Sec. 10.30.01.05. Patient Selection Standards

A. General Considerations.

(1) Selection of patients for dialysis and renal transplantation shall be on medical grounds alone.

(2) Selection may not be based on age, race, sex, social background, national origin, religion, or financial resources.

(3) The Kidney Disease Program is financially responsible only for residents of the State who are certified as eligible for participation in the Kidney Disease Program.

(4) Maryland residents treated in dialysis facilities or transplant centers outside the State are not eligible for reimbursement unless the treatment has been preauthorized by the Commission.

(5) The Commission may authorize a treatment for documented reasons of continuity of care, or geographical proximity of the patient's residence to the dialysis facility or transplant center, or both.

(6) Patient selection is the responsibility of the dialysis or transplant centers, or both, but shall conform to the medical guidelines established in §B of this regulation.

(7) Except as provided in §C of this regulation, if a patient is accepted by a facility for dialysis, transplantation, or both, the patient is the responsibility of that facility and the facility's staff until that responsibility is terminated by mutual agreement between the facility and patient.

(8) The Commission shall review each facility's policy regarding discharge of patients from the facility's program.

(9) Any separation that is not mutually accepted shall be documented in writing by the facility and reviewed by the Commission to determine whether there has been a violation of laws or regulations of the State.

B. Medical Guidelines. A patient may be accepted for treatment if the patient meets any of the following criteria:

(1) Has end-stage renal disease requiring renal replacement therapy to sustain life;

(2) A patient who grants informed consent and who has had a thorough medical, psychosocial evaluation indicating a reasonable expectation of benefiting from either chronic dialysis or transplantation;

(3) Has chronic end-stage renal disease and is a qualified resident of this State, except when documented medical reasons contraindicate dialysis; or

(4) Has rejected a transplanted kidney making the patient immediately eligible for consideration for readmission into a chronic dialysis program if the patient is a medically suitable candidate.

C. Abusive and Dangerous Patients.

(1) A facility shall:

(a) Develop policies for the management of abusive and dangerous patients;

(b) Maintain these policies in the policy and procedures manual in the dialysis facility; and

(c) Inform the patient in writing of the facility's policy for the management of abusive and dangerous patients.

(2) A separation or discharge may be implemented by the facility only after the patient has been given written notice by the facility and has had a reasonable opportunity to terminate the abusive and dangerous behavior, however:

(a) A patient who commits violence in a facility may be discharged; and

(b) The Commission shall require documentation of the violence to support a discharge.

(3) The Commission shall review each facility's policy for the management of abusive and dangerous patients and the facility's method of implementation of this policy during the Commission's annual survey.

D. Complaints.

(1) The Commission shall investigate complaints received from patients, providers, anonymous persons, and other interested parties including family members.

(2) The Commission shall consider all complaints submitted to the Commission office for further investigation.