(1) The Department
will assist in the payment for services rendered to eligible renal patients
insofar as budget funds will allow. The Department may place a cap on
enrollment in the program and/or a cap on expenditures per participant, when
the budgetary limits are reached.
Covered services may include:
(a) Legend and over-the-counter drugs
required for the treatment of end stage renal disease which are included in the
program's formulary and not covered by a participant's third party insurer. For
TennCare recipients, legend drugs will be covered by TennCare.
(b) In-center dialysis services for patients
who do not have health insurance and are ineligible for TennCare during the
waiting period before Medicare eligibility begins following the onset of
(c) Medicare insurance
premiums for eligible program participants including both "Part A" and "Part B"
premiums, as determined by the U.S. Department of Health and Human
(d) Acute Dental services
to relieve pain and suffering. Any more extensive rehabilitative work or
dentures would have to be approved by the Commissioner and the decision made on
the exceptional nature of the need for these services and the availability of
(e) Case management and
other services provided by the Renal Disease Intervention Program.
(f) Out-of-state dialysis services for
participants. The Renal Disease Program pays Medicare coinsurance for
participants to travel out of state. Most out-of-state dialysis units will not
accept patients unless they have full coverage.
Tenn. Comp. R. &
Original rule certified
June 7, 1974. Amendment filed January 27, 1976; effective February 26, 1976.
Repeal and new rule filed October 9, 1985; effective January 14, 1986.
Amendment filed June 8, 1989; effective July 14, 1989. Amendment filed January
29, 1992; effective April 29, 1992. Amendment filed May 10, 1995; effective
September 28, 1995. Repeal and new rule filed September 17, 1998; effective
January 28, 1999.
Authority: T.C.A. §§