
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC426-1]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
  SUBCHAPTER II--FEDERAL OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE 
                                BENEFITS
 
Sec. 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
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    \1\ So in original. Probably should be ``(d)''.
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    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.
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    \2\ See References in Text note below.
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(Aug. 14, 1935, ch. 531, title II, Sec. 226A, as added Pub. L. 95-292, 
Sec. 1(a), June 13, 1978, 92 Stat. 307; amended Pub. L. 97-248, title 
II, Sec. 278(b)(2)(C), Sept. 3, 1982, 96 Stat. 561; Pub. L. 97-448, 
title III, Sec. 309(b)(1), Jan. 12, 1983, 96 Stat. 2408; Pub. L. 99-272, 
title XIII, Sec. 13205(b)(2)(B), Apr. 7, 1986, 100 Stat. 317; Pub. L. 
103-296, title II, Sec. 201(a)(3)(D)(ii), Aug. 15, 1994, 108 Stat. 
1497.)

                       References in Text

    The Railroad Retirement Act of 1974, referred to in subsec. 
(a)(1)(A), (B), is act Aug. 29, 1935, ch. 812, as amended generally by 
Pub. L. 93-445, title I, Sec. 101, Oct. 16, 1974, 88 Stat. 1305, which 
is classified generally to subchapter IV (Sec. 231 et seq.) of chapter 9 
of Title 45, Railroads. For further details and complete classification 
of this Act to the Code, see Codification note set out preceding section 
231 of Title 45, section 231t of Title 45, and Tables.
    Parts A and B of subchapter XVIII of this chapter, referred to in 
text, are classified to sections 1395c et seq. and 1395j et seq., 
respectively, of this title.
    Section 425(c) of this title, referred to in subsec. (c), was 
repealed by Pub. L. 104-121, title I, Sec. 105(a)(4), Mar. 29, 1996, 110 
Stat. 853.


                               Amendments

    1994--Subsec. (c). Pub. L. 103-296 added subsec. (c) relating to 
continuing eligibility of certain terminated individuals.
    1986--Subsec. (a)(1)(A)(ii), (B)(iii). Pub. L. 99-272 substituted 
``medicare qualified government employment'' for ``medicare qualified 
Federal employment''.
    1983--Subsec. (a)(1)(B)(iii). Pub. L. 97-448 substituted ``section 
410(p)'' for ``410(p)'' and struck out ``after December 31, 1982,''.
    1982--Subsec. (a)(1)(A). Pub. L. 97-248 designated existing 
provisions as cl. (i), substituted ``within the meaning of the term 
`employment' for purposes of this subchapter'' for ``in the term 
`employment' as defined in this chapter'', and added cl. (ii).
    Subsec. (a)(1)(B). Pub. L. 97-248 designated ``is entitled to 
monthly insurance benefits under this subchapter'' as cl. (i), 
substituted ``(ii) is entitled to an annuity under the Railroad 
Retirement Act of 1974'' for ``or an annuity under the Railroad 
Retirement Act of 1974'', and added cl. (iii).
    Subsec. (a)(1)(C), (D). Pub. L. 97-248 combined former subpars. (C) 
and (D) into subpar. (C) and substituted a reference to individuals 
described in subpar. (A) or (B) for a more detailed definition of such 
individuals.


                    Effective Date of 1994 Amendment

    Amendment by Pub. L. 103-296 applicable with respect to benefits 
based on disability (as defined in section 425(c)(9) of this title) 
which are otherwise payable in months beginning after 180 days after 
Aug. 15, 1994, with Secretary of Health and Human Services to issue 
regulations necessary to carry out such amendment not later than 180 
days after Aug. 15, 1994, see section 201(a)(3)(E)(i) of Pub. L. 103-
296, set out as an Effective Date of 1994 Amendment; Sunset Provision 
note under section 425 of this title.


                    Effective Date of 1986 Amendment

    Amendment by Pub. L. 99-272 effective after Mar. 31, 1986, with no 
individual to be considered under disability for any period beginning 
before Apr. 1, 1986, for purposes of hospital insurance benefits, see 
section 13205(d)(2) of Pub. L. 99-272, set out as a note under section 
410 of this title.


                    Effective Date of 1983 Amendment

    Section 309(c)(2) of Pub. L. 97-448 provided that: ``Any amendment 
to the Social Security Act [this chapter] made by this section [amending 
this section and sections 410, 1320c-2, 1320c-3, 1395d, 1395f, 1395r, 
1395y, 1395cc, 1395mm, 1395ww, 1396b, 1396n, 1396o, and 1396p of this 
title] shall be effective as if it had been originally included as a 
part of that provision of the Social Security Act to which it relates, 
as such provision of such Act was amended or added by the Tax Equity and 
Fiscal Responsibility Act of 1982 [Pub. L. 97-248, Sept. 3, 1982, 96 
Stat. 324].''


                    Effective Date of 1982 Amendment

    Amendment by Pub. L. 97-248 effective on and after Jan. 1, 1983, see 
section 278(c)(2)(A) of Pub. L. 97-248, set out as a note under section 
426 of this title.


                             Effective Date

    Section effective with respect to services, supplies, and equipment 
furnished after the third calendar month beginning after June 13, 1978, 
except that provisions for the implementation of an incentive 
reimbursement system for dialysis services furnished in facilities and 
providers to become effective with respect to a facility's or provider's 
first accounting period beginning after the last day of the twelfth 
month following the month of June 1978, and except that provisions for 
reimbursement rates for home dialysis to become effective on Apr. 1, 
1979, see section 6 of Pub. L. 95-292, set out as an Effective Date of 
1978 Amendment note under section 426 of this title.

                  Section Referred to in Other Sections

    This section is referred to in sections 410, 418, 1320a-7a, 1395c, 
1395i-2a, 1395w-23, 1395y, 1395rr of this title; title 10 section 1086.
