When opening a new dialysis facility, certain steps must be taken to meet federal and/or state compliance. Prospective new facilities should refer to the Conditions for Coverage which govern dialysis facilities and set forth the requirements dialysis providers must fulfill in order to be eligible to obtain Medicare funding.
Certificate of Need (CON)
The District of Columbia and the state of West Virginia require a Certificate of Need (CON) when developing or acquiring a new health care facility. The Certificate of Need is a review process analyzing the population, along with financial feasibility, quality, accessibility, and the state health plan, to determine the need for additional services in a particular area.
Once granted CON approval, the facility should then contact the local State Survey Agency for their area and notify them of intent.
District of Columbia Department of Health: Health Care Facilities Division
Maryland Office of Health Care Quality: Department of Health & Mental Hygiene
Virginia Department of Health: Office of Licensure and Certification
West Virginia Office of Health Facility Licensure & Certification (OHFLAC)
The State Surveyor, as an agent of the Centers for Medicare & Medicaid Services (CMS), will process and evaluate the facility, followed by an on-site survey. After the on-site survey, the facility contact will be notified of the outcome. If the facility meets all ESRD program requirements as set forth by the Conditions for Coverage, the facility will be issued a Medicare Provider number for use with all dialysis-related Medicare claims.
Visit the CMS Dialysis Survey & Certification web page for further guidance on laws & regulations related to dialysis facility certification.
Once the Centers for Medicare & Medicaid Services (CMS) issue a Medicare Provider Number to the facility, a copy of the official certification letter is sent to the Network. Facilities may also fax a copy of the letter they receive to the Network at 804.320.5918.
The Network then contacts the facility by mail to initiate a Membership Agreement with the facility. Once the signed Membership Agreement is received at the Network office, the Network Executive Director executes the agreement. The executed agreement is returned to the facility, along with a New Facility Notebook.
Pursuant to the Conditions for Coverage, facilities are required to submit patient data through an electronic data system called CROWNWeb.