If the patient dies before an ESRD Medicare application is filed, the application
may be filed by a legal representative, a surviving spouse, child, or parent, or by
a supplier of dialysis services, i.e., by anyone who could file an application if
alive but unable to transact business, see HI 00801.196.B. However, benefits that would have been paid to, or on behalf of, the patient if
alive will be paid in accordance with GN 02335.025.
EXAMPLE: In 9/02, Mr. Jackson, a fully insured worker, files a CMS-43 on behalf of his son,
Alan, who died in 4/02 at age 17 of complications following kidney transplantation.
Alan began a regular course of dialysis on 2/15/02, but entered the hospital in 3/02
and had a transplant that month.
The application Mr. Jackson filed in 9/02 permits entitlement beginning 3/1/02, the
first month in which Alan met all R-HI eligibility requirements. However, if the application
were not filed until May 2003, the 12 month limit on retroactivity would be the controlling
factor and no entitlement to R-HI could be established.