On March 22, 2023, the Centers for Medicare & Medicaid Services (“CMS”) updated its guidance and survey process for home dialysis services in nursing homes.^[1] The updated guidance is based on comments, questions, and feedback received from state survey agencies, the dialysis community and other stakeholders since CMS initially issued guidance in 2018. CMS’ updated guidance became effective immediately and provides additional direction on the following topics:

1. Written agreements between the dialysis provider and the nursing home outlining the responsibilities of the parties and the services provided.

2. Training requirements and qualifications of personnel administering dialysis services including documented competency verification.

3. Coordination of care between the nursing home and dialysis provider including mechanisms for communication and patient management.

4. Dialysis provider policies and procedures for providing services in nursing homes.

5. Emergency plans related to dialysis care coverage and managing complications.

6. Quality assessment and performance improvement programs (“QAPI”), including assessment of how home dialysis performed in a nursing home is incorporated into the dialysis provider’s QAPI program.

The guidance updates the survey process for home dialysis services provided in a nursing home.  On-site surveys at a nursing home will include: a tour of the nursing home dialysis environment, direct observation of nursing home dialysis care, including machine setup, vascular access care, initiation and discontinuation of home hemodialysis treatments, and infection control techniques, among other things.  Any non-dialysis related quality of care concerns observed during the visit may be shared with the state survey agency with oversight of nursing home compliance. Surveyors are instructed not to discuss such observations with the nursing home.

FOOTNOTES

[1] https://www.cms.gov/files/document/qso-18-24-esrd-revised.pdf.