My husband is recently out of the hospital in ESRD, doing HD in clinic via Central catheter. He wants his PD catheter placed, and we want to get trained immediately on PD, because he has no insurance and the ESRD Medicare insurance starting December 24th, will start retroactively the first day of HD (Sept 23) if we get trained in PD within 90 days. His 16 days in hospital, subsequent ER visit to replace the poorly placed central catheter, and current m,w,f HD in clinic will not be covered if we cannot get trained in the next few weeks. Our clinic says trainings are closed due to the Baxter fluid shortage. This is unacceptable. We can still be trained, be signed off by a dr, and wait to start PD when Baxter is providing fluids again. My husband has a right to his insurance, and we need to find a place to train us since our clinic is stonewalling us. Do you have suggestion about how we can obtain training and getting a catheter placed?
Thank you so much.
He should be covered while using the port. Technically he is doing dialysis. Who told you he wasn’t?
There has been a shortage of Baxter PD solution because the only plant in the U.S. that makes PD fluid for Baxter PD machines was damaged in Hurricane Helene. However, it appears from this HHS notice that efforts are underway to resolve this shortage. The Baxter plant has reopened and begun shipping PD fluids and HHS approved importing PD fluids from overseas.
https://www.hhs.gov/about/news/2024/10/18/fact-sheet-hhs-continues-action-increase-access-supply-iv-fluids-hurricane-helene.html
If your husband’s clinic and nephrologist haven’t seen this, it might mean that they can start moving ahead with PD. He will need to have a PD catheter placed and he could do HD until his exit site heals. Talk with the doctor about whether he can get the catheter placed now and start training down the road after the exit site has healed. Medicare will pay for up to 15 days of training for PD, but most people can learn PD much faster, often in a week or so.
As you were probably told, there is a 3-month waiting period for Medicare if someone chooses to do in-center dialysis. However, if his first dialysis treatment was September 23, 2024, he just needs to START home training by December 1, 2024 to get Medicare backdated to September 1 to hopefully cover the medical expenses he had the month dialysis started. Here’s a booklet that describes Medicare coverage for dialysis and transplant. https://www.medicare.gov/publications/10128-medicare-coverage-esrd.pdf.
There is a 3-month waiting period for Medicare for people with kidney failure. If a patient starts training for home dialysis before the end of that period, Medicare can be backdated to the first of the month dialysis started.
Thank you, Beth, for making this clear for me. I will go back to my husband’s doctors on Monday and push a little harder for PD catheter placement date, and for the training to begin. I’m being told they can’t train me because of the Baxter fluid shortage. I maintain they can train me anyway because I will understand what’s necessary whether or not the fluids are available.
Another option is to check to see if there is a Fresenius clinic nearby. Fresenius provides dialysis care and makes PD machines and supplies. I don’t believe Fresenius manufacturing was impacted by the hurricane. I found this press release that might be of interest.
6 month waiting period for disability to kick in and 3 months for Medicare to kick in
Call around to different dialysis clinics if your a patient on dialysis they are to put you on a waitlist
The waiting period for SSDI is actually 5 months. The first check is paid in the 6th month. There is a 3-month waiting period for Medicare UNLESS you get a transplant or you start home dialysis training before the end of that 3-month period. In either of those cases, Medicare can be backdated to the month of the transplant or the first day of the month you started dialysis.
Thank you. I just realized last night that we can do home hemodialysis. He has a Central cath, and I never knew that hhd was an option until last night when I was rereading the CMS guidelines. So I spoke with a nephrologist today and asked her to please speak to the education nurse at DaVita where he does his dialysis, and ask her to contact me. I realize we only have a small window of time here. Unfortunately my husband just went back into the hospital with pneumonia, and a mass in his right lung. So starting training for home dialysis has now got a wrench in it… Three hospitalizations in 37 days… we somehow need to get that training started to get that Medicare backdated.
I reviewed the 2728 form, and tried to explain to the doctor they just need to “start” training, and sign off that they expect we would be able to do it. And that would be enough to have it go through.
I will keep pushing. Thank you again for your support. It means so much right now. 
Dear Beth,
My husband started dialysis in the hospital September 23rd. He’s been in and out of the hospital for over 2 months and finally I spoke with the home dialysis nurse trainer today. I want to double-check about the Medicare 2728 process. Are we still within the window to start training in order to back date the Medicare to September? I don’t know who to call to ask so I thought I would ask you. Thank you so much! Ruth
He needs to START home training before December 1, 2024, to have Medicare backdate to September 1, 2024. The CMS 2728 form at Section D asks these questions about home training:
This patient is expected to complete (or has completed) training and will self-dialyze on a regular basis. … Yes No
Date when patient completed, or is expected to complete, training (mm/dd/yyyy)
Medicare allows up to 15 training days for PD or 25 training days for home HD. Most people learn PD in a week or so, but it often takes 3-6 weeks to learn home HD.
If your husband is a candidate for PD, that would be the fastest training and is often recommended as a first treatment. Toward that end, the FDA is temporarily allowing Baxter to import of PD dialysate from overseas. Knowing this might make a difference with his clinic if he still is interested in PD.
For now, he has a central cath. We might switch to PD in the future, but Chris’s health is tenuous.
Transfusion dependent anemia. Happily, 8.2 this week. But, he’s been very ill with lung cancer, surgery to remove tumor entirely blocking right main stem bronchus two weeks ago through bronchoscopy. Entire right lung is full of cancer nsclc, squamous, so they were able to clean out the upper right lobe but have not gone in to clean out the lower two lobes yet. Doing radiation. Really tough days, but tolerating well. I’m an RN, Home Care. So we brought him home on Friday even though it was recommended he go to SNF. He’s started to eat better. Generally doing better overall. Moving around more. Home is always better.
With no insurance, and the pressure of losing this window to train for HHD, I was freaking out… We got the call from the trainer today that they could probably accommodate us. So we might be able to get the Medicare retroactively after all.
Beth, you have been a lifesaver with your information. I read the CMS site. I understand what I’m reading, but trying to get others to understand what I’m telling them is so frustrating.
Gratefully,
Ruth
Dear Beth,
Although I understand all we’ve been texting about, and what I read on the CMS site, I’m still getting pushback from DaVita.
They say I have 90 days from September 23rd to start training, that’s when he first started dialysis, when he was inpatient and first diagnosed.
I maintained that what I’ve read and what you’ve told me is that it’s 90 days from September 1st to December 1st. That is the window we need to start training within, in order to get the retroactive Medicare to September 1.
Fortunately the home trainer met with us with us today. Unfortunately she will not have all the supplies necessary until December 2nd.
I’m doing a giant head smack.
So frustrating.
PS, also, does Medicare make exceptions, for instance Chris was diagnosed with lung cancer in the middle of the 90 day period,and had to be treated to survive. 
The following is from the following manual which can be found at https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/ge101c02.pdf
Medicare General Information, Eligibility, and Entitlement
Chapter 2–Hospital Insurance and Supplemental Medical Insurance
**10.4.1 - Effective Date of Entitlement for Persons on Dialysis **
(Rev. 1, 09-11-02)
Entitlement usually begins after a 3-month waiting period has been served, i.e., with the
first day of the third month after the month in which a course of regular dialysis begins.
Entitlement begins before the waiting period has expired if the individual receives a
transplant or participates in a self-dialysis training program during the waiting period.
**10.4.2 - Entitlement Based on Transplant **
(Rev. 1, 09-11-02)
Entitlement begins with the month the individual is admitted as an inpatient to a hospital
for procedures in preparation for or in anticipation of a kidney transplant, provided the
transplant surgery takes place within the following 2 months. If the transplant is delayed more than 2 months after the preparatory hospitalization, entitlement begins with the second month prior to the month of transplant. Under the Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP) Benefits Improvement and Protection Act of 2000, Congress extended immunosuppressive drug benefits to lifetime, as long as the beneficiary is entitled to Medicare and was entitled to Medicare when his/her transplant took place.
10.4.3 - Effect on Self-dialysis Training on Entitlement
(Rev. 1, 09-11-02)
Entitlement begins with the first month of the course of dialysis if the individual is
expected to complete the self-dialysis training program and self-dialyze thereafter.
Who is telling you that Medicare counts from the specific day in the month when dialysis starts. This is not true. Medicare ALWAYS starts counting the 3-month qualifying (waiting) period with the first day of the month that dialysis started. A patient’s Medicare card will always show a start date of the first day of the month, never mid-month.
Suggest that the dialysis clinic refer to the Medicare manual above and the Medicare Coverage for Kidney Dialysis and Kidney Transplant Services booklet at https://www.medicare.gov/publications/10128-medicare-coverage-esrd.pdf.
This booklet explains when Medicare begins if a patient does not start home dialysis training as the first day of the 4th month of dialysis. The following is in a chart on page 5 of that booklet I can’t copy to this site. What it says is:
July - First month of dialysis.
August - Second month of dialysis.
September - Third month of dialysis.
October - Fourth month of dialysis. Medicare coverage begins
In your husband’s case:
September - First month of dialysis
October - Second month of dialysis
November - Third month of dialysis.
December - Fourth month of dialysis. Medicare coverage begins 12/1/2024.
Home Dialysis Central has a Medicare calculator that I used to enter the date that he started dialysis and here’s what it gave me.
When Will Medicare Start To Pay For Dialysis?
You entered September 23rd, 2024 as your first day of dialysis.
If you do standard in-center dialysis:
Medicare will not start until December 1st, 2024 (1st day of the 4th month.)
If you start training for PD, home HD, or in-center self-care before December 1st, 2024:
The clinic can send in forms to back-date Medicare to September 1st, 2024.
If you train for PD, home HD, or in-center self-care ON OR AFTER December 1st, 2024:
Medicare will start on December 1st, 2024.
*NOTE: The clinic may have already sent the CMS 2728 form to Social Security or filled out the CMS 2728 data on CROWNWeb without training dates. If so, the clinic can add the home training dates in CROWNWeb and mail a supplemental CMS 2728 with the training dates so Medicare will backdate coverage.
So, to get backdating, your husband’s home training needs to start before December 1. Can the nurse get the equipment and supplies expedited? Could he start home training at a different clinic that has equipment and supplies on hand?
I wish I was, but I am not aware of any exception that would extend the time to start home training to get backdating. That would be a question to ask Social Security.