Alabama Administrative Code Chapter 795-5-1 — Hemophilia Program

795 Alabama Division of Rehabilitation Services

Ala. Admin. Code r. 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.

History

• Author: Alabama Board of Rehabilitation Services Statutory
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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 Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.02 Program Administration

(1) Administrator. The Director of Children's Rehabilitation Service (CRS) 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.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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 Repealed and Replaced: Filed January 26, 1996; effective March 1, 1996. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 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 CRS office.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 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 CRS office.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.05 Enrollment

CRS staff meet with clients/families during enrollment to obtain medical and social history information, complete a needs assessment to develop a Plan of Care (POC), 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.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.06 Family Application For Additional Resources

Clients/families are required to apply for other appropriate resources such as insurance and patient assistance programs which may be available to them.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.07 Financial Participation

A CRS financial participation plan, based on a sliding fee scale, will be established with each client. All clients are financially eligible for the Hemophilia Program.

(1) The amount of financial participation is determined at the time of enrollment, annually, or as the client’s financial situation changes. A CRS financial participation co-pay is determined based upon family size and taxable annual family income.

(2) There is no CRS co-pay for Medicaid recipients, ALL KIDS enrollees, and families with taxable annual incomes under 200% of Federal Poverty Guidelines as published in the Federal Register by the United States Department of Health and Human Services.

(3) The CRS family participation co-pay will apply only to families that have received a purchased service (hospitalization, x-rays, dental, orthotics, therapy, etc.) from the Hemophilia Program during the previous calendar year. If the total amount of purchased services is less than the co-pay amount, the family will be responsible for the lesser amount.

(a) Family Income. Household income will be determined based on a copy of the most recent U.S. Individual Income Tax Return or other documentation that indicates the Taxable Income as filed with the federal Internal Revenue Service.

(b) Financial Responsibility Related to Custody Issues. The Hemophilia Program will make a financial participation plan with the parent who has the legal custody of the child if the client is a minor. If this is not the parent who is court-ordered to provide medical care for the child, the Hemophilia Program will work with the parent who has legal custody to get a resource contribution and information about insurance coverage.

1. When a child resides in a related home without custody, the parents or legal guardian must complete the enrollment form regardless of whether the parent or legal guardian lives in or out of state. The caregiver’s income will not be considered when establishing CRS family financial participation. If the parent or legal guardian cannot be located, the child’s income will be deemed the family’s annual taxable income.

2. A stepparent’s income will be included in the taxable income of the family.

3. No CRS 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/foster care.

(c) Family size and Multiple Clients in the Hemophilia Program. Parent(s) and/or legal guardian(s) and their children (adopted or natural) shall compose the family unit. Regardless of the number of family members served by CRS, only one CRS family participation amount will apply.

(d) Computing Family Participation/Co-Pay. The Hemophilia Program family financial participation policies provide uniform procedures for establishing yearly family participation co-pays. 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:

1. Determine taxable income.

2. Determine family size.

3. Using the participation tables, determine the level of percent of the Federal Poverty Guidelines (FPG) for a family. The co-pay amount, ranging from $0 - $500, represents the financial participation for families at 200% to over 500% of the Federal Poverty Guidelines. The level of co-pay to percentage of FPG is as follows:

4. A letter will be sent to the family specifying the annual financial plan.

(e) Annual Billing. Annual family participation amount may be billed and will be based upon the financial plan on record when the bill is generated or for the majority of the billing time frame, to the benefit of the family.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed May 7, 2003; effective June 11, 2003. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.08 Third Party Resources

Third party resources such as insurance and/or patient assistance programs, etc., available to a client are utilized prior to CRS making an expenditure.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.09 Client Records

Client records are maintained through accurate documentation of services provided to clients and families.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.10 Requests For Client Information

Client information is requested when needed for evaluation or for continuation of care.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.11 Authorization For Service

Payment of services must be authorized by CRS prior to the provision of specified services.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.12 Physician/Dentist Enrollment

Payment of services must be authorized by CRS prior to the provision of specified services.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.13 Resident Physicians

Physicians-in-training must work under the direct supervision of a CRS vendor physician in CRS clinics making recommendations and/or issuing orders only with the approval of the CRS vendor physician.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.14 Payment For Services

CRS 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.

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed and New Rule: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.15 Operating Funds (Repealed 8/1/19)

(Repealed)

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• Emergency adoption filed January 17, 1995; effective January 18, 1995. Permanent adoption filed April 13, 1995; effective May 18, 1995. Repealed and Replace d: Filed January 26, 1996; effective March 1, 1996. Repealed: Filed June 17, 2019; effective August 1, 2019.

Ala. Admin. Code r. 795-5-1-.16 Forms Appendix (Repealed 6/11/03)

(Repealed)

History

• Author: Alabama Board of Rehabilitation Services
• Authority: Code of Ala. 1975, §§21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.
• 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. Repealed: Filed May 7, 2003; effective June 11, 2003.