405 IAC 2-3.3-1 - Definitions
Authority: IC 12-15-2.3-12; IC 12-15-21
Affected: IC 12-15-2; IC 12-15-2.3
Sec. 1.
The following definitions apply throughout this rule:
(1) "Applicant" means an individual who has
been determined presumptively eligible for Medicaid and has submitted an
application.
(2) "Application"
means an Indiana application for health coverage.
(3) "Presumptive eligibility period" means
the period that begins on the day on which a qualified hospital makes a
presumptive eligibility determination and ends on the earlier of the following:
(A) In the case of an applicant, the day that
a decision is made on the application.
(B) In the case of a presumptively eligible
individual, the last day of the month following the month in which a qualified
hospital determined the individual to be presumptively eligible.
(C) In the case of an individual eligible
under
405 IAC
10-4-1(a), the periods, as
applicable, in accordance with
405 IAC 10-4-11(c)
through
405 IAC
10-4-11(e).
(4) "Presumptively eligible individual"
refers to a person who has been determined presumptively eligible by a
qualified hospital but has not yet attained full Medicaid
eligibility.
(5) "Qualified
hospital" means a hospital that meets all of the following criteria:
(A) Participates as a Medicaid or waiver
provider.
(B) Notifies the office
of its intention to make presumptive eligibility determinations under this
rule.
(C) Agrees to make
presumptive eligibility determinations in accordance with applicable laws and
policies.
(D) Agrees to assist an
applicant or individual in completing and submitting an application during the
presumptive eligibility period.
(E)
Is not disqualified in accordance with section 3 of this rule.
(6) "Sufficiently complete" means
an application that includes, at a minimum, an applicant's:
(A) name;
(B) date of birth;
(C) Social Security number;
(D) marital status;
(E) citizenship status;
(F) pregnancy status;
(G) presumptive eligibility member
identification number;
(H)
income;
(I) home address;
(J) mailing address;
(K) phone number;
(L) number of members in family;
and
(M) signature.
Notes
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