Effective July 1, 2001, a disability beneficiary diagnosed with ALS will not have
to serve the 24-month Medicare waiting period. 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
The Diagnosis code 3350 is used to identify an ALS diagnosis. This can be the Primary
(DIG) or Secondary (SDIG) diagnosis.
A new hospital insurance (HI) period code of "W" will be annotated on the MBR that
will indicate these cases as "NO WAITING PERIOD."
The supplemental medical insurance (SMI) period code will be "I" (Initial Enrollment
NOTE: This legislation only affects Title II and Title XVIII and has no impact on Title
XVI entitlement. In addition, this legislation does not include non-ALS anterior horn
cell diseases (e.g., Werdnig-Hoffmann disease, spinal muscular atrophy, etc.).