Federal Certification Requirements

The US Federal Centers for Medicare and Medicaid Services (CMS) is the branch of the government that reimburses dialysis clinics for the majority of the costs associated with long-term dialysis treatment. The CMS was assigned this responsibility many years ago because of the extreme costs associated with treatment and the inability of most patients to pay. In 2008, the CMS established new guidelines for compensation. The new rules for coverage must be followed in order for a facility to receive federal reimbursement.


The revised federal rules outlined in 42 CFR Part 494.140 are designed to focus on improving the care provided to patients. Federal requirements that are included in this legislation seek to establish up-to-date performance expectations for facilities, encourage patients to participate in their plan of care and treatment, eliminate the procedural requirements from the previous conditions for coverage, promote patient safety, and encourage continuous quality improvement. No changes to dialysis treatment regulations had been made since 1976 prior to the adoption of this updated legislation on October 14th, 2008.

Dialysis Technician Certification Requirements

According to the legislation adopted in 2008, “The dialysis facility’s staff (employee or contractor) must meet the personnel qualifications and demonstrated competencies necessary to serve collectively the comprehensive needs of the patients. The dialysis facility’s staff must have the ability to demonstrate and sustain the skills needed to perform the specific duties of their positions.” Patient care dialysis technicians must…

  • Meet all applicable State requirements for education, training, credentialing, competency, standards of practice, certification, and licensure in the State in which he or she is employed as a dialysis technician
  • Have a high school diploma or equivalency
  • Have completed a training program that is approved by the medical director and governing body, under the direction of a registered nurse, focused on the operation of kidney dialysis equipment and machines, providing direct patient care, and communication and interpersonal skills, including patient sensitivity training and care of difficult patients. The training program must include the following subjects…
      • Principles of dialysis
      • Care of patients with kidney failure, including interpersonal skills
      • Dialysis procedures and documentation, including initiation, proper cannulation techniques, monitoring, and termination of dialysis
      • Possible complications of dialysis
      • Water treatment and dialysate preparation
      • Infection control
      • Safety
      • Dialyzer reprocessing
  • Be certified under a State certification program or a national commercially available certification program, as follows…
      • For newly employed patient care technicians, within 18 months of being hired as a dialysis patient care technician; or
      • For patient care technicians employed on October 14, 2008, within 18 months after such date

Technicians who perform monitoring and testing of the water treatment system must complete a training program that has been approved by the medical director and the governing body. Documentation of issues affecting dialysis treatment personnel who actively provide care can be found on the Centers for Medicare and Medicaid Services (CMS) website. Another valuable resource for new and experienced technicians is the ESRD Network Organization that operates in the state where the individual plans to work.

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