Library: Policy

317:30-5-307. Payment methodology

Revised 6-25-12

     Payment of in‑facility dialysis treatments and home dialysis treatment is made under the PPS rate reimbursement system.

• (1) All items and services included under the PPS rate must be furnished by the facility, either directly or under arrangements, to all of its dialysis patients.  If the facility fails to furnish (either directly or under arrangements) any part of the items and services covered under the rate, then the facility cannot be paid any amount for the part of the items and services that the facility does furnish.  These items and services include:

  • (A) medically necessary dialysis equipment and dialysis support equipment;

  • (B) home dialysis support services including the delivery, installation, maintenance, repair, and testing of home dialysis equipment, and home support equipment;

  • (C) purchase and delivery of all necessary dialysis supplies;

  • (D) routine ESRD related laboratory tests; and

  • (E) all dialysis services furnished by the facility's staff.

• (2) Some examples (but not an all-inclusive list) of items and services that are included in the PPS rate and may not be billed separately when furnished by a dialysis facility are:

  • (A) staff time used to administer blood;

  • (B) declotting of shunts and any supplies used to declot shunts;

  • (C) oxygen and the administration of oxygen; and

  • (D) staff time used to administer nonroutine peritoneal items.