WAC 182-540-055 Kidney disease program (KDP) covered services

Effective January 1, 2014

  1. The kidney disease program (KDP) covers the cost of health care services essential to the treatment of end-stage renal disease (ESRD) and its complications. Within available funding and at the discretion of the KDP contractor covered services include:
    1. Dialysis:
      1. Center dialysis - Covers the cost of dialysis, necessary supplies, and related services provided in a kidney center;
      2. Home dialysis - Covers the cost of providing dialysis and related services in the home; and
      3. Dialysis while hospitalized - Covers the cost of dialysis and related services while the KDP client is confined to an acute care facility and is unable to dialyze at his/her regular site.
    2. Medication - As defined in the approved drug list in the KDP manual;
    3. Access surgery (venous and peritoneal) - Covers costs associated with surgically preparing the client for dialysis and medical complications related to the access site;
    4. Laboratory tests and X-rays considered to be part of the overall treatment plan for ESRD;
    5. Pretransplant work-up including, but not limited to, transportation, lodging, and physician visits;
    6. Post-transplant visit to assess client's ESRD status to include, but is not limited to, transportation, lodging, and physician visits;
    7. Health insurance premium including copays and deductibles when found to be cost-effective;
    8. Spenddown expenses when found to be cost-effective; and
      1. Other services as approved by the agency's KDP program manager.
  2. If the KDP pays for medical and dental services required to receive a transplant, and the KDP client does not follow through with their recommended treatment plan in order to receive or make progress towards receiving a transplant, the KDP contractor must submit a request for a determination of noncompliance to the agency's KDP manager. If the request is approved, KDP funds must not be used for any follow-up or additional services. Once the KDP client makes progress with their treatment plan, the agency may rereview the request.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.