CMS SOM App. H, Tag V592

(1) …Services include, but are not limited to, the

following: (iv) Patient consultation with members of the interdisciplinary team, as needed.

Interpretive Guidance § 494.100(c)(1)(iv):

The home dialysis patients must have access to members of the IDT (i.e. registered nurse,

dietitian, social worker, physician treating the patient, as defined at V501), who must be

available to provide clinical services as needed by the patient. The IDT should include the staff

member who is responsible for the coordination of that patient’s care. Contact may be in-person,

by phone, by mail or by email with confirmation of patient receipt. The required minimum

frequency of contacts may be defined by facility policy, but must meet the individual needs of

each patient in accordance with their plan of care.

Note the requirements at V510 for initial and periodic evaluation of all patients by a qualified

social worker and at V509 for evaluation by a qualified dietitian.

Stable home dialysis patients are not seen frequently at the dialysis facility. . The facility must

have a policy regarding how the appropriate IDT member will consult with the home dialysis

patient and to ensure that the home patient’s dialysis care provided by the IDT is equivalent to

in-center patients. Records of patient consultation by the physician must be documented in the

patient’s medical record at the facility. Because they are not frequently on-site at the facility,

home dialysis patients may see their physicians in their offices instead of seeing their physicians

at the dialysis facility. If patients see their physicians in the physician’s office, there must be a

system in place to transfer information related to the care of the home patient from the

physician’s office to the dialysis facility.

Note: The requirement at § 494.90(b)(4) (V560), which calls for at least monthly evaluation of

all dialysis patients by a physician or another licensed practitioner is separate and distinct from

any supportive patient consultations provided by an IDT member.