Utah Admin. Code R414-19A-5 - Service Coverage
(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.
Notes
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