Dialysis Services Provided in SNFs

Over the last month, the American Health Care Association’s (AHCA) Legal Committee and the Long Term Care Consortium (LTCC) Compliance Work Group have discussed the current position of the Centers for Medicare and Medicaid Services (CMS) concerning dialysis in skilled nursing facilities (SNFs).  SNFs must be End Stage Renal Disease (ESRD) certified providers to furnish and bill for both hemodialysis and peritoneal dialysis for residents in their facilities.  The governing guidance is found in S&C-04-24 and S&C-04:37

The guidance indicates that CMS allows properly trained family members and SNF staff (trained by a certified ESRD facility) to furnish peritoneal or hemodialysis dialysis at the resident’s bedside in the facility.  This service is referred to as “home” dialysis.  Only ESRD providers can furnish the training and support for these individuals.  ESRD providers working with a SNF also must have a written coordination agreement, ensuring adequate coordination of care.  Both the ESRD provider and the SNF are accountable for the coordination and quality of dialysis services delivered to SNF residents.

Given the fact that the ESRD certification requirements are quite burdensome; most SNFs do not apply to become ESRD facilities.  Instead, SNFs providing home dialysis follow the 2004 guidance referenced above. 

AHCA staff reached out to CMS/OCSQ (Office of Clinical Standards and Quality) to determine if CMS had updated its 2004 position; but CMS indicated that until some future time, the current policy will remain in effect.  CMS had an opportunity to update its position in 2008 when it issued a final rule, Conditions for Coverage for End-Stage Renal Disease Facilities.  According to CMS, they are currently working on updated guidance to clarify this outstanding issue; but to date, the agency has not determined the timeline for the guidance release.  AHCA staff will continue to keep in contact with CMS and apprise you of any updates when/if they occur.  Please contact AHCA’s Dianne De La Mare at ddmare@ahca.org if you have questions related to this issue.