End-Stage Renal Disease Dialysis Facility
Initial Application Packet
A dialysis clinic may be certified as an End-Stage Renal Disease (ESRD) facility in California. An ESRD facility is an entity that provides outpatient maintenance dialysis services, or home dialysis training and support services, or both, pursuant to Title 42 Code of Federal Regulations (CFR) section 494.10
General Medicare Process Reminder
Providers seeking Medicare certification must first complete and submit an enrollment application through the Centers for Medicare and Medicaid Services (CMS), prior to submitting an ESRD application packet to the Centralized Applications Branch (CAB). Information on Medicare enrollment, applicable forms, and instructions can be found on the CMS website (https://www.cms.gov/medicare/provider-enrollment-and-certification). If you receive a recommendation of approval letter from the Medicare Administrative Contractor (MAC) for California, Noridian Healthcare Solutions, include a copy of this letter along with your ESRD application packet to CAB.
To apply for Initial certification, you must complete the required application packet. Refer to 42 CFR Part 494, Subpart A for the Conditions For Coverage For End-Stage Renal Disease Facilities.
How to Apply
An applicant must submit a completed application packet to CAB. The provider instructions are a resource to guide you through the process. The provider checklist identifies the required forms and supporting documents needed to apply for certification.
Please refer to the following links to get started:
Application Packet Forms
Where to Submit Applications
Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.
California Department of Public Health
Licensing and Certification Division
Centralized Applications Branch
P.O. Box 997377, MS 3207
Sacramento, CA 95899-7377