Section R382-10-2 - Definitions(1) The definitions found in Subsections 2110(b) and (c) of the Compilation of Social Security Laws, and in Section R382-1-2 apply to this rule.(2) In addition, the department adopts the following definitions: (a) "American Indian or Alaska Native" means someone having origins in any of the original peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment.(b) "Best estimate" means the eligibility agency's determination of a household's income for the upcoming eligibility period, based on past and current circumstances and anticipated future changes.(c) "COBRA" means health insurance coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985.(d) "Copayment and coinsurance" means a portion of the cost for a medical service, in which the member is responsible to pay for services received under CHIP.(e) "Due process month" means the month that allows time for the member to return verifications, and for the eligibility agency to determine eligibility and notify the member.(f) "Eligibility agency" means the Department of Workforce Services (DWS) that determines eligibility for CHIP under contract with the department.(g) "Employer-sponsored health plan" means a health insurance plan offered by an employer.(h) "Ex parte review" means a review process the agency conducts without contacting the member for information as defined in 42 CFR 457.343.(i) "Federally Facilitated Marketplace" (FFM) means the entity an individual can access to enroll in health insurance and apply for assistance from insurance affordability programs such as Advanced Premium Tax Credits, Medicaid, and CHIP.(j) "Member" means any person who is enrolled in the Medicaid program and is eligible to receive Medicaid services.(k) "Modified Adjusted Gross Income" (MAGI) means the income determined using the methodology defined in 42 CFR 435.603(e).(l) "Presumptive eligibility" means a period that a child may receive CHIP benefits based on preliminary information that the child meets the eligibility criteria. (m) "Review month" means the last month of the eligibility certification period for a member, in which the eligibility agency determines a member's eligibility for a new certification period.(n) "Utah's Premium Partnership for Health Insurance" or "UPP" means the program described in Rule R414-320.Utah Admin. Code R382-10-2
Amended by Utah State Bulletin Number 2014-22, effective 11/1/2014Amended by Utah State Bulletin Number 2015-8, effective 4/1/2015Amended by Utah State Bulletin Number 2024-14, effective 7/1/2024