Sec. 10.20.01.01. Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Applicant" means an individual who has applied for, or is in the process of applying for, Kidney Disease Program enrollment and has not yet been certified as an eligible recipient.

(2) "Certification period" means the 12-month period during which an individual is certified as eligible to receive Kidney Disease Program benefits.

(3) "Certified facility" means a hospital, dialysis facility, or transplantation center which the Department certifies meets the standards that the Commission adopts for providing services to recipients and which is certified by Medicare.

(4) "Commission" means the State Commission on Kidney Disease.

(5) "Department" means the Maryland Department of Health.

(6) "Dialysis" means chronic hemodialysis or chronic peritoneal dialysis provided in a certified facility or a facility approved by the Commission or in the patient's home under the auspices of a certified facility or home dialysis program approved by the Commission.

(7) "End stage renal disease (ESRD)" means that stage of renal impairment that appears irreversible and permanent, and requires a regular course of maintenance dialysis or kidney transplantation to maintain life.

(8) "Family" means the recipient and all of the following individuals sharing the same household with the recipient:

(a) The recipient's spouse;

(b) The recipient's natural or adopted children who are younger than 21 years old;

(c) The recipient's natural or adoptive parent, if the recipient is a child younger than 21 years old; and

(d) The recipient's stepchildren or grandchildren for which the recipient has legal or presumed guardianship.

(9) "Liquid assets" means cash or an asset that can readily be converted to cash.

(10) "Medical Assistance" means the State program of comprehensive medical and other health-related care for indigent and medically indigent persons.

(11) "Medicare" means the insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq.

(12) "Poverty income guidelines" means the federal poverty income guidelines contained in the most recent annual update of the Department of Health and Human Services poverty income guidelines as published in the Federal Register.

(13) "Preauthorization" means an approval required from the Program before services are rendered to a recipient.

(14) “Primary Adult Care Program (PAC)” has the meaning stated in COMAR 10.09.60.02.

(15) "Program" means the Kidney Disease Program of Maryland.

(16) "Program participation fee" means an annual premium which may be assessed by the Program and is based on family income or liquid assets, or both.

(17) "Provider" means an individual, association, partnership, corporation, or unincorporated group licensed or certified to provide health care services for Program recipients.

(18) “Qualified alien” means an alien who:

(a) Has been fully admitted for permanent residence in the United States under the Immigration and Nationality Act (INA);

(b) Has been granted asylum in the United States under §208 of the INA;

(c) Has been admitted into the United States as a refugee under §207 of the INA;

(d) Has been paroled into the United States under §212(d)(5) of the INA for a period of at least 1 year;

(e) Has had deportation withheld under §243(h) of the INA; or

(f) Has been granted conditional entry into the United States under §203(a)(7) of the INA in effect before April 1, 1980.

(19) "Quarterly amount" means the quarterly installment payment which is equal to 25 percent of a recipient's annual Program participation fee.

(20) "Recipient" means an individual who is certified for enrollment in the Kidney Disease Program of Maryland.

(21) "Reimbursable drug list" means the Kidney Disease Program formulary of medications approved for payment.

(22) "Representative" means an individual who, because of an applicant's or a recipient's mental or physical incapacity or youth, or specified dialysis or transplant facility personnel who have been so designated by virtue of the applicant's or recipient's voluntarily signed authorization form, is authorized, in accordance with State law, to complete, sign, or withdraw an application for enrollment in the Program or to activate a hearing process.

(23) Resident.

(a) "Resident" means an individual permanently living in Maryland whose temporary absence from the State does not interrupt continuity of residence.

(b) "Resident" does not mean:

(i) Members or their families, or both, of the United States armed services temporarily stationed in Maryland; or

(ii) Foreign nationals employed in embassies of their native country.