(a)

1. (1) The effective date a client shall be eligible to receive paid for services provided by the State Kidney Disease Commission shall be established by the program.
2. (2) An applicant must be determined eligible prior to funds being authorized.
3. (3) The commission shall not authorize payment for any services provided prior to the effective date of service.

(b) Financial cap.

1. (1)

   1. (A) The commission may establish an annual limit on per-client expenditures prior to the beginning of the new state fiscal year, based on funds available and number of clients participating in the program in the prior year.
   2. (B) This annual cap is subject to change based on increases or decreases in the number of patients in the programs and or changes in program funding.
2. (2) Exceptions may be made on a case-by-case basis as determined by the commission.
3. (3) During the course of a fiscal year, should expenditures for a client exceed the limit allowed, the case will be referred to the commission for review to determine a course of action.

(c) Termination of services.

1. (1) The commission will pay for services and medication prescribed up to the client’s date of death.
2. (2) Eligibility for covered services will also be ended the day a client moves out of state or the last day of the month a client’s course of dialysis is terminated unless the individual has received a kidney transplant.

(d) Annual review.

1. (1) Individuals determined eligible to receive commission services shall submit an eligibility renewal application annually to determine continued program eligibility.
2. (2) The review process will consist of a determination as to whether the individual continues to meet program medical, residential, and financial need eligibility criteria.

3. (3)

   1. (A) Clients who meet eligibility requirements will continue to receive commission services.
   2. (B) Any client who no longer meets program eligibility requirements shall be issued a letter of termination of services effective thirty (30) days after the date of review.
4. (4) The commission shall not pay for services for patients who fail to renew within one and one-half (1 1/2) years of their last date of eligibility (year of eligibility, plus six-month grace period).
5. (5) Medications prescribed within a client’s annual eligibility period (plus six-month grace period) shall be covered, even if the claim is received by the commission after the patient’s eligibility has lapsed.