California Code of Regulations
Title 22 - Social Security
Division 3 - Health Care Services
Subdivision 1 - California Medical Assistance Program
Chapter 3 - Health Care Services
Article 4 - Scope and Duration of Benefits
Section 51330 - Chronic Hemodialysis

Universal Citation: 22 CA Code of Regs 51330

Current through Register 2024 Notice Reg. No. 12, March 22, 2024

(a) Chronic hemodialysis is covered only as an outpatient service. Prior authorization may be granted for dialysis, physician services, medical supplies, equipment and drugs required for dialysis services, when provided by renal dialysis centers or community hemodialysis units.

(b) Authorization for outpatient chronic hemodialysis may be granted for up to 12 months at any one time.

(c) The following information shall be provided on or attached to the authorization request form for home dialysis or training:

(1) Evidence that the beneficiary, the beneficiary's spouse, or other co-learner is suitable for training in home dialysis.

(2) Evidence establishing the suitability of the home facilities for dialysis.

(3) Evidence that the overall installation costs in the home are reasonable and in no event exceed $750.00.

(4) Evidence that the water supply in the home is suitable for renal dialysis.

(5) Evidence of the availability of a qualified local physician to be responsible for the ongoing medical supervision of the beneficiary.

(6) The plan for continuing case management.

(7) A budget for all expenses related to home dialysis, including supplies prorated on a monthly cost basis.

(d) Reauthorization for a patient on chronic hemodialysis is required at least every 12 months. Reauthorization requests shall be submitted at least one month prior to expiration of the current authorization period.

(e) Inpatient hospitalization for persons undergoing chronic hemodialysis shall be in accordance with the provisions of Section 51327.

1. Amendment of subsections (a) and (b) and new subsection (e) filed 9-27-72; designated effective 11-1-72 (Register 72, No. 40). For prior history, see Register 72, No. 5.
2. Amendment of subsection (e) filed 8-8-78; effective thirtieth day thereafter (Register 78, No. 32).
3. Amendment of subsections (b) and (c) filed 8-31-79; effective thirtieth day thereafter (Register 79, No. 35).
4. Change without regulatory effect of NOTE (Register 86, No. 49).

Note: Authority cited: Section 14124.5, Welfare and Institutions Code. Reference: Sections 14133, 14133.1 and 14133.3, Welfare and Institutions Code.

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