10 Colo. Code Regs. § 2505-10-8.310.3

Current through Register Vol. 47, No. 20, October 25, 2024

Section 10 CCR 2505-10-8.310.3 - General Services

8.310.3.A.Provider Requirements

1. The Provider must utilize the most cost efficient method of dialysis treatment appropriate for each client, as assessed through an evaluation for peritoneal dialysis based upon an individual medical diagnosis and condition.

2. The Provider Facility must develop and implement a written, individualized comprehensive plan of care for each patient, which must include:

a. The services necessary to address the patient's needs;

b. The comprehensive assessment and changes in the patient's condition;

c. Measurable and expected outcomes, and estimated timetables to achieve these outcomes;

d. The outcomes specified in the patient plan of care must be consistent with current evidence-based professionally-accepted clinical practice standards; and

e. The plan of care must represent the selection of a suitable treatment modality (e.g., dialysis or transplantation) and dialysis setting (e.g., home, self-care) for each patient (42 CFR 405, 410, 413, 414, 488 and 494).

8.310.3.B.Covered Dialysis Services

The following are covered services under the Colorado Medicaid Dialysis Center Program:

1. In-Center Dialysis

a. Dialysis treatments completed by facility staff, and all necessary equipment and supplies.

b. In-Center dialysis is a benefit when the client meets one of the following conditions:

i) The client requires dialysis treatments prior to completing home dialysis training;

ii) Training to perform self-treatment in the home environment is contraindicated;

iii) The client is otherwise not a proper candidate for self-treatment in a home environment;

iv) The home environment of the eligible client contraindicates self-treatment; or

v) The eligible client is awaiting a kidney transplant.

c. Self-dialysis may be performed within the facility with limited professional assistance, if the client has completed an appropriate course of training.

i) The benefit includes training of the client by qualified personnel.

2. Home Dialysis

a. To be eligible for home dialysis a client or client's caregiver must receive appropriate training to perform dialysis at home.

b. The benefit includes training by qualified personnel, necessary supplies, and equipment for dialysis services.

c. The Benefit includes delivery, installation, and maintenance of equipment for home dialysis

3. The following are included in the Dialysis Center reimbursement and should not be billed separately:

a. Costs associated with home dialysis other than necessary delivery, equipment, installation, maintenance, supplies, or training.

b. Blood and blood products.

c. Additional staff time or personnel costs.

d. Routine Laboratory Services

i) All laboratory services considered routine for dialysis treatment, and performed by a dialysis treatment facility, are included as part of the dialysis treatment reimbursement.

ii) A Provider performing routine laboratory services must be a certified clinical laboratory.

e. Routine Pharmaceuticals for Dialysis Treatment

i) All pharmaceuticals considered routine for dialysis treatment, and dispensed by a dialysis treatment facility, are included as part of the dialysis treatment reimbursement.

ii) Pharmaceuticals not dispensed by the dialysis provider are billed by and reimbursed to the dispensing pharmacy.

8.310.3.C.Non-Covered Services

The following are non-covered services under the Colorado Medicaid Dialysis Center benefit:

1. Personal care items such as slippers or toothbrushes.

10 CCR 2505-10-8.310.3

46 CR 11, June 10, 2023, effective 6/30/2023