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...everything you need to know about doing dialysis at home.
By Beth Witten, MSW, ACSW, LSCSW
So…you’re thinking about doing home dialysis and want to know how and where you will get what you need—and what it will cost. There is good news: if you have Medicare or another health plan, it should cover most of the direct costs. Some costs may fall on you. We’ll help you learn what is covered and how—and you can bring this article to your clinic in case you run into a snag.
You and a care partner (if you need one) will be trained at a clinic that is approved by Medicare to offer home training and support. The clinic will bill Medicare or your other health plan for your training. The staff will help you at home or when you come to the clinic. This includes the nurse, dietitian, and social worker. In fact, Medicare rules for dialysis (Section 42 CFR 494.100) say that the clinic must give you the same services at home as it would if you did your treatments in the clinic.
If Medicare is your primary payer and you have Part B, it will pay 80% of the allowed charge for training after you have met the yearly Part B deductible. It will also pay 80% of the cost for each treatment. A Medigap (Medicare supplement) plan, Medicaid, or an employer group health plan will pay the rest—as long as you’ve met any deductible. Otherwise, you could owe 20% of the Medicare-allowed charge.
If you have Indian Health Service, VA benefits or an employer group health plan, check your policy, visit the payer’s website, or call the plan provider to find out what it will cover.
Medicare covers “support services” from your nurse, social worker, and dietitian to help you stay healthy. They will answer your questions or troubleshoot problems. You can call them, and you will see them when you come for clinic visits, which are usually monthly.
A staff member may come to your home to help you decide where and what you need to set up your dialysis machine and where to store your supplies. Your home training nurse should make a home visit to make sure you can dialyze at home safely.
If you have Medicare Part B, your doctor will prescribe what you need to do the type of treatment you will be trained for. Your training nurse will order your machine, if you will use one, and the first batch of supplies Medicare covers. During training, you will learn how to order your own supplies, which will be delivered to your home. You will also learn to keep track of what you have used (inventory) to make re-ordering easier.
You’ll need to be home or have someone there to sign for the supplies and put them away:
Medicare covers a machine, supplies, and “support equipment” under the rate per treatment that Medicare lets a clinic charge. If you have Medicare only, you’d pay 20%. If you have more than one health plan, check your policy or call your health plan’s customer service to ask about coverage and what you might pay.
Medicare pays for equipment you will keep using, such as:
Medicare also covers supplies you will use up and reorder, such as:
If you do standard or daily home HD while sitting, there could be times when your blood pressure will drop and you need to lower your head below your heart. (This is very rare at home, but it could happen.) Because of this, Medicare will cover a basic recliner chair. It will not cover extras on a recliner that make it heat, vibrate, swivel, or rock (though you may be able to pay for these yourself when your clinic orders your chair). If you do nocturnal HD, you won’t need a recliner chair because you can safely do your HD in bed while you sleep.
Some patients have told us that their clinics don’t believe they need to provide a recliner chair. Chapter 11 of the Medicare Benefit Policy Manual under Section 40.2 says if a dialysis clinic fails to provide any of the items or services covered under the rate it pays per treatment, Medicare won’t pay the clinic for items and services it did provide (see the quotation below). If you have a hard time getting your clinic to provide one of the covered items we list here, refer your clinic staff to this manual. If the problem is not solved, file a complaint with your ESRD Network or State Survey Agency. Their phone numbers should be posted in your clinic.
Chapter 11 of the Medicare Benefit Policy Manual, Section 40.21
All items and services described in this section are covered and included under the composite rate and must be furnished by the facility, either directly or under arrangements, to all of its Method I home dialysis patients who elect this method of reimbursement. If it fails to furnish (either directly or under arrangements) any part of the items and services covered under the rate, then its intermediary cannot pay the facility any amount for the part of the items and services that the facility does furnish.
NOTE: Medicare dialysis payment changes in 2011 combined Method I and Method II options and Medicare now follows payment rules for Method I for all patients.
Some dialysis machines are “plug and play.” They don’t need special wiring or plumbing—but you would need an electrical outlet and perhaps a faucet. Other machines do need special wiring or plumbing. Medicare will pay for parts and labor for minor work to connect a dialysis machine to electricity and plumbing that is already in the room. It will not cover wiring or plumbing to bring power or water into the room where you will do dialysis.
Medicare covers equipment, installation, and support equipment under the rate it pays your clinic for each home dialysis treatment. It will not pay you back for any of these things if you pay for them yourself.
If you bought equipment or supplies that your clinic should have given you, ask your clinic to pay you back. Show the box in this article as proof that they need to do so. If your clinic refuses, contact your ESRD Network (http://www.esrdncc.org) or call 1-800-MEDICARE to report possible Medicare fraud.
Medicare will pay to maintain or fix a dialysis machine under the per treatment rate it pays your clinic. This includes replacing filters on the HD water treatment system, sending a machine out for repair, or having someone come to your home. It covers these things under the rate it pays your clinic for each home dialysis treatment. During training, you will learn to do some simple maintenance yourself.
Getting equipment and supplies for home treatments sounds complex, but your home training nurse will help you. He or she will suggest ways to track and order supplies, and you can also talk to others at home to see how they handle it. It can be helpful to see how others set up their treatment rooms and store their supplies. Knowing what Medicare covers and what your clinic must supply to you can help you get off to the right start with home treatments.
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