For notification to beneficiary of actual termination of Medicare, the notices shown
in DI 45001.098 and DI 45001.099 will be assigned by the earnings review examiner using an SSA-865 (or SSA-573 if
appropriate) to the benefit authorizer. These notices of ESRD based terminations of
Medicare include conversions from R-HI and/or R-SMI based on age 65 or disability.
Be especially careful that notice of conversions to disability based HI-SMI will not
be premature—i.e., is there an open CDR or has the issue of CDR been recently resolved
to impending disability termination which may (or may not) affect D-HI/D-SMI entitlement
in the near future? A disability (CDR) examiner must be consulted in such cases before
notification is assigned. File the form on the left side of the folder on top of the
In termination involving a beneficiary for which the MBR shows RRB jurisdicition (“P” option codes), send a manual notice (either DI 45001.103 or DI 45001.104). It is important that the beneficiary be advised that the notice of termination
refers only to ESRD Medicare and that his/her HI/SMI entitlement will continue based
on the Medicare determination made by RRB.