Tenn. Comp. R. & Regs. 1200-11-01-.04 - COVERED SERVICES

(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.
(2) 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 dialysis.
(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 Services.
(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 funds.
(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. & Regs. 1200-11-01-.04
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. ยงยง 68-35-103 and 4-5-202.

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