Definitions

As used in 101 CMR 337.00, unless the context requires otherwise, terms have the meanings in 101 CMR 337.02. Acute Kidney Injury (AKI). A sudden and often reversible reduction in the kidney function, as measured by increased creatinine or decreased urine volume. Calcimimetics. A class of drugs used to treat hyperparathyroidism, a condition in which the parathyroid glands produce a high amount of parathyroid hormone in patients with chronic kidney disease. Center. The Center for Health Information and Analysis, established under M.G.L. c. 12C. Centers for Medicare & Medicaid Services (CMS). The federal agency in the Department of Health and Human Services that is responsible for the determination of reimbursement for the provision of services to Medicare-covered patients. Chronic Maintenance Dialysis Treatment. Dialysis treatment provided on an outpatient basis for a stabilized patient. The treatment may take the form of hemodialysis, hemofiltration, intermittent peritoneal dialysis, continuous ambulatory peritoneal dialysis, or continuous cycling peritoneal dialysis and may occur in a facility or at home. Dialysis Program Rate(s). A provider's rate(s) established by CMS for the end stage renal disease (ESRD) program of Medicare. EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A. Established Charge. The lowest rate paid by any payer for treatment. Governmental Purchaser. The Commonwealth of Massachusetts and any of its departments, agencies, boards, commissions, and political subdivisions, which purchase dialysis services. Home Dialysis Supplies. Supplies used in conjunction with home dialysis treatment identified in 101 CMR 322.00: Rates for Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment. Individual Consideration (IC). For service codes under 101 CMR 337.00 for which no rate is listed and that EOHHS has designated “IC,” the purchaser determines the payment amount on an IC basis upon receipt of a bill and supporting documentation describing the services/items rendered. In determining the appropriate payment, the purchaser considers (a) the time required; (b) the degree of skill required; (c) the severity and complexity of the patient’s condition; (d) the cost of goods supplied, including catalog prices and, where applicable, invoices; and (e) the policies, procedures, and practices of other third-party purchasers of care (governmental and private).   Industrial Accident Patient. A person who receives medical services for which persons, corporations, or other entities are in whole or part liable under M.G.L. c. 152. Provider. Any independent outpatient dialysis facility licensed by the Department of Public Health and certified by the MassHealth agency. Publicly Aided Individual. A person who receives health care and other services for which a governmental unit is in whole or in part liable under a statutory program of public assistance. Purchaser under M.G.L. c. 152. An insurance company, self-insurer, or worker's compensation agent of a department of the Commonwealth, county, city, or district that purchases medical services subject to M.G.L. c. 152, § 1.