42 U.S.C. § 426-1 : US Code - Section 426-1: End stage renal disease program

Search 42 U.S.C. § 426-1 : US Code - Section 426-1: End stage renal disease program

(a) Entitlement to benefits
Notwithstanding any provision to the contrary in section 426 of
this title or subchapter XVIII of this chapter, every individual
who -
(1)(A) is fully or currently insured (as such terms are defined
in section 414 of this title), or would be fully or currently
insured if (i) his service as an employee (as defined in the
Railroad Retirement Act of 1974 [45 U.S.C. 231 et seq.]) after
December 31, 1936, were included within the meaning of the term
"employment" for purposes of this subchapter, and (ii) his
medicare qualified government employment (as defined in section
410(p) of this title) were included within the meaning of the
term "employment" for purposes of this subchapter;
(B)(i) is entitled to monthly insurance benefits under this
subchapter, (ii) is entitled to an annuity under the Railroad
Retirement Act of 1974 [45 U.S.C. 231 et seq.], or (iii) would be
entitled to a monthly insurance benefit under this subchapter if
medicare qualified government employment (as defined in section
410(p) of this title) were included within the meaning of the
term "employment" for purposes of this subchapter; or
(C) is the spouse or dependent child (as defined in
regulations) of an individual described in subparagraph (A) or
(B);
(2) is medically determined to have end stage renal disease;
and
(3) has filed an application for benefits under this section;
shall, in accordance with the succeeding provisions of this
section, be entitled to benefits under part A and eligible to
enroll under part B of subchapter XVIII of this chapter, subject to
the deductible, premium, and coinsurance provisions of that
subchapter.
(b) Duration of period of entitlement
Subject to subsection (c) of this section, entitlement of an
individual to benefits under part A and eligibility to enroll under
part B of subchapter XVIII of this chapter by reasons of this
section on the basis of end stage renal disease -
(1) shall begin with -
(A) the third month after the month in which a regular course
of renal dialysis is initiated, or
(B) the month in which such individual receives a kidney
transplant, or (if earlier) the first month in which such
individual is admitted as an inpatient to an institution which
is a hospital meeting the requirements of section 1395x(e) of
this title (and such additional requirements as the Secretary
may prescribe under section 1395rr(b) of this title for such
institutions) in preparation for or anticipation of kidney
transplantation, but only if such transplantation occurs in
that month or in either of the next two months,
whichever first occurs (but no earlier than one year preceding
the month of the filing of an application for benefits under this
section); and
(2) shall end, in the case of an individual who receives a
kidney transplant, with the thirty-sixth month after the month in
which such individual receives such transplant or, in the case of
an individual who has not received a kidney transplant and no
longer requires a regular course of dialysis, with the twelfth
month after the month in which such course of dialysis is
terminated.
(c) Individuals participating in self-care dialysis training
programs; kidney transplant failures; resumption of previously
terminated regular course of dialysis
Notwithstanding the provisions of subsection (b) of this section -

(1) in the case of any individual who participates in a self-
care dialysis training program prior to the third month after
the month in which such individual initiates a regular course of
renal dialysis in a renal dialysis facility or provider of
services meeting the requirements of section 1395rr(b) of this
title, entitlement to benefits under part A and eligibility to
enroll under part B of subchapter XVIII of this chapter shall
begin with the month in which such regular course of renal
dialysis is initiated;
(2) in any case in which a kidney transplant fails (whether
during or after the thirty-six-month period specified in
subsection (b)(2) of this section) and as a result the individual
who received such transplant initiates or resumes a regular
course of renal dialysis, entitlement to benefits under part A
and eligibility to enroll under part B of subchapter XVIII of
this chapter shall begin with the month in which such course is
initiated or resumed; and
(3) in any case in which a regular course of renal dialysis is
resumed subsequent to the termination of an earlier course,
entitlement to benefits under part A and eligibility to enroll
under part B of subchapter XVIII of this chapter shall begin with
the month in which such regular course of renal dialysis is
resumed.
(c) (!1) Continuing eligibility of certain terminated individuals
For purposes of this section, each person whose monthly insurance
benefit for any month is terminated or is otherwise not payable
solely by reason of paragraph (1) or (7) of section 425(c) (!2) of
this title shall be treated as entitled to such benefit for such
month.