1. (a)

   1. (1) Persons suffering from chronic renal failure may be referred to the State Kidney Disease Commission.

   2. (2) Referrals shall come from:

      1. (A) Clients themselves;
      2. (B) Physicians;
      3. (C) Social workers;
      4. (D) Hospital or kidney dialysis center personnel;
      5. (E) Pharmacists;
      6. (F) Rehabilitation counselors; and
      7. (G) Others, including individuals and agencies familiar with the person’s kidney disease.

2. (b) Eligibility requirements.

   1. (1) Eligibility requirements shall be applied without regard to:

      1. (A) Sex;
      2. (B) Race;
      3. (C) Creed;
      4. (D) Color; or
      5. (E) National origin.
   2. (2) With respect to age, no upper or lower limit shall be set as a guide to turn away a referral.

3. (c) Residency requirement.

   1. (1) Clients must be a resident of Arkansas.
   2. (2) To be eligible, an applicant must provide a copy of his or her driver’s license or identification card issued by the State of Arkansas.
4. (d) Physician certification requirement. Certification by a nephrologist (or other physician) or advanced practice registered nurse 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.

5. (e) Financial eligibility.

   1. (1) A client’s annual income may not exceed two hundred fifty percent (250%) of the federal poverty level percentage for the year in which they are applying for assistance.

   2. (2)

      1. (A) The commission shall consider the available financial resources of the total household.
      2. (B) Income sources to be considered include:

6. (i) Wages;

   1. (ii) Business income;

      1. (iii) Social Security, Social Security Disability Insurance, and Supplemental Security Income benefits;

         1. (iv) Retirement income;
         2. (v) Veteran’s benefits;
         3. (vi) Income from stocks, bonds, or other investments; and
         4. (vii) Other identifiable liquid assets.

      2. (C)

         1. (i) If the applicant is a dependent, the resources of the parent or parents shall be determined.
         2. (ii) The exception is if the applicant is a dependent and is receiving Supplemental Security Income benefits, he or she may be considered a family of one (1).

7. (f) Insurance eligibility.

   1. (1) Clients with insurance must provide proof of insurance coverage.
   2. (2) Individuals with or without insurance are not prohibited from receiving services on the basis of their insurance status.
   3. (3) However, the commission shall be payor of last resort.

8. (g) Application for services.

   1. (1) Individuals applying for services available through the program shall complete the commission’s Initial Referral Application.
   2. (2) The Initial Referral Application includes the required nephrologist or other health professional certification indicating the applicant has ESRD or has been the recipient of a kidney transplant.

9. (h) Certificate of eligibility/ineligibility.

   1. (1) A certificate of eligibility/ineligibility (AKDC-10) shall be completed prior to the provision of services, or the refusal of services, as the case may be.

   2. (2) The State Kidney Disease Commission Program Manager shall:

      1. (A) Review the Initial Referral Application, applying the established financial needs and residential criteria and ensuring the applicant’s physician has certified that the applicant meets the medical criteria; and

      2. (B) Sign the Certificate of Eligibility/Ineligibility for each applicant, indicating the applicant’s eligibility or ineligibility.

         1. (i) Other resources/similar benefit.
   3. (1) Applicants shall be required to apply and provide evidence of acceptance/denial from all applicable pharmaceutical company patient assistance programs.
   4. (2) Any services that the applicant may receive or be eligible to receive from other sources shall be used first.
   5. (3) The commission may only supplement these benefits.

10. (j) Copayment.

    1. (1) The commission shall establish a copayment for services paid by a client of the program at the point of sale.
    2. (2) The copayment amount is two dollars ($2.00) for each medication each month.

Codification Notes: "ESRD" means end-stage renal disease.