This is an obsolete version of the rule. Please click on the rule number to view the current version.

37.57.102    DEFINITIONS

Unless otherwise indicated, the following definitions apply throughout this subchapter:

(1) "Advisory committee" means a committee that is composed of health care service providers, public health providers, consumers, and children's special health service (CSHS) program staff and that advises the department about CSHS program operation.

(2) "Applicant" means a child or youth who has applied or whose parent or guardian has applied on the child's behalf to receive CSHS benefits from the department.

(3) "Benefits" means payment by the department for CSHS-authorized medical care for a child or youth eligible for the CSHS program.

(4) "Child or youth" means an individual under 22 years of age.

(5) "CHIP" means the Montana children's health insurance plan administered by the department.

(6) "Client" means a child or youth who is eligible to receive CSHS benefits as determined by the department under this subchapter.

(7) "Clinic" means a place where a team of health care providers with specialties appropriate to treating children come together to evaluate and develop a comprehensive plan of care for children with specific disabilities.

(8) "CSHS" means the children's special health services program of the department, authorized by 50-1-202 , MCA, that serves children with special health care needs.

(9) "CSHCN" means children with special health care needs, the population served by CSHS.

(10) "Department" means the Montana department of public health and human services.

(11) "Disability" or "disabling condition" means a chronic physical, developmental, behavioral or emotional condition requiring health and related services of a type or amount beyond that required by children generally.

(12) "Disabled" means having any physical defect or characteristic, congenital or acquired, that prevents or restricts normal growth or capacity for activity.

(13) "Eligibility year" means the year in which a child or youth receives CSHS benefits, beginning with the date the application for those benefits is received by the department and ending 12 months later.

(14) "Evaluation" means the medical examination and testing needed to determine the cause and possible treatment for a suspected or known disability.

(15) "Family" means a group of related or non-related individuals who are living together as a single economic unit.

(16) "Federal fiscal year" means the period beginning October 1 and ending the following September 30.

(17) "ICD-9-CM" means the World Health Organization's International Classification of Diseases, Clinical Modification, 9th Revision.

(18) "Initial diagnosis and evaluation" means taking a medical history and performing a physical examination, medical procedures, laboratory tests, hearing tests, or other procedures necessary for the diagnosis of a condition for the purpose of establishing CSHS eligibility.

(19) "Medical advisor" means a physician with expertise in treating children with special health care needs and licensed by the state of Montana who serves as an advisor to the department.

(20) "Poverty income guidelines" means the poverty income guidelines published in 2003 in the Federal Register by the U.S. department of health and human services. The department hereby adopts and incorporates by reference the federal poverty guidelines that establish income thresholds according to family unit size for purposes of determining eligibility for government assistance or services and that are published in the February 7, 2003, Federal Register. A copy of the 2003 poverty guidelines may be obtained from the Department of Public Health and Human Services, Child and Adult Health Resources Division, Children's Special Health Services Program, 1218 East Sixth, Helena, MT 59620, telephone (406)444-3617.

(21) "Program" means the department's children's special health services program for children with special health care needs, authorized by 50-1-202 , MCA.

(22) "Provider" means a supplier of medical care or services, medical appliances, prescribed medications, or formula or foods.

(23) "Services" means assistance other than benefits provided to CSHCN, such as resource and referral information, transition information, specialty clinic services, and care coordination.

(24) "Third party" means a public or private agency that is or may be liable to pay all or part of the medical costs for a client, including, but not limited to, private insurance, tri-care, medicaid, medicare, CHIP, the caring program for children, and the early intervention program, part C, of the department's disabilities services division.

(25) "Treatment" means medical, corrective, and/or surgical intervention to alleviate a disabling condition.

History: Sec. 50-1-202, MCA; IMP, Sec. 50-1-202, MCA; NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1637, Eff. 8/1/03.

Home  |   Search  |   About Us  |   Contact Us  |   Help  |   Disclaimer  |   Privacy & Security