DI 45001.088 Subsequent Determination of Deferred Decision, Denial of Earlier R-HI/ R-SMI Entitlement
Based on Self-Dialysis Training
You were previously advised that we could notify you later if your Medicare coverage
could begin at an earlier date. However, it has been determined from the information
given to the Social Security Administration about your training in self-care dialysis,
that you are not eligible for coverage prior to the date we previously established.
Therefore, the beginning date of your hospital insurance coverage will remain as and the beginning date of your medical insurance coverage will remain as .
Generally, Medicare coverage based on kidney dialysis treatment does not start until
a qualifying period of 2 months is served after the month in which dialysis treatment
begins. However, coverage can begin immediately with the month dialysis treatment
starts if the person has undergone or is undergoing self-care dialysis training in
a program offered by a Medicare approved facility. Although you participated in self-care
dialysis training in at , that facility did not meet the required standards to be a medicare approved self-care
dialysis training facility. Therefore, your coverage cannot begin until after the
usual qualifying period.
If you believe this determination is not correct, you may request that your case be
reexamined. If you want this reconsideration, you must request it not later than 60
days from the date you receive this notice. You may make your request through any
social security office. If additional evidence is available, you should submit it
with your request.