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Title 5: Centrally Administered Programs Page 3 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) General Administration Revised July 3, 2009 Definitions “hawk-i Board” or “Board” means the entity that adopts rules, establishes policy, and directs the Department regarding the hawk-i program. “hawk-i program” or “program” means the Healthy and Well Kids in Iowa program described in this chapter to provide health care coverage to eligible children. “MAC” means the Mothers and Children Medicaid coverage group that provides Medicaid to infants under age one, children ages one through 18, and pregnant women. “Medically Needy” means the Medicaid coverage group for people who meet all Medicaid eligibility factors except for excess income or excess resources. “Participating dental plan” means a dental plan contracted with the Department to provide dental services to eligible children under this chapter. “Participating health plan” means any entity licensed by the Division of Insurance of the Department of Commerce to provide health insurance in Iowa or an organized delivery system licensed by the director of the Department of Public Health that has contracted with the Department to provide health care coverage to eligible children under this chapter. “Provider” means an individual, firm, corporation, association, or institution that is providing or has been approved to provide medical or dental care or services to an enrollee through a participating health or dental plan. “Prudent-person concept” refers to the authority given to the third-party administrator to review and analyze information in order to decide whether the information is sufficient for making an eligibility determination, or if further checking should be done. The “prudent person” must be vigilant, cautious, perceptive, and guided by generally sound judgment. “Third-party administrator” or “TPA” means the person or entity with which the Department contracts to provide administrative services for the hawk-i program.