CMS SOM App. H, Tag V684

(1) Nurse manager. The facility must have a nurse

manager responsible for nursing services in the facility who must—

(i) Be a full time employee of the facility;

(ii) Be a registered nurse; and

(iii) Have at least 12 months of experience in clinical nursing, and an additional 6 months of

experience in providing nursing care to patients on maintenance dialysis.

Interpretive Guidance § 494.140(b)(1)(i)-(iii):

“Responsible for nursing services” means the nurse manager provides oversight and direction to

all direct care staff that provide dialysis and nursing care in the facility, including but not

limited to, input into hiring, evaluating, and terminating these staff.

The nurse manager is the only staff person who must be a direct employee of the facility rather

than a contracted employee, e.g. person for whom the facility files a W-2 Tax Form, supervises

nursing staff in the dialysis facility, oversees nursing care, makes management and budgetary

decisions, etc.

“Full-time” means the nurse manager is available to work in the dialysis facility the number of

hours that the facility is open or as facility policy requires for full-time employment. For

example, a dialysis facility that is only open for 24 hours a week would need to employ the nurse

manager for 24 hours a week to satisfy this requirement. If the facility is open 6 days a week or

provides nocturnal dialysis, the nurse manager would need to be available to work at least 40

hours a week, and provide on-call coverage, in rotation with other qualified staff, all hours that

the facility is open, including night and weekend hours.

The nurse manager must be registered and licensed to practice in the applicable State. They

must have at least 12 months experience as a registered nurse, and an additional 6 months

experience as a registered nurse providing clinical nursing care to patients on maintenance

dialysis, in either a chronic or acute setting.

The same registered nurse(s) who meets these requirements may fulfill multiple nursing roles in

the dialysis facility as long as the facility has an adequate number of qualified nurses present

while patients are dialyzing to meet patients’ clinical needs for the level of dialysis care

provided. Refer to V758.