Regulation .04 Covered Services.
Regulation .04 Covered Services.LinkCopy Citation
A.
The Program covers medically necessary services described in §B of this regulation, rendered to participants in a free-standing dialysis facility, when these services are:
(1)
Performed by a physician or by one of the following:
(a)
A physician assistant;
(b)
A nurse practitioner;
(c)
An RN;
(d)
An LPN;
(e)
A social worker; or
(f)
A dietitian-nutritionist;
(2)
Provided by a non-physician listed in §A(1) of this regulation, when the following conditions are met:
(a)
The individual performing the service is in the employ of, or under contract with, the free-standing dialysis facility;
(b)
The individual performing the service is under a physician's direct supervision or written direction;
(c)
The individual performs the service within the scope of the individual's license or certification for the purpose of assisting in the provision of the physician's services; and
(d)
The services are provided according to the free-standing dialysis facility physician's written plan of care;
(3)
Curative or rehabilitative services, when clearly related to the participant’s individual needs;
(4)
Adequately described in the participant’s medical record and consistent with the physician’s written plan of care.
B.
Covered services include:
(1)
Dialysis services furnished on an outpatient basis and provided by a free-standing dialysis facility, to include hemodialysis, peritoneal dialysis, CAPD, CCPD, and home dialysis training; and
(2)
Laboratory tests, supplies, and prescription drugs as related to dialysis services.