Section 7 AAC 145.607 - End-stage renal disease facility payment rate(a) The department will pay a facility that meets the requirements of 7 AAC 140.700 - 7 AAC 140.720 a rate based upon the formula set out in this section, including a composite, per-treatment payment rate for hemodialysis and a separate composite, per-treatment payment rate for peritoneal dialysis. (b) The facility may bill a maximum of one treatment per day and a maximum of three hemodialysis treatments per week. Before treatment in excess of the maximum allowed under this subsection is approved, the facility shall submit all documentation necessary to support the medical necessity of the additional treatment. Any treatment above the maximum allowed must be approved by the department under the department's prior authorization process. (c) The composite, per-treatment payment rates for hemodialysis and peritoneal dialysis will be set annually based upon the reports submitted under 7 AAC 140.700 each July 1. (d) The rates established for end-stage renal disease facilities are all-inclusive, except that the department will pay separately for erythrocyte-stimulating agents and peritoneal iron replacement products in accordance with 7 AAC 145.410(g). (e) The composite, per-treatment payment rates for hemodialysis and for peritoneal dialysis will be calculated as statewide weighted averages. The department will use the following to develop the statewide weighted averages: (1) information that regards a claim made under this state's Medicaid program, that is obtained from the Medicaid Management Information System (MMIS) defined in 42 C.F.R. 433.411(b), and that identifies the number of hemodialysis and separately the number of peritoneal dialysis treatments delivered to recipients during the most recent calendar year for which timely filing has passed; and (2) the average cost per-treatment included on Medicare cost reports filed with the Medicare fiscal intermediary by end-stage renal disease clinics for the calendar year that aligns with the claims information in (1) of this subsection, as follows: (A) the cost for the hemodialysis cost per treatment will be taken from the Average Cost of Treatments values entered on the Computation of Average Cost Per Treatment Basic Composite Cost worksheet for maintenance hemodialysis portion of the Medicare cost reports; and (B) the cost for the peritoneal cost per treatment will be taken from the Average Cost of Treatments values entered on the Computation of Average Cost Per Treatment Basic Composite Cost worksheet for Home Program Continuous Ambulatory Peritoneal Dialysis (CAPD) and for Home Program Continuous Cycling Peritoneal Dialysis (CCPD) portion of the Medicare cost reports; for purposes of this subparagraph, if the average cost of treatments from the Computation of Average Cost Per Treatment Basic Composite Cost worksheet are reported as weekly costs on the Medicare cost report, the department will divide hemodialysis values by three treatments per week and peritoneal dialysis values by seven treatments per week to calculate the average cost per treatment.Eff. 4/1/2012, Register 201; am 1/1/2013, Register 204; am 3/24/2019, Register 229, April 2019 Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.070