Section 1200-11-02-.03 - ELIGIBILITY REQUIREMENTS(1) Any individual diagnosed with a genetic bleeding disorder who is a resident of Tennessee is eligible to apply for program services.(2) To receive program services, the applicant must meet the following criteria. (a) The applicant must submit a completed, properly signed, and dated application provided by the Department. If the applicant is legally incompetent to consent to medical treatment because of age or mental condition, said application shall be completed and signed by the applicant's parent or legal guardian.(b) The applicant must meet the medical criteria established in these Rules and must meet the financial criteria at the time of application and/or recertification.(3) Each applicant's medical diagnosis must be an acceptable diagnosis as established in these Rules. Any medical treatment must directly relate to the diagnosis for which the applicant was accepted as required by these Rules.(4) An applicant will be determined diagnostically eligible for the program, if the applicant has been diagnosed with any of the following: (a) clotting factor deficiencies - including factors I, II, V, VII, VIII, IX, X, XI, XIII; or(b) other bleeding disorders - including von Willebrand disease, genetic platelet disorders, or other hemorrhagic disorders.(5) Individuals will be financially eligible for the Hemophilia Program, if the family's gross income is at or below 300% of the federal poverty level for the number in the family. When a family has more than one (1) individual with a Hemophilia Program eligible condition, one person may be added to the total number of family members for each additional family member with an eligible condition when determining eligibility. The Department shall determine the family income of the applicant as a family as defined in Rule 1200-11-2-.02(3).
(a) income shall include: 1. wages, salaries, and/or commissions;2. income from rental property or equipment;3. profits from self-employment enterprises, including farms;4. alimony and/or child support;6. pensions and benefits; and7. public assistance grants.(b) After the income of the family is determined, any verified medical payments including medical or health insurance premiums made by the family for any family member during the previous twelve (12) months shall be prorated over twelve months and deducted from the gross monthly income.(c) Verified child support or alimony paid to another household shall be deducted from the gross monthly income.(6) All applicants to or participants in the Hemophilia Program who have no third party insurance coverage must apply for TennCare coverage and provide proof of acceptance or denial to the Hemophilia Program. Once accepted for TennCare coverage, Hemophilia Program participants must meet all TennCare requirements in order to maintain eligibility for the Hemophilia Program.(7) Applicants may be denied participation in the Hemophilia Program, if they are diagnostically ineligible, financially ineligible, or fail to apply for TennCare coverage.(8) All participants in the Hemophilia Program must be financially certified annually.(9) Once a patient has been certified for services, the certification extends for one year regardless of changes in family income.Tenn. Comp. R. & Regs. 1200-11-02-.03
Original rule filed April 3, 1974, effective May 3, 1974. Amendment filed July 27, 1977, effective August 26, 1977. Repeal and new rule filed May 15, 2000; effective September 28, 2000.Authority: T.C.A. §§ 4-5-202, 53-5604, 68-41-102 and 68-41-104.