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

Current through Register Vol. 42, No. 9, June 28, 2024
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.