53-4-1105. Rulemaking -- active enrollment -- plan coordination.
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53-4-1105 . Rulemaking -- active enrollment -- plan coordination.
(1)The department shall adopt rules necessary to implement this part, including plan administration, plan enrollment, outreach efforts, and standards of performance to allow enrollment partners to assist in enrolling children in the plan or other health coverage plans administered by the department.
(2)The rules must:
(a)establish a process for identifying and approving enrollment partners;
(b)create and define an active enrollment process;
(c)promote seamless movement between programs described in 53-4-1104 (2);
(d)promote accessible enrollment through enrollment partners;
(e)provide, to the extent permitted by law, a single point of access in the department for plan members;
(f)define income for purposes of determining eligibility for children's health coverage programs within the plan;
(g)provide for presumptive eligibility; and
(h)encourage enrollment partners to actively enroll as many eligible, uninsured children as possible in the plan or in an employer-sponsored plan as described in 53-4-1108 .
(3)The rules may include the development of enrollment partner training, technical assistance programs, and performance measures.
(4)The rules may provide for an exemption from the active enrollment process based upon an individual showing of:
(a)religious conviction;
(b)private insurance that offers creditable coverage, as defined in 42 U.S.C. 300gg(c), obtained by the parents for the child from a private group or individual health insurance issuer or under a self-funded employer health plan; or
(c)other compelling circumstances.
(5)The rules governing eligibility and premium assistance must be consistent with this part. Rules may include but are not limited to financial standards and criteria for income, nonfinancial criteria, family responsibility, residency, the application process, termination of eligibility, definition of terms, and confidentiality of applicant and recipient information.