Ala. Admin. Code r. 560-X-24-.03

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-24-.03 - Coverage For Outpatient Maintenance Dialysis

(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

Ala. Admin. Code r. 560-X-24-.03

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.

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §405.2163.