New Facility Certification
New Facilities
When opening a new dialysis facility, certain steps must be taken to meet federal and/or state compliance. Prospective new facilities should refer to the Conditions for Coverage which govern dialysis facilities and set forth the requirements dialysis providers must fulfill in order to be eligible to obtain Medicare funding.
Certificate of Need (CON)
The District of Columbia, the state of Maryland, and the state of West Virginia require a Certificate of Need (CON) when developing or acquiring a new health care facility. The Certificate of Need is a review process analyzing the population, along with financial feasibility, quality, accessibility, and the state health plan, to determine the need for additional services in a particular area.
Survey Process
Once granted CON approval, the facility should then contact the local State Survey Agency for their area and notify them of intent.
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District of Columbia Department of Health: Health Care Facilities Division
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Virginia Department of Health: Office of Licensure and Certification
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West Virginia Office of Health Facility Licensure & Certification (OHFLAC)
The State Surveyor, as an agent of the Centers for Medicare & Medicaid Services (CMS), will process and evaluate the facility, followed by an on-site survey. After the on-site survey, the facility contact will be notified of the outcome. If the facility meets all ESRD program requirements as set forth by the Conditions for Coverage, the facility will be issued a Medicare Provider number for use with all dialysis-related Medicare claims.
Visit the CMS Quality Safety & Oversight - Guidance to Laws & Regulations web page for further guidance on laws & regulations related to dialysis facility certification.
End Stage Renal Disease Quality Reporting System (EQRS) Requirements
Pursuant to the Conditions for Coverage, facilities are required to submit patient data through an electronic data system called EQRS.
Network Membership
Once the Centers for Medicare & Medicaid Services (CMS) issue a Medicare Provider Number to the facility, a copy of the official certification letter is sent to the Network. Facilities should email a copy of the letter they receive to the Network at network5@qualityinsights.org.
Facilities may initiate a Membership Agreement below, once the facility has received their National Provider Identification (NPI) number. Please see the steps below to initiate your new facility's Network Membership Agreement. You may download or print your agreement during this process. Your facility should maintain the executed agreement on-site, in the event surveyors request it.
Opening a New ESRD Facility in Virginia, West Virginia, Maryland, or District of Columbia
Initiate Membership Agreement
1. Complete and submit this form to initiate your new facility's Membership Agreement with Network 5
2. Obtain access to the following national data systems:
3. Hang Network 5 Grievance Posters (English or Spanish) in area visible by patients. Contact the Network at network5@qualityinsights.org to request additional or larger copies.
After CMS Certification
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Once the Centers for Medicare & Medicaid Services (CMS) issue a Medicare Provider Number to the facility, facilities should email a copy of the letter they receive to the Network at network5@qualityinsights.org.
Important Resources
Email Alison Crittenden at the Network office at acrittenden@qualityinsights.org or call Alison at 804-320-0004, Ext. 2707, with any questions.