CMS SOM App. H, Tag V581

ensure through its interdisciplinary team, that home dialysis services are at least equivalent

to those provided to in-facility patients and meet all applicable conditions of this part.

Interpretive Guidance § 494.100:

Home dialysis patients are considered part of the census of the ESRD facility and are entitled to

the same rights, services, and efforts to achieve expected patient outcomes as the in-center

dialysis patients of the facility. The requirements of 42 CFR part 494, including those listed at

the Conditions for patients’ rights, patient assessment, patient plan of care, and QAPI, apply

equally to home dialysis patients and in-center dialysis patients.

Home dialysis patients include those receiving peritoneal dialysis (PD) and hemodialysis (HD)

therapies at home. At the time of publishing these regulations (April 15, 2008, 73FR20369),

there were:

1. Two methods of PD routinely available to home patients: continuous ambulatory peritoneal

dialysis (CAPD), and continuous cycling peritoneal dialysis (CCPD), also known as

automated PD (APD); and,

2. Three methods of HD routinely available to home patients: conventional home HD

(treatments generally 3 to 4 hours, 3 days a week), short daily home HD (2-3 hours, 5-6

days/week), and, nocturnal home HD (6-8 hours, 3 to 6 nights/week).

At the time of publication of these regulations (April 15, 2008, 73 FR 20369), several different

technologies for home hemodialysis were available. These included: conventional water

treatment components and single-pass (conventional) dialysis machines; integrated systems

which used manufacturer packaged, bagged dialysate or which incorporated water treatment

and dialysate preparation and delivery into one system; and, sorbent-based systems which

utilized columns (cartridges) of chemicals to regenerate the used dialysate for recirculation

through the dialyzer. All of these, and any future home hemodialysis technologies developed,

present the home dialysis facility with both common and unique challenges for monitoring to

ensure the continued efficacy and safety of the home hemodialysis patients’ treatments.

The IDT as defined at V501 consists of, at a minimum, the patient or the patient’s designee (if the

patient chooses), a registered nurse, a physician treating the patient for ESRD, a social worker,

and a dietitian who meet the requirements as specified under the Condition for Personnel

qualifications. Most home dialysis patients are active participants in their care and actively

engaged with the IDT in their plan of care.

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The medical records of home dialysis patients should contain evidence of the care and

management aspects of patient assessment, plan of care development and implementation of that

plan of care by the facility IDT as outlined in these regulations.