Page 58

UNOFFICIAL 1700.1-58 participating health plan as defined in the health plan's contract with the department. “Severe, disabling mental illness” means a mental disorder which exhibits emotional or behavioral functioning that is so impaired as to interfere substantially with a person's capacity to remain in the community without treatment or services of a long- term or indefinite duration. This mental disability is severe and persistent, encompassing individuals with serious mental illness (SMI), serious or persistent mental illness (SPMI), or requiring support for emotional and behavioral development (SEBD), resulting in a long-term limitation of a person's functional capacities for primary activities of daily living such as interpersonal relationships, homemaking, self-care, employment, and recreation. “Shared eligibility service” means a common or shared eligibility system or service used by a State to determine individuals' eligibility for insurance affordability programs. “SHIP” means the discontinued state health insurance program that was administered by the department of health. “SHOTT” means the State of Hawaii Organ and Tissue Transplant program. “Sixty-day grace period” means the first sixty- days after the date of the confirmation notice that an enrollee has to change health plans, with or without cause, provided the health plan is not at its maximum enrollment. “SLMB” means a specified low income Medicare beneficiary who is a member of a special Medicaid coverage group. These group members are only eligible for coverage of premiums for Medicare supplementary medical insurance. “SMAC” or “State maximum allowable cost” is based on drug prices obtained from a nationally recognized comprehensive data file maintained by a vendor under contract with the Department agent. A generic drug may be considered SMAC for the pricing if there are two or more therapeutically equivalent, multi-source, non-innovator drugs with a cost difference. The SMAC