If the patient dies before an ESRD Medicare application is filed, the application
may be filed by his/her legal representative, a surviving spouse, child, or parent,
or by a supplier of dialysis services, i.e., by anyone who could file an application
for him/her if he/she were 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 he/she were 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.