Tribal facilities & contract health dollars

I have recently started as RN Case Mgr for a tribal facility and have alot of patients on dialysis. Are any fed. programs in exsistence that assist with HD?[/i]

Assist in what way, Tina? Do you mean assist with home dialysis set-up?

Some tribes – especially those with gaming interests or access to other valuable resources – have money to set up dialysis clinics while those in other areas do not. Lending insitutions make loans for those who want to own and set up clinics. Start-up costs for a dialysis clinic can be high. Encouraging as many patients patients to do home dialysis can keep sizes of facilities lower and staffing less so the overhead costs are less.

Medicare, Medicaid, and other insurance are the common payer sources for people on home or in-center dialysis. Patients who are Native American and need dialysis can have Medicare if they (or their spouse or parent, if the patient is a child) has worked enough. Patients who start on home dialysis and have no insurance can get Medicare sooner. As a primary payer, Medicare pays 80% of the allowed charge for dialysis.

Patients can have Medicaid as a primary payer if they have no other coverage and meet the state’s guidelines. Medicaid can pay secondary or tertiary if they have Medicare or other coverage.

Some Native American patients work or are dependents of workers. They may have health insurance through jobs. Employer group coverage pays first for the first 30 months from the date the person could have had Medicare whether they signed up for it or not. Employer group health plans are typically billed at a higher rate and pay more than Medicare.

Although it takes time, if someone has to take out a loan to set up a dialysis clinic and/or buy necessary equipment, they can be paid back with revenues from these payers.