HI 00820.105 Cessation of Renal Disease (RD)

AUDIENCE: BA, BATA, CCDIPS, ER, LCC, RECOVR, EE, EHS, EIE, IES

Entitlement to HI/SMI under the renal disease (RD) provisions ends with the last day of the 12th month after the month in which a course of dialysis treatment terminates or the last day of the 36th month after the month in which the individual receives a successful kidney transplant. Entitlement to HI /SMI based on 24 months of entitlement to disability benefits ends with the month after the month of notification of cessation of benefit entitlement or, effective 12/80, the 24th month after the month of cessation of disability if the beneficiary had a TWP. Therefore, when HI/SMI entitlement terminates under either of these provisions, the action to be taken depends upon whether entitlement exists under the other.

As there is no fully automated methods to effectuate HI/SMI terminations based on RD cessation, such terminations must be processed via either the MISCOR CIP R facility or the MADCAP program. Generally, the MISCOR facility will be utilized to remove the RD indicator from the MBR when HI/SMI entitlement continues based on entitlement to disability benefits, while the MADCAP facility will be utilized to terminate Medicare coverage for nonbeneficiary RD claimants, and to terminate such coverage for monthly beneficiaries where the RD termination occurs in the 24th month of disability entitlement or earlier. Instructions for processing RD terminations through MISCOR and MADCAP are located in SM 00613 and SM 00618 respectively.