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317:30-5-305.Eligible providers
[Revised 09-01-17]

Payment can be made to a Medicare certified Renal Dialysis Center when its clinical services are under the medical direction of a physician licensed by the Oklahoma State Board of Medical Licensure and Supervision, the Oklahoma Board of Osteopathic Examiners, or the appropriate licensing body of the state where the provider is located. Renal Dialysis Centers must also have a current contract on file with the Oklahoma Health Care Authority.

317:30-5-306.Coverage by category
[Revised 06-25-12]
Payment is made to renal dialysis facilities as set forth in this Section.
(1) Adults. Payment is made for outpatient renal dialysis for adults at the PPS rate.
(2) Children. Coverage for children is the same as for adults.
(3) Individuals eligible for Part B of Medicare. Payment is made utilizing the Medicaid allowable for comparable service.

317:30-5-307.Payment methodology
[Revised 06-25-12]
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.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.