(a) License designation. An agency may not provide peritoneal dialysis or hemodialysis services in a client's residence, independent living environment, or other appropriate location unless the agency holds a license to provide licensed home health or licensed and certified home health services and designated to provide home dialysis services. In order to receive a home dialysis designation, the agency must meet the licensing standards specified in this section and the standards for home health services in accordance with Subchapter C of this chapter (relating to Minimum Standards for All Home and Community Support Services Agencies) and §558.401 of this subchapter (relating to Standards Specific to Licensed Home Health Services), except for §558.401(b)(2)(A) and (B) of this subchapter. If there is a conflict between the standards specified in this section and those specified in Subchapter C of this chapter and §558.401 of this subchapter, the standards specified in this section will apply to the home dialysis services.
(b) Governing body. An agency must have a governing body. The governing body must appoint a medical director and the physicians who are on the agency's medical staff. The governing body must annually approve the medical staff policies and procedures. The governing body on a biannual basis must review and consider for approval continuing privileges of the agency's medical staff. The minutes from the governing body of the agency must be on file in the agency office.
(c) Qualifications and responsibilities of the medical director.
  (1) Qualifications. The medical director must be a physician licensed in the State of Texas who:
    (A) is eligible for certification or is certified in nephrology or pediatric nephrology by a professional board; or
    (B) during the five-year period prior to September 1, 1996, served at least 12 months as director of a dialysis facility or program.
  (2) Responsibilities. The medical director must:
    (A) participate in the selection of a suitable treatment modality for all clients;
    (B) assure adequate training of nurses in dialysis techniques;
    (C) assure adequate monitoring of the client and the dialysis process; and
    (D) assure the development and availability of a client care policy and procedures manual and its implementation.
(d) Personnel files. An agency must have individual personnel files on all physicians, including the medical director. The file must include the following:
  (1) a curriculum vitae which documents undergraduate, medical school, and all pertinent post graduate training; and
  (2) evidence of current licensure, and evidence of current United States Drug Enforcement Administration certification, Texas Department of Public Safety registration, and the board eligibility or certification, or the experience or training described in subsection (c)(1) of this section.
(e) Provision of services. An agency that provides home staff-assisted dialysis must, at a minimum, provide nursing services, nutritional counseling, and medical social service. These services must be provided as necessary and as appropriate at the client's home, by telephone, or by a client's visit to a licensed ESRD facility in accordance with this subsection. The use of dialysis technicians in home dialysis is prohibited.
  (1) Nursing services.
    (A) An RN, licensed by the State of Texas, who has at least 18 months experience in hemodialysis obtained within the last 24 months and has successfully completed the orientation and skills education described in subsection (f) of this section, must be available whenever dialysis treatments are in progress in a client's home. The agency administrator must designate a qualified alternate to this RN.
    (B) Dialysis services must be supervised by an RN who meets the qualifications for a supervising nurse as set out in §558.244(c)(2) of this chapter (relating to Administrator Qualifications and Conditions and Supervising Nurse Qualifications).
    (C) Dialysis services must be provided by a qualified licensed nurse who:
      (i) is licensed as an RN or LVN by the State of Texas;
      (ii) has at least 18 months experience in hemodialysis obtained within the last 24 months; and
      (iii) has successfully completed the orientation and skills education described in subsection (f) of this section.
  (2) Nutritional counseling. A dietitian who meets the qualifications of this paragraph must be employed by or under contract with the agency to provide services. A qualified dietitian must meet the definition of dietitian in §558.2 of this chapter (relating to Definitions) and have at least one year of experience in clinical nutrition after obtaining eligibility for registration by the American Dietetic Association, Commission on Dietetic Registration.
  (3) Medical social services. A social worker who meets the qualifications established in this paragraph must be employed by or be under contract with the agency to provide services. A qualified social worker is a person who:
    (A) is currently licensed under the laws of the State of Texas as a social worker and has a master's degree in social work from a graduate school of social work accredited by the Council on Social Work Education; or
    (B) has served for at least two years as a social worker, one year of which was in a dialysis facility or program prior to September 1, 1976, and has established a consultative relationship with a licensed master social worker.
(f) Orientation, skills education, and evaluation.
  (1) All personnel providing dialysis in the home must receive orientation and skills education and demonstrate knowledge of the following:
    (A) anatomy and physiology of the normal kidney;
    (B) fluid, electrolyte, and acid-base balance;
    (C) pathophysiology of renal disease;
    (D) acceptable laboratory values for the client with renal disease;
    (E) theoretical aspects of dialysis;
    (F) vascular access and maintenance of blood flow;
    (G) technical aspects of dialysis;
    (H) peritoneal dialysis catheter, testing for peritoneal membrane equilibration, and peritoneal dialysis adequacy clearance, if applicable;
    (I) the monitoring of clients during treatment, beginning with treatment initiation through termination;
    (J) the recognition of dialysis complications, emergency conditions, and institution of the appropriate corrective action. This includes training agency personnel in emergency procedures and how to use emergency equipment;
    (K) psychological, social, financial, and physical complications of chronic dialysis;
    (L) care of the client with chronic renal failure;
    (M) dietary modifications and medications for the uremic client;
    (N) alternative forms of treatment for ESRD;
    (O) the role of renal health team members (physician, nurse, social worker, and dietitian);
    (P) performance of laboratory tests (hematocrit and blood glucose);
    (Q) the theory of blood products and blood administration; and
    (R) water treatment to include:
      (i) standards for treatment of water used for dialysis as described in §3.2.1 (Hemodialysis Systems) and §3.2.2 (Maximum Level of Chemical Contaminants) of the American National Standard, Hemodialysis Systems, March 1992 Edition, published by the Association for the Advancement of Medical Instrumentation (AAMI), 3330 Washington Boulevard, Suite 500, Arlington, Virginia 22201. Copies of the standards are indexed and filed in the Texas Health and Human Services Commission, 701 W. 51st Street, Austin, Texas 78751, and are available for public inspection during regular working hours;
      (ii) systems and devices;
      (iii) monitoring; and
      (iv) risks to clients of unsafe water.
  (2) The requirements for the orientation and skills education period for licensed nurses are as follows.
    (A) The agency must develop an 80-hour written orientation program that includes classroom theory and direct observation of the licensed nurse performing procedures on a client in the home.
      (i) The orientation program must be provided by an RN qualified under subsection (e)(1) of this section to supervise the provision of dialysis services by a licensed nurse.
Cont'd...