5-Step Enrollment for Home Dialysis Facilities – CMS QIP
For complete detailed enrollment instructions please download the NHSN Facility Administrator Enrollment Guide March 2018. [PDF – 797K] . Please see FAQs about NHSN and the CMS ESRD QIP Rule .
Step 1: Training and Preparation
Step 2: Register
Agree to Rules of Behavior and register facility with NHSN using CMS Certification Number (CCN) or CDC assigned enrollment ID.
Time to complete step 2: 10 minutes
After registration, you will receive two emails: ‘Welcome to NHSN!’
arrives from NHSN immediately and ‘Invitation to Register’
arrives from SAMS-no-reply within 24 hours.
Step 3a: Register with SAMS
From the ‘Invitation to Register’ email, log in to SAMS with your username (i.e., email address) and temporary password provided. Accept the SAMS Rules of Behavior and complete the online SAMS registration form.
Time to complete step 3a: 16 minutes
Within 24 hours of successful online registration,
receive SAMS ‘Identity Verification Request’ email.
Step 3b: Complete and Submit Identity Proofing Verification
From the ‘Identity Verification Request’ email, print the Identity Verification Form, complete it, and take it to a notary public for endorsement. Fax the form and supporting documentation to CDC. You will receive ‘SAMS Account Activation’ and ‘SAMS Activity Authorization’ emails when your access is approved.
To access SAMS, you must receive your SAMS grid card, which will be delivered to your home address via U.S. mail within 14-21 days of your SAMS approval email. If you do not receive your grid card within 21 days, please contact email@example.com for assistance.
Time to complete step 3b: 35 minutes
Step 4: Submit NHSN Forms Electronically
Log in to SAMS using your password and SAMS grid card and select ‘NHSN Enrollment.’ Submit required NHSN forms online, including facility contact information.
Time to complete step 4: 32 minutes
Shortly after successfully submitting the forms, the Facility Administrator
and Primary Contact will receive a “NHSN Facility Enrollment Submitted” email.
Step 5: Submit Consent
Login to NHSN, select the appropriate component, and review the “Agreement to Participate and Consent”. Check the box to ‘Accept’ next to the appropriate contact name and then ‘Submit’ the form in each component.
Time to complete step 5: 5 minutes
Congratulations, enrollment is complete!
- Page last reviewed: January 27, 2017
- Page last updated: February 9, 2018
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