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.