42 C.F.R. Subpart C—Documentation Required for Complete Petitions
Title 42 - Public Health
In all instances in which medical documentation is referred to, medical documentation may be submitted in the following forms: (a) Copies of relevant portions of medical records, records maintained by a physician, nurse, or other licensed health care provider, test results, prescription information, or other documentation deemed credible by the Secretary; or (b) An affidavit, signed under penalty of perjury, by a physician, nurse practitioner or physician assistant, verifying that the medical criteria necessary for a petitioner to be eligible for payment under the Act are satisfied. Such an affidavit must include the physician's, nurse practitioner's or physician assistant's State of practice, and license, certification or registration number, as applicable. A sample affidavit is set forth at Appendix B to this part. [65 FR 34864, May 31, 2000, as amended at 66 FR 58671, Nov. 23, 2001] The following rules apply to all petitions filed by persons with HIV: (a) All petitions filed under the Act must include written medical documentation showing the following: (1) That the individual described in §130.10(a) has (or had) a blood-clotting disorder, such as hemophilia; (2) That the individual with a blood-clotting disorder and HIV was treated with antihemophilic factor at any time between July 1, 1982, to December 31, 1987; and (3) That the individual with a blood-clotting disorder and HIV has (or had) an HIV infection under any of the criteria set out in the definition of HIV infection at §130.2(i). (b) The individual. Petitions filed by the individual with a blood-clotting disorder and HIV need only include the documentation described in paragraph (a) of this section. (c) The lawful spouse. Petitions filed by the lawful spouse with HIV must include the following written documentation: (1) The documentation described in paragraph (a) of this section; (2) Medical documentation showing that the lawful spouse with HIV has an HIV infection; and (3) A marriage certificate or other proof of a lawful marriage, which shows that the lawful spouse with HIV and the individual with a blood-clotting disorder and HIV are married. (d) The former lawful spouse. Petitions filed by the former lawful spouse with HIV must include the following written documentation: (1) The documentation described in paragraph (a) of this section; (2) Medical documentation showing that the former lawful spouse with HIV has an HIV infection; (3) A marriage certificate or other proof of a lawful marriage, which shows that the former lawful spouse with HIV and the individual with a blood-clotting disorder and HIV were married at any time after the date of the individual's treatment with antihemophilic factor (this date of treatment must have been between July 1, 1982, to December 31, 1987); (4) A divorce certificate or other proof of termination of the marriage between the former lawful spouse with HIV and the individual with a blood-clotting disorder and HIV; and (5) Medical documentation which shows with reasonable certainty that the former lawful spouse with HIV contracted HIV from the person with a blood-clotting disorder and HIV. (e) The child. Petitions filed by the child with HIV must include the following written documentation: (1) The documentation described in paragraph (a) of this section; (2) Medical documentation showing that the child with HIV has an HIV infection; (3) A birth certificate or other proof, which shows that the child with HIV is the child of: (i) The individual with a blood-clotting disorder and HIV; (ii) The lawful spouse with HIV; or (iii) The former lawful spouse with HIV; (4) A marriage certificate or other proof of a lawful marriage, which shows that the lawful spouse with HIV or the former lawful spouse with HIV and the individual with a blood-clotting disorder and HIV are/were married, except where the individual with a blood-clotting disorder and HIV is the mother of the child with HIV; (5) Medical documentation showing that the child with HIV acquired an HIV infection through perinatal transmission from a parent who is: (i) The individual with a blood-clotting disorder and HIV; (ii) The lawful spouse with HIV; or (iii) The former lawful spouse with HIV; and (6) Where the child with HIV acquired an HIV infection through perinatal transmission from the former lawful spouse with HIV, medical documentation which shows with reasonable certainty that the former lawful spouse with HIV contracted HIV from the person with the blood-clotting disorder and HIV.
Title 42: Public Health
PART 130—RICKY RAY HEMOPHILIA RELIEF FUND PROGRAM
Subpart C—Documentation Required for Complete Petitions
§ 130.20 Form of medical documentation.
§ 130.21 What documentation is required for petitions filed by living persons with HIV?
§ 130.22 What documentation is required for petitions filed by survivors of persons with HIV, which are filed in cases where the person with HIV dies before filing a petition?
(a) In those cases in which the person with HIV, as described in §130.10, dies before filing a petition under the Act, a survivor of that person, as described in §130.11, may file a petition.
(b) Petitions filed by survivors must include two types of information:
(1) Documentation regarding the person with HIV; and
(2) Documentation regarding the eligibility of the survivor to receive payments as a survivor of the person with HIV.
(c) Petitions filed by survivors must include the following information regarding the person with HIV:
(1) The individual. Petitions filed by a survivor of the individual with a blood-clotting disorder and HIV must include the documentation described in §130.21(b).
(2) The lawful spouse. Petitions filed by a survivor of the lawful spouse with HIV must include the documentation described in §130.21(c).
(3) The former lawful spouse. Petitions filed by a survivor of the former lawful spouse with HIV must include the documentation described in §130.21(d).
(4) The child. Petitions filed by a survivor of the child with HIV must include the documentation described in §130.21(e).
(d) Petitions filed by survivors must include the following information regarding the relationship between the survivor and the person with HIV:
(1) The surviving spouse. Petitions filed by the surviving spouse must include the following written documentation:
(i) A death certificate for the person with HIV, or other evidence of that individual's death;
(ii) A marriage certificate or other proof of a lawful marriage, which shows that the survivor was the spouse, as defined in §130.11(d)(1), of the person with HIV; and
(iii) A sworn statement signed by the surviving spouse which states that the surviving spouse and the person with HIV were married at the time of that individual's death.
(2) The surviving child/children. Petitions filed by the surviving child/children must include the following written documentation:
(i) A death certificate for the person with HIV, or other evidence of that individual's death;
(ii) A birth certificate, adoption certificate, documentation that shows that the survivor is the stepchild of the person with HIV (for example, a certificate of marriage between the survivor's parent and the person with HIV), or other documentation which shows that the survivor is the child, as defined in §130.11(d)(2), of the person with HIV; and
(iii) A sworn statement signed by the surviving child/children which either:
(A) States that, to the best of the petitioner's knowledge, there are no other survivors who are eligible for payment under the Act, as described in §130.11 (i.e., no eligible surviving spouses or other surviving children); or
(B) Provides information regarding other survivors who are eligible for payment under the Act.
(3) The surviving parent(s). Petitions filed by the surviving parent(s) must include the following written documentation:
(i) A death certificate for the person with HIV, or other evidence of that individual's death;
(ii) A birth certificate, adoption certificate or other documentation which shows that the survivor is the parent, as defined in §130.11(d)(3), of the person with HIV; and
(iii) A sworn statement signed by the surviving parent(s) which either:
(A) States that, to the best of the petitioner's knowledge, there are no other survivors who are eligible for payment under the Act, as described in §130.11 (i.e., no eligible surviving spouse, surviving children or other surviving parents); or
(B) Provides information regarding other survivors who are eligible for payment under the Act.
(Approved by the Office of Management and Budget under control number 0915–0244)§ 130.23 What documentation is required for amendments to petitions, which are filed by survivors of persons with HIV?
(a) The following survivors must file amendments to petitions in order to retain the assigned order number described in §130.32 and to receive payment under the Act:
(1) A survivor of the person with HIV, when the person with HIV has filed a petition under the Act, but then died before receiving payment;
(2) The next-ranked survivor eligible to receive payment under the Act, as described in §130.11(b), when a previously-ranked survivor has filed a petition or an amendment to a petition as a survivor of the person with HIV, but then died before receiving payment; and
(3) In the case of petitions filed by multiple survivors (i.e., multiple surviving children or multiple surviving parents), where one of the survivors dies before receiving payment, the other survivors must file an amendment in order to notify the Secretary that the payment should be made to, and divided among, only the remaining survivors.
(b) Survivors described in paragraph (a) of this section shall amend the original petition by filing the petition form set forth at Appendix C to this part, including the section pertaining to amendments to petitions.
(c) Amendments to petitions filed by survivors must include the following documentation:
(1) Survivors described in paragraph (a)(1) of this section must include the documentation described in §130.22(d), which shows that the survivor is eligible to file a petition as a survivor of the person with HIV.
(2) Survivors described in paragraph (a)(2) of this section must include:
(i) The documentation described in §130.22(d), which shows that the survivor is eligible to file a petition as a survivor of the person with HIV; and
(ii) A death certificate for the survivor whose petition is being amended, or other evidence of that survivor's death.
(3) Survivors described in paragraph (a)(3) of this section must include a death certificate for the survivor who has died, or other evidence of that survivor's death.
(d) Amendments to petitions filed by survivors described in paragraph (a) of this section will retain the same order number assigned to the original petition.
(e) In those cases in which the Secretary has reviewed the original petition prior to receiving an amendment to the petition, the Secretary will determine whether to pay the survivors described in paragraph (a) as follows:
(1) If the Secretary has determined that the original petition does not include all of the documentation described in this Subpart C (i.e., it is incomplete), the survivor will be given the opportunity to complete the petition prior to a final determination in accordance with the procedures set forth at §130.33.
(2) If the Secretary has determined that the original petition does not meet the requirements of the Act, the survivor will be so notified and payment will not be made. The survivor may seek reconsideration under §130.40.
(3) If the Secretary has determined that the original petition meets the requirements of the Act, and the survivor meets the survivor requirements of the Act, the survivor will receive payment as described in §130.3.
(f) In those cases in which the Secretary has not yet made the determination whether the original petition meets the requirements of the Act, the Secretary will review the amended petition according to the order number assigned to the original petition, and then determine whether the petition is complete and whether to pay the petition as described in paragraph (e) of this section.
(Approved by the Office of Management and Budget under control number 0915–0244)§ 130.24 What additional documentation may the Secretary require to resolve eligibility or payment issues?
(a) In addition to the applicable documentation required under this subpart, the Secretary may require the petitioner to provide other documentation, as the Secretary deems appropriate, to resolve issues of eligibility, or of the procedure for payment, raised by a petition.
(b) Where a petition filed on behalf of a minor or other individual who is legally incompetent to receive payment has been approved for payment, the personal representative filing the petition on the individual's behalf must submit the following before payment can be made for the legally incompetent individual:
(1) Documentation of a guardianship or conservatorship, established in accordance with State and local law; and
(2) Information identifying a guardianship or conservatorship account.
(Approved by the Office of Management and Budget under control number 0915–0244)[66 FR 58672, Nov. 23, 2001]
Browse Previous | Browse Next
