50. DEFINITIONS 50.1 “Applicant” shall mean a person applying for benefits on behalf of a child and/or themselves. 50.2 “Child” means a person who is less than nineteen years of age. 50.3 “Department” shall mean the Colorado Department of Health Care Policy and Financing. 50.4. “Dispute Resolution Conference”, or “Conference” shall mean a conference with the Department or its Designee in which a contested decision regarding an applicant or enrollee is reexamined. 50.5 “Enrollee” shall mean an eligible person who is enrolled in the Children's. Basic Health Plan. 50.6 “Essential Community Provider” means a healthcare provider that: (a) Has historically served medically needy or medically indigent patients and demonstrates a commitment to serve low-income and medically indigent populations who make up a significant portion of its patient population, or in the case of a sole community provider, serves, medically indigent patients, within its medical capability, and (b) Waives, charges or charges for services on a sliding scale based on income and does not restrict access, or services because of a, client's financial limitations. 50.7 “Evidence of Coverage” or “EOC” shall mean:

A. Any certificate, agreement, or contract issued to an enrollee from time-to-time by an MGO setting out the coverage to which the enrollee is or was entitled under the Children's Basic Health Plan.

50.8 “Family” shall mean a group of people who are related by blood, marriage or other legally recognized domestic relationship, live in the same household and receive at least 50% of their support from the household.

50.9 “Managed Care Organization” or “MGO” shall mean:

A. A carrier which meets the definition in 10-16-102 (8), C.R.S. with which the Department contracts to provide health care or dental services covered by the Children's Basic Health Plan; or, B. Essential community providers and other health care and dental service providers with whom the Department contracts to provide health care services under the Children's Basic Health Plan using a managed care model 100 ELIGIBILITY 110 INDIVIDUALS ASSISTED UNDER THE PROGRAM 110.1 To be eligible for the Children’s Basic Health Plan, an eligible person shall: A.

1. Be less than 19 years of age; or 2. Be a pregnant woman; however, the Department shall not enroll any pregnant women in the Plan on and after May 5, 2003 until June 30, 2004; and B. Fall into one of the following categories:

1. A citizen or national of the United States, the District of Columbia, Puerto Rico, Guam, the United States Virgin Islands, the Northern Mariana Islands, American Samoa or Swain's Island; or 2. An alien or immigrant who entered the United States at least five years prior to the date of application and who is:

a. Lawfully admitted for permanent residence under the U.S. Immigration and Nationality Act; or b. Paroled into the United States for at least one year under Section 212(d)(5) of the U.S. Immigration and Nationality Act; or c. Granted conditional entry under Section 203(a)(7) of the U.S. Immigration and Nationality Act; or 3. An alien who arrived in the United States on any date who is: a. Lawfully residing in Colorado and is an honorably discharged military veteran; or 1. A spouse of such military veteran; or 2. An unremarried surviving spouse of such military veteran; or 3. An unmarried dependent child of such military veteran. b. Lawfully residing in Colorado and is on active duty in the United States Armed Forces, excluding military training; or 1. A spouse of such individual; or 2. An unremarried surviving spouse of such individual; or 3. An unmarried dependent child of such individual.

c. Granted asylum under Section 208 of the U.S. Immigration and Nationality Act; or d. Refugee under Section 207 of the U.S. Immigration and Nationality Act; or e. An individual with deportation withheld:

1. Under Section 243(h) of the U.S. Immigration and Nationality Act, as in effect prior to September 30, 1996; or 2. Under Section 241(b)(3), as amended by P.L. 104-208 of the U.S. Immigration and Nationality Act.

f. A Cuban or Haitian entrant, as defined under Section 501(e)(2) of the U.S. Refugee Education Assistance Act of 1980; or g. An individual who:

1. Was born in Canada and possesses at least 50 percent American Indian blood; or 2. Is a member of an Indian tribe, as defined in 25 U.S.C. Section 450(b)e.

h. Admitted into the United States as an Amerasian immigrant under Section 584 of the U.S. Foreign Operations, Export Financing, and Related Programs Appropriation Act of 1988, as amended by P.L. 100-461; or i. A lawfully admitted, permanent resident, who is a Hmong or Highland Lao veteran of the Vietnam conflict; and C. Be a resident of Colorado; and D. Have family income less than or equal to 200% of the Federal Poverty Level, adjusted for family size.

120 INSUFFICIENT ACCESS TO OTHER HEALTH COVERAGE 120.1 To be eligible for the Children’s Basic Health Plan, an eligible person shall not: A. Be covered under a group health plan or under health insurance coverage; or B. Currently have, or have had within the three months prior to application, comparable (as defined in Title XXI of the Social Security Act, Section 2103) health coverage through an employer where the employer contributes at least fifty percent of the premium cost for the individual unless the individual lost health coverage due to a change in or loss of employment; or C. Be a member of a family that is eligible for health benefits coverage under a State health benefits plan on the basis of a family member's employment with a public agency in the State of Colorado; or D. Be eligible to receive assistance under Title XIX of the Social Security Act; or E. Be an inmate of a public institution or a patient in an institution for mental diseases. 130 DOCUMENTATION 130.1 To be eligible for the Children’s Basic Health Plan, an eligible person shall provide the following: A. Verification of earned income for the family of the applicant if money has been earned within 30 days of the date of application. Verification may include one of the following: 1. Current wage stubs; or 2. A note from an employer; or 3. A phone call to an employer (if permitted by applicant); or 4. Ledgers or receipts for self-employed applicants.

B. The person described in §110.1.A.2. shall be presumed eligible for the Children’s Basic Health Plan if their self reported income meets self-declared income guidelines. 140. REDETERMINATION 140.1 Eligibility shall be redetermined when twelve (12) months have passed since the last eligibility determination.

150 CALCULATION OF FAMILY INCOME 150.1 Income includes all employment, self-employment, and unearned income, with the following exceptions:

A. College grants and scholarships;

B. Grants from non-profit, tax-exempt, charitable foundations specifically for cost sharing; C. Child support and foster care payments;

D. Food stamps and Women, Infants, and Children (WIC) payments; E. Assistance provided by non-profit organizations, if the assistance is need-based (i.e. the cost of meals at a soup kitchen);

F. Settlements;

G. Stipends;

H. College loans;

I. Medical care provided for free or if a third party made the payments; J. Payments by credit life or disability insurance;

K. Proceeds of a loan;

L. Disaster relief assistance;

M. Tax refunds;

N. Moving expenses paid by employer for relocation; and O. Income of children less than 18 years of age.

150.2 Estimated earned income may be used to determine eligibility if the applicant/client provides less than a full calendar month of wage stubs for the application month. Verification of earned income received during the month prior to the month of application shall be acceptable if the application month verification is not yet available. Actual earned income shall be used to determine eligibility if the client provides verification for the full calendar month. 150.3 The following are allowable deductions to income: A. Day and elder care expenses incurred by the family within ninety (90) days of the date of the application; and B. Expenses for medical services, prescriptions or durable medical equipment incurred within ninety (90) days of the date of application; and C. Child support payments; and D. Alimony payments; and E. Health insurance premiums.

160 APPEALS PROCESS 160.1 Applicants shall be notified of any action regarding the eligibility requirements for the enrollees’ participation in the Children’s Basic Health Plan and appeal rights regarding those requirements by the Department or its designee.

160.2 The Department or its designee shall notify the applicant within ten (10) calendar days of a decision regarding eligibility. The notice shall:

A. Be in writing; and B. Be in his/her primary language, to the extent practicable; and C. Describe to the applicant the reasons for the decision; and, D. Document the authority for the decision (e.g. rule citation); and E. Inform the applicant of his/her rights and responsibilities regarding the decision. 160.3 If an applicant does not agree with the eligibility determination assessed by the Department or its designee, the applicant may appeal the decision by requesting, in writing, redetermination of eligibility.

160.4 An applicant who disagrees with a denial of eligibility may appeal by means of a dispute resolution conference, which shall be requested by the applicant in writing within thirty (30) calendar days of the date of the notification of denial of eligibility. The results of the dispute resolution conference shall be communicated to the applicant within ten (10) calendar days of the dispute resolution conference and shall be final. The following guidelines shall apply to the dispute resolution conference:

A. The dispute resolution conference shall be conducted by an independent panel appointed by the Executive Director of the Department. The panel shall include at least three people not previously involved with the grievance. A person previously involved with the grievance may be present at the conference and appear before the panel to present information and answer questions, but shall not have a vote. The Department shall ensure that those appointed to the panel have sufficient experience to make an informed decision regarding the grievance under review.

B. The applicant may be present at the dispute resolution conference in person or by telephone. C. The applicant may be represented by the person of the applicant’s choice (i.e. legal counsel, friend, family member, etc.) during the dispute resolution conference. D. The applicant may have access to documents that were used by the Department or its designee in making the decision under appeal.

200. Benefits Package 210. The following are covered benefits including any applicable limitations: 1. Emergency Care and Urgent/After Hours Care;

2. Emergency Transport/Ambulance Services;

3. Hospital/Other Facility Services Including:

A. Inpatient;

B. Physician;

C. Outpatient/Ambulatory;

4. Medical Office Visits Including:

A. Physician;

B. Mid-Level Practitioner;

C. Specialist;

5. Diagnostic Services;

6. Preventative, Routine and Family Planning Services Including: A. Immunizations;

B. Well-child visits;

C. Health maintenance visits;

7. Maternity Care Including:

A. Prenatal;

B. Delivery and inpatient well-baby care;

C. Postpartum care 8. Mental Illness Treatments such as:

A. Neurobiologically-based mental illness including:

a. Schizophrenia;

b. Schizoaffective disorder;

c. Bipolar affective disorder;

d. Major depressive disorder;

e. Specific obsessive compulsive disorder;

f. Panic disorder;

B. All other mental illness;

a. Inpatient coverage shall be limited to 45 inpatient days with the option of converting those 45 inpatient days to 90 outpatient days of day treatment services;

b. Outpatient coverage shall be limited to 20 visits;

9. Chemical Dependency Treatments shall be limited to 20 visits with no inpatient coverage; 10. Physical Therapy, Speech Therapy and Occupational Therapy shall be limited to 30 visits per diagnosis per year;

11. Durable Medical Equipment shall be limited to the lesser of the purchase price or rental price for medically necessary durable medical equipment that shall not exceed two thousand dollars per year.

12. Transplants must be medically necessary and are limited to: A. Liver;

B. Heart;

C. Heart/lung;

D. Cornea;

E. Kidney;

F. Bone marrow which shall be limited to the following conditions: a. Aplastic anemia;

b. Leukernia;

c. Immunodeficiency disease;

d. Neuroblastoma;

e. Lymphoma;

f. High risk stage ii and iii breast cancer;

g. Wiskott aldrich syndrome;

G. Peripheral stem cell support which shall be limited to the following conditions: a. Aplastic anemia;

b. Leukemia;

c. Immunodeficiency disease;

d. Neuroblastoma;

e. Lymphoma;

f. High risk stage ii and iii breast cancer;

g. Wiskott aldrich syndrome;

13. Home health care;

14. Hospice care;

15. Prescription medication;

16. Kidney dialysis shall be excluded only if the member is also eligible for medicare; 17. Skilled nursing facility care must be provided only when there is a reasonable expectation of measurable improvement in the members' health status.

18. Vision services shall be limited to:

A. Vision screenings for age appropriate preventative care; B. Referral required for refraction services;

C. Maximum fifty dollar benefit for eyeglasses;

19. Audiology services shall be limited to:

A. Hearing screenings for age appropriate preventative care; B. A maximum of eight hundred dollars per year for hearing aides for the following conditions:

a. congenital b. traumatic injury 20. Intractable pain;

21. Autism;

22. Case management is covered only when medically necessary; 23. Dietary counseling/nutritional services shall be limited to: A. Formula for metabolic disorders;

B. Total parenteral nutrition;

C. Enterals and nutrition products;

D. Formulas for gastrostemy tubes;

24. Dental services are limited to:

A. Those dental services described in the Evidence of Coverage provided to enrollees aged 18 and under by the MCO (or its designee) with which the Department has contracted for the applicable plan year to provide such dental services; B. Orthodontic and prosthodontic treatment for cleft lip or cleft palate in newborns (covered as a medical service in accordance with 10-16-104, C.R.S.); and C. Treatment of teeth or periodontium required due to accidental injury to naturally sound teeth (covered as a medical service in accordance with 10-16-104, C.R.S.). A physician or legally licensed dentist must perform treatment within 72 hours of the accident.

25. Therapies covered shall include:

A. Chemotherapy;

B. Radiation;

26. The following are not covered benefits:

A. Acupuncture;

B. Artificial conception;

C. Biofeedback;

D. Blood, plasma or derivatives;

E. Inpatient chemical dependency treatment;

F. Chiropractic care;

G. Convalescent care or rest cures;

H. Cosmetic surgery;

I. Custodial care;

J. Domiciliary care;

K. Duplicate coverage;

L. Government institution or facility services;

M. Hair loss treatments;

N. Hypnosis;

O. Infertility services;

P. Maintenance therapy;

Q. Nutritional therapy unless specified otherwise;

R. Post-termination services;

S. Personal comfort items;

T. Physical exams for employment or insurance;

U. Private duty nursing services;

V. Routine foot care;

W. Sex change operations;

X. Sexual disorder treatments;

Y. Taxes;

Z. TMJ treatment;

AA. Other therapies and treatments which are not medically necessary; BB. Vision services unless specified otherwise;

CC. Vision therapy;

DD. War-related conditions;

EE. Weight-loss programs;

FF. Work-related conditions;

300 ENROLLMENT FEES AND COPAYMENTS 310 ANNUAL ENROLLMENT FEES AND DUE DATE 310.1 For eligible children, the following annual enrollment fees shall be due prior to enrollment in the Children's Basic Health Plan:

A. For families with income, at the time of eligibility determination, less than 151% of the federal poverty level, the annual enrollment fee shall be waived. B. For families with income, at the time of eligibility determination, between 151% and 200% of the federal poverty, the annual enrollment fee shall be: 1. Twenty-five dollars for a single eligible child; and 2. Thirty-five dollars for two or more eligible children. 3. Waived for families who include an eligible pregnant woman. 310.2 If the required enrollment fee is not received with the application for the Children's Basic Health Plan, the Department or its designee shall notify the applicant: A. That applicable enrollment fees are a requirement for enrollment; B. That fees shall be due within thirty (30) days of the date of notification; C. Of effective date of enrollment if payment is received; and D. That the application shall be denied if payment is not received by the due date indicated. 310.3 The application shall be denied if payment is not received by the due date indicated on the notification.

310.4 The enrollment fees stated in this section shall apply to applications received on or after January 1, 2001.

310.5 Once enrollment has occurred, the annual enrollment fee is non-refundable. 320 COPAYMENTS 320.1 The following copayments shall be due for enrollees at the time of service: A. For families with income, at the time of eligibility determination, less than 101% of the federal poverty level, all copayments shall be waived, except for emergency and urgent/after hours care, which shall be three dollars per use.

B. For families with income, at the time of eligibility determination, between 101% and 150% of the federal poverty level, the copayment shall be:

1. Two dollars per office visit;

2. Two dollars per outpatient mental health or substance abuse visit; 3. One dollar per prescription;

4. Two dollars per physical therapy , occupational therapy or speech therapy visit; 5. Two dollars per vision visit;

6. Three dollars per use of emergency care and urgent/after hours care. C. For families with income, at the time of eligibility determination, between 151% and 200% of federal poverty level, the copayment shall be:

1. Five dollars per office visit;

2. Five dollars per outpatient mental health or substance abuse visit; 3. Three dollars per generic prescription;

4. Five dollars per brand name prescription;

5. Five dollars per physical therapy, occupational therapy or speech therapy visit; 6. Five dollars per vision visit;

7. Fifteen dollars per use of emergency care and urgent/after hours care. 330 COST SHARING LIMITATIONS 330.01 Cost sharing shall mean payments, such as copayments or enrollment fees that are due on behalf of the enrollee.

330.1 American Indians and Alaskan Natives shall be exempt from cost sharing requirements. American Indian shall mean a member of a federally recognized Indian tribe, band, or group, or a descendant in the first or second degree of any such member. Alaskan Native shall mean an Eskimo or Aleut or other Alaska Native enrolled by the Secretary of the Interior. 330.2 The maximum yearly cost sharing requirements for families of enrollees shall be 5% of income. 330.3 No copayments shall apply to preventive services. For the purpose of this section, preventive services shall mean:

A. All healthy newborn and newborn inpatient visits, including routine screening whether provided on an inpatient or outpatient basis.

B. Routine examinations.

C. Laboratory tests.

D. Immunizations and related office visits.

E. Routine preventive and diagnostic dental services.

350 APPEALS PROCESS 350.1 Applicants shall be notified of any action regarding the cost sharing requirements for the enrollee’s participation in the Children’s Basic Health Plan and appeal rights regarding those requirements by the Department or its designee.

350.2 If an applicant is to be denied for nonpayment of the enrollment fee, the Department or its designee shall notify the applicant within ten (10) calendar days of the decision to deny the application. The notice shall:

A. Be in writing; and B. Be in his/her primary language, to the extent practicable; and C. Describe to the applicant the reasons for the decision; and D. Document authority for the decision (e.g. rule citation); and E. Inform the applicant of his/her rights and responsibilities regarding the decision. 350.3 If an applicant does not agree with the cost sharing requirements for the enrollee’s participation, the applicant may appeal the requirements by requesting, in writing, reassessment of income. 350.4 An applicant who disagrees with a denial of enrollment for nonpayment of the enrollment fee may appeal by means of a dispute resolution conference, which shall be requested by the applicant in writing within thirty (30) calendar days of the date of the notification of denial. The results of the dispute resolution conference shall be communicated to the applicant within ten (10) calendar days of the dispute resolution conference and shall be final. The following guidelines shall apply to the dispute resolution conference:

A. The dispute resolution conference shall be conducted by an independent panel appointed by the Executive Director of the Department. The panel shall include at least three people not previously involved with the grievance. A person previously involved with the grievance may be present at the conference and appear before the panel to present information and answer questions, but shall not have a vote. The Department shall ensure that those appointed to the panel have sufficient experience to make an informed decision regarding the grievance under review.

B. The applicant may be present at the dispute resolution conference in person or by telephone. C. The applicant may be represented by the person of the applicant's choice (i.e. legal counsel, friend, family member, etc.) during the dispute resolution conference. D. The applicant may have access to documents that were used by the Department or its designee in making the decision under appeal.

400 ENROLLMENT 410 SELECTION OF A MANAGED CARE ORGANIZATION 410.1 A. An applicant shall select, at the time of application, a participating MCO in the county of the eligible person's residence. If there is only one participating MCO available in the county of the eligible person's residence, the eligible person shall be enrolled in that MCO.

B. In the event the Department contracts with an MCO to provide dental services to CBHP enrollees, an enrollee automatically will be enrolled with such MCO. No separate MCO election will be required.

410.2 APPLICATIONS WITH NO MCO SELECTION A. If the applicant has not chosen a participating MCO at the time of application, the applicant's eligibility shall be determined. Within 2 working days of eligibility determination, the Department or its designee shall attempt to contact the applicant for selection of a participating MCO. If the applicant fails to choose an MCO within 14 calendar days from the date contact was initiated, the Department or its designee shall assign the eligible person to a participating MCO. The applicant shall be notified of and required to approve the MCO assignment before the eligible person is enrolled in the Children's Basic Health Plan. If the applicant does not approve the MCO assignment or make an MCO selection within 30 calendar days of the date of the notification letter, the application shall be denied.

B. For renewal applications, if the applicant has not chosen a participating MCO at the time of renewal, the applicant's eligibility will be redetermined. For eligible persons, the Department or its designee shall reassign the eligible person to the participating MCO the applicant approved for the previous enrollment period. The applicant shall be notified of and asked to approve the MCO assignment. If the applicant does not approve the assignment, or make an alternative MCO selection within 30 calendar days of the date of the notification letter, renewal applicants will be enrolled with the MCO from the previous enrollment period.

410.3 In counties in which a participating MCO as defined in §50.9.A is not available, the eligible person shall be enrolled in an MCO as defined in §50.9.B.

410.4 Once an enrollee is enrolled in an MCO, the enrollee shall remain enrolled in that MCO for one year, unless the eligible person meets any of the disenrollment criteria set forth in §450. 410.5 An eligible person shall have an opportunity to change to a different MCO serving the child's geographic region, if one is available, during the applicant's annual redetermination period. 420 ENROLLMENT OF ALL ELIGIBLE PERSONS IN A FAMILY 420.1 If one eligible child from a family is enrolled in the Children's Basic Health Plan, all eligible children in that family must be enrolled in the Children's Basic Health Plan. 420.2 All eligible persons in a family must be enrolled in the same MCO. 430 ENROLLMENT DATE 430.1 If determined eligible, an eligible person's date in the Children's Basic Health Plan shall be the date of submission of a complete application.

A. If determined eligible, the enrollment span of a pregnant woman is the date of the submission of a complete application to 60 days after the birth of the child or termination of the pregnancy.

B. If determined presumptively eligible, a pregnant woman's presumptive eligibility enrollment span shall be from the date of presentation to the last day of the following month. 430.2 An eligible person's enrollment date in the selected MCO shall be no later than: A. The first of the month following eligibility determination and MCO selection if eligibility is determined on or before the 23rd of the month.

B. The first of the second month following eligibility determination and MCO selection if eligibility is determined after the 23rd of the month.

430.3 Upon birth, a child born to an eligible woman in the Children's Basic Health Plan shall be automatically enrolled for twelve months.

450 DISENROLLMENT 450.1 An enrollee shall be disenrolled from an MCO for the following reasons: A. Administrative error on the part of the Department, the Department's designee, or the MCO, including but not limited to enrollment of a person who does not reside in the MCO's service area; or, B. A change in the enrollee's residence to an area not in the MCO's service area; or, C. If the enrollee is receiving services through health care providers with whom the Department contracts and a private MCO becomes available in the child's county of residence. D. When an enrollee's coverage is terminated as described in 430.1.A. 450.2 If an enrollee is disenrolled from an MCO for any of the reasons stated in §450.1 and there is another participating MCO available in the enrollee's county of residence, the enrollee shall be allowed to select a new MCO.

450.3 If an enrollee is disenrolled from an MCO for any of the reasons stated in §450.1 and there is not another participating MCO available in the enrollee's county of residence, the enrollee shall be disenrolled from the Children's Basic Health Plan.

450.4 An enrollee may be disenrolled from both an MCO and the Children's Basic Health Plan for the following reasons:

A. Fraud or intentional misconduct, including but not limited to knowing misuse of covered services, knowing misrepresentation of membership status; or, B. An enrollee's receipt of other health care coverage; or, C. The admission of an enrollee into any federal, state, or county institution for the treatment of mental illness, narcoticism, or alcoholism, or into any correctional facility; or, D. Ineligibility for the program, based on the guidelines set forth in the Children's Basic Health Plan eligibility rules; or, E. Failure to comply with cost sharing requirements (annual enrollment fees and copayments) set forth in the Children's Basic Health Plan cost sharing rules. 450.5 If an eligible person or an eligible person's family displays an ongoing pattern of behavior that is abusive to provider(s), staff or other patients; or, disruptive to the extent that the provider's ability to furnish services to the child or other patients is impaired, the eligible person may be disenrolled from his/her managed care organization. If there is another participating MCO available in the eligible person's county of residence, the Department may allow the eligible person to select a new MCO. If there is not another MCO available in the eligible person's county, the eligible person may be disenrolled from the Children's Basic Health Plan. 460 APPEALS PROCESS 460.1 Applicants shall be notified of any action regarding enrollment requirements for participation in the Children's Basic Health Plan and appeal rights regarding those requirements by the Department or its designee.

460.2 The Department or its designee shall notify the applicant within ten (10) calendar days of a decision regarding enrollment. The notice shall:

A. Be in writing; and B. Be in his/her primary language, to the extent practicable; and C. Describe to the applicant the reasons for the decision; and, D. Document the authority for the decision (e.g. rule citation); and, E. Inform the applicant of his/her rights and responsibilities regarding the decision. 460.3 If an applicant does not agree with enrollment requirements for the applicant's participation, the applicant may appeal the requirements by requesting, in writing, a review of the enrollment decision.

460.4 An applicant who disagrees with a decision regarding enrollment may appeal by means of a dispute resolution conference, which shall be requested by the applicant in writing within thirty (30) calendar days of the date of the notification of the decision. The results of the dispute resolution conference shall be communicated to the applicant within ten (10) calendar days of the dispute resolution conference and shall be final. The following guidelines shall apply to the dispute resolution conference:

A The dispute resolution conference shall be conducted by an independent panel appointed by the Executive Director of the Department. The panel shall include at least three people not previously involved with the grievance. A person previously involved with the grievance may be present at the conference and appear before the panel to present information and answer questions, but shall not have a vote. The Department shall ensure that those appointed to the panel have sufficient experience to make an informed decision regarding the grievance under review.

B. The applicant may be present at the dispute resolution conference in person or by telephone. C. The applicant may be represented by the person of the applicant's choice (i.e. legal counsel, friend, family member, etc.) during the dispute resolution conference. D. The applicant may have access to documents that were used by the Department or its designee in making the decision under appeal.

460.5 If an eligible person is enrolled in the Children's Basic Health Plan, the eligible person shall remain enrolled in the program pending the decision of the dispute resolution conference. 500 FINANCIAL MANAGEMENT The Children's Basic Health Plan, being a non-entitlement program, must manage to its legislative appropriation. Therefore, the Department shall track expenditures, caseload, and other financial information to ensure the program does not over spend its appropriation. 510 The Department shall make quarterly assessments of projected expenditures. If it appears the program may overspend its appropriation due to changes in enrollment, health care costs, funding, legislation, or other factors, the Department shall make adjustments to the program. The program may use, but is not limited to, any of the following financial management tools: waiting lists, adjustments of eligibility criteria and/or levels, instituting open enrollment periods, or temporary closure of the program.