1. (a)

   1. (1) The services provided by the State Kidney Disease Commission shall be dependent on the availability of funds.
   2. (2) The commission may determine specific services to be funded by the program prior to the beginning of each new state fiscal year.

   3. (3) Covered services may include:

      1. (A) Outpatient pharmaceutical drugs and nutritional supplements;
      2. (B) Pretransplant dental services;
      3. (C) Transportation;
      4. (D) Patient education; and
      5. (E) Referral.
   4. (4) Specific services to the commission’s clients, including those in need of continuing services, shall be provided based upon the availability of funds.

   5. (5)

      1. (A) During the course of a fiscal year should it be determined that available funding is insufficient to fund services provided by the program at existing levels for the remaining portion of the fiscal year, the commission shall establish the manner in which services will be curtailed or, if required, terminated for the remainder of that fiscal year.
      2. (B) Should the curtailing of services result, preference will be given to those in need of continuing services, as determined by the commission.

2. (b) Financial assistance from the commission may include:

   1. (1)

      1. (A) Outpatient prescriptions.
      2. (B) The commission may provide financial assistance for no more than three (3) outpatient prescriptions per month.
      3. (C) Amount payable to pharmacy is the allowable amount in the formulary fee schedule, after insurance payment and less client copayment;

   2. (2)

      1. (A) Immunosuppressant drugs.
      2. (B) The commission may provide financial assistance for immunosuppressant drugs.
      3. (C) A client copay for allowable drugs is required.
      4. (D) The commission shall only participate in the purchase of immunosuppressant medications as a copayer.
      5. (E) Program copayment for immunosuppressant drugs shall not exceed twenty percent (20%) of the Medicare allowable rate;

   3. (3)

      1. (A) Nutritional supplements.
      2. (B) The commission may provide for nutritional supplements if ordered by physician.
      3. (C) Amount payable to pharmacy is the allowable amount in the formulary fee schedule, after insurance and less client copayment;

   4. (4)

      1. (A) Transportation.
      2. (B) The commission may provide for dialysis appointment transportation mileage reimbursement, at the state employee mileage reimbursement rate for the applicable year.
      3. (C) Clients who prove they must take a taxi or other paid transportation service are eligible for transportation mileage reimbursement.
      4. (D) Patients must first attempt to use personal or Medicaid transportation, if available, prior to engaging a taxi or other paid transportation.
      5. (E) Evidence of efforts to use Medicaid transportation must be provided.
      6. (F) Taxi or paid transportation receipt is required prior to mileage reimbursement; and

   5. (5)

      1. (A) Dental.
      2. (B) The commission may provide for dental care when a dental problem jeopardizes the health and treatment program outlined by the renal specialist and may be covered only for the purpose of kidney transplantation.
      3. (C) Payment for services rendered will be prior approved and consistent with the established dental fee schedule herein attached as Appendix A.
3. (c) Patient education. The commission may partner with local, state, regional, and national agencies and organizations to educate its clients and the public at large regarding the importance of prevention and/or treatment of kidney disease.
4. (d) Referral services. The commission may assist clients diagnosed with ESRD with referral to other programs, including vocational rehabilitation.

5. (e) Formulary.

   1. (1) The commission shall establish a formulary.
   2. (2) The formulary will include nutritional supplements designed for kidney dialysis patients.
   3. (3) The formulary and fee schedule may be updated periodically and is attached as Appendix A.

6. (f) Payment for services to vendors.

   1. (1) The commission shall process payment for covered services to program clients when in receipt of a signed vendor statement or letter that includes:

      1. (A) The client’s name and other necessary identifiable information;
      2. (B) A description of services provided;
      3. (C) Date or dates of service provision; and
      4. (D) Cost.
   2. (2) Claims made for payment of prescription drugs or transportation reimbursement are to be submitted on the appropriate commission claim form or applicable online form if available.
   3. (3) The commission shall not prepay for a service, only providing payment after the service has been rendered.
   4. (4) Requests for payment for services rendered must be received by the program within one (1) calendar year of the date of service.
   5. (5) The commission will not provide remittance for those requests for payment that exceed the one-year from date of service limit.

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