US Code

Public Law 119-73 (01/23/2026)

42 U.S.C. § 426–1

End stage renal disease program

(a)

Entitlement to benefits

section 426 of this titleNotwithstanding any provision to the contrary in or subchapter XVIII, every individual who—
(1)
(A)
section 414 of this title45 U.S.C. 231section 410(p) of this title is fully or currently insured (as such terms are defined in ), or would be fully or currently insured if (i) his service as an employee (as defined in the Railroad Retirement Act of 1974 [ et seq.]) after , were included within the meaning of the term “employment” for purposes of this subchapter, and (ii) his medicare qualified government employment (as defined in ) were included within the meaning of the term “employment” for purposes of this subchapter;
(B)
(i)
45 U.S.C. 231section 410(p) of this title is entitled to monthly insurance benefits under this subchapter, (ii) is entitled to an annuity under the Railroad Retirement Act of 1974 [ et seq.], or (iii) would be entitled to a monthly insurance benefit under this subchapter if medicare qualified government employment (as defined in ) 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, subject to the deductible, premium, and coinsurance provisions of that subchapter.
(b)

Duration of period of entitlement

Subject to subsection (c), entitlement of an individual to benefits under part A and eligibility to enroll under part B of subchapter XVIII 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)
section 1395x(e) of this titlesection 1395rr(b) of this title 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 (and such additional requirements as the Secretary may prescribe under 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)
section 1395x(s)(2)(J) of this title shall end, in the case of an individual who receives a kidney transplant (except for eligibility for enrollment under part B solely for purposes of coverage of immunosuppressive drugs described in ), 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)—
(1)
section 1395rr(b) of this title 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 , entitlement to benefits under part A and eligibility to enroll under part B of subchapter XVIII 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)) 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 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 shall begin with the month in which such regular course of renal dialysis is resumed.

Aug. 14, 1935, ch. 531Pub. L. 95–292, § 1(a)92 Stat. 307Pub. L. 97–248, title II, § 278(b)(2)(C)96 Stat. 561Pub. L. 97–448, title III, § 309(b)(1)96 Stat. 2408Pub. L. 99–272, title XIII, § 13205(b)(2)(B)100 Stat. 317Pub. L. 103–296, title II, § 201(a)(3)(D)(ii)108 Stat. 1497Pub. L. 114–74, title VIII, § 844(b)129 Stat. 617Pub. L. 116–260, div. CC, title IV, § 402(a)(1)134 Stat. 2998(, title II, § 226A, as added , , ; amended , , ; , , ; , , ; , , ; , , ; , , .)

Editorial Notes

References in Text

act Aug. 29, 1935, ch. 812Pub. L. 93–445, title I, § 10188 Stat. 1305section 231 of Title 45section 231t of Title 45The Railroad Retirement Act of 1974, referred to in subsec. (a)(1)(A), (B), is , as amended generally by , , , which is classified generally to subchapter IV (§ 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 , , and Tables.

Amendments

Pub. L. 116–260section 1395x(s)(2)(J) of this title2020—Subsec. (b)(2). inserted “(except for eligibility for enrollment under part B solely for purposes of coverage of immunosuppressive drugs described in )” before “, with the thirty-sixth month”.

Pub. L. 114–742015—Subsec. (c). struck out subsec. (c) relating to continuing eligibility of certain terminated individuals.

Pub. L. 103–2961994—Subsec. (c). added subsec. (c) relating to continuing eligibility of certain terminated individuals.

Pub. L. 99–2721986—Subsec. (a)(1)(A)(ii), (B)(iii). substituted “medicare qualified government employment” for “medicare qualified Federal employment”.

Pub. L. 97–4481983—Subsec. (a)(1)(B)(iii). substituted “section 410(p)” for “410(p)” and struck out “after ,”.

Pub. L. 97–2481982—Subsec. (a)(1)(A). 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).

Pub. L. 97–248Subsec. (a)(1)(B). 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).

Pub. L. 97–248Subsec. (a)(1)(C), (D). 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.

Statutory Notes and Related Subsidiaries

Effective Date of 1994 Amendment

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

Effective Date of 1986 Amendment

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

Effective Date of 1983 Amendment

Pub. L. 97–448, title III, § 309(c)(2)96 Stat. 2410

42 U.S.C. 301oPub. L. 97–24896 Stat. 324“Any amendment to the Social Security Act [ et seq.] made by this section [amending this section and sections 410, 1320c–2, 1320c–3, 1395d, 1395f, 1395r, 1395y, 1395cc, 1395mm, 1395ww, 1396b, 1396n, 1396, 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 [, , ].”
, , , provided that:

Effective Date of 1982 Amendment

Pub. L. 97–248section 278(c)(2)(A) of Pub. L. 97–248section 426 of this titleAmendment by effective on and after , see , set out as a note under .

Effective Date

section 6 of Pub. L. 95–292section 426 of this titleSection effective with respect to services, supplies, and equipment furnished after the third calendar month beginning after , 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 , see , set out as an Effective Date of 1978 Amendment note under .