Duration of Coordination Period

20.1.1 - Duration of Coordination Period (Rev. 11755, Issued:12-21-2022, Effective: 01-23-2023, Implementation: 01-23-23) The coordination period is a period that begins with the earlier of the first month of entitlement to or eligibility for Medicare Part A based on ESRD. Eligibility refers to the first month the individual would have become entitled to Medicare Part A on the basis of ESRD if he/she had filed an application for such benefits. The Balanced Budget Act (BBA) of 1997, extended the coordination period from 18 months to 30 months. Eligibility refers to the first month the individual would have become entitled to Medicare Part A on the basis of ESRD if an application were filed for such benefits. In the rare case of an untimely application by an individual, the coordination period could begin with the first month in which the individual would have been entitled to Medicare benefits if a timely application had been filed. It is not necessary to consider this possibility absent a specific indication, e.g., information that the transplant occurred before the first month of entitlement. If further development is required, A/B MACs and DME MACs contact the RO. When the coordination period begins before the month the individual becomes entitled to Medicare, the A/B MACs and DME MACs pay secondary benefits for the portion of the period during which the individual is entitled. Medicare entitlement usually begins with the third month after the month in which the individual starts a regular course of dialysis. However, for individuals who undertake a course in self-dialysis training or who receive a kidney transplant during the 3-month waiting period, Medicare may be the secondary payer for up to the first 30 months of the individual's entitlement. Individuals eligible for Medicare on the basis on ESRD cannot enroll for Part B during a Special Enrollment Period (SEP)SEP, but can defer entitlement to both Part A and B and file an initial application later, usually at the end of the coordination period. More examples illustrating when Medicare pays secondary in cases of ESRD entitlement and eligibility are found at 42 CFR § 411.162(d).