On March 22, 2023, CMS issued updated guidance for home dialysis services performed in a skilled nursing facility or nursing home. The updated guidance emphasizes having written agreements outlining arrangements between an End Stage Renal Dialysis (ESRD) facility and a nursing home and provides that an agreement establishes a connection between both entities and fosters accountability that is vital to patient health and the success of the care plan. The revised guidance also clarifies that the ESRD facility should collaborate with the nursing home to develop and implement protocols for the delivery of dialysis services, and to the extent possible, ensure that nursing home dialysis patients are provided the same standard of care as dialysis patients receiving treatments in a dialysis facility. The updated guidance also covers qualifications and training of any dialysis administering personnel and coordination of care.