DI 45010.025 ESRD Medicare Continuance—Completion of SSA-892-U3 Determination Form

1. A. 

   If timely medical evidence of continuing entitlement to R-HI/R-SMI is obtained (i.e., evidence of a new transplant or a new course of dialysis is received before the actual termination action is forwarded for processing), prepare an SSA-892-U3 as follows:

   1. 1. 

      Complete items 1-14.

   2. 2. 

      Complete items 19 block C.

   3. 3. 

      Complete item 30, showing the date dialysis began (resumed) or the date of the last transplant.

   4. 4. 

      Complete item 36 to show “none” if dialysis continues; if not, write the diary date (first day of the 33rd month after the month of the latest transplant). It will be necessary to also prepare (and release) diary Form SSA-5015 under code 2-C-67.

   5. 5. 

      Complete items 37, 40 and 41.

      NOTE: 

      : When a system generation termination is scheduled in the PEPPER facility because Form SSA-1598 was previously processed in accordance with instructions in DI 45010.040, the ERE will forward the case to a BA via an SSA-559 and advise the BA that the termination information must be deleted from the system. When a new termination date applies based on the current medical evidence, the ERE will also complete a new Form SSA-1598 in accordance with DI 45010.040 and advise the BA to delete the earlier date before processing the current Form SSA-1598.

2. B. 

   If reversal of a previously processed termination action to continuance is appropriate, prepare an SSA-892-U3 as described in A. above, with the following exceptions:

   1. 1. 

      Check item 19, block D. Specify “reversal.”

   2. 2. 

      In a transplant situation, prepare a new SSA-1598 per DI 45010.040.

   In addition to preparation of the SSA-892-U3, send a notice of continuance of ESRD Medicare to the claimant (original to the claimant and a copy for the folder). The suggested language for the notice is in DI 45001.093; this language is designed mainly for the more prevalent situations. Modify it if necessary to fit the rarer variations to the resumption of dialysis after transplant.

   Prong file the original (folder) copy on the left side and release the district office and data copies without the folder.