Section 210-RICR-50-00-4.3 - DefinitionsA. For the purposes of this rule, the following definitions apply: 1. "ACA adults" means persons between the ages of 19 and 64 who are eligible for Medicaid authorized by the federal Affordable Care Act (ACA) of 2010.2. "Additional documentation request" or "ADR" means the notice sent to applicants subsequent to an initial review of the application's completeness that identifies any additional information/forms that must be submitted, and any related deadlines, for a determination of eligibility to proceed.3. "Application completeness" means the point in time when all information requested by the State, including the application and any ancillary required forms and authorizations necessary to determine eligibility, are date-stamped as received by the State.4. "Application timeliness" means the specific time frame for making determinations of Medicaid eligibility as set forth in federal and State law, regulations and rules. The timelines vary in length depending on whether a functional/clinical eligibility determination is required.5. "Clinical or functional eligibility" means the application of needs-based criteria to determine whether a person requires the level of care typically provided in an LTSS health institution as defined herein.6. "Department of Human Services" or "DHS" means the State agency established under the provisions of R.I. Gen. Laws Chapter 40-1 that has been delegated the responsibility through an interagency service agreement with the Executive Office of Health and Human Services (EOHHS), the Medicaid Single State Agency, to determine Medicaid eligibility in accordance with applicable State and federal laws, rules and regulations.7. "DHS-2 application form" means the principal paper application form for Medicaid LTSS.8. "Eligibility pathway" means one of the various ways authorized under the State's Medicaid State Plan and/or Section 1115 demonstration waiver that a person may be found eligible for LTSS. 9. "Executive Office of Health and Human Services" or "EOHHS" means the State agency established in 2006 under the provisions of R.I. Gen. Laws Chapter 42-7.2 which is designated as the "single State agency," authorized under Title XIX of the U.S. Social Security Act (42 U.S.C. § 1396a et seq.) and, as such, is legally responsible for the program / fiscal management and administration of the Medicaid Program.10. "Financial eligibility" means the process for determining whether an applicant meets the income and resources requirements for Medicaid eligibility.11. "Home and community-based services" or "HCBS" means the services and supports provided to Medicaid LTSS beneficiaries at home or in a community-based setting who would require the level of care associated with one of the three institutions (health care facilities identified below) recognized in federal Medicaid law if they were not receiving these services and supports.12. "Institution" means one of the long-term care institutions recognized in federal Medicaid law and is a State-licensed health care facility where health and/or social services are delivered on an inpatient basis. For the purposes of this document, the term means long-term care hospitals and treatment facilities (LTHR), intermediate care facilities for persons with intellectual disabilities (ICF/ID), and nursing facilities (NF).13. "Integrated eligibility system" or "IES" means the State's health and human services computer eligibility system - known as RI Bridges - which processes applications for Medicaid as well as for the programs and services administered by the DHS.14. "Long-term services and supports" or "LTSS" means a spectrum of services covered by the Medicaid program for people with functional impairments and/or chronic illness that provide assistance with activities of daily living (such as eating, bathing, and dressing) and instrumental activities of daily living (such as preparing meals, managing medication, and housekeeping).15. "LTSS specialist" means a State agency representative responsible for determining eligibility for long-term services and supports, authorizing services, and/or providing assistance to people in navigating the Medicaid health care system.16. "Needs-based criteria" means the basis for determinations of functional/ clinical eligibility for Medicaid LTSS including medical, social, functional and behavioral factors, and the availability of family support and financial resources.17. "Supplemental forms" means the additional forms all LTSS applicants are required to complete.18. "Types of LTSS" means the two forms of LTSS authorized under federal law and the State's Medicaid State Plan and Section 1115 waiver: Medicaid LTSS in health care institutions (NFs, ICF/IDs, and LTHR) and Medicaid home and community-based LTSS.210 R.I. Code R. 210-RICR-50-00-4.3