Section 405 IAC 10-12-1 - DefinitionsAuthority: IC 12-15-44.5-9
Affected: IC 12-15-44.5; IC 20-18-2-18; IC 20-33-2; IC 21-7-13-6; IC 21-17-1-15
Sec. 1.
The following definitions apply throughout this rule:
(1) "Certified temporary illness or incapacity" means either of the following:(A) An inpatient or observation hospital stay covered under the plan.(B) An illness or injury certified by a provider, via a face-to-face interaction, within the first seven (7) days of incapacity, that leaves a member incapacitated for more than three (3) consecutive, full calendar days, and any subsequent treatment or period of incapacity relating to the same condition that also involves either: (i) treatment by a health care provider two (2) or more times within thirty (30) days of the first day of incapacity, unless extenuating circumstances exist (i.e., the health care provider does not have any available appointments during that timeframe); or(ii) treatment by a health care provider on at least one (1) occasion that results in a regimen of continuing treatment under the supervision of the healthcare provider.(2) "Disabled dependent" means a qualifying child or relative, as defined by the Internal Revenue Service, determined to be disabled, or who has a pending determination, by: (A) the Social Security Administration as set forth in 20 CFR 416 Subpart I; or(B) the Indiana Medicaid medical review team (MMRT).(3) "Family and Medical Leave Act" or "FMLA" means the federal law set forth in 29 U.S.C. 28.(4) "Gateway to Work" or "GTW" means the community engagement program of the Healthy Indiana Plan (HIP) to encourage and support members to engage in educational opportunities, secure employment, and engage in community service.(5) "Gateway to Work eligibility period" means the annual period, from January 1 through December 31, in which a member's Gateway to Work compliance is determined.(6) "Gateway to Work exempt" or "exempt" means the Gateway to Work status of a member who meets any of the listed exemptions in section 3 of this rule and is not required to report activities.(7) "Gateway to Work required" means the Gateway to Work status of a member who is determined not to meet any of the exemptions in section 3 of this rule.(8) "Half-time" means at least six (6) credit hours per semester or equivalent time period as defined by the institution.(9) "Homeless" means an individual who lacks a fixed, regular, and adequate nighttime residence or who has a primary nighttime residence that is a supervised temporary shelter, an institution that provides a temporary residence, or a place not designed or ordinarily used as a regular sleeping accommodation.(10) "Homeschooling" means a nonaccredited and nonpublic education provided by a member to the member's own child or children. Homeschooling must meet all applicable legal requirements in IC 20-33-2.(11) "Institutionalized" means a member who is:(A) an inpatient in a nursing facility;(B) an inpatient in a medical institution for whom payment is made based on a level of care provided in a nursing facility; or(C) receiving home and community based waiver services.(12) "Phase-in period" means the period from January 1, 2019, through June 30, 2020, when the community engagement minimum hour requirements shall be less than twenty (20) hours per week.(13) "Recently incarcerated" means a member who has been imprisoned for at least thirty (30) days and has since been released. Incarceration shall include imprisonment in a county, state, or federal facility.(14) "Student" means a member enrolled and attending one (1) of the following: (A) A secondary school as set forth in IC 20-18-2-18.(B) A postsecondary educational institution as set forth in IC 21-7-13-6.(C) A vocational school as set forth in IC 21-17-1-15.(15) "Substance use disorder treatment" means active participation during the month in any covered treatment that includes: (A) individual and group counseling (including Medicaid Rehabilitation Option services);(C) residential treatment;(D) intensive outpatient treatment;(E) partial hospitalization;(F) case or care management after completing an inpatient or residential stay; or(G) medication assisted treatment.Office of the Secretary of Family and Social Services; 405 IAC 10-12-1; Filed 3/18/2019, 2:27 p.m.: 20190417-IR-405180371FRA