Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 6142 (September 30, 2023).

55 Pa. Code § 1128.53. Limitations on payment.

§ 1128.53. Limitations on payment.

 (a)  The Department does not pay for services provided by a dialysis facility except as specified under §  1128.51 (relating to general payment policy).

 (b)  Payment will not be made for services provided by facility based or contract employes if the services are those specified under §  1128.51.

 (c)  Payment is limited to services provided to recipients who meet Federal Medicaid eligibility requirements and who are enrolled in the Department of Health Chronic Renal Disease Program.

 (d)  Payment is limited to one procedure including related services, per day.

 (e)  Initial training for home dialysis is limited to 24 sessions per patient or partner.

 (f)  Payment for backup visits to the facility is limited to no more than 15 in one calendar year. For the purposes of this chapter, backup procedures are dialysis procedures provided at a facility when a patient is required to resume treatment at the facility following home dialysis treatment. Backup services may be necessitated by worsening of the patient’s condition, absence of the dialysis treatment partner, or for the purpose of training a new partner or retraining for a new procedure to be managed in the home.

 (g)  Payment for nonexpendable equipment or installation of equipment necessary for home dialysis procedures is limited to one time per patient per item.

Cross References

   This section cited in 55 Pa. Code §  1128.41 (relating to participation requirements).

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