CMS SOM App. H, Tag V560

(4) The dialysis facility

must ensure that all dialysis patients are seen by a physician, nurse practitioner, clinical

nurse specialist or physician’s assistant providing ESRD care at least monthly, as

evidenced by a monthly progress note placed in the medical record, and periodically while

the hemodialysis patient is receiving in-facility dialysis.

Interpretive Guidance § 494.90(b)(4):

This requirement ensures that patients see a medical practitioner (i.e., physician, advanced

practice registered nurse or physician assistant) at least monthly. The patient may see the

practitioner in the dialysis facility (before, during or after treatment), or in the physician’s

office. If the patient is seen in the physician’s office, the record of care for that visit must be

available in the patient’s dialysis medical record.

“Periodically while the hemodialysis patient is receiving in-facility dialysis” refers to in-center

patients and should generally result in at least quarterly practitioner visits at the dialysis center

during dialysis treatment. By periodically visiting the patient in the dialysis facility, the

physician has an opportunity to assess the patient’s response to treatment and observe the team's

care.

At a minimum, monthly medical progress notes should document that a physician or a non-physician practitioner (i.e., advanced practice registered nurse or physician assistant) has seen

each patient, addressed their status, and reviewed their plan for renal and active comorbid

problems.

A monthly visit is required for each home patient by either a physician, an advanced practice

registered nurse, or a physician assistant. This visit may be conducted in the dialysis facility, at

the physician’s office, or in the patient’s home (either in person or through telehealth).

Section 50302 of the Balanced Budget Act of 2018 amended sections 1881(b)(3) and 1834(m) of

the Social Security Act to allow home dialysis patients the option to receive certain ESRD-related clinical assessments via telehealth. Effective January 1, 2019, home dialysis patients

may choose to receive ESRD-related clinical assessments via telehealth. In order to receive

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clinical assessments via telehealth, the amendment requires the home dialysis patient to receive

a face-to face clinical assessment (without the use of telehealth), i.e. “in person” visits, at least

once a month during the initial 3 months of home dialysis; and then at least once every 3

consecutive months thereafter (83 FR 59452, 59495 (Nov. 23, 2018).