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Provider Manual

End Stage Renal Disease Care Coordination

Last Updated on August 28, 2018

ESRD Definition

ESRD is defined as a stage of kidney impairment that is irreversible and permanent. ESRD requires a regular course of dialysis or a kidney transplant to maintain life. An individual who has received a kidney transplant that restores kidney function and who no longer requires a regular course of dialysis to maintain life is not considered to have ESRD. Therefore, the individual may be eligible to elect a Medicare Advantage plan.

ESRD Guidelines

Members already enrolled in Security Health Plan who subsequently become eligible for Medicare because of ESRD and aging Medicare members who subsequently develop ESRD cannot be disenrolled from the HMO as a result of the development of ESRD.

Process for submitting ESRD Annotation to CMS for Medicare Advantage is the same as that for original Medicare.