5-Step Enrollment for Home Dialysis Facilities – CMS QIP

For complete detailed enrollment instructions please download the NHSN Facility Administrator Enrollment Guide March 2014. [PDF – 797K] . Please see FAQs about NHSN and the CMS ESRD QIP Rule .

Step 1: Training and Preparation

Print and follow detailed checklist [PDF – 352 KB]to ensure successful and efficient enrollment.

Complete required training and Home Dialysis Center Practices Survey [PDF – 95 KB]. Be sure to check trusted websites and spam blockers.

Time to complete step 1: 2 hours, 45 minutes

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 samshelp@cdc.gov 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

Immediately after submitting forms, receive NHSN email,
subject “NHSN facility enrollment submitted.”

Step 5: Sign and Send Consent

Using the above NHSN email, open, print, and sign the consent form. Ensure two signatures are on the form and fax to CDC.

Tip: To open the consent form, you may need to log in to SAMS using your grid card and password, and then copy and paste the link into that browser window.

Time to complete step 5: 10 minutes

Within 3 business days, receive NHSN email, subject ‘NHSN enrollment approved.’

Congratulations, enrollment is complete!