Memorandum  Solo Home Hemodialysis Guidance

Date:	04/01/2022
Referenced Sources:	105 CMR 145.00

Memorandum

TO: At-Home Dialysis Providers

FROM: Elizabeth Kelley, MBA, MPH Bureau Director, Bureau of Health Care Safety and Quality

DATE: April 1, 2022

RE: Solo Home Hemodialysis

Pursuant to 105 CMR 145.000, home hemodialysis is defined as chronic maintenance dialysis performed at home by a trained patient with the assistance of a trained partner.  This memorandum provides guidance to providers of at-home dialysis services that are seeking a waiver of the requirement that home dialysis be performed by a trained partner.

The Centers for Medicaid and Medicare (CMS) does not prohibit solo home hemodialysis (HHD) and Department of Public Health will allow waivers for providers seeking to allow patients to complete home hemodialysis alone.

Those providers seeking a waiver must, at minimum, meet the following requirements prior to allowing a patient to conduct solo HHD and be able to provide documentation of the same if required by the Department:

• A sleep cycle assessment has been completed on the patient and that HHD will only be completed during the hours that a patient is awake. 
• A provider must ensure that the patient is conducting solo HHD in a bedside chair, and not in a bed. 
• Providers must conduct home visits at least three times a year to verify cannulation, safe needle taping, use of safety devices such as needle dislodgement and fluid detection systems as mandated by the device manufacturer and to verify that there are no changes in the home environment that could impact when solo HHD could be safely performed, including an assessment for sleep cycle changes. 
• The provider has established an emergency plan with the patient and must review the plan at each visit. 
• The provider must develop and have available if required, patient selection guidelines, including but not limited to factors such as: stability of treatment, stability of patient access to treatment, a patient’s cognitive functioning, a review of co-morbidities that may affect the patient’s ability to stay alert, including obstructive sleep apnea, a patient’s mental health that may affect treatment compliance, a patient’s mobility, and a home safety evaluation. 

• A provider must develop and have available if required, informed consent policies which include informing patients of the risks and benefits of treatment and solo HHD and informing patients of their rights to have all questions answered by their treating nephrologist.

All providers must adhere to all other Department regulations and sub-regulatory guidance pertaining to home dialysis.

For further questions, please contact the Bureau of Health Care Safety and Quality at [phone].