Current through Register No. 50, December 12, 2024
Section He-W 511.03 - Definitions(a) "Cost effective" means that the cost to enroll an individual in a group health plan is likely to be less than the medicaid expenditures for an equivalent set of services.(b) "Cost effectiveness test" means the method by which the department determines if a recipient's group health plan costs less than the expected medicaid expenditure.(c) "Department" means the New Hampshire department of health and human services.(d) "Group health plan" means any plan of, or contributed to by, an employer, including a self-insured plan, to provide health care to the employer's employees, former employees, or the families of employees or former employees, and which meets S. 5000(b) (1) of the Internal Revenue Code of 1986, and includes continuation coverage pursuant to Title XXII of the Public Health Services Act, S. 4980B of the Internal Revenue Code of 1986, or Title VI of the Employee Retirement Income Security Act of 1974.(e) "Health insurance premium payment program (HIPP) " means a premium assistance program administered by the department consistent with section 1906 of the Social Security Act, which permits the use of medicaid funds to purchase group health plan coverage on behalf of eligible medicaid recipients.(f) "Medicaid" means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.(g) "New Hampshire health protection program (NHHPP) " means the program established by SB 413 (Chapter 3, Laws of 2014), which authorizes medical assistance for adults up to 133% federal poverty levels under 42 USC §1396 a(a) (10) (A) (i) (VIII) .(h) "Newly eligible adult" means adults who are eligible for medicaid under the New Hampshire health protection program and the provision of section 1902(a) (10) (A) (i) (VIII) of the social security act of 1935 as amended, 42 USC §1396 a(a) (10) (A) (i) (VIII) .(i) "Wrap-around services" means to the extent that a group health plan does not cover a benefit contained in the NH state medicaid benefit package for newly eligible adults, the service is covered by traditional medicaid so that the individual has access to the same services to which they are entitled if they were covered directly through the state's medicaid program.N.H. Admin. Code § He-W 511.03