Basic (05-11)

DI 11052.040 Termination of Medicare Coverage Based on End-Stage Renal Disease

Medicare based on End-Stage Renal Disease (ESRD) (R-HI and R-SMI) ends with the earliest of one of the following events:

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  The date of death of the beneficiary;

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  The last day of the 36^th month following the month in which the beneficiary receives a kidney transplant, unless on or before such last day he or she receives another transplant or begins a new course of dialysis. For example, transplant occurred in 01/06, Medicare terminates 01/31/09. (Although coverage prior to 10/78 is limited to 12 months after the month of the transplant, the 12 months limitation affects only transplants occurring prior to 09/77 in light of the overlap of 12 months and 36 months coverage provision); or

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  The last day of the 12^th month following the month in which the beneficiary terminates dialysis, unless on or before such last day, he or she receives a transplant or begins a new course of dialysis. For example, dialysis ends in 01/08; Medicare ends 01/31/09.

NOTE: If the beneficiary is entitled to Medicare as an aged or disabled beneficiary, see HI 00801.248. Subsections E-G explain when we extend drug coverage for transplants in ESRD cases.

References:

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  HI 00801.248, Effect of Immunosuppressive Drug Coverage on Filing for R-HI and R-SMI

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  HI 00820.030, Termination of R-HI

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  HI 00820.035, Termination of SMI Entitlement