Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-19A - Coverage for Dialysis Services by an End Stage Renal Disease Facility
Section R414-19A-5 - Service Coverage
Universal Citation: UT Admin Code R 414-19A-5
Current through Bulletin 2024-06, March 15, 2024
(1) Medicaid covers dialysis services, including hemodialysis and peritoneal dialysis treatments provided by an ESRD facility for categorically or medically needy Medicaid members for three months pending the establishment of Medicare eligibility.
(a) Medicaid may cover dialysis services for
longer than three months if a member is not eligible for Medicare.
(b) Medicaid reimburses dialysis services
through a composite payment.
(2) A member may receive dialysis services, including hemodialysis and peritoneal dialysis treatments performed at home, if:
(a) the services are supervised by an
enrolled ESRD facility; and
(b) the
services are performed by an appropriately trained Medicaid member for three
months pending the establishment of Medicare eligibility.
(3) Medicare becomes the primary reimbursement source for individuals who meet Medicare- eligibility criteria. ESRD facilities must assist members in applying for and pursuing final Medicare eligibility.
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