Title: Section 43-2.2 - Definitions

Effective Date

06/02/2010

43-2.2 Definitions.

(a) An applicant is a person who has directly or by a representative, applied in writing to the New York State Department of Health.

(b) An application is the process by which a person indicates, in writing on a Department of Health-approved form, his/her desire to receive assistance.

(c) Resident means a person domiciled within the State.

(d) Authorized representative means any person authorized by an applicant or participant to act on his/her behalf.

(e) Period of coverage. Coverage for assistance for each individual program component is effective as specified in the individual's notification of eligibility. Coverage will terminate under the following circumstances:

(1) the applicant indicates in writing that he/she no longer needs or desires assistance;

(2) the department determines that a change in the participant's circumstances or residence has affected his/her eligibility.

(3) the participant has died or cannot be located; and

(4) funding for the HIV Uninsured Care Programs is exhausted.

(f) Program means the HIV Uninsured Care Programs, including the following service components: (1) AIDS Drug Assistance Program, which provides coverage of medications; (2) ADAP Plus, which provides coverage for ambulatory care services; (3) ADAP Plus Insurance Continuation, which pays for insurance premiums for eligible individuals who have cost effective insurance policies; and (4) the HIV Home Care Program, which provides coverage for home care services.

(g) Household. The applicant, persons legally responsible for the applicant, and persons for whom the applicant is legally responsible, shall be considered part of the household.

(h) Income means total gross income of the household. Income shall include: monetary compensation for services, including wages, salary, commissions or fees; net income from self-employment; unemployment insurance compensation; government civilian employee or military retirement or pension, including veterans' payments; pensions or annuities; alimony or child support payments; regular contributions from persons not living in the household; net royalties; social security benefits; dividends or interest on savings or bonds; income from estates or trusts; net rental income; public assistance or welfare payments; cash or any other income resource.

(i) Available household income means the applicant's household income after deducting the amount paid by the applicant under the Federal Insurance Contributions Act for Social Security and Medicare and the cost of health care coverage paid by the applicant. (j) Provider means a medical provider, including a pharmacy, hospital, clinic, physician, laboratory or home health care agency.
 

Volume

VOLUME A-1 (Title 10)

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