Current through Register Vol. 48, No. 38, September 20, 2024
a) An eligible person shall:
1) Be a resident of the State of Illinois as
provided in 305 ILCS 5/2-10;
2) Meet requirements of citizenship as
provided in
305 ILCS 5/1-11;
and
3) Meet the requirements of the
Patient Protection and Affordable Care Act (ACA) (
26 USC
5000 A) by obtaining health coverage.
Payment of a tax penalty for not obtaining insurance does not meet the
requirement.
b) The
following information shall be verified by the dialysis facility and maintained
in the patient's record:
1) Citizenship or
immigration status;
2)
Address;
3) Social Security Number;
and
4) Documentation of health
coverage.
c) Eligibility
of patients shall be determined by the Department based on the information
required in this Section. To maintain eligibility for participation in the
Program, a patient shall meet the following criteria on an ongoing basis:
1) A physician's diagnosis of End Stage Renal
Disease for the patient must be on file at the dialysis facility;
2) The designated Department of Human
Services office has determined the patient is not eligible for medical
assistance; and
3) The patient
shall provide documentation to the dialysis facility of his or her
ineligibility for non-spenddown Medicaid or QMB (Qualified Medicare
Beneficiary) status.
d)
Participation Fees
1) Participants in the
Program shall be responsible for paying a monthly participation fee to the
dialysis facility from which they receive dialysis treatment. The amount of the
Department's payment, as determined under Section
148.620,
shall be reduced by the amount of the participation fee. The fee shall be
determined by the Department based on income and information contained in the
Bureau of Labor Statistics (BLS) standards, as described in Table B, and
calculated pursuant to the Direct Care Program Renal Participation Worksheet
(Table A).
2) The following shall
be obtained and verified by the dialysis facility and submitted with the
patient's application to the Department for determination of the amount of a
patient's participation fee.
A) Pay stubs for
the 90 days preceding the date of signature on the application if not employed
for the past year; or
B) Previous
year's federal and State Income Tax Returns if employed during the previous
year.
3) The following
are allowed as deductions from income:
A)
Federal, State and local taxes;
B)
Special care for children;
C)
Support (child, relative or alimony);
D) Retirement or Social Security
benefits;
E) Employment expenses
(union dues, special tools and clothing);
F) Transportation to and from the site of
dialysis; and
G) Medical expenses,
both paid and outstanding.
4) If a substantial change in the financial
status of any patient occurs after the patient has been found eligible for the
Program, the patient shall report the change to the dialysis center. Based on
the extent of the change, a new participation fee may be determined and imposed
by the Department.
e)
The following shall be verified by the dialysis facility and submitted with the
patient's application to the Department for determination of nonfinancial
eligibility by the Department:
1) Third Party
Liability
A) Proof of insurance coverage;
and
B) Proof of Medicare
coverage.
2) Consent
form required under subsection (f), signed by the patient or his or her
representative.
f) The
applicant or the applicant's parent or guardian must sign a consent form
authorizing the release of all medical and financial records to the Department
and to an approved chronic renal disease treatment facility.
