Wash. Admin. Code § 182-540-200

Current through Register Vol. 24-23, December 1, 2024

Section 182-540-200 - Epoetin alpha (EPO) therapy

The medicaid agency reimburses the kidney center for EPO therapy when:

(1) Administered in the kidney center to a client:

(a) With a hematocrit less than thirty-three percent or a hemoglobin less than eleven when therapy is initiated;

(b) Continuing EPO therapy with a hematocrit between thirty and thirty-six percent; or

(c) Medical justification documented in the client's record is required for hematocrits more than thirty-six or hemoglobins more than twelve. Medical justification includes:

(i) Documentation that the dose is being titrated downward to bring a patient's hematocrit back within target range; or

(ii) Documentation that it is medically necessary for the client to have a target hematocrit more than thirty-six percent.

(2) Provided to a home dialysis client:

(a) Under the same hematocrit and hemoglobin guidelines as stated in (1)(a) and (b) of this section; and

(b) When permitted by Washington board of pharmacy rules. (Refer to WAC 246-905-020 Home dialysis program Legend drugs.)

Wash. Admin. Code § 182-540-200

Amended by WSR 15-14-040, Filed 6/24/2015, effective 7/25/2015

11-14-075, recodified as §182-540-200, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520, 74.09.522, and 42 C.F.R. 405.2101. 03-21-039, § 388-540-200, filed 10/8/03, effective 11/8/03.