Alabama Administrative Code › Title 795 - ALABAMA DEPARTMENT OF REHABILITATION SERVICES HOMEBOUND PROGRAM › Chapter 795-5-1 - HEMOPHILIA PROGRAM › Section 795-5-1-.07 - Financial Participation

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