Current through Register Vol. 43, No. 12, March 20,
2024
(a) Each applicant
shall fulfill these requirements:
(1) supply
financial, insurance and family information essential to the establishment of
eligibility within 30 days of the request for service, on forms approved by the
secretary;
(2) submit written
permission on forms prescribed by the secretary for release of information
needed to determine medical and financial eligibility; and
(3) report to the secretary changes in any of
the following circumstances;
(A) eligible
person's address;
(B) the number
of persons living in the home;
(C)
marital status of the eligible person, parents, or legal guardians;
(D) custody of the eligible person;
(E) medical insurance coverage for
the eligible person;
(F) medicaid
eligibility or supplemental security income eligibility for the eligible
person;
(G) family income or cash
assets of more than $500.00 per year; or
(H) other circumstances that affect the
special health care needs of the eligible person.
(b) Each eligible person who is
enrolled in the department of social and rehabilitation services managed care
arrangements shall, within 10 working days of enrolling, report the following
information:
(1) the eligible person's
medical number;
(2) the name of
the managed care provider; and
(3)
the name of the eligible person's primary care network physician at the time of
application or subsequent enrollment in the managed care arrangement.
(c) Each eligible
person under 21 years of age enrolled in medicaid shall participate in the
kan-be-healthy program.
(d) Each
eligible person enrolled in a managed care arrangement under the medicaid
program or an insurance policy shall obtain referrals for care as required by
the managed care provider.
(e)
Each eligible person shall fulfill these requirements:
(1) obtain prior authorization for services;
(2) apply for insurance, medicaid
coverage, supplemental security income or benefits from other sources, when
requested;
(3) assign the
insurance benefits to hospitals and other providers of service for any medical
treatment;
(4) apply the benefits
of any non-assignable insurance by making payments to hospitals or other
providers of service for items ordered by the attending physician; and
(5) reimburse the secretary for
any insurance proceeds sent directly to the recipient if the insurance payment
is made for medical treatment provided by the hemophilia program.
(f) Each eligible person shall
obtain from one of the comprehensive centers initial and annual evaluations of
medical eligibility for the hemophilia program.
(g) Each eligible person shall submit any
bills received for prior authorized services to the secretary within six months
of the date of service.
(h) Each
eligible person shall obtain from one of the comprehensive centers a written
prescription for blood products or other efficacious agents and shall provide a
copy of the current prescription to the secretary.
