Medicaid to Cover Dialysis Services for ESO Beneficiaries in Dialysis Facilities

The Michigan Department of Health and Human Services (MDHHS) recently released concurrent proposed and final policies to clarify Medicaid policy for the treatment of End Stage Renal Disease (ESRD) for beneficiaries covered under Medicaid Emergency Services Only (ESO).

Medicaid considers ESRD to be an emergency condition, with treatment to include dialysis. Effective April 1, coverage for dialysis services appropriate for the treatment of the ESRD diagnosis is not limited to the hospital emergency department (ED), since Medicaid will also cover these services when provided in an enrolled dialysis outpatient facility. Provider claims must include the ESRD diagnosis and emergency service designation.

Comments regarding the policy are due to the MDHHS Feb. 3. The MHA submitted comments supporting this policy, which will help ensure that services are provided timely in the appropriate setting while also reducing unnecessary ED visits. Members with questions should contact Vickie Kunz at the MHA.