Washington State DOH has revised the application form that providers and potential providers must use to request a Certificate of Need to build a new or expand an existing dialysis facility in Washington State. Find a copy of the revised application at https://www.doh.wa.gov/Portals/1/Documents/2300/2019/ESRDApp2019.pdf. Letters of Intent for the 2019 “Special Circumstances, Cycle One” review of CoN applications must be filed by April 1, 2019. Call 360-236-2955 or email DOH at FSLCON@doh.wa.gov if you have questions. For more information on Washington CoN, see https://www.doh.wa.gov/LicensesPermitsandCertificates/FacilitiesNewReneworUpdate/CertificateofNeed.
Dialysis providers that wish to be considered during 2019 in Concurrent Review situations for Washington State dialysis facility applications must file specific information with the WA Department of Health Certificate of Need Program before February 15, 2019. WA DOH has already downloaded information on Home Training, Shift Beginning After 5pm, SMR, and SHR from your DFC or DFR, and TPS from your QIP PSR.* The additional information providers need to submit by February 15 includes:
- From the DFR:
- Nursing Home Patients from Table 1
- Average Number of Comorbid Conditions from Table 12
- From the Medicare Cost Report (MCR)
- Net Patient Revenues from Worksheet F-1
- Total Provider Treatments from Worksheet C
DOH encourages submission earlier than February 15 if possible. Submission after February 15 will disqualify a provider from 2019 Concurrent Review Applications.
The applicable pages from these reports, for each dialysis facility owned or operated in Washington State, and for any out-of-state facilities that may potentially be used as a comparable facility, should be emailed to firstname.lastname@example.org in PDF format. Though not required, a cover page that identifies which facilities are included is strongly recommended.
If any of the data elements above (from any of the DFR, DFC, MCR, or QIP) are unavailable for any reason, an exemption request can be submitted until February 28, 2019. Valid reasons for an exemption could include, but are not limited to, any of:
- A facility has opened too recently and data has not yet been published
- Volumes at the facility are insufficient to generate a score
- A change of ownership has taken place and valid data under your ownership and control does not yet exist
Regardless of the reason for your exemption request, it must be clear that absence of data is not a result of failure to report to CMS, and you must provide any applicable documentation.
Call DOH CoN at 360-236-2955 if you have any questions.
*PS: See our Acronyms table at https://nwrnbulletins.wordpress.com/abbreviations/ if we ever use abbreviations you don’t recognize.
CMS is preparing to improve rules for Accrediting Organizations (AOs) that on contract survey healthcare facilities for Medicare Certification. They are requesting public comment on whether it should be considered a conflict of interest for an AO to also accept consulting fees from the corporation that’s opening the new facility. Comments are due by approximately February 18, 2019 (sixty days after publication of the RFI in the Federal Register, scheduled for December 20, 2018). The RFI is summarized at https://www.cms.gov/newsroom/fact-sheets/medicare-program-cms-requests-stakeholder-feedback-accrediting-organizations-conflict-interest-and. The proposed Federal Register text can be found at https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-27506.pdf.
CMS has announced in the Federal Register that Accreditation Commission for Health Care, Inc. has applied to be recognized as an approved national accrediting organization for ESRD facilities. CMS is requesting comments about their application, with a deadline of December 3, 2018. For details see https://www.federalregister.gov/documents/2018/11/02/2018-23925/medicare-and-medicaid-programs-accreditation-commission-for-health-care-inc-achc-for-approval-of-its.
CMS has published a comprehensive update of chapter 2 (ESRD) of the State Operations Manual (SOM), which describes the oversight activities of State Survey Agencies for certified Medicare providers and suppliers. Chapter 2 of the SOM includes guidance and instructions on procedures for ESRD facilities, including nursing homes. The update incorporates current Conditions for Coverage, and CMS policies for ESRD issued previously through memoranda. Find the document at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO18-22-ESRD.pdf.
Kidney Care Partners (https://www.pr.com/press-release/744275) has summarized the ESRD-related provisions of the new budget law, H.R.1892 – Bipartisan Budget Act of 2018; the Act “will expand the use of home dialysis therapy through use of telehealth services; expedite patient access to quality dialysis care at newly certified facilities; and extend authority for Special Needs Plans (C-SNPs) without interruption in care.” In addition, payments for non-emergency ambulance use are reduced.
While the legislation as passed and signed may not be effective until HHS converts it to administrative law, the original lawyerese can be found at:
- For home health telehealth, https://www.congress.gov/bill/115th-congress/house-bill/1892/text#toc-HD17800AE048F430AB1B9EEFBB03FDD55.
- For newly certified units: “an initial survey of a … renal dialysis facility … shall be initiated not later than 90 days after such date on which both the provider enrollment form … [is] complete and the provider’s enrollment status indicates approval is pending the results of such survey,” https://www.congress.gov/bill/115th-congress/house-bill/1892/text#toc-H63740900ED184AAFA50F73B6BE696312.
- For continued access to Medicare Advantage special needs plans for vulnerable populations, https://www.congress.gov/bill/115th-congress/house-bill/1892/text#toc-H89926B550ADD45858E6C1A410176952E.
- For reduction of non-emergency ESRD ambulance transport payments, https://www.congress.gov/bill/115th-congress/house-bill/1892/text#toc-HC2CE8E0B05404D7CAB3E35F887FDC255.
The Greater Puget Sound Chapter #503 of ANNA will present their 2018 Renal Update February 1-2, 2018 in Lynnwood WA. Topics include incivility, surveys, iatrogenic death, teach-back, calciphylaxis, difficult conversations, passion and compassion, AKI, organ donation, ultrafiltration, lupus, hyponatremia, hyperoxaluria, and the future of dialysis. Registration is online only, and closes on January 29, 2018. Discounts are available until 11:30 pm PST January 10, 2018. For more information see https://s3-us-west-2.amazonaws.com/nwrn.org/files/N/ANNA/RenalUpdate2018.pdf.