US · guidance
CMS SOM App. H, Tag V683
§ 494.140(a)(2) – If a physician, as specified in paragraph (a)(1) of this section, is not
available to direct a certified dialysis facility another physician may direct the facility,
subject to the approval of the Secretary.
Interpretive Guidance § 494.140(a)(2):
If the facility is using a physician as medical director who does not meet the requirement at §
494.140(a)(1), there must be documentation available that the Secretary of HHS approved the
facility’s use of the physician as medical director.
An on-site survey is not required to determine the approval or denial of a medical director
waiver request. A desk review may be conducted and CMS should evaluate all materials
Page 263 of 420
submitted by the dialysis facility when reviewing and processing a waiver request. Reference
State Operations Manual, Ch. 2, Section 2281B for additional information on the review of a
medical director waiver request.
History
Rev.
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
1888706070d4318baf315a6fd4638f0d5dcb749b4d8e78642e0e196d2443801e
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.