Basic (03-86)

DI 45001.088 Subsequent Determination of Deferred Decision, Denial of Earlier R-HI/ R-SMI Entitlement Based on Self-Dialysis Training

You were previously advised that we could notify you later if your Medicare coverage could begin at an earlier date. However, it has been determined from the information given to the Social Security Administration about your training in self-care dialysis, that you are not eligible for coverage prior to the date we previously established. Therefore, the beginning date of your hospital insurance coverage will remain as          and the beginning date of your medical insurance coverage will remain as          .

Generally, Medicare coverage based on kidney dialysis treatment does not start until a qualifying period of 2 months is served after the month in which dialysis treatment begins. However, coverage can begin immediately with the month dialysis treatment starts if the person has undergone or is undergoing self-care dialysis training in a program offered by a Medicare approved facility. Although you participated in self-care dialysis training in           at                  , that facility did not meet the required standards to be a medicare approved self-care dialysis training facility. Therefore, your coverage cannot begin until after the usual qualifying period.

If you believe this determination is not correct, you may request that your case be reexamined. If you want this reconsideration, you must request it not later than 60 days from the date you receive this notice. You may make your request through any social security office. If additional evidence is available, you should submit it with your request.