Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-540 - Kidney disease program and kidney center services
KIDNEY CENTER SERVICES
Section 182-540-200 - Epoetin alpha (EPO) therapy
Universal Citation: WA Admin Code 182-540-200
Current through Register Vol. 24-18, September 15, 2024
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.)
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.
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