20-77-1104. Waiver — Rules — Definitions.

20-77-1104. Waiver — Rules — Definitions. (a) As used in this section: (1)(A) “Healthcare coverage” means healthcare insurance regulated by the State Insurance Department, including without limitation group and employer-sponsored health insurance plans. (B) The Department of Human Services may by rule exclude other plans or coverage from the definition of healthcare coverage; (2) “Parity for mental health care” means coverage for the diagnosis and mental health treatment of mental illnesses and the mental health treatment of individuals with developmental disabilities under the same terms and conditions as provided for covered benefits offered under the program for the treatment of other medical illnesses or conditions and with no differences in the program in regard to any of the following: (A) The duration or frequency of coverage; (B) The dollar amount of coverage; or (C) Financial requirements; and (3) “Program” means the ARKids First Program. (b) The Department of Human Services shall administer the program. (c)(1) The Department of Human Services shall not enroll any population defined in this section until the Department of Human Services has sought and obtained approval from the Centers for Medicare & Medicaid Services necessary to allow the use of matching federal funds to provide program services to that population. (2) The Department of Human Services shall apply to the Centers for Medicare & Medicaid Services for approval to enroll the populations defined in subdivisions (d)(4)(B) and (C) of this section. (d) The Department of Human Services shall administer and promulgate rules for the program in a manner that: (1) Provides for the automatic assignment of medical payments due under §§ 20-77-302 and 20-77-307 as a condition of eligibility for benefits under the uninsured children's program; (2) Defines the services to be covered under the program, including without limitation parity for outpatient mental health care; (3) Establishes a copayment for services received in the program as determined through rules adopted by the Department of Human Services; (4) Defines the population which may receive services provided or reimbursed through this program within the following limitations: (A) Children eighteen (18) years of age or younger without healthcare coverage who are members of a family with a gross family income not exceeding two hundred fifty percent (250%) of the federal poverty guidelines; (B) Persons nineteen (19) years of age or older but less than twenty-one (21) years of age who: (i) Are without healthcare coverage; (ii) Are members of a family with a gross family income not exceeding two hundred fifty percent (250%) of the federal poverty guidelines; (iii) Are enrolled as full-time students in a public or private college, university, technical institute, technical college, or other institution of higher education located in the state; and (iv) Are covered under the program under subdivision (d)(4)(A) of this section on the day before becoming nineteen (19) years of age; or (C) Persons twenty-one (21) years of age or older but less than twenty-five (25) years of age who: (i) Are without healthcare coverage; (ii) Are members of a family with a gross family income not exceeding two hundred fifty percent (250%) of the federal poverty guidelines; (iii) Are enrolled as full-time students in a public or private college, university, technical institute, technical college, or other institution of higher education located in the state; and (iv) Are covered under the program under subdivision (d)(4)(A) of this section on the day before becoming twenty-one (21) years of age. (e) A person enrolled in the full Medicaid program shall not be concurrently enrolled in the program except as required by federal law. (f)(1) Subdivisions (d)(4)(B) and (C) of this section apply only to students who enroll as students in a public or private college, university, technical institute, technical college, or other institution of higher education no less than six (6) months after graduation from high school and who maintain a continuous enrollment each consecutive semester thereafter with no periods of time in which the person is not enrolled as a student, excluding regularly scheduled summer breaks. (2) If a person who has enrolled in the program under subdivision (d)(4)(B) or subdivision (d)(4)(C) of this section is not enrolled as a student as set forth in subdivision (f)(1) of this section, the person shall not be entitled to healthcare coverage under the program and shall not be entitled to later resume coverage following a break in eligibility. (g) Providers of covered services shall be enrolled as Medicaid providers, and reimbursement shall be at the rates established by the program.