The 1972 Amendments to the Social Security Act extended health insurance coverage to people who have Chronic Renal Disease (CRD) and require dialysis (including peritoneal dialysis) or kidney transplantation. Effective October 1, 1978, amendments to title II and title XVIII of the Social Security Act made significant modifications in the CRD provisions of the Medicare program. By law, it is designated the End-Stage Renal Disease (ESRD) program although SSA will in its communications to claimants continue to refer to it by the less ominous term, “chronic renal disease.”
is entitled to monthly social security benefits, or to an annuity under Railroad Retirement Act (RRA), or
fully or currently insured (see HI 00801.201 and HI 00801.400) or entitled to monthly social security benefits or to an annuity under RRA, and
have ESRD, and is undergoing regular dialysis or has received a kidney transplantation, andhas filed an application; the CMS-43 (Application for Hospital Insurance Benefits for Individuals with End Stage Renal Disease) is the prescribed application form. However, any signed request for, or inquiry about, Medicare on behalf of a specified ESRD patient is considered an application filed as of the date of receipt by SSA, CMS, or RRB, (or the date of the postmark if more advantageous), provided it is perfected by filing of the prescribed application within 6 months after the month its completion is requested in writing. If an individual dies the application may be filed by a proper applicant on his behalf after the patient’s death (see HI 00801.196). The application's retroactivity is limited to 12 months from the application date of inquiry (as described above). Finalization of the regulatory authority for the policy providing that an application may be effectively filed after the claimant’s death was published March 25, 1983.
If the above requirements for entitlement are met, entitlement to R-HI begins the earliest of the first day of:
the 3rd month after the month in which dialysis begins; orthe month dialysis begins, if before the qualifying period would have ended, the individual begins a self-dialysis training program in a renal Medicare approved center, has completed or is expected to complete the program, and can reasonably be expected to self-dialyze after the training (i.e., effective 10/1/78, the qualifying period may be waived in cases of appropriate self-dialysis training), or
the month dialysis is resumed following a previously terminated period of R-HI (i.e., no new qualifying period, 10/78 on, if prior R-HI entitlement existed); or