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 state of New Jersey, Puerto Rico and the US Virgin Islands 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 its area and notify them of intent.
New Jersey Department of Health: Certificate of Need and Facility Licensing
Puerto Rico Department of Health: Division of Certificates of Convenience and Necessity
U.S Virgin Islands Department of Health
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 CMS' Quality Safety & Oversight - Guidance to Laws & Regulations webpage 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 should email a copy of the letter they receive to the Network at email@example.com.
Facilities may initiate a Membership Agreement online with information from the certification letter. The online membership agreement is validated and executed online; you may download or print your agreement during this process. Facility should maintain executed agreement on-site.
Facilities may initiate a Membership Agreement below, once the facility has received their National Provider Identification (NPI) number. Please see the steps below to initiate your new facility's Network Membership Agreement. You may download or print your agreement during this process. Your facility should maintain the executed agreement on-site, in the event surveyors request it.
Opening a New ESRD Facility in New Jersey, Puerto Rico, or the US Virgin Islands
INITIATE MEMBERSHIP AGREEMENT
Obtain access to the following national data systems:
AFTER CMS CERTIFICATION
Once the Centers for Medicare & Medicaid Services (CMS) issue a Medicare Provider Number to the facility, facilities should email a copy of the letter they receive to the Network at firstname.lastname@example.org.
Email Tricia Phulchand at the Network office at email@example.com or call Tricia at 609-490-0310, Ext. 2422, with any questions.
End Stage Renal Disease Quality Reporting System (EQRS) Requirements
Pursuant to the Conditions for Coverage, facilities are required to submit patient data through an electronic data system called EQRS.