ESRD Beneficiary

ESRD Beneficiary means a beneficiary who meets any of the following:
(1) Is receiving dialysis or other services for end-stage renal disease, up to and including the month in which the beneficiary receives a kidney transplant up to and including the month in which the beneficiary receives a kidney transplant.
(2) Has already received a kidney transplant and has a non-AKI dialysis or MCP claim at least 12 months after the beneficiary's latest transplant date.
(3) Has a kidney transplant failure less than 12 months after the beneficiary's latest transplant date as identified by:
(i) Two or more MCP claims in the180 days following the date on which the kidney transplant was received;
(ii) 24 or more maintenance dialysis treatments at any time after 180 days following the transplant date; or,
(iii) Indication of a transplant failure after the beneficiary's date of transplant based on data from the Scientific Registry of Transplant Recipients (SRTR) database.
(4) If a beneficiary meets more than one of criteria described in paragraphs (3)(i) through (iii) of this definition, the beneficiary will be considered an ESRD beneficiary starting with the earliest month in which transplant failure was recorded.

Source

42 CFR § 512.310

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Scoping language

For purposes of this subpart, the following definitions apply.

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