ALABAMA DEPARTMENT OF REHABILITATION SERVICES ADMINISTRATIVE CODE

CHAPTER 795-5-1 HEMOPHILIA PROGRAM

TABLE OF CONTENTS

795-5-1-.01 Hemophilia Program

795-5-1-.02 Program Administration

795-5-1-.03 Eligibility

795-5-1-.04 Referral

795-5-1-.05 Enrollment

795-5-1-.06 Family Application For Additional Resources

795-5-1-.07 Financial Participation

795-5-1-.08 Third Party Resources

795-5-1-.09 Client Records

795-5-1-.10 Requests For Client Information

795-5-1-.11 Authorization For Service

795-5-1-.12 Physician/Dentist Enrollment

795-5-1-.13 Resident Physicians

795-5-1-.14 Payment For Services

795-5-1-.15 Operating Funds

795-5-1-.16 Forms Appendix

795-5-1-.01 Hemophilia Program. Established by legislative action to assist persons who require continuing treatment with blood, blood derivatives, or a manufactured pharmaceutical product to avoid crippling conditions, hospitalization or other effects associated with hemophilia. Pursuant to Code of Ala. 1975, §21-8-3 through §21-8-5 the Department of Rehabilitation Services shall administer the hemophilia treatment program. Author: Alabama Board of Rehabilitation Services Statutory Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13 and 21-8-1 through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.02 Program Administration.

(1) Administrator. The Director of Children's Rehabilitation Service is the administrator of the statewide Hemophilia Program for children and adults.

(2) Hemophilia Advisory Committee. Pursuant to Code of Ala. 1975, §21-8-4 the Commissioner of the Alabama Department of Rehabilitation Services shall appoint not more than twelve members to said committee to advise in the development and expansion of the Hemophilia Program.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13 and 21-8-1 through 21-8-5.

History: Emergency adoption filed January 17, l995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.03 Eligibility. Legal residents of the State of Alabama who have the diagnosis of hemophilia and other related diseases are eligible for the Hemophilia Program regardless of age. For application forms and additional information, the applicant may contact the nearest Children's Rehabilitation Service office.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13 and 21-8-1 through 21-8-5.

5-l-2

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.04 Referral. An oral or written referral may be received from a family, a physician, an agency, an interested individual or directly from a potential client and may be directed to any office of Children's Rehabilitation Service.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13 and 21-8-1 through 21-8-5.

History: Emergency adoption filed January 17, l995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.05 Enrollment. Children's Rehabilitation Service staff meet with clients/families during enrollment to obtain medical and social history information, complete a needs assessment to develop a Patient/Family Care Plan (PCP), obtain written consent, determine the family's financial resources and determine the need for referral to other agencies. Clients may be enrolled in any CRS Office regardless of where the family resides in the State of Alabama.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13 and 21-8-1 through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.06 Family Application For Additional Resources.

Clients/families are required to apply for other appropriate resources which may be available to them.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13 and 21-8-1 through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.07 Financial Participation. A financial participation plan, based on a sliding fee scale, is developed with each family requesting financial assistance.

(a) All clients are financially eligible for Children Rehabilitation Services. Financial participation is based on a sliding fee scale. In those instances where a family is not requesting financial assistance, financial information is not requested and the family is responsible for the total cost of services.

(b) The level of financial participation is determined at the time of application, annually, or as the family financial situation changes. Medicaid recipients will not be charged any fees, co-pays, nor will they be required to pay a fee for purchased services for those items or services covered by Medicaid. However, families are asked to financially participate on items not covered by Medicaid if the adjusted income computes to a level requiring participation (see (2)(b) What is Not Included).

(1) Family Income.

(a) What is Included.

1. Income is defined according to the annual income guidelines for federal programs and reported in the Federal Register. Income refers to total annual cash receipts before taxes from all sources, with the exceptions noted below. Income includes money, wages and salaries before any deductions. Income also includes net receipts from nonfarm or farm self-employment (receipts from a person's own business or from an owned or rented farm after deductions for business or farm expenses).

2. Income also includes regular payments from social security, railroad retirement, unemployment compensation, strike benefits from union funds, workers' compensation, veterans' payments, public assistance (including Aid to Families with Dependent Children, Supplemental Security Income, and non-Federally-funded General Assistance or General Relief money payments), training stipends, alimony, child support, military family allotments or other regular support from an absent family member or someone not living in the household; private pensions, government employee pensions (including military retirement pay), and regular insurance or annuity payments; college or university scholarships, grants, fellowships and assistantships; dividends, interest, net rental income, net royalties, periodic receipts from estates or trusts, and net gambling or lottery winnings.

(b) What is Not Included. As defined here, income does not include the following types of money received: capital gains; any assets drawn down as withdrawals from a bank, the sale of property, a house, or a car; one-time payments from a government assistance agency to a family or person who is in temporary financial difficulty; tax refunds including earned income credit, gifts, loans, lump-sum inheritances, one-time insurance payments, or compensation for injury. Also excluded are noncash benefits, such as the employer-paid or union-paid portion of health insurance or other employee fringe benefits, food or housing received in lieu of wages, the value of food and fuel produced and consumed on farms, the imputed value or rent from owner-occupied nonfarm or farm housing and such Federal noncash benefit programs as Medicare, Medicaid, Food Stamps, school lunches, and housing assistance. Income does not include temporary possession of funds designated for a specific purpose, i.e., funds received by the family to purchase medical or educational services as a result of philanthropy, community fund raising, or gifts.

(2) Financial Responsibility Related to Custody Issues. CRS will make a financial participation plan with the parent who has the legal custody of the child. If this is not the parent who is court-ordered to provide medical care for the child, the Children's Rehabilitation Services' worker will work with the parent who has legal custody to get a resource contribution and information about insurance coverage.

(a) A stepparent is not financially responsible unless the child has been legally adopted; however, unless he/she has refused to support the child, his/her income is included in the total gross salaries of the family.

(b) When a child resides in a related home without custody, the parents or legal guardian must complete the application form regardless of whether he/she lives in or out of state. The support in/of the related home is not considered in establishing the financial plan.

(c) No financial participation will be required for children with special health care needs with Medicaid who have been adopted through the State Department of Human Resources or are in temporary custody.

(3) Deductions from Gross Income. After computing annual income, the following deductions are allowable with documentation:

(a) The annual cost to the family of the family health

insurance policy.

(b) Out-of-pocket medical expenses paid during the previous year, including medical/dental expenses paid for this child and other family members.

(c) Associated costs, or those costs incurred in the previous year which represent the added expense of caring for a child with special health care needs, not general expenses for caring for a child. Examples include: specialized day care, respite care, diapers for children over age 3, etc.

(d) For single parent households where a single parent maintains a separate family unit, a $5,000 deduction from the annual income figure is allowable.

(4) Family Size and Multiple Children in CRS Programs.

(a) Parent(s) and/or legal guardian(s) and their children (adopted or natural) shall compose the family unit.

(b) If more than one person in the family receives services from CRS, all amounts paid by the family for multiple members will be added together to establish the annual cap. No further financial participation is required after the annual cap is reached.

(5) Computing Participation. The CRS family financial participation policies provide uniform procedures for establishing family participation rates. These participation rates apply equally to all CRS direct services (clinics, therapy, counseling, care coordination) and purchased services (hospitalization, x-rays, dental, orthotics, etc.). Annual income guidelines published in the Federal Register are used as the basis for the participation tables. The process for computing family financial participation is as follows:

(a) Determine gross annual income.

(b) Subtract allowable deductions to arrive at adjusted annual income. (See (3) Deductions from Gross Income.)

(c) Determine family size.

(d) Using the sliding fee scale, select appropriate family size in the .Family Size. column of the table. Locate income range for appropriate family size that includes the adjusted income figure for the family being considered. The percentage figure at the top of the column represents the rate of participation for the family.

1. If the client has health insurance coverage, which meets or exceeds this rate of participation for a service, then the insurance reimbursement will be considered as full payment with no additional family participation required.

2. If the client does not have insurance coverage or the insurance does not cover this service or item, the participation percentage rate is applied against the cost to CRS for the item. If it is a small expenditure, the family may pay their percentage directly to the vendor or CRS will authorize the balance. If it is a large expenditure, CRS may authorize the entire amount and the family will be billed for their percentage participation according to a payment plan which will be handled centrally through the CRS State Office.

(e) The .Self Pay. column on the participation table/sliding fee scale indicates the income level at which families are responsible for the total cost of services provided by CRS and are responsible on a private basis with vendors for the cost of items and/or services ordered in clinic. Families will work with the vendor of their choice regarding payment arrangements.

(f) A financial participation plan letter must be sent to the family by the district team specifying the explicit plan made with the family and the participation percentage to be provided by the family, together with the cap for each calendar year.

(5) Annual Family Participation Caps (refer to Table). A dollar cap or participation ceiling will be established for each family that is contributing financially. The cap is either 7%, or 10% of adjusted income depending on whether the income is greater than 200% or 300% of the annual Federal income guidelines. A cap will be established for each family upon application and receipt of income and family size data. The family will be notified when their financial contributions reach this cap. If more than one family member is participating in CRS programs, all amounts paid by the family will accumulate toward one annual cap. No further financial participation is required after the annual cap is reached.

(6) Special Circumstances.

(a) The District Supervisor may adjust or delete financial participation rates and fees when extenuating circumstances exist, such as recent employment preceded by layoffs or unemployment, or loss of income due to unemployment of wage earner. The District Supervisor will forward such cases to the State Office with instructions for reducing or waiving fees, adjusting participation rates, or adjusting monthly payment plans.

(b) Families in the .Self Pay. category of family participation may be considered for CRS sponsorship as a special circumstance after they have expended the amount of money equal to their cap. Request for consideration in these circumstances must be submitted to the State Supervisor for Field Services for approval.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13 and 21-8-1 through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996..

795-5-1-.08 Third Party Resources. Third party resources available to a client are utilized prior to Children's Rehabilitation Service making an expenditure.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13 and 21-8-1 through 21-8-5.

History: Emergency adoption filed January 17, l995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.09 Client Records. Client records are maintained by way of accurate documentation of services provided to clients and families.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-l through 21-9-13, 21-8-l through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.10 Requests For Client Information. Client information is requested when needed for evaluation or for continuation of care.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13 and 21-8-l through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.11 Authorization For Service. Payment of services must be authorized by Children's Rehabilitation Service prior to the provision or specified services.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13 and 21-8-1 through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.12 Physician/Dentist Enrollment. Children’s Rehabilitation Service enrolls only Board eligible/Board certified physicians and licensed dentists who are experienced in their specialty areas of practice. All physician/dental providers must also be Medicaid providers.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-l through 21-9-13, and 21-8-l through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.13 Resident Physicians. Physicians-in-training must work under the direct supervision of a staff physician in Children's Rehabilitation Service clinics making recommendations and/or issuing orders only with the approval of the staff physician.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13 and 21-8-1 through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.14 Payment For Services. Children's Rehabilitation Service will withhold payment from any provider or person who has knowingly or willfully made or caused to be made, any false statement in application for payment under Title XVIII of the Social Security Act; or, who has submitted, or caused to be submitted, bills or requests for payment under Title XVIII of the Social Security Act in excess of customary charges; or who has furnished services or supplies substantially in excess of the needs of the client, or harmful, or of grossly inferior quality.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-l through 21-9-13, and 21-8-l through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.15 Operating Funds

(l) The source of the operating funds for the Agency are:

(a) Yearly appropriations from the State Legislature.

(b) Donations and reimbursements from parents, clubs, the general public, other organizations and third-party payors.

(2) Definitions:

(a) A donation is defined as cash received from any person, or group of persons, unrelated to the treatment of any particular client.

(b) A reimbursement is defined as payment from a third party payor or cash received from a parent, guardian, or relative of any client enrolled with Children's Rehabilitation Service, whether or not the cash is so designated by the reimbursor.

(3) All funds are received, deposited, recorded, and disbursed in accordance with the fiscal policies of the STATE OF ALABAMA, DEPARTMENT OF FINANCE, FISCAL PROCEDURE, MANUAL OF INSTRUCTION, and the rules and regulations as outlined in the 39 Fed. Reg. 141-41, Part II, July 22, 1974. The agency budget reflects 100 percent specialized expenditures for the Children's Rehabilitation Service program.

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-l through 21-9-13 and 21-8-l through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

795-5-1-.16 Forms Appendix.

(l) Sliding Fee Scale

(2) Social History Form CR Form 2

(3) Financial Assistance Form CR Form 2A

(4) Medical History Form CR Form 9

(5) Consent Form CR Form 90

(6) Notice of Action Form CR Form 12

(7) Client and Family Rights CR Form 14

Author: Alabama Board of Rehabilitation Services

Statutory Authority: Code of Ala. 1975, §§21-9-1 through 21-9-13, and 21-8-l through 21-8-5.

History: Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996.

Sliding Fee Scale

See Master Code For Form

Social History Form

CR Form 2

See Master Code For Form

Social History Form

CR Form 2 (pg. 2)

See Master Code For Form

Financial Assistance Form

CR Form 2A

See Master Code For Form

Medical History Form

CR Form 9

See Master Code For Form

Consent Form

CR Form 90

See Master Code For Form

Notice of Action Form

CR Form 12

See Master Code Form

Notice of Action Form

CR Form 12 (pg. 2)

See Master Code For Form

Client And Family Rights

CR Form 14

See Master Code For Form

Client And Family Rights

CR Form 14 (pg. 2)

See Master Code For Form