Statutes, codes, and regulations
Alabama Administrative Code
Title 795 - ALABAMA DEPARTMENT OF REHABILITATION SERVICES HOMEBOUND PROGRAM
Chapter 795-4-1 - CHILDREN'S REHABILITATION SERVICES PROGRAM
Section 795-4-1-.08 - Financial Participation

Ala. Admin. Code r. 795-4-1-.08

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Current through Register Vol. 43, No. 02, November 27, 2024
Section 795-4-1-.08 - Financial Participation

Families are eligible for all CRS Programs (i.e., clinical medical, clinical evaluation, care coordination, etc.) regardless of income. Purchased services is income based. A CRS financial participation plan based on a sliding fee schedule will be established with each family to determine eligibility for purchased services.

(1) The amount of CRS financial participation is determined at the time of enrollment, annually, or as the family 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 CRS 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. CRS may suspend purchased services and/or determine whether to bill for the family participation co-pay.
(a) Family Income. Household income will be determined based on a copy of the most recent U.S. Individual Income Tax Return that indicates the Taxable Income as filed with the Federal Internal Revenue Service or other documentation.
(b) 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 CRS worker 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 Children in CRS Programs. 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 CRS Family Participation/Co-Pay. The CRS 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 CRS 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 450% of the FPG. The level of co-pay to percentage of FPG is as follows:

% Federal Poverty Guidelines

Co-Pay Amount

0 up to 200%

$0

250%

$50

300%

$100

350%

$200

400%

$300

450%

$400

over 450%

$500

4. A letter will be sent to the family specifying the annual financial plan. The letter will explain the CRS process for receiving services and whether the client/family is eligible for purchased services. CRS may suspend purchased services after appropriate review and will notify families should their purchased services eligibility be discontinued.
(e) Annual Billing. Annual family participation amount may be billed and will be based upon the CRS financial plan on record when the bill is generated or the plan on record for the majority of the billing period time frame, whichever benefits the family.

Ala. Admin. Code r. 795-4-1-.08

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. Amended: Filed August 29, 2005; effective October 03, 2005.
Adopted by Alabama Administrative Monthly Volume XXXVII, Issue No. 09, June 28, 2019, eff. 8/1/2019.

Author: Alabama Board of Rehabilitation Services

Statutory Authority:Code of Ala. 1975, §§ 21-9-1 through 21-9-13, 21-3-1 through 21-3-8 and 16-38-1 through 16-38-9.