Medicare Program; Revisions to the Definition of End-Stage Renal Disease and Resumption of Entitlement

요약

We propose to revise the definition of end-stage renal disease to reflect that more than one dialysis treatment is required for there to be a ``regular course of dialysis'' and to require that generally accepted diagnostic criteria and laboratory findings must form the basis of the physician's certification of end-stage renal disease. The purpose of this proposed revision is to eliminate any misinterpretation of the definition of end-stage renal disease. We propose to do so by clarifying that only those individuals whose kidneys have failed and for whom the disease is expected to be a lifelong affliction are eligible for Medicare end-stage renal disease benefits. We also propose to amend the regulations to specify that Medicare entitlement is resumed for individuals who again begin a regular course of renal dialysis treatments after a previous course is terminated (with or without a transplant), and to add the same considerations for those who have a second transplant. Therefore, the purpose of these proposed revisions is to conform the regulations more closely to the intent of sections 226A (c)(2) and (c)(3) of the Social Security Act regarding resumption of entitlement to Medicar