R414-19A-7. Limitations

(1) 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. (2) Medicaid reimburses dialysis services through a composite rate. Payment for services that are part of the composite rate may not be reimbursed separately. (3) Regardless of the dialysis method used, composite payments are limited to one unit each session and no more than one unit each day. Continuous cycling peritoneal dialysis, or any other dialysis services that occur overnight, are eligible for one composite payment.