Section 7 AAC 140.720 - End-stage renal disease payment conditions(a) The department will pay an end-stage renal disease facility under 7 AAC 145.607 for the recipient's first day of treatment through the last day of the third month of treatment.(b) The department will continue to pay a facility for outpatient end-stage renal disease services beginning the fourth month of treatment only if(1) the recipient (A) is enrolled in Medicare Part B; or(B) has been determined ineligible for Medicare Part B, and the ineligibility is not related to failure to comply with any part of the Medicare enrollment process; and(2) the first claim for services beginning the fourth month of treatment is accompanied by written verification of Medicare eligibility or the reason for ineligibility.(c) If the recipient is not enrolled in Medicare Part B at the commencement of treatment, (1) the end-stage renal disease facility must ensure that a Medicare application is made by or on behalf of the recipient; and(2) the claim for the recipient's first treatment for end-stage renal disease must be accompanied by (A) a photocopy of the recipient's completed Form CMS-2728-U3, End Stage Renal Disease Medical Evidence Report - Medicare Entitlement and/or Patient Registration, signed by both the patient and the attending physician;(B) verification from the United States Social Security Administration that an application for Medicare Part B has been made by or on behalf of the recipient; or(C) a Medicare Part B enrollment denial.(d) The end-stage renal disease facility shall notify the department of each change in the recipient's Medicare status or eligibility.Eff. 1/1/2013, Register 204Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.070