The California Department of Health has issued an All Facilities Letter (AFL 07-23) allowing skilled nursing facilities (SNFs) to provide peritoneal and hemodialysis services as an optional service. SNFs wishing to offer these services must apply for approval and meet the End Stage Renal Dialysis (ESRD) standards for federal certification. Dialysis services will only be available to residents of the facility, not the general public. If the SNF does not employ qualified personnel to provide dialysis services, they must have a written agreement with outside resources meeting the standards for providing such services. SNFs that provided dialysis services before June 13, 2007, may continue to do so pending approval of their application, as long as it is filed by October 15, 2007. Hemodialysis technicians must work under the immediate supervision of a licensed registered nurse. The letter aims to ensure the safe delivery of dialysis services to vulnerable populations in SNFs.

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