as a physician assistant without a license issued under AS 08.64, including federal employees and individuals working under contract with the United States;

(44) "psychiatric hospital" means

(A) a hospital described in 7 AAC 12.215(a); or

(B) a similar hospital that is

(i) owned or operated by the United States, an Indian tribe, or a tribal organization; and

(ii) exempt from state licensure under applicable law;

(45) "recipient" means an individual who has been found eligible to receive, and is receiving Medicaid benefits;

(46) "resource" means cash, or an asset that can be converted to cash; "resource" includes

(A) real estate;

(B) cash on hand; cash on deposit; and other liquid resources such as a promissory note, stock, bond, or security that is readily convertible to cash;

(C) a life insurance policy, burial insurance policy, or a prepaid burial contract;

(D) a United States government savings bond or treasury note; a municipal or government bond; or a corporate bond, stock, or security;

(E) the portion of a lump-sum payment received by the applicant or recipient that is treated as a resource rather than income under this chapter; a lump-sum payment includes a large termination paycheck, insurance policy cash-in, and inheritance;

(F) a motor vehicle; and

(G) all household goods and personal effects;

(47) "sibling" means a brother or sister related by blood or adoption; "sibling" includes a half-sibling; "sibling" does not include a step-sibling;

(48) "sponsor" means a person who agrees in writing to support an alien as a condition of the alien's entry into the United States; "sponsor" does not include an alien's parent or spouse;

(49) "SSDI" means social security disability insurance under 42 U.S.C. 423 (sec. 223 of the Social Security Act);

(50) "SSI" means supplemental security income under 42 U.S.C. 1381 - 1383 f;

(51) "stepparent" means an individual who is not a child's natural or adoptive parent, but who is legally married to a natural or adoptive parent of the child;

(52) "Title IV-E" means 42 U.S.C. 670 - 675 (Title IV-E of the Social Security Act);

(53) "Transitional Medicaid" means medical assistance provided under 7 AAC 100.200 - 7 AAC 100.209;

(54) "tribal organization" has the meaning given in 25 U.S.C. 450 b (l);

(55) "TRICARE" means the United States Department of Defense regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors;

(56) "USCIS" means the United States Department of Homeland Security, United States Citizenship and Immigration Services;

(57) "Indian tribe" means a tribe recognized by the United States Secretary of Interior to exist as an Indian tribe under 25 U.S.C. 479 a (Federally Recognized Indian Tribe List Act of 1994).

(58) "dentist" means an individual

(A) licensed as a dentist under AS 08.36; or

(B) who is authorized by federal law to practice as a dentist without a license issued under AS 08.36, including federal employees and individuals working under contract with the United States.

7 AAC 100.990

Eff. 7/20/2007, Register 183; am 2/1/2010, Register 193; am 1/1/2011, Register 196; am 9/20/2015, Register 215, October 2015

Authority:AS 47.05.010

AS 47.07.020

AS 47.07.040