To be eligible for the hemophilia home care program, a
patient shall:
(1) Be a resident of
Wisconsin;
(2) Be diagnosed by a
comprehensive hemophilia treatment center as having hemophilia;
(3) Enter into a written agreement with a
comprehensive hemophilia treatment center for compliance with a maintenance
program. The agreement shall specify:
(a) The
services to be provided;
(b)
Responsibilities of the patient and the center relating to development of the
plan of treatment and conformance of the patient to applicable center
policies;
(c) The manner in which
services are to be controlled, coordinated and evaluated by the center;
and
(d) Procedures for semi-annual
evaluation of the maintenance program and for verification that the patient is
complying with the established treatment regimen; and
(4) Provide to the department or its
designated agent full, truthful and correct information necessary for the
department to determine eligibility and liability on forms specified by the
department. A patient shall be ineligible for financial assistance if he or she
refuses to provide information, withholds information, refuses to assist the
department in verifying the information or provides inaccurate information. The
department may verify or audit an applicant's total family income.
(5) Complete one of the following actions:
(a) First apply for benefits under all other
health care coverage programs for which the person may reasonably be eligible,
including medicare, BadgerCare, medical assistance and SeniorCare.
(b) Apply for and receive from the department
a waiver from par. (a) for religious reasons. If the department does not
approve the request for a waiver, the applicant shall meet the requirements of
par. (a).
Notes
Wis. Admin. Code Department
of Health Services
§
DHS
153.03
Cr. Register, December,
1994, No. 468, eff. 1-1-95; CR 04-051: cr. (5) Register November 2004 No. 587,
eff. 12-1-04.
Persons desiring a waiver from the requirements under par.
(a) should submit their request to the Division of Public Health, Bureau of
Community Health Promotion, Wisconsin Chronic Disease Program, P.O. Box 2659,
Madison, WI 53701-2659, or call 1-800-947-9627. Requests must describe the
basis of the religious belief that precludes application for benefits under one
or more of the programs listed under par. (a).
