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.