Section 182-540-150 - Reimbursement-General(1) Kidney center services described in this section are paid by one of two methods: (a)Composite rate payments - This is a payment method in which all standard equipment, supplies, and services are calculated into a blended rate. (i) A single dialysis session and related services are reimbursed through a single composite rate payment (refer to WAC 182-540-160) .(ii) Composite rate payments for continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD) are limited to thirty-one per month for an individual client.(iii) Composite rate payments for all other types of dialysis sessions are limited to fourteen per month for an individual client.(b)Noncomposite rate payments - End-stage renal disease (ESRD) services and items covered by the medicaid agency but not included in the composite rate are billed and paid separately (refer to WAC 182-540-170) .(2)Limitation extension request - The agency evaluates billings for covered services that are subject to limitations or other restrictions, and approves the services beyond those limitations or restrictions when medically necessary under WAC 182-501-0165 and 182-501-0169.(3)Take-home drugs - The agency reimburses kidney centers for take-home drugs only when they meet the conditions described in WAC 182-540-170(1). Other drugs for at-home use must be billed by a pharmacy and be subject to the agency's pharmacy rules.(4)Medical nutrition - Medical nutrition products must be billed by a pharmacy or a durable medical equipment (DME) provider.(5)Medicare eligible clients - The agency does not reimburse kidney centers as a primary payer for medicare eligible clients.Wash. Admin. Code § 182-540-150
Amended by WSR 15-14-040, Filed 6/24/2015, effective 7/25/201511-14-075, recodified as §182-540-150, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. 06-24-036, § 388-540-150, filed 11/30/06, effective 1/1/07. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520, 74.09.522, and 42 C.F.R. 405.2101. 03-21-039, § 388-540-150, filed 10/8/03, effective 11/8/03.