1. (1) Independent End Stage Renal Dialysis (ESRD) Facilities:

   1. (a) ESRD facilities are reimbursed for Continuous Ambulatory Peritoneal Dialysis.

   2. (b) (CAPD), Continuous Cycling Peritoneal Dialysis (CCPD), and Hemodialysis:

      1. (A) Composite at 80% of the Medicare allowed amount, except for Epoetin.
      2. (B) Epoetin is reimbursed at 100% of the Medicare maximum allowed amount.
2. (2) Other dialysis related charges which are allowed by Medicare, are reimbursed at 80% of the Medicare maximum allowed amount. Allowable clinical laboratory charges are reimbursed according to the Division’s fee schedule. Billed charges may not exceed the Medicare maximum allowable amount.
3. (3) The Division follows Medicare's criteria for coverage of Epoetin, Intradialytic Parenteral Nutrition services, and the frequency schedule for laboratory tests for ESRD services. When laboratory tests are performed at a frequency greater than specified by Medicare, the additional tests must be billed separately, and are covered by the Division only if the tests are medically justified by accompanying documentation. A diagnosis of ESRD alone is not sufficient medical evidence to warrant coverage of the additional tests.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.065

History

OMAP 73-2005, f. 12-29-05, cert. ef. 1-1-06
OMAP 34-1999, f. & cert. ef. 10-1-99
HR 53-1991, f. & cert. ef. 11-18-91, Renumbered from 410-125-0820
HR 28-1991(Temp), f. & cert. ef. 7-1-91
HR 2-1991, f. & cert. ef. 1-4-91
HR 31-1990(Temp), f. & cert. ef. 9-11-90
HR 21-1990, f. & cert. ef. 7-9-90, Renumbered from 461-015-0560
HR 9-1990(Temp), f. 3-30-90, cert. ef. 4-1-90
AFS 72-1989, f. & cert. ef. 12-1-89, Renumbered from 461-015-0124
AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89
AFS 45-1989, f. & cert. ef. 8-21-89
AFS 37-1989(Temp), f. 6-30-89, cert. ef. 7-1-89
AFS 36-1989(Temp), f. & cert. ef. 6-30-89
AFS 15-1989(Temp), f. 3-31-89, cert. ef. 4-1-89
AFS 7-1989(Temp), f. 2-17-89, cert. ef. 3-1-89
AFS 63-1988, f. 10-3-88, cert. ef. 12-1-88
AFS 47-1988(Temp), f. 7-13-88, cert. ef. 7-1-88
AFS 26-1988, f. 3-31-88, cert. ef. 4-1-88
AFS 12-1988, f. 2-10-88, cert. ef. 6-1-88
AFS 62-1987(Temp), f. 12-30-87, cert. ef. 1-1-88
AFS 46-1987, f. & cert. ef. 10-1-87
AFS 33-1987(Temp), f. & cert. ef. 7-22-87
AFS 61-1986, f. 8-12-86, cert. ef. 9-1-86
AFS 46-1986(Temp), f. 6-25-86, cert. ef. 7-1-86
AFS 52-1985, f. 9-3-85, cert. ef. 10-1-85
AFS 6-1985, f. 1-28-85, cert. ef. 2-1-85
AFS 45-1984, f. & cert. ef. 10-1-84
AFS 1-1984, f. & cert. ef. 1-9-84
AFS 37-1983(Temp), f. & cert. ef. 7-15-83
Renumbered from 461-015-0120(5)
AFS 60-1982, f. & cert. ef. 7-1-82
AFS 18-1982(Temp), f. & cert. ef. 3-1-82
AFS 57-1980, f. 8-29-80, cert. ef. 9-1-80
AFS 14-1980, f. 3-27-80, cert. ef. 4-1-80