CSHCN 2009 > Renal Dialysis > Benefits, Limitations, and Authorization Requirements

31.3.7 Prior Authorization Requirements

Prior authorization is required for renal dialysis. Providers must submit the "CSHCN Services Program Prior Authorization Request for Renal Dialysis Treatment" form to the CSHCN Services Program or its designee.

An initial prior authorization of 3 months is given to clients seeking eligibility with Medicare. An additional 3 months may be prior authorized on a case-by-case basis if clients have applied for, but have not yet received, a determination from Medicare at the end of the initial prior authorization.

If a denial for Medicare is received, or if the referring provider attests that the client is ineligible for Medicare, an open-ended prior authorization may be granted.

Refer to: Section 4.3, "Prior Authorizations" for detailed information about prior authorization requirements.