Effective July 1, 2001, a disability beneficiary diagnosed with ALS will not have
to serve the 24-month Medicare waiting period. Effective July 23, 2020, the 5-month
DIB entitlement waiting period is also waived for claimants with ALS.
The date of entitlement to Medicare is the date of entitlement to disability (DOED)
benefits or July 1, 2001, whichever is later. If ALS onset is established later than
the month of initial disability onset (i.e., initial onset is based on another disability), but the ALS onset is still within the 24-month Medicare waiting period,
Medicare entitlement begins with the ALS onset month or July 1, 2001, whichever is
later.
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Use the diagnosis code 3350 to identify an ALS diagnosis. This can be the Primary
(DIG) or Secondary (SDIG) diagnosis.
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Annotate a new hospital insurance (HI) period code of "W" on the Master Beneficiary
Record (MBR) to designate these cases as "NO WAITING PERIOD."
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The supplemental medical insurance (SMI) period code is "I" (Initial Enrollment Period).
NOTE: This legislation only affects Title II and Title XVIII eligibility and has no impact
on Title XVI eligibility. In addition, this legislation does not include non-ALS anterior
horn cell diseases (e.g., Werdnig-Hoffmann disease, spinal muscular atrophy).