The California Department of Health has issued an All Facilities Letter (AFL) providing updated guidance on the provision of home dialysis services in skilled nursing facilities (SNFs). The letter outlines the primary options for residents to receive dialysis treatments, including in-center services at a Medicare-certified End Stage Renal Disease (ESRD) facility or a licensed Chronic Dialysis Clinic (CDC), and home dialysis services in a SNF under a collaborative arrangement with an approved ESRD or CDC. The updated guidance allows a dialysis facility meeting federal standards to provide dialysis services to SNF residents in their "home" setting. The letter also details the responsibilities of the dialysis facility and the SNF, components of the written agreement between the two, and requirements for onsite supervision and administration of dialysis services. SNFs seeking to provide peritoneal or hemodialysis services must apply for approval of the optional service. No additional approval is required from CMS for a qualified, federally-certified dialysis facility to enter into an arrangement with a SNF, but the dialysis facility must notify CDPH of any arrangement.

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