New Facility Requirements
A signed agreement between the facility and the applicable Network is required prior to the initial survey.” Based on this the Network shall enter into a signed agreement with facilities prior to an initial survey as requested by facilities, the State Survey Agency, or the Regional Office Survey and Certification staff.
Opening a New ESRD Facility in Texas
Submit the ESRD Facility Application and license fee to the Texas Department of State Health Services (DSHS)TEXAS DEPARTMENT OF STATE HEALTH SERVICES REGULATORY LICENSING UNIT FACILITY LICENSING GROUP
DELIVERY CODE 2835
P.O. BOX 149347, MC 2003
AUSTIN, TEXAS 78714-9347
- Complete the New Facility Agreement click here for the online application
- Download the Network Agreement Packet, complete the Acknowledgement Form (page 11) and Agreement form (page 12)
- Download the New Facility Handbook and submit the signed acknowledgement form (page 17).
You can submit the completed forms when completing your on-line application, email to firstname.lastname@example.org , or fax to 972-503-3219. If you have any questions, contact Debbie via email or at 469-916-3804.
Network 14 Agreement Packet for New Facilities
Once the Network has received your application and Acknowledgement Forms,
- You will receive an electronic copy of your ESRD Network 14 Agreement. Print and file it in a safe location where it can be easily accessed by any necessary staff. Surveyors will be requesting to review the Network 14 agreement during initial and re-certification surveys.
- Network staff will enter your facility into EQRS. A notification email will be sent to you once this has been completed. You will be requested to gain access to HARP/EQRS (you will need a Security Officer as well as staff assigned as Managers). For questions or assistance in accessing EQRS go to https://harp.cms.gov/login/help. Once the Network has entered your facility in EQRS, you can access the facility using the facility UPI number until a CMS Medicare Provider number is assigned. NOTE: any change in key staff personnel must be updated in EQRS within 5 business days.
- Network staff will enter your facility into EMResouce which is part of the ESRD Network 14 emergency disaster plan. EMResource is database system that provides information in live time during a natural or man-made disaster. Joining and updating EMResource is a requirement for all Texas ESRD facilities as outlined in the ESRD Network 14 Goals and Objects in your new facility packet. EMResource must be updated by the 8th of each month in accordance with State regulations.
- You will need to assign a staff member to become your facility’s Master Account Holder (MAH). The MAH is responsible for the facility’s Dialysis Facility Report (DFR). For questions please contact Sade Castro, Health Information Coordinator, at email@example.com.
- You must set up an account with NHSN/CDC to log your COVID-19 cases, BSI, and vaccination information as per CMS requirements. Please note it does take several weeks from the date you submit your application before you receive your access card, so enrolling early is very important.