Utah Admin. Code R414-19A-2 - Definition s

(1) "Composite payment" means each treatment unit of payment that applies to claims for dialysis services. The composite payment rate includes payment for training, services, evaluations, laboratory tests, items, supplies, medications, and equipment necessary to treat ESRD or perform dialysis.

(2) "Dialysis" means the type of care or service furnished to an ESRD patient and includes training, services, evaluations, laboratory tests, items, supplies, medications, and equipment necessary to perform dialysis in a facility, outpatient, or home setting.

(3) "End-stage renal disease" or "ESRD" means that stage of renal impairment that appears irreversible and permanent, and requires a regular course of dialysis or kidney transplantation to maintain life.

(4) "ESRD facility" means a facility enrolled with Medicaid and Medicare to furnish at least one specific dialysis service. These facilities include:

(a) A renal transplantation center approved to furnish transplantation directly, and other medical and surgical specialty services required for the care of ESRD transplant patients, including inpatient dialysis furnished directly or under arrangement. A renal transplantation center may also be a renal dialysis center.

(b) A renal dialysis center approved to furnish the spectrum of diagnostic, therapeutic, and rehabilitative services required for the care of ESRD dialysis patients, including inpatient dialysis furnished directly or under arrangement. A hospital need not provide renal transplantation to qualify as a renal dialysis center.

(c) A renal dialysis facility approved to furnish dialysis services directly to ESRD patients.

(d) A self-dialysis unit that furnishes self-dialysis services and is part of an approved renal transplantation center, renal dialysis center, or renal dialysis facility.

(e) A special purpose renal dialysis facility approved to furnish dialysis at special locations on a short-term basis to a group of dialysis patients who cannot otherwise obtain treatment in the geographical area. The special locations, including vacation locations, must be either rehabilitative and serve ESRD patients who reside there temporarily, or locations in need of ESRD facilities under emergency circumstances.

Notes

Utah Admin. Code R414-19A-2

Amended by Utah State Bulletin Number 2015-6, effective 2/18/2015 Amended by Utah State Bulletin Number 2016-17, effective 8/10/2016 Amended by Utah State Bulletin Number 2023-21, effective 10/12/2023