Medicare reimbursement of dialysis chair for home dialysis

Hi, I am in the process of ordering a medical recliner for use when I start home dialysis in the next few weeks. Can
you tell me if Medicare provides reimbursement for this. My dialysis unit says that they only pay for a Gerichair but I find it hard to believe that if nothing else they will pay the same amount for a different recliner. Anyone know what
the rules are. thanks in advance for your replies

The Medicare Benefit Policy Matnual, Chapter 11 states that an adjustable chair (recliner) is covered under the rate that Medicare pays dialysis clinics. We have been told by CMS (Medicare) policy personnel that facilities should NOT require patients to buy their own recliners when they are required for home hemodialysis. Dialysis chairs are considered “support equipment” just like water treatment equipment, blood and heparin pumps, etc.

This is a statement about the recliner from that manual:
“Adjustable chairs, such as recliners, are covered when required as a component of a home hemodialysis delivery station. These chairs serve to preserve patients’ health by allowing rapid manipulation in body position when medical circumstances warrant such changes during dialysis (e.g., when acute hypotension occurs and the patient is in danger of going into shock).”

Clinics are only required to provide a basic recliner. The recliner does not need to heat, massage, or rock. Medicare will not pay separately for these recliners that shbould e provided by dialysis clinics. I’d refer your clinic to this manual, especially Section 10 (Definitions D.6) and 50.3.

I have so far been unsuccessful at getting a chair. We are using our couch and pushing it back and forth each treatment :frowning: Seems wrong as we will be having to replace our couch, AND still be needing a chair for dialysis. The clinic has reasured me that ‘the chair’ is not their responsibility and Kiaser sais it’s not theirs. hum!

If you have traditional Medicare or Kaiser is your Medicare Advantage plan, the cost of the chair is included in the “composite rate” that Medicare pays your clinic to provide home dialysis. Show your clinic the Medicare Benefit Policy Manual citation that I provided before. If you’re doing standard hemodialysis or short daily dialysis, be sure your doctor understands that the reason Medicare is willing to pay for an adjustable chair is so that if you have low blood pressure you will be able to recline so your head is below your heart to help correct your blood pressure (medical justification). Your doctor and clinic management should recognize that dialysis chairs in-center are adjustable to allow patients to recline that far for the same reason. The ESRD regulations require that the care for patients at home should be the same treatment the care patients receive in-center so not only is the clinic not complying with the Medicare reimbursement policy but the ESRD regulations.

If the clinic still doesn’t provide you a recliner chair, you have a right to complain to your Network and the state survey agency that your clinic is not providing what Medicare is paying for. Your clinic should have the phone numbers for these two organizations posted in a common area. Be sure to share the citation in the Medicare Benefit Policy manual with them. If they have any questions about this coverage, have them call us.

If your Kaiser insurance is an employer group plan instead of Medicare and that insurance has a durable medical equipment benefit, ask your doctor to provide medical justification for the recliner so your insurance will cover the chair under that benefit.

NOTE: If you are doing nocturnal dialysis, most patients dialyze in bed and this is not a problem because the blood flow rate for nocturnal dialysis is much slower so there aren’t the blood pressure drops that can occur with standard or daily dialysis.

Thank you so much Beth… I will persue once again, as soon as i get some energy back :wink: I really appreciate your info and time!