CMS Pub. 100-16, ch. mc86c16b, § 40.3

Pursuant to section 1851(a)(3)(B) of the Act, MAOs are not permitted to enroll individuals with

ESRD. However, a SNP may enroll individuals with ESRD if it has obtained a waiver from CMS to

be open for enrollment to individuals with ESRD under 42 CFR 422.52(c). MAOs should request

this waiver as part of the SNP application. The ESRD waiver is available to all types of SNPs.

CMS’s decision to grant an ESRD waiver is conditional upon the SNP arranging access to services

specifically targeted to individuals living with ESRD (e.g., nephrologists, hemodialysis centers, and

renal transplant centers).

SNP applicants requesting an ESRD waiver must complete an upload document as part of the SNP

application. This document must include:

• A description of how the applicant intends to monitor and serve the unique needs of the

ESRD enrollees, including their care coordination.

• A list of any additional service(s) provided to enrollees with ESRD, including a

description of how/why these services are relevant to ESRD enrollees. Additional

benefits may include, but are not limited to:

- Transportation;

- Support groups (e.g., enrollee, family, caregiver); and

- Self-care education (e.g., nutrition, wound care).

• A description of the interdisciplinary care team’s role in the assessment and delivery of

services needed by enrollees with ESRD.

• A list of the contracted nephrologist(s) that meets the current CMS-required health services

delivery (HSD) access criteria.

• A list of the contracted dialysis facility(ies) that meets the current CMS-required HSD

access criteria.

• A description of the dialysis options available to enrollees (e.g., home dialysis,

nocturnal dialysis).

• A list of the contracted kidney transplant facility(ies).

• A description of enrollee access to contracted kidney transplant facility(ies), including the

average distance enrollees in each county served by the SNP must travel to reach a

contracted kidney transplant facility.

SNPs that did not initially elect to enroll ESRD individuals at the time of application must submit a

new SNP application if they wish to begin enrolling individuals with ESRD. Refer to section 30 of

this chapter for further guidance on the SNP application process. Once CMS approves the ESRD

waiver, the SNP must allow all eligible ESRD individuals to enroll, in accordance with the Medicare

Advantage Enrollment and Disenrollment Guidance.