ESRD & Disability

6. ESRD & Disability
*6.1 End Stage Renal Disease – Provider Resources on Medicare*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/center/esrd.asp	N/A	N/A	CMS	Partner	Link
This site, web page, or URL contains information of interest to the ESRD Community. You will find important links related to Billing and Payment, Data, ESRD Quality Initiative and Enrollment and Participation.
*6.2 Physician’s Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant Services*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/MLNProducts/downloads /Book_Kidney_Dialysis-Final.pdf	1/07	50	CMS	Partner	ICN 006558
This booklet explains to physicians how Medicare helps pay for kidney dialysis and kidney transplant services in the Original Medicare Plan, also known as fee-for-service. If patients are in a Medicare Advantage Plan, which includes Medicare Managed Care Plans, Medicare Private Fee-for-Service Plans, and Medicare Preferred Provider Organization Plans, their plan must give them at least the same coverage as the Original Medicare Plan, but it may have different rules. The costs, rights, protections, and/or choices of where patients get their care may be different if they are in one of these plans, and they may be able to get extra benefits. Physicians should encourage patients to read their plan materials or call their benefits administrator for more information.
*6.3 Getting Help with Medicare Prescription Drug Plan Costs, Information for Medicare Beneficiaries With Disabilities*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.ssa.gov/pubs/10118.pdf	1/07	2	SSA	Beneficiary	05-10118
This fact sheet is designed to provide you with background information concerning Social Security’s role in the Medicare Modernization Act (MMA).
Spanish
*6.4 Medicare Coverage of Kidney Dialysis and Kidney Transplant Services*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.medicare.gov/Publications/Pubs/pdf/10128.pdf	11/04	64	CMS	Beneficiary	10128
This booklet discusses how to get Medicare if kidneys fail, how Medicare helps pay for kidney dialysis and kidney transplants, and where to get help.
Braille	Large Print		Audiotape (English)
Spanish	Audiotape (Spanish)		Large Print (Spanish)
*6.5 Dialysis Facility Compare Brochure*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.medicare.gov/Publications/Pubs/pdf/10208.pdf	3/07	2	CMS	Beneficiary	10208
A fact sheet to assist with accessing the comparative quality and facility information for Medicare certified dialysis facilities found in Dialysis Facility Compare.
*6.6 Preparing for Emergencies: A Guide for People on Dialysis*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.medicare.gov/Publications/Pubs/pdf/10150.pdf	11/02	37	CMS	Beneficiary	10150
A booklet for people on dialysis in emergency situations.
Spanish
*6.7 You Can Live - Your Guide to Living with Kidney Failure*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.medicare.gov/Publications/Pubs/pdf/02119.pdf	2/07	48	CMS	Beneficiary	02119
This booklet gives tips on treating kidney failure, making treatments better, and living a healthier lifestyle.
*6.8 Medicare ESRD Network Organizations Manual*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/manuals/downloads/eno114c5.pdf	8/05	45	CMS	Partner	100-14
This reference identifies the chapters within the Medicare ESRD Network Organizations Manual, which can be found in the IOM section of the CMS site, web page, or URL.
*6.9 Emergency Preparedness and Response by the National Kidney Foundation*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.kidney.org/help/	N/A	N/A	National Kidney Foundation	Beneficiary	Link
This site, web page, or URL provides information for providers, patients and families. See also QIO/ESRD network FAQ for people in a hurricane with kidney disease who need dialysis.
*6.10 Dialysis Facility Compare Quality Measures*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/ESRDQualityImproveInit/downloads/Measures.pdf	N/A	1	CMS	Partner	Reference
This reference provides the three quality measures for which Dialysis Facility Compare (DFC) reports for Medicare-approved dialysis facilities across the nation.
*6.11 FirstStep: Benefits for People who are Homeless – Online Tool*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/apps/firststep/index.html	N/A	N/A	CMS	Partner	Tool
The U.S. Department of Housing and Urban Development (HUD) developed this online tool for case managers and outreach workers to help assist their clients who are homeless access Federal benefit programs. Clients who are homeless need to access Federal mainstream benefit programs in five basic assistance categories: Food, Income, Health Care, Housing, and Employment. FirstStep provides information and tips on several mainstream benefit programs within each of these categories. Critical care services vary by state – see list of Federal services.
*6.12 Access to LTC Pharmacies for Beneficiaries Residing in IMDs and ICFs/MR*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/PrescriptionDrugCovContra/ 11_RxContracting_ThirdParty.asp	10/06	N/A	CMS	Partner	Link
This site, web page, or URL features IMD & ICF/MR Pharmacy Access Guidance in the form of Frequently Asked Questions (FAQ) regarding pharmacy access for people residing in intermediate care facilities for the mentally retarded (ICFs/MR) and institutes for mental disease (IMDs). It also contains State Contacts for ICF-MR/ IMD Providers (see p.3-4), and State Run Veterans Homes.
*6.13 Dialysis Facilities Compare – Online Tool*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.medicare.gov/Dialysis/Home.asp	1/07	N/A	CMS	Partner	Tool
Dialysis Facility Compare is a consumer-oriented online tool that allows consumers to review and compare facility characteristics and quality information on all Medicare approved dialysis facilities in the United States. This information can help consumers, especially dialysis patients, choose a dialysis facility that meets their needs and/or stimulate patients to discuss this information with their dialysis caregiver. Another goal of the website is to drive quality improvement efforts by the dialysis facilities by publicly reporting facility-specific information.
*6.14 ESRD Network Organizations*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/ESRDNetworkOrganizations/	12/05	N/A	CMS	Partner	Link
This site, web page, or URL provides information on End-Stage Renal Disease (ESRD) Network Program consisting of a national network of 18 ESRD Networks, responsible for each U.S. state, territory, and the District of Columbia. ESRD Networks work with consumers, ESRD facilities, and other providers of ESRD services to refine care delivery systems to make sure ESRD patients get the right care at the right time. Also contains a job aid, visual aid, or tool on the Agency’s first breakthrough initiative, Fistula First. The purpose of the initiative is to increase the use of fistulas when Medicare beneficiaries with kidney failure require hemodialysis – learn more from the official initiative website and download publications to use in patient education. See also description of the ESRD Quality Initiative.
*6.15 End Stage Renal Disease Composite Payment Rate System*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/MLNProducts/downloads /ESRDCompRatePaymentSys.pdf	1/05	4	CMS	Partner	Tip Sheet
This tip sheet highlights significant policy changes in the ESRD composite payment rate system that were published in the November 15, 2004 Final Rule for End Stage Renal Disease (ESRD).
*6.16 Train-the-Trainer Module 6. Medicare for People with ESRD*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/NationalMedicareTrainingProgram/TL/list.asp	3/07	76	CMS	Partner	Classroom
This classroom training module focuses on those beneficiaries entitled to Medicare because of End-Stage Renal Disease or a disability. It consists of PowerPoint slides with speakers’ notes used in national Train-the-Trainer workshops. It provides in-depth information on eligibility, benefits, Medicare health plan options, Medigap guaranteed issue rights, and legislative changes affecting these two populations. Refer to the Training Library for updates.
*6.17 Benefits for People with Disabilities – Social Security Administration*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.socialsecurity.gov/disability	N/A	N/A	SSA	Partner	Link
This site, web page, or URL hosted by the Social Security Administration (SSA) offers resources helpful to people with disabilities. The Social Security and Supplemental Security Income disability programs are the largest of several Federal programs that assist people with disabilities. Social Security Disability Insurance pays benefits to you and certain members of your family if you are "insured," meaning that you worked long enough and paid Social Security taxes. Supplemental Security Income pays benefits based on financial need.
*6.18 Medicaid Waivers and Demonstrations*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/MWDL/list.asp	3/07	N/A	CMS	Partner	Link
Comprehensive library containing information about state-specific Medicaid waiver and demonstration programs. Users can access fact sheets, copies of proposals, approval letters, and other documents related to specific programs across the country. It includes links to Section 1115 Research & Demonstration Projects, Section 1915(b) Managed Care/Freedom of Choice Waivers, and Section 1915(c) Home and Community-Based Services Waivers.
*6.19 Long-Term Care Roadmap to Medicaid Reform*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/NewFreedomInitiative/ downloads/LTC%20Roadmap%20to%20Reform.pdf	N/A	5	CMS	Partner	Tip Sheet
Tip sheet describing new options to support individuals with disabilities and long-term care needs. See also latest news on New Freedom Initiative (NFI) opportunities. NFI is a nationwide effort to remove barriers to community living for people of all ages with disabilities and long-term illnesses. It represents and important step in working to ensure that all Americans have the opportunity to learn and develop skills, engage in productive work, choose where to live and participate in community life. Learn more about mental health, Psychiatric Residential Treatment Facilities (PRTF) Demonstration, as well as Money Follows the Person (MFP) grants, and grants to states for children with mental illness.
*6.20 Demonstration Project for Medical Adult Day Care Services*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/ContractorLearning Resources/downloads/JA3660.pdf	2/05	3	CMS	Partner	Notice
Notice (MLN article) describing demonstration project available through select home health agencies in WI, TX, PA, NY, FL to meet the day-time needs of individuals with functional or cognitive impairments. Useful for Home Health Agencies (HHAs) participating in the Medicare Demonstration Project for Medical Adult Day-Care Services. See more recent press release.
*6.21 HHS Office on Disability*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.hhs.gov/od/	2/07	N/A	DHHS	Partner	Link
Site, web page, or URL maintained by the HHS Secretary's Office on Disability, hosting a library of resources. Includes links to SSA's 2006 Red Book, Emergency Preparedness for people with disabilities, 508 access, Surgeon General's Call to Action, DisabilityInfo.gov - the New Freedom Initiative's online resource for Americans with Disabilities, etc.
*6.22 DisabilityInfo.gov*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.socialsecurity.gov/disability	4/06	N/A	Department of Labor	Partner	Link
This site, web page, or URL serves as the federal government's one-stop connection for information of interest to people with disabilities, their families, employers, service providers and others. Published by the U.S. Department of Labor’s Office of Disability Employment Policy (ODEP), it includes information from the Department of Homeland Security on disaster relief, disaster preparedness, emergency preparedness, and an interactive map of state and local disability resources.
*6.23 Part D Access for Medicare Eligible Children*
Web Address	Pub Date	No. of Pages	Published By	Appropriate Audience	Pub Number/ Type
http://www.cms.hhs.gov/PrescriptionDrugCov Contra/downloads/MemoChildrenESRD_07.11.06.pdf	7/06	1	CMS	Partner	Notice
This latest notice explains that plans must facilitate exceptions and appeals for Medicare eligible children and ensure that medically necessary medications are provided. Children under 20 years of age are only eligible for Medicare under the End Stage Renal Disease (ESRD) provision of the law. These children either require regular dialysis or have received a kidney transplant. The total population of children entitled to the ESRD benefit is estimated at somewhere around 4,000 and most are also eligible for Medicaid.

Resource Guide for Partners

ESRD & Disability

Spanish