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

(1) "Applicant" means a child or youth with special health care needs (CYSHCN) who has applied or whose parent or guardian has applied on the child's behalf to receive children's special health service (CSHS) financial assistance from the department.

(2) "Child or Youth with Special Health Care Needs" (CYSHCN) means a child or youth, under the age of 22, who has or is at increased risk for chronic physical, development, behavioral, or emotional condition and who also requires health and related services of a type or amount beyond that required by children generally.

(3) "Client" means a CYSHCN who is eligible to receive CSHS financial assistance as determined by the department under this subchapter.

(4) "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.

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

(6) "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.

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

(8) "Eligibility year" means the federal fiscal year in which a CYSHCN receives CSHS direct payment financial assistance.

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

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

(11) "Financial Assistance" means payment by the department for CSHS-authorized medical care for a CYSHCN eligible for the CSHS program.

(12) "HMK" means Healthy Montana Kids insurance plan administered by the department.

(13) "HMK Plus" means Healthy Montana Kids Plus plan administered by the department.

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

(15) "Interdisciplinary Team" means a group of allied health professionals and a patient, family, or both a patient and family who work together to address the shared health goals.

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

(17) "Poverty income guidelines" means the poverty income guidelines published in 2015 in the Federal Register by the U.S. Department of Health and Human Services. The department 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 2015, Federal Register. A copy of the 2015 poverty guidelines may be obtained from the Department of Public Health and Human Services, Public Health and Safety Division, Children's Special Health Services Program, 1400 Broadway, Rm A-116, Helena, MT 59620, telephone (406) 444-3617.

(18) "Program" means the department's children's special health services program for a CYSHCN, authorized by 50-1-202, MCA.

(19) "Provider" means a supplier of medical care or services, interventions, medical appliances, prescribed medications, formula or foods, and consultations.

(20) "Services" means assistance other than financial assistance provided to a CYSHCN, such as resource and referral information, transition information, specialty clinic services, and care coordination.

(21) "Special Health Care Need" means a chronic condition that requires

health and related services of a type or amount beyond that generally required by children.

(22) "Third-party payer" means a public or private entity that is or may be liable to pay all or part of the medical costs for a client.

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