42 C.F.R. § 413.210
Conditions for payment under the end-stage renal disease (ESRD) prospective payment system
Except as noted in § 413.174(f), items and services furnished on or after January 1, 2011, under section 1881(b)(14)(A) of the Act and as identified in § 413.217 of this part, are paid under the ESRD prospective payment system described in § 413.215 through § 413.235 of this part.
(a) Qualifications for payment. To qualify for payment, ESRD facilities must meet the conditions for coverage in part 494 of this chapter.
(b) Payment for items and services. CMS will not pay any entity or supplier other than the ESRD facility for covered items and services furnished to a Medicare beneficiary. The ESRD facility must furnish all covered items and services defined in § 413.217 of this part either directly or under arrangements.
Notes of Decisions
Cited in 2
cases (2 in the last 5 years), 2021–2021 · leading case: Renal Treatment Centers West Inc. v. Allegiant Healthcare West LLC (D. Ariz. 2021).
Renal Treatment Centers West Inc. v. Allegiant Healthcare West LLC (D. Ariz. 2021). “16 Here, Allegiant alleges that the agreements violated 42 C.F.R. § 413.210 . That 17 provision states, 18 Except as noted in § 413.”
State of Hawaii v. Liberty Dialysis-Hawaii LLC (D. Haw. 2021). “Under 42 C.F.R. § 413.210 (a) (titled “Conditions for payment under the [ESRD] prospective payment system”), “[t]o qualify for payment, ESRD facilities must meet the conditions for coverage in part 494 of this chapter.”
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