- (1) Maintenance dialysis treatments are covered when they are provided by a Medicaid enrolled ESRD hospital-based renal dialysis center or freestanding ESRD facility. The most common elements of a dialysis treatment are overhead costs, personnel services (administrative services, registered nurse, licensed practical nurse, technician, social worker, dietician), equipment and supplies, use of a dialysis machine and its maintenance, ESRD related laboratory tests, certain injectable drugs such as heparin and its antidote, and biologicals. Reimbursement will be based on a composite rate consisting of these elements.
- (2) Hemodialysis is defined as the removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane while the blood is being circulated outside the body. Limited to 156 sessions per year which provides for three sessions per week.
(3) Peritoneal dialysis is defined as a process by which waste products and excess fluids are removed from the blood, but unlike hemodialysis where the blood passes through a machine, peritoneal dialysis is done inside the body. There are two types of peritoneal dialysis that will be covered.
- (a) Continuous cycling peritoneal dialysis (CCPD), which requires a machine, and
- (b) Continuous ambulatory peritoneal dialysis (CAPD), which does not require a machine. CAPD is a continuous dialysis process that uses the patient’s peritoneal membrane as a dialyzer. CCPD and CAPD are furnished on a continuous basis, not in discrete sessions, and will be paid a daily rate, not on a per treatment basis.
Author: Jerri Jackson, RN Analyst, Institutional Services Unit
Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §405.2163.
History: Rule effective October 1, 1982. Emergency Rule effective January 1, 1987. Amended: Effective January 14, 1987; August 14, 1991. Amended: Filed April 11, 2005; effective May 16, 2005.