50 DEFINITIONS

50.1 “Applicant” shall mean a person applying or re-applying for benefits on behalf of a child and/or themselves. 50.2 “CBMS” shall mean Colorado Benefits Management System is the computer system that determines an applicant’s eligibility for public assistance in the state of Colorado. 50.3 “Child” means a person who is less than nineteen years of age. 50.4 “Cost sharing” shall mean payments, such as copayments that are due on behalf of the enrollee. 50.5 “Department” shall mean the Colorado Department of Health Care Policy and Financing which is responsible for administering the Colorado Medical Assistance Program and Children’s Basic Health Plan as well as other State- funded health care programs. 50.6 “Dependent child” shall mean a child who lives with a parent, legal guardian, caretaker relative or foster parent and is under the age of 18, or, is age 18 and a full-time student, and expected to graduate by age 19 50.7 “Effective Date” shall mean the first day of eligibility which is the date the application is received and date-stamped by the Eligibility site or the date the application was received and date-stamped by an Application Assistance site or Presumptive Eligibility site. In the absence of a date-stamp, the application date is the date that the application was signed by the client. 50.8 “Eligibility Site” shall mean a location outside of the Department that has been deemed by the Department as eligible to accept applications and determine eligibility for applicants. 50.9 “Enrollee” shall mean an eligible person who is enrolled in the Children’s Basic Health Plan. 50.10 “Essential Community Provider” means a healthcare provider that: Code of Colorado Regulations Secretary of State State of Colorado A. Has historically served medically needy or medically indigent patients and demonstrates a commitment to serve low-income and medically indigent populations who make up a significant portion of its patient population, or in the case of a sole community provider, serves medically indigent patients within its medical capability; and B. Waives charges or charges for services on a sliding scale based on income and does not restrict access or services because of a client's financial limitations. 50.11 “Evidence of Coverage” or “EOC” shall mean any certificate, agreement, or contract issued to an enrollee from time-to-time by a Managed Care Organization (MCO) setting out the coverage to which the enrollee is or was entitled under the Children’s Basic Health Plan. 50.12 “Grievance Committee” shall mean a conference with the Department or its Designee in which a contested decision regarding an applicant or enrollee is reexamined. 50.13 “Household” shall be determined by relationships to the tax filer as declared on the Single Streamlined Application and as required in 10 CCR 2505-10- 8.100.4.E. 50.14 “Income” shall be any compensation from participation in a business, including wages, salary, tips, commissions and bonuses. The Modified Adjusted Gross Income is a methodology used to determine eligibility as required in 10 CCR 2505-10-8.100.4.C. 50.15 “Managed Care Organization” or “MCO” shall mean: A. A carrier which meets the definition in §10-16-102 (8), C.R.S. with which the Department contracts to provide health care or dental services covered by the Children’s Basic Health Plan; or, B. Essential community providers and other health care and dental service providers with whom the Department contracted to provide health care services under the Children’s Basic Health Plan using a managed care model. 50.16 “Presumptive Eligibility” shall mean children and pregnant women who have applied and appear to be eligible for the Children’s Basic Health Plan shall be presumed eligible and may receive immediate temporary medical coverage. 50.17 “Qualified Hospital Presumptive Eligibility Site” is a hospital that has voluntarily elected to serve as a Presumptive Eligibility site. Qualified Hospital Presumptive Eligibility Sites agree to make determinations in accordance with State policies and assist individuals with completing Medical Assistance applications and understanding documentation requirements. 50.18 “Unearned Income” shall be the gross amount received in cash or kind that is not earned from employment or self-employment. 50.19 “Woman” shall mean a female who is 19 years in age or older.