37.81.104    DEFINITIONS

In addition to the definitions in 53-6-1001, MCA, the following definitions apply to this chapter:

(1) "Assets" mean cash or other resources that a person owns and could convert to cash to be used for his or her support and maintenance.

(2) "Closed" means an individual or case that was enrolled but is no longer receiving a benefit amount or was on a waiting list but is no longer on the waiting list.

(3) "Completed application" means the applicant has provided all required information to the department.

(4) "Contract" means an agreement between the department and a PDP provider for the provision of premium payments for enrollees of the program.

(5) "Countable income" means the amount of an applicant's income that is compared to the federal poverty level (FPL) to determine the applicant's FPL percentage.

(6) "Department" means the Department of Public Health and Human Services.

(7) "Earned income" means salary, wages, and self-employment net earnings.

(8) "Eligible" means an applicant has met all the Big Sky Rx Program eligibility criteria stated in ARM 37.81.307.

(9) "Eligibility threshold" means Big Sky Rx Program income up to 200% of FPL.

(10) "Enrolled" means an eligible applicant enrolled in the program.

(11) "Extra help" means the federal program that assists with premiums, copayments, and deductibles for clients who meet the social security program's requirements. The program is sometimes referred to as Low Income Subsidy (LIS).

(12) "Family" means individuals residing together, related by blood, marriage, or adoption, and dependent on the household for at least one-half of their support.

(13) "Federal poverty level (FPL)" means the poverty income guidelines published annually in the Federal Register by the U.S. Department of Health and Human Services.

(14) "First in first served" means completed applications will be processed and eligible applicants enrolled based on the date the complete application is received by the department.

(15) "Income" or "family income" means salary, wage, self-employment net earnings, royalties, honoraria, social security benefits, veterans benefits, railroad benefits, pensions, workers compensation, alimony, net rental income, trust income, dividends, and interest.

(16) "Incomplete" means the application is missing information required by ARM 37.81.318.

(17) "Ineligible" means the individual or case does not meet the criteria for enrollment in the program.

(18) "Insurer" means an authorized insurer of the federal Medicare Part D Prescription Drug Plan (PDP).

(19) "Low income subsidy (LIS)" means the federal program that assists with premiums, copayments, and deductibles for clients who meet the social security program's requirements. The program is sometimes referred to as Extra Help.

(20) "Open" means a case or individual that is pending, currently enrolled, or eligible to receive the benefit amount but on a waiting list.

(21) "Pending" means the department is waiting to determine eligibility because the individual's application was incomplete.

(22) "Premium assistance" or "benefit amount" means the amount of money the department either pays monthly to an insurer for the provision of benefits for an enrollee or pays to an enrollee.

(23) "Prepopulated" means a computer generated document that includes information from the department's records to be verified by the applicant.

(24) "Prescription drug plan (PDP)" means the private insurance plans for federal prescription drug benefit for people with Medicare. The benefit was created by the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA), (42 USC 1302, 1395w-101 through 1395w-152, and 1395hh). It is implemented at 42 CFR, part 423.

(25) "Processing" means the application is matched against program criteria.

(26) "Program" means the Big Sky Rx Program administered by the department.

(27) "Qualified" means the applicant is a Montana resident with a family income at or below 200% of the FPL.

(28) "Renewal" means the process of verification to remain eligible for Big Sky Rx benefits.

(29) "Representative" means a person who the applicant has given permission to assist the applicant with program requirements by communicating with the program and receiving information from the department.

(30) "Residing" means living in Montana voluntarily with the intention of making a home here and not for a temporary purpose.

(31) "Temporary enrollment" means the three month enrollment allowed for those applicants that are only missing Social Security Extra Help determination.

(32) "Unearned income" means any income other than salary, wages, and earnings from self-employment.

(33) "Waiting list" means the list compiled by the department of applicants who are eligible for premium assistance but who are not enrolled in the Big Sky Rx Program because funds are not available to pay their program benefits.


History: 53-2-201, 53-6-1004, MCA; IMP, 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA; NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08; AMD, 2009 MAR p. 2378, Eff. 1/1/10; AMD, 2019 MAR p. 60, Eff. 1/12/19.