On March 22, 2023, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance to address provisions for nursing home residents who are receiving dialysis. The initial guidance was released in 2018, but CMS received questions, comments, and feedback from state surveyors, providers, and others, and wrote the revised guidance to address those questions and incorporate the feedback that was received. Information in the memorandum also reinforces guidance that was originally added as an attachment but is now included in the revised memo with revisions marked in red font.
The CMS Center for Clinical Standards and Quality/Quality, Safety & Oversight Group stated in its release QSO-18-24-ESRD REVISED 3/22/2023, “All chronic dialysis patients receiving dialysis services must be under the care of a certified ESRD facility to have their outpatient dialysis care and treatments reimbursed by Medicare. For individuals residing in nursing homes with dialysis needs, dialysis treatments may be provided in an in-center setting or they may receive dialysis in the nursing home, i.e., home dialysis” that is administered in the skilled nursing facility or nursing facility. “It is important to note that in-center dialysis may be furnished by a certified dialysis facility that is located offsite, adjacent to the nursing home, or occupying leased space within the nursing home itself. Nursing homes are not required to accommodate dialysis services on-site. Some State regulations may not allow dialysis services to be provided in a nursing home setting or may have additional requirements regarding the qualifications of personnel who provide dialysis treatments in a nursing home.”
According to CMS, the goal of the guidance is to enable an effective and consistent approach to evaluate the quality of care and promote improvements in performance and outcomes for the nursing home dialysis population. The nursing home and EndStage Renal Disease (ESRD) care teams should ensure protections are in place to secure effective and safe treatments. These include:
- Ongoing collaboration of care between the dialysis facility and nursing home;
- Adequate training for anyone that administers dialysis treatments;
- Appropriate monitoring of the dialysis patient’s status before, during, and after the treatments; and
- Ensuring a safe and sanitary environment for the treatments.
The revised memo can be accessed here.
Compliance Perspective
Issue
Facilities must ensure that residents who require dialysis receive such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents’ goals and preferences. The nursing home remains responsible for the overall quality of care the resident receives and must provide the same services to a resident who is receiving dialysis as it furnishes to its residents who are not. There must be a coordinated plan of care for dialysis treatments developed with input from the nursing home, dialysis facility, and the resident or representative. The resident should not experience any lack of nursing home services or care because of his or her dialysis status.
Discussion Points
- Review your policies and procedures on dialysis services and resident care to ensure they are up to date with the latest CMS guidance.
- Train appropriate staff on the necessity of including dialysis patients in the decision processes that affect their health status. Also provide staff education on coordination of care with the ESRD team and appropriate monitoring of dialysis patients’ status before, during, and after treatment.
- Periodically audit to ensure that resident care plans are being followed and that there is ongoing communication and collaboration with the ESRD team. Interview residents who receive dialysis to ensure their rights to person-centered care are honored.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
