Section DHS 152.03 - Eligibility and certification(1) CONDITIONS. To be eligible for the CRD program, a patient shall: (a) Be a resident of Wisconsin;(b) Be diagnosed as having ESRD;(c) If eligible for medicare, register and pay the premium for coverage by medicare; and(d) Provide to the department or its designated agent full, truthful and correct information necessary for the department to determine patient eligibility and liability, including information about any change in income of more than 10%. A patient shall be denied reimbursement if he or she refuses to provide information, withholds information or provides inaccurate information. The department may verify or audit a certified patient's total family income. The department may redetermine a certified patient's estimated total family income for the current year based on change in the family's financial circumstances.(e) First apply for benefits under all other health care coverage programs for which the person may reasonably be eligible, including medicare, BadgerCare, medical assistance and SeniorCare.(2) PATIENT CERTIFICATION. (a) Certification for coverage of dialysis shall be determined by the department upon the recommendation of a nephrologist from an approved dialysis unit. Certification for coverage of renal transplantation shall be determined by the department upon the recommendation of a transplant surgeon from an approved renal transplantation center.(b) A statewide list of certified ESRD patients shall be maintained either by the department or by another agency upon arrangement with the department. This list shall include names of all certified outpatient dialysis and kidney transplant patients in the state. Additional information deemed necessary and appropriate by the department shall be provided by the dialysis and transplant centers to determine eligibility and facilitate reimbursement.(c) The department or its fiscal agent shall certify an eligible patient for reimbursement upon receipt from any dialysis unit approved under ss. DHS 152.05 and 152.08 or renal transplantation center approved under ss. DHS 152.05 and 152.07 of a satisfactorily completed application for certification submitted on behalf of the patient.Wis. Admin. Code Department of Health Services DHS 152.03
Cr. Register, June, 1988, No. 390, eff. 7-1-88; emerg. am. (1) (c), eff. 9-1-93; r. and recr. (1), am. (2) (c), Register, December, 1994, No. 468, eff. 1-1-95; CR 04-051: cr. (1) (e) Register November 2004 No. 587, eff. 12-1-04.