PURPOSE: This rule establishes the way in which clients maintain their program eligibility.

1. (1) Clients and their families are responsible for providing Crippled Children’s Service
2. (CCS) with accurate information concerning their financial status.
3. (2) The client or the client’s family shall use all available health insurance benefits, Medicaid or other third-party payment mechanism-including recoveries specifically awarded for medical expenses from third-party insurance sources through settlement of personal injury claims attributable to the 19CSR40-l-HEALTH

condition being treated-for payment toward medical expenses.

1. (3) The client or the client’s family shall enroll in any state orotherpublic programs for which they are eligible in order to provide maxinwn comprehensive services.
2. (4) The client or the client’s family shall report any major changes in income, household composition, insurance, Medicaid coverage or address within ten (10) working days after the date the client or the client’s family becomes avme of the change.
3. (5) The client or the client’s family shall keep the CCS case manager updated on the medical progress of the client’s individual care plan.
4. (6) The client or the client’s family shall take the client’s CCS service authorization to all diagnostic and therapeutic appointments being covered by CCS.
5. (7) To maintain eligibility, an applicant shall complete and have approved another application at theend oftheeligibility period. A” eligi bility period shall be the year following the anniversary date of original application or the year following the date of the filing of a new 1040 tax fornl.
6. (8) Provisions of sections (l)-(7) of this rule are considered mandatory, and if not followed by the client or the client’s family, CCS may discontinue services.
7. (9) A” applicant who is detamined ineligible for CCS may reapply when s/he feels there have been changes which may make the applicant eligible.
8. (10) When a” application is denied, the applicant shall be informed of his/her right to appeal.

9. (11) Infornmtion shall be released by CCS only upon receipt of a release of information form signed by the client or the client’s parent or appointed guardian indicating the client’s approval of the release of information to the party seeking the information. Information shall not be released to the client unless the client requests the information from CCS.

   Auth: sections 192.005.2. and 201.120, RSMo (19861. This rule was previously filed 13 CSR 50-160.050. Emergency rule filed Dec. 12,1984, effect& Dec. 22,1984, expired April 20,1985. Original rule filed Dec. 22, 1984, effective April II, 1985. Amended: Filed June 2, 1987, effectiue Aug. 13, 1987.