Ala. Admin. Code r. 795-5-1-.07
Current through Register Vol. 43, No. 1, October 31, 2024
Section 795-5-1-.07 - Financial ParticipationA 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: % 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.(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.Ala. Admin. Code r. 795-5-1-.07
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..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, §§ 21-8-1 through 21-8-5 and 21-9-1 through 21-9-13.