End-Stage Renal Dialysis (ESRD) Certification

This page contains information and forms required to operate as an end-stage renal dialysis facility in Minnesota.

Responsibilities and Requirements for End-Stage Renal Dialysis Certification

For the process required to make changes to your Medicare certifications, see below for specific information:

• Initial Medicare Certification
• Location Change
• Adding In-Center Stations
• Change of Administrator
• Doing Business as (DBA) Name Change
• Legal Entity Name Change 
• Change of Ownership (CHOW)
• Voluntary Closure
• Temporary Closure/Reopen
• Change in Modalities/In-Center Stations
• Addition or Elimination of Modalities

Involuntary Discharge Reporting

Providers are responsible for submitting reports of involuntary discharge or transfer of patients to MDH as described in the State Operations Manual, Appendix H, part V767 (available on the CMS End-Stage Renal Disease Facilities website).

Send reports of involuntary discharge to Health.FederalTriage@state.mn.us with the subject line Involuntary Discharge Report. Reports should include the following:

• Provider's name and location
• Patient name
• The reason for the discharge
• Whether the discharge is planned (with 30-day notice) or abbreviated.

Federal Requirements

State Operations Manual, Chapter 2-The Certification Process

State Operations Manual, Chapter 5, Complaint Procedures

State Operation Manual, Appendix H- Guidance to Surveyors: End-Stage Renal Disease Facilities
Click on "Appendices Table of Contents," then click on the letter H, End-Stage Renal Disease Facilities.

Medicare Benefit Policy Manual, Chapter 11, End Stage Renal Dialysis (PDF)

Centers for Medicare and Medicaid Services (CMS) Information on End-Stage Renal Dialysis

CMS: End-Stage Renal Disease (ESRD)
Center for Clinical Standards and Quality/Survey & Certification Group

CMS Policy & Memos to States and Regions
CMS issues S&C memos weekly. It will be the responsibility of providers to check weekly for new information listed at the CMS S&C memo website.

Quality Assurance for the Medicare & Medicaid Program Mission & Priority Document (MPD)

The mission of the survey and certification (S&C) program is to assure basic levels of quality and safety for all patients, residents and clients receiving care from Medicare and Medicaid certified institutional providers. Survey and certification is the system that provides on-site, objective and outcome-based verification by knowledgeable and trained individuals to assure that basic standards of quality are being met by healthcare providers across the nation or, if not met, that appropriate remedies are promptly applied and implemented effectively.
Fiscal Year (FY) 2023 Mission & Priority document (MPD) – Action

Important Federal Survey Data Including Results of Inspections and Complaints

S&C's Quality, Certification and Oversight Reports (QCOR) 
Quality and Certification Oversight Reports (QCOR) website includes summarized federal survey and certification and complaints data, including results of on-site inspections, of providers and suppliers and deficiency data links and more.

Dialysis Facility Compare

Medicare.gov Dialysis Facility Compare
Medicare data comparing dialysis facilities (centers) quality of patient care the facility provides and comparison of patient experience survey results.

Federal and State Emergency Preparedness

Emergency Preparedness are not waivable and are required. 

Emergency Preparedness Rule
Emergency preparedness resources and surveyor tool.

Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers
Links to resources that can help provider and suppliers comply with the recently released Centers for Medicare & Medicaid Emergency Preparedness Rule. Has a document titled "Resources at Your Fingertips," which contains check lists and fact sheets on the essential four core elements of the CMS Emergency Preparedness Rule.

State Operation Manual, Appendix Z- Guidance to Surveyors: Emergency Preparedness for All Provider and Certified Supplier Types Interpretive Guidance 
Directions: Select Appendices Table of Contents, Scroll to Appendix Letter Z, and Federal Regulations for Emergency Preparedness for All Provider and Certified Supplier types

CMS Quality, Safety & Education Portal (QSEP) - CMS Emergency Preparedness Basic Surveyor Training Course (EP)
The Centers for Medicare & Medicaid Services (CMS) Survey & Certification Group (SCG) developed the Emergency Preparedness Basic Surveyor Training Course to help health and safety and Life Safety Code (LSC) surveyors and reviewers gain proficiency in surveying all affected participating providers and certified suppliers for compliance with their individual emergency preparedness requirements. Because the individual regulations for each provider and supplier type share a majority of standard provisions, this training provides consistent guidance and survey procedures for all provider and supplier types in a single course. The estimated course completion time for this training is 16 hours.

MDH Emergency Preparedness & Response Contact Information
This section of MDH coordinates preparedness activities and assists Minnesota Department of Health staff, local public health agencies, hospitals, health care organizations, tribes and public safety officials in their efforts to plan for respond to and recover from public health emergencies.

Resources

Minnesota e-Health
E-health is the adoption and effective use of Electronic Health Record (EHR) systems and other health information technology (HIT) to improve health care quality, increase patient safety, reduce health care costs, and enable individuals and communities to make the best possible health decisions.

Information Bulletins

MDH Health Regulation Division Information Bulletins
Includes MDH updates. Subscription for automatic updates via email.

Other Important Information

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