Cal. Code Regs. Tit. 22, § 51330 - Chronic Hemodialysis
(a) Chronic hemodialysis is covered only as
an outpatient service. Prior authorization may be granted for dialysis,
physician services, medical supplies, equipment and drugs required for dialysis
services, when provided by renal dialysis centers or community hemodialysis
units.
(b) Authorization for
outpatient chronic hemodialysis may be granted for up to 12 months at any one
time.
(c) The following information
shall be provided on or attached to the authorization request form for home
dialysis or training:
(1) Evidence that the
beneficiary, the beneficiary's spouse, or other co-learner is suitable for
training in home dialysis.
(2)
Evidence establishing the suitability of the home facilities for
dialysis.
(3) Evidence that the
overall installation costs in the home are reasonable and in no event exceed
$750.00.
(4) Evidence that the
water supply in the home is suitable for renal dialysis.
(5) Evidence of the availability of a
qualified local physician to be responsible for the ongoing medical supervision
of the beneficiary.
(6) The plan
for continuing case management.
(7)
A budget for all expenses related to home dialysis, including supplies prorated
on a monthly cost basis.
(d) Reauthorization for a patient on chronic
hemodialysis is required at least every 12 months. Reauthorization requests
shall be submitted at least one month prior to expiration of the current
authorization period.
(e) Inpatient
hospitalization for persons undergoing chronic hemodialysis shall be in
accordance with the provisions of Section
51327.
Notes
2. Amendment of subsection (e) filed 8-8-78; effective thirtieth day thereafter (Register 78, No. 32).
3. Amendment of subsections (b) and (c) filed 8-31-79; effective thirtieth day thereafter (Register 79, No. 35).
4. Change without regulatory effect of NOTE (Register 86, No. 49).
Note: Authority cited: Section 14124.5, Welfare and Institutions Code. Reference: Sections 14133, 14133.1 and 14133.3, Welfare and Institutions Code.
2. Amendment of subsection (e) filed 8-8-78; effective thirtieth day thereafter (Register 78, No. 32).
3. Amendment of subsections (b) and (c) filed 8-31-79; effective thirtieth day thereafter (Register 79, No. 35).
4. Change without regulatory effect of NOTE (Register 86, No. 49).
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