Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.607 - End-stage renal disease facility payment rate

Current through May 31, 2024
(a) The department
				  will pay a facility that meets the requirements of
				  7 AAC 140.700 -
				  7 AAC 140.720 a rate based upon the formula set out in
				  this section, including a composite, per-treatment payment rate for
				  hemodialysis and a separate composite, per-treatment payment rate for
				  peritoneal dialysis.
(b) The
				  facility may bill a maximum of one treatment per day and a maximum of three
				  hemodialysis treatments per week. Before treatment in excess of the maximum
				  allowed under this subsection is approved, the facility shall submit all
				  documentation necessary to support the medical necessity of the additional
				  treatment. Any treatment above the maximum allowed must be approved by the
				  department under the department's prior authorization process.
(c) The composite, per-treatment payment
				  rates for hemodialysis and peritoneal dialysis will be set annually based upon
				  the reports submitted under
				  7 AAC 140.700 each July 1.
(d) The rates established for end-stage renal
				  disease facilities are all-inclusive, except that the department will pay
				  separately for erythrocyte-stimulating agents and peritoneal iron replacement
				  products in accordance with
				  7 AAC 145.410(g).
(e) The composite, per-treatment payment
				  rates for hemodialysis and for peritoneal dialysis will be calculated as
				  statewide weighted averages. The department will use the following to develop
				  the statewide weighted averages:
(1)
				  information that regards a claim made under this state's Medicaid program, that
				  is obtained from the Medicaid Management Information System (MMIS) defined in
				   42 C.F.R. 433.411(b), and that identifies the number of hemodialysis and
				  separately the number of peritoneal dialysis treatments delivered to recipients
				  during the most recent calendar year for which timely filing has passed; and
(2) the average cost per-treatment
				  included on Medicare cost reports filed with the Medicare fiscal intermediary
				  by end-stage renal disease clinics for the calendar year that aligns with the
				  claims information in (1) of this subsection, as follows:
(A) the cost for the hemodialysis cost per
				  treatment will be taken from the
Average Cost of Treatments
values entered on the Computation of Average Cost Per Treatment Basic Composite
				  Cost worksheet for maintenance hemodialysis portion of the Medicare cost
				  reports; and
(B) the cost for the
				  peritoneal cost per treatment will be taken from the
Average Cost of
				  Treatments
values entered on the Computation of Average Cost Per
				  Treatment Basic Composite Cost worksheet for
Home Program Continuous
				  Ambulatory Peritoneal Dialysis (CAPD)
and for
Home Program
				  Continuous Cycling Peritoneal Dialysis (CCPD)
portion of the Medicare
				  cost reports; for purposes of this subparagraph, if the average cost of
				  treatments from the
Computation of Average Cost Per Treatment Basic
				  Composite Cost
worksheet are reported as weekly costs on the Medicare
				  cost report, the department will divide hemodialysis values by three treatments
				  per week and peritoneal dialysis values by seven treatments per week to
				  calculate the average cost per treatment.