Arkansas Administrative Code › Agency 172 - Department of Career Education › Rule 172.00.08-002 - Arkansas Kidney Disease Commission (AKDC) Rules of Operation

Current through Register Vol. 49, No. 6, June, 2024
INTRODUCTION
This manual delineates the rules of operation established for the
	 Arkansas Kidney Disease Commission. Changes, additions, and deletions will be
	 made from time to time in order to insure the best possible services for
	 clients with permanent kidney failure who are residents of the State of
	 Arkansas. Rule changes will only be considered during Commission meetings when
	 a quorum is declared. A majority vote is required for any change.
Arkansas Kidney Disease Commission
RULES
AUTHORITY
The Arkansas Kidney Disease Commission (AKDC) was established by the
	 General Assembly of the State of Arkansas through Act 450 of 1971 to establish
	 a program for the care and treatment of persons suffering from chronic renal
	 disease. The legislation charged the AKDC to "provide financial assistance for
	 persons suffering from chronic renal disease who require life-saving care and
	 treatment to the extent as determined by the Commission".
Legislative Findings and Purpose
Legislative findings declared and found that one of the major problems
	 facing medicine and the public health and welfare is the lack of an adequate
	 program to assist in the treatment and cure of persons suffering from chronic
	 kidney disease. It is estimated that a number of citizens of this State
	 annually are confronted with chronic kidney disease, requiring complicated and
	 expensive treatment, which is often beyond the financial resources of such
	 individuals. There is a critical shortage of adequate facilities within the
	 State for the discovery, evaluation, diagnosis, treatment, and cure of
	 individuals suffering from chronic kidney disease. In order to provide for the
	 care and treatment of persons suffering from acute or chronic kidney disease,
	 and in order to encourage and assist in the development of adequate treatment
	 facilities for persons suffering from acute or chronic kidney disease, it is
	 essential that the State develop a program of financial assistance to aid in
	 defraying a portion of the cost for the care and treatment of chronic renal
	 disease to the extent that the individual suffering from such disease is unable
	 to pay for such services on a continuing basis.
COMMISSION
Powers and Duties of the Commission
The Commission shall have the following functions, powers and
	 duties:
* To establish a program to assist suffering from acute or chronic
	 renal failure in obtaining care and treatment requiring dialysis. Such program
	 shall provide financial assistance for persons suffering from chronic renal
	 diseases who require life-saving care and treatment for such renal disease to
	 the extent, as determined by the Commission, that such persons are unable to
	 pay for such services on a continuing basis without causing unjust and unusual
	 hardship to himself and his immediate family, including, but not limited to, a
	 drastic lowering of the standard of living.
* Develop standards for determining eligibility for assistance in
	 defraying the cost of care and treatment of renal disease under this
	 program.
* To cooperate with hospitals, private groups, organizations, and
	 public agencies in the development of positive programs to bring about
	 financial assistance and support of evaluation and treatment of patients
	 suffering from chronic kidney disease.
* To cooperate with the National and State Kidney Foundations, and with
	 medical programs of the State and Federal Government, for the purpose of
	 obtaining the maximum amount of Federal and private assistance possible in
	 support of a kidney disease treatment program.
* Establish criteria and standards for evaluating the financial ability
	 of persons suffering from chronic renal disease to pay for their own care,
	 including third party insurance coverage, for the purpose of establishing
	 standards for eligibility for financial assistance in defraying the cost of
	 such care and treatment from funds approved to the commission for renal disease
	 treatment purposes.
* To accept gifts, grants, and donations from private sources, from
	 municipal and county governments, and from the Federal Government, to be used
	 for the purpose of this Act in defraying costs incurred by persons suffering
	 from acute or chronic renal disease who are unable to meet the total cost of
	 life-saving care and treatment for renal disease.
Commission Committees
Financial Committee
The Financial Committee will be composed of at least two (2) members
	 appointed by the Chairman of the Commission. It will be the responsibility of
	 this Committee to review and make recommendations to the full Commission
	 regarding program rules and practices related to establishing the client
	 financial needs criteria to be utilized by the AKDC.
Medical Committee
The Chairman of the Commission will appoint the Medical Committee. This
	 Committee will be composed of as many as eight (8) members, and will include
	 specialists who treat end stage renal disease (ESRD), and may include others
	 who work in allied medical fields and are knowledgeable about chronic renal
	 conditions. One member shall serve at the discretion of the Chairman of the
	 Commission as chairman of this committee. The Chairman of the Medical Committee
	 must be a physician knowledgeable in ESRD. It will be the responsibility of
	 this committee to review and make recommendations to the full Commission
	 regarding program rules and practices related to the services provided by the
	 AKDC. This committee will also establish the specific medical criteria a client
	 must have in order to receive services provided by the program. The Chairman of
	 the Medical Committee may assist in the application review process to ascertain
	 if the individual applying for services meets the established medical criteria.
	 In certain instances the full Medical Committee may be asked to review an
	 application if such is indicated.
ELIGIBILITY
Persons suffering from chronic renal failure may be referred to the
	 Arkansas Kidney Disease Commission. Referrals will come from physicians,
	 clients themselves, rehabilitation counselors, social workers, hospital
	 personnel, the Association of Kidney Disease Patients, the Arkansas Kidney
	 Foundation, the Social Security Administration, and others including
	 individuals and agencies familiar with the person's kidney disease.
Eligibility Requirements
Eligibility requirements will be applied without regard to sex, race,
	 creed, color, or national origin. With respect to age, no upper or lower limit
	 will be set as a guide to turn away a referral.
No residence requirement, durational or other, will be imposed which
	 would exclude any individual, who lives in Arkansas and makes or intends to
	 make Arkansas home, from receiving services.
Certification by a Nephrologist is required confirming the applicant
	 has a diagnosis of ESRD with an indication that the individual is in need of
	 regular renal dialysis treatments or has been the recipient of a kidney
	 transplant.
Financial need will be considered in determining eligibility.
The AKDC will conform to the policies of the Directive/Protection of
	 Families from Government.
Application for Services
Individuals applying for services available through the program are
	 requested to complete the AKDC Referral Application. Utilization of the AKDC
	 Referral Application (Form KD -1) is preferred as it contains the necessary
	 individual identifying information as well as income, benefit, and asset
	 information to determine financial need. The Referral Application also includes
	 the required Nephrologist certification indicating the applicant has ESRD or
	 been the recipient of a kidney transplant.
Certificate of Eligibility/Ineligibility
A certificate of eligibility-ineligibility (Form KD-10) will be
	 completed prior to the provision of services, or the refusal of services, as
	 the case may be. The AKDC Program Administrator will have the responsibility to
	 review the Referral Application applying the established financial needs
	 criteria. The applicant will be notified if financial need is not met. The
	 signature of the AKDC Program Administrator will only be required on the
	 Certificate of Eligibility/Ineligibility for those applicants not meeting the
	 program's established financial needs criteria. Applications of individuals
	 determined to meet the established financial needs criteria will be referred to
	 the Chairman of the Medical Committee or, if so determined by the Commission
	 Board, a physician employed by Arkansas Rehabilitation Services to ascertain
	 whether the applicant's medical condition is consistent with the established
	 program criteria to be eligible for services. The signature of the AKDC Program
	 Administrator, the reviewing physician, and the Chairman of the Commission is
	 required on the Certificate of Eligibility/Ineligibility for those applicants
	 determined eligible to receive program services. The Vice-Chairman of the
	 Commission will sign in the absence of the Chairman. Applicants and other
	 concerned will be notified of the decision made, whether approved or
	 denied.
FINANCIAL NEED/COMPARABLE
	 BENEFITS
Client's Resources
Every applicant's request for services will be reviewed to determine if
	 other benefits are available. It is the intention of the AKDC to assist all
	 eligible ESRD cases, but only to the extent that such services will supplement
	 other benefits.
Financial need is basic for AKDC services. Many individuals lack
	 adequate financial resources to maintain themselves and/or their dependents and
	 are often unable to meet needs arising from the extraordinary circumstances
	 associated with ESRD. AKDC rules and practices are based on the concept of
	 assisting the client with a limited number of prescriptions as well as some
	 dental and medical services. In determining an individual's financial
	 resources, all resources available to the client and his/her household will be
	 considered. If the applicant is a dependent, the resources of the parent(s)
	 will be determined. The exception is if the applicant is a dependent and is
	 receiving SSI benefits, he/she may be considered a family of one. The
	 Commission members will establish the standards for determining financial
	 need.
When determining financial need, the AKDC will consider the available
	 financial resources of the total household unless an exception exists. Income
	 sources to be considered include wages; business income; social security, SSDI,
	 and SSI benefits; retirement income; veteran's benefits; income from stocks,
	 bonds, or other investments; and other identifiable liquid assets.
Comparable Benefits of the Individual
The comparable benefits provision provides the AKDC with an organized
	 method for assessing an individual's eligibility for benefits under other
	 programs. Any benefits available to individuals under any other program to
	 meet, in whole or in part, the cost of any AKDC service is not a factor in
	 determining eligibility for AKDC services.
Other Resources/ Similar Benefit
Any services that the applicant may receive, or be eligible to receive
	 from other sources will be used first. The AKDC may only supplement these
	 benefits.
Co-Payment
The Commission Board members will establish any co-payment for services
	 that is to be paid by a client of the program. The AKDC has assessed clients a
	 co-payment for prescription drugs to be paid at the point of sale.
EFFECTIVE DATE OF SERVICE
The effective date a client will be eligible to receive paid for
	 services provided by the AKDC will be established by the program. An applicant
	 must be determined eligible prior to program funds being authorized. The AKDC
	 shall not authorize payment for any services prior to the effective date of
	 service.
Financial Cap
The Commission Board members will establish a limit on per client
	 expenditures per state fiscal year. During the course of a fiscal year should
	 expenditures for a client exceed the limit allowed per year the case will be
	 referred to the Commission Board for review to determine a course of
	 action.
Termination of Services
Paid for services provided by the AKDC will be terminated the day a
	 client dies. Eligibility_for paid for services will also be ended the last day
	 of the month a client's course of dialysis is terminated unless the individual
	 has received a kidney transplant. It will be the_practice of the AKDC to mirror
	 Medicare regarding clients receiving kidney transplants.
SERVICES
The availability of funds will influence the services provided by the
	 AKDC. The Commission Board will determine specific services to be funded by the
	 program each fiscal year. Covered services can include: outpatient
	 pharmaceutical drugs, medical services, pre-transplant dental services,
	 transportation, and referral. Specific services to AKDC clients, including
	 those in need of continuing services, will be provided based upon the
	 availability of funds. During the course of a fiscal year should it be
	 determined insufficient monies are available to fund services provided by the
	 program at existing levels for the remaining portion of the fiscal year, the
	 Commission Board will establish the manner in which services will be curtailed,
	 or if required, terminated for the remainder of that fiscal year. Should the
	 curtailing of services result, preference will be given to those in need of
	 continuing services.
Outpatient Pharmaceutical Drugs
The AKDC may pay for a limited number of ESRD related prescription
	 drugs. Medications paid for by the program must be consistent with the approved
	 AKDC drug list. A client co-pay for allowable drugs is required. The AKDC will
	 only participate in the purchase of immuno-suppressant medications as a
	 co-payer. Program co-payment for immuno-suppressant drugs shall not exceed
	 twenty percent of the Medicare allowable rate.
Medical Services
The AKDC may assist in paying for some of the ESRD related medical
	 treatment costs during the Medicare three-month waiting period or when no other
	 coverage exists. Documentation of lack of coverage and prior authorization is
	 required to be eligible for this service. The AKDC shall not provide payment
	 for any durable medical equipment. Payment for any medical service will be
	 consistent with the established fee schedule.
Pre-Transplant Dental Services
The AKDC may assist with dental charges when a dental problem
	 jeopardizes the health and treatment program outlined by the renal specialist
	 and may be covered only for the purpose of kidney transplantation. Payment for
	 services rendered will be prior approved and consistent with the established
	 dental fee schedule.
Transportation
The AKDC may assist in paying for some client transportation costs
	 specifically associated with ESRD treatment. Eligibility to receive this
	 service will be on a prior-approved basis with determination consisting of a
	 review of existing client/household income and expenses, other available
	 resources, and documentation of a lack of other assistance. Reimbursement will
	 be based on a mileage per diem rate with the maximum allowed established by the
	 Commission Board.
Referral Services
The AKDC will assist clients diagnosed with ESRD with referral to other
	 programs including vocational rehabilitation.
Payment for Services to
	 Vendors
The AKDC will process payment for services when in receipt of a signed
	 vendor statement or letter that includes the client's name and other necessary
	 identifiable information, a description of services provided, date(s) of
	 service provision, and cost. Claims for prescription drugs are to be submitted
	 on the AKDC Prescription Drug Claim Form. The AKDC will not pre-pay for a
	 service, only providing payment after the service has been rendered. Requests
	 for payment for services rendered must be received by the program within one
	 calendar year of the date of service. The AKDC will not provide remittance for
	 those requests for payment that exceed the one-year from date of service
	 limit.
Confidentiality, Use, and Release of Client Records
	 and Information
The AKDC will develop and maintain a case record for applicants and
	 individuals determined eligible to receive services available through the
	 program. Client information developed or received by the AKDC will be the
	 property of the program. Information contained in the case record may only be
	 used for determining eligibility/ineligibility for AKDC services, providing
	 payment for services rendered, or other program operations. The AKDC will
	 endeavor to maintain personal information contained in the case record in a
	 secure manner and treat such information with the highest degree of
	 confidentiality.
The AKDC Program Administrator shall be designated as the custodian of
	 applicant and client case records. The Program Administrator will have the
	 responsibility of insuring such information is maintained in a safe and secure
	 manner consistent with State and Federal regulations. The Program Administrator
	 shall provide training to AKDC staff regarding how applicant and client
	 information will be developed, maintained, and shared with affected parties.
	 The Program Administrator will be responsible for the destruction of all closed
	 case files.
When requested in writing, the AKDC will make available to the
	 applicant or client, of if appropriate the individual's representative,
	 information contained in that person's case record. Should the applicant or
	 client or, if appropriate, that individual's representative believes
	 information contained in the case record to be inaccurate or misleading, a
	 written request can be made to the program to amend such information.
In the event another agency or organization requests personal
	 information contained in the case record of an AKDC applicant or client, the
	 program will only release such information with written consent of the
	 applicant or client or, if appropriate, that individual's representative. It
	 will be the responsibility of the AKDC and parties involved to respect the
	 confidential nature of personal information and limit information exchanged to
	 that minimally necessary. The AKDC will release personal information contained
	 in the case record in response to investigations in connection with law
	 enforcement, fraud, and abuse unless expressly prohibited by State and Federal
	 laws and regulations and in response to an order issued by a judge, magistrate,
	 or other authorized judicial official.