R414-19A-5. Service Coverage

  (1) Dialysis services, including hemodialysis and peritoneal dialysis treatments provided by an ESRD facility, are a covered service for categorically or medically needy Medicaid recipients for three months pending the establishment of Medicare eligibility.

  (a) Medicaid may cover dialysis services for longer than three months if a recipient is not eligible for Medicare.

  (b) Medicaid reimburses dialysis services through a composite payment.

  (2) Medicaid covers dialysis services, including hemodialysis and peritoneal dialysis treatments performed at home, when they are supervised by an enrolled ESRD facility and performed by an appropriately trained Medicaid recipient 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 patients in applying for and pursuing final Medicare eligibility.