State Launches New Licensure Model for Dialysis in Nursing Homes

The Department of Health’s (DOH) Division of Hospitals and Diagnostic and Treatment Centers has just released Dear Administrator Letter (DAL) 19-08, which informs nursing homes and end stage renal dialysis (ESRD) providers that DOH has developed State licensure requirements for hemodialysis services provided to residents in nursing homes. The Centers for Medicare and Medicaid Services (CMS) allows ESRD providers to offer these services if they are already federally certified in Home Hemodialysis Training and Support. The State’s process will require submission of a Limited Review Application through DOH’s New York State Electronic Certificate of Need (NYSECON) system.

In August 2018, CMS released new survey guidance for ESRD Surveyors to use in reviewing dialysis services furnished in nursing homes as well as updates to the State Operations Manual (SOM) for ESRD providers. These followed release of a November 2017 CMS long term care facilities SOM update addressing on-site delivery of dialysis services in nursing homes [see 42 CFR §483.25(l) discussion, beginning on page 384].

There are two models of home hemodialysis service delivery that can be licensed in this way: (1) dialysis at the resident’s bedside; and (2) dialysis in a dedicated treatment room in the nursing home, also known as a “den.” Both require the involvement of a certified dialysis provider. Home hemodialysis services were previously allowed in nursing homes by CMS under the home dialysis benefit and were licensed by DOH on a limited basis under the State operating certificate service category of Home Hemodialysis Training and Support.

DOH’s new licensure process, which is now operational, will include the following steps:

Nursing homes seeking to offer dialysis services on-site must submit a Limited Review Application through the NYSECON system to add the service of Nursing Home Hemodialysis or Nursing Home Hemodialysis-Bedside Only to their operating certificate.
The nursing home must establish an agreement with an ESRD provider that has a fixed location, has been federally certified in Home Hemodialysis Training and Support, and has been State-licensed or has submitted a Limited Review Application to be State-licensed in Nursing Home Hemodialysis. CMS Dialysis Facility Compare identifies a total of 305 dialysis facilities in New York and displays the quality ratings and other information on each provider for your review. Of this total, 88 are approved to offer Home Hemodialysis Training and Support.
If the nursing home is only performing bedside hemodialysis, an initial survey will be at DOH’s discretion. Approval will be based on the review of the agreement between the nursing home and the ESRD provider as well as on policies and procedures and environmental checklists uploaded through the NYSECON system.
If the application is for the construction of a treatment room, in addition to a review of the materials uploaded through NYSECON, approval will require an on-site pre-opening survey. A separate Limited Review Application must be submitted for any subsequent dens in the same facility.

DOH has posted more details on the application process and licensure of these services on its website, including Guidance and Instructions for Submitting a Limited Review Application for Nursing Home Hemodialysis Services and Frequently Asked Questions (FAQs) for Nursing Home Hemodialysis.

Nursing home patients/residents who require hemodialysis services must typically be transported to a regular dialysis center three times a week. Providing hemodialysis services in the nursing home eliminates the need for the patient to endure these disruptive and risky transports and allows patients to spend more time receiving therapy and working to improve their condition and prospects for discharge. With the increased communication between the nursing home and the dialysis provider that results from these arrangements, quality of care can also be enhanced, in addition to a better quality of life.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866