1. (a) An ESRDDC who provides home dialysis services to nursing home residents in a designated area of the nursing home shall do so under a written agreement with the nursing home.
2. (b) The ESRDDC shall maintain direct responsibility for the dialysis related care and services provided to the nursing home residents.
3. (c) The ESRDDC shall not provide dialysis services at the nursing home to persons other than current residents of the nursing home.

4. (d) A signed written agreement between the authorized representatives of the nursing home and the authorized representatives of the ESRDDC, shall be consistent with the written policies and procedures of the ESRDDC and the nursing home, and contain at a minimum:

   1. (1) The lines of authority of each party;
   2. (2) The responsibilities of each party, including that the ESRDDC shall maintain direct responsibility for the dialysis related care and services provided to the nursing home residents consistent with the federal End Stage Renal Disease (ESRD) Conditions for Coverage (CfC) requirements;
   3. (3) A description of how coordination between the parties will occur;
   4. (4) A description of the accountability for the dialysis services provided, including reporting any adverse events;
   5. (5) Specification of the method by which the parties shall ensure adherence to the terms of the agreement, communicate as issues arise, and take remedial action when appropriate; and
   6. (6) Specification that the agreement will be reviewed at least annually and updated as needed.

5. (e) An ESRDDC shall notify the department of their addition to provide home dialysis in a nursing home setting and submit a narrative that includes the following:

   1. (1) In the area of space, the ESRDDC shall ensure a location that promotes dignity, individual privacy during treatments, access to a call system, hand washing sinks, a soiled utility area, and sufficient space for treatment. Sufficient space shall be 90 square feet per dialysis bed or 80 square feet per dialysis chair, minimum 4-foot clearance between dialysis beds, and a minimum 3-foot clearance between a dialysis bed or chair and any wall, and to accommodate the dialysis equipment both when in use and when not in use;
   2. (2) In the areas of staffing and documentation of training, the ESRDDC shall ensure personnel meet the criteria for qualifications, training, and competency verification, including for hemodialysis by a trained registered nurse (RN) with dialysis experience. The dialysis facility shall ensure that staff are prepared to appropriately address and respond to dialysis related complications and provide emergency interventions, as needed. There shall be policy and procedures for the documentation of training and competency requirements for all individuals providing dialysis treatments;
   3. (3) In the area of coordination of care and medical records, the ESRDDC shall maintain direct responsibility for the dialysis related care and services provided to the nursing home resident consistent with the federal ESRD CfC requirements pursuant to 42 CFR 494, as well as the terms of the written agreement with the nursing home, and how coordination between the parties shall occur. The ESRDDC shall have procedures for the initiation, administration, and discontinuation of dialysis treatments, the type of monitoring required before, during, and after the treatments, including documentation requirements, procedures for methods of communication between the nursing home and the ESRDDC including how it shall occur, with whom, and where the communication and responses shall be documented, and the development and implementation of a coordinated comprehensive care plans that identify nursing home and ESRDDC responsibilities and provides direction for nursing home and dialysis staff;
   4. (4) In the areas of medication supply and security, the ESRDDC shall ensure the supply and security of how and where medications are stored in the nursing home including a refrigerator as necessary, and the procedures for discarding or disposal of medications used in the nursing home for dialysis services and care;
   5. (5) In the areas of equipment and water, the ESRDDC shall be responsible for providing all equipment necessary for the nursing home resident’s dialysis treatment and for the maintenance of such equipment;
   6. (6) In the areas of housekeeping and waste management, the ESRDDC shall ensure that housekeeping, cleaning, and waste, including medical or potentially hazardous waste, and the disposal of equipment and supplies shall follow professional standards and guidelines;
   7. (7) In the area of emergencies, the ESRDDC shall develop and implement policies and procedures to ensure nursing home staff are prepared to appropriately address and respond to dialysis related complications and provide emergency interventions, as needed, and to ensure the availability of emergency equipment and supplies. The policy shall provide the plan for emergency back-up dialysis services when there is an interruption, or anticipated interruption, of routine home dialysis treatment in the nursing home, including but not limited to, non-functional equipment, power or water outages, or a resident’s anticipated travel away from the nursing home;
   8. (8) In the area of infection control, the ESRDDC shall develop and implement policies and procedures to prevent the spread of disease and avoid the potential for cross-contamination. This includes ensuring that a resident who is hepatitis B+ is not dialyzed using the same machine or in the same location as resident who is not hepatitis B+. Consideration shall be given to implementing appropriate infection control practices related to care of a resident who is hepatitis B+, such as using dedicated staff, a dedicated machine, equipment, instruments, and supplies that shall not be used by other residents, including a resident who is not hepatitis B+. The ESRDDC shall be in compliance with the federal ESRD CfC for infection control pursuant to 42 CFR 494.30;
   9. (9) In the area of resident choice, the nursing home shall accommodate and work with residents who may already be receiving, or prefer to receive, dialysis care from another provider; and
   10. (10) In the area of quality assurance and performance improvement (QAPI) program, the ESRDDC shall collect data from the home dialysis program in the nursing home and incorporate the data into the ESRDDC QAPI program.
6. (f) Where rehabilitation is done within an existing facility, all such work shall comply with applicable sections of the FGI “Guidelines for Design and Construction of Outpatient Facilities, Renal Dialysis Center Chapter” (2022 edition), available as noted in Appendix A.

Source. #14206, eff 2-28-25