HI 00830.055 Delayed Terminations
A. Delayed Termination of Disability Benefits
An individual who has not reached the 25th month of entitlement to a disability benefit is not eligible for HI/SMI coverage. However, if the disabled individual is not notified and action is not taken to stop benefits prior to or equal to the 25th month of entitlement, SMI coverage will extend to the month in which benefits are terminated, although the HI award must be reversed. Code a HOC and SOC of “F” with a HTD and DTS equal to COM +1. The update of these entries to the MBR will result in a HOC of “F” and no DOEH or DOTH. It will also result in a SOC of “F” and the appropriate DTS.
B. Delayed Termination of Renal Disease Benefits
When a beneficiary receives a transplant, SSA must be notified of this event within 36 months following the transplant. When the beneficiary ceases dialysis, SSA must be notified of this event within 12 months following the cessation of treatment. Where information regarding these events is received by SSA within the proper time frames, and SSA fails to terminate the SMI coverage and fails to give notification of such termination, SMI entitlement should be extended through the end of the month in which termination action is taken (e.g., DOTS = COM +1). The HI entitlement, however, will be terminated as of the end of the 36th or 12th month following the month of transplant or cessation of dialysis. In addition to other required coding, the HOC of SOC of “K” will be coded in RID 6 of the SSA-2795-U3 and will serve as positive indicators that the discrepant DOTH/ DOTS dates are what the coder intended as opposed to a coding or keying error. The HOC/SOC will be changed to “S” for annotation purposes.