Arkansas Administrative Code › Agency 172 - Department of Career Education › Rule 172.00.13-001 - Revisions to the Arkansas Kidney Disease Commission Rules

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 persons suffering from acute or
	 chronic renal failure in obtaining care and treatment requiring dialysis. The
	 program shall provide financial assistance for persons suffering from chronic
	 renal diseases who require life-saving care and treatment for the renal disease
	 to the extent, as determined by the Commission, that a person is unable to pay
	 for such services on a continuing basis without causing unjust and unusual
	 hardship to himself or herself and his or her immediate family, including
	 without limitation a drastic lowering of the standard of living.
* To 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, and 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.
* To establish criteria and standards for evaluating the financial
	 ability of persons suffering from chronic renal disease to pay for their own
	 care, including the availability of third party insurance coverage, for the
	 purpose of establishing standards for eligibility for financial assistance in
	 defraying the cost of the care and treatment from funds appropriated to the
	 commission for renal disease treatment purposes.
* To accept gifts, grants, and donations from private sources, and the
	 federal government and support from municipal and county governments to be used
	 for the purposes 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.
* To accept gifts, grants, and donations from private sources and the
	 federal government and support from municipal and county governments to be used
	 to honor persons who have provided living kidney donations to Arkansans in need
	 of kidney transplantation.
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.
CHAIN OF LIFE AWARD
The AKDC Chain of Life award recognizes individuals who have made a
	 living kidney donation to a current resident of Arkansas who is in need of
	 kidney transplantation. Nominations for the award are received by the AKDC and
	 presented to the Commission Board for approval. The AKDC shall not use state
	 funds appropriated for program services but will accept gifts, grants, and
	 donations from private sources and the federal government and support from
	 municipal and county governments to maintain the award.
ELIGIBILITY
Persons suffering from chronic renal failure may be referred to the
	 Arkansas Kidney Disease Commission. Referrals will come from clients
	 themselves, physicians, social workers, hospital or kidney dialysis center
	 personnel, pharmacists, rehabilitation counselors, 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 their permanent residence, 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 AKDC-01) 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
	 has been the recipient of a kidney transplant.
Certificate of Eligibility/Ineligibility
A certificate of eligibility-ineligibility (AKDC-10) will be completed
	 prior to the provision of services, or the refusal of services, as the case may
	 be. The AKDC Program Manager 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 Manager 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
	 Manager, 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
	 providing financial assistance to address specific treatment needs of eligible
	 clients consistent with services offered by the program.
When 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 Board 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 benefitavailable to an individual 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 service provided 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 day a
	 client moves out of state or 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.
Annual Review
Individuals determined eligible to receive AKDC services will
	 participate in an annual review to determine continued program eligibility. The
	 review process will consist of a determination as to whether the individual
	 continues to meet program medical and financial need eligibility criteria.
	 Clients who meet eligibility requirements will continue to receive AKDC
	 services. Any client who no longer meets program eligibility requirements will
	 be issued a letter of termination of services effective 30 days after the date
	 of review.
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 and nutritional supplements; pre-transplant dental
	 services; transportation, patient education 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 and Nutritional
	 Supplements
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.
If funds allow, the AKDC may purchase nutritional supplements
	 specifically designed for kidney dialysis patients. Purchases will be made
	 consistent with state purchasing requirements. Distribution of the supplements
	 will be coordinated by the program.
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 the Internal Revenue Service (IRS) standard medical mileage rate in
	 effect the date the service was provided.
Patient Education
The AKDC will partner with local, state, regional, and national
	 agencies and organizations to educate its clients and the public at large
	 regarding the importance of prevention and/or treatment of kidney
	 disease.
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 covered services to program clients
	 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 made for
	 payment of prescription drugs or transportation reimbursement are to be
	 submitted on the appropriate AKDC 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 Manager will have the
	 responsibility of insuring such information is maintained in a safe and secure
	 manner consistent with State and Federal regulations. The Program Manager shall
	 provide training to AKDC staff regarding how applicant and client information
	 will be developed, maintained, and shared with affected parties. The Program
	 Manager 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, or 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