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CMS-2728 Crosswalk 508 3-9-23 clean.docx

End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration (CMS-2728)

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Crosswalk for Changes to Section 226A of the Social Security Act

End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration (CMS-2728)

Table. Crosswalk to Section 226A of the Social Security Act

Section of Current CMS-2728 (10/22)

Type of Change

Rationale for Change

Section A #3

Add: Place for Social Security Number

Necessary for improved identification for coverage benefits

Section A #7

Add: Place for Alternate Phone Contact

Necessary for improved contact during disasters and emergencies

Section A #8

Add: Selection of pronouns

Provide inclusion for gender identity

Section A #9

Add: Section to provide clarity of gender changed male to cisgender man and female to cisgender woman

Provide inclusion for gender identity

Section A #12

Add: Middle Eastern North Africa

Remove: Decline to answer

Provide clarity for racial inclusion

Section A #19

Add: Co-Morbidities that are more relevant to pediatric patients and additional co-morbidities for adults

Provide acknowledgement and inclusion of pediatric issues along with additional co-morbidities affecting adult ESRD patients

Section A #20 d

Add: Response for additional accesses with which a patient may start dialysis.

Add: Question regarding starting dialysis using both a Central Venous Catheter and a fistula or graft.

Add: Question regarding the presence of a maturing peritoneal catheter

Provide clarity of the access choice of incident patients and assist staff in reporting correctly by clearly defining the choices

Section A #20 e

Add: Question related to presence of acute kidney injury in the last 12 months

Identify predisposing factors that could be mitigated to prevent ESRD

Section A #20 f

Add: Question related to education regarding home dialysis modality education prior to starting dialysis

Identify the education and understanding of options a patient has been made aware of prior to starting dialysis

Section A #20 g

Add: Question related to education regarding kidney transplant education prior to starting dialysis

Add: Question related to education regarding living donor kidney transplant education prior to starting dialysis

Identify the education and understanding of options, including living donor transplant, a patient has been made aware of prior to starting dialysis

Section A #20 h

Add: Question related to active medical management without dialysis

Identify the education and understanding of options, including active medical management without dialysis, a patient has been made aware of prior to starting dialysis

Section A #21

Add: Ability for providers to use laboratory values from the admission to the dialysis facility if previous laboratory values are not available in 30 days

Provide an avenue to provide required information to the providers if there is an issue obtaining access to the previous medical record

Section A #21 g

Remove: Lipid Profile

Add: LDL

Change request for laboratory values that are more pertinent to the ESRD patient

Section A #22

Add: Question related to the patient have living will or Medical/Physician order for life sustaining treatment.

Provide inclusion of end of life decisions

Section A #23

Add: Question related to concern about patient access to shelter

Provide inclusion of social determinants of health

Section A #24

Add: Question related to caregiver support for daily care

Add: Question related to caregiver support with home dialysis/kidney transplant

Add: Question related to whether the caregiver lives with the patient

Provide inclusion of social determinants of health

Section A #25

Add: Question related to access to transportation

Provide inclusion of social determinants of health

Section A #26

Add: Question related to understanding health literature in English

Add: Question related to different way other than written documents to learn about health

Add: Question related to the need for a translator to understand health information

Provide inclusion of social determinants of health

Section A #27

Add: Question related to ability to support the very basics like housing, medical care, electricity, and heating

Provide inclusion of social determinants of health

Section A #28

Add: Question related to access to food in the last twelve (12) months

Provide inclusion of social determinants of health

Section A #29

Add: Question related to whether the patient has been threatened with harm or been physically hurt in the last twelve (12) months

Provide inclusion of social determinants of health

Section B #36

Clarified: The previous CMS-2728 asked if the patient was informed of transplant options. This was revised to does the patient understand transplant options at the time of admission with an option to indicate not applicable if question #20(g) had a yes response.

Provide clarity that informing patients of transplant options requires understanding on the part of the patient.

Section B #37

Add: Responses that assist in clarifying the reason a patient has not chosen transplant as an option

Provide clarity as to why a patient isn’t choosing transplant as a modality option

Section B #37

Add: Place for the provider to indicate if they have been referred to a transplant center.

Add: “At this time” to the option “Patient has not been assessed”

Revise: “is not eligible” to “has a absolute contraindication”

Gain insight into how providers are working toward the CMS goal of ESRD patients receiving a transplant

Section B #38

Add: Question related to referral to a transplant center and the name of the transplant center

Gain insight into referral of ESRD patients to receive a transplant

Section B #39

Add: Question related to the patient’s understanding of home modality options at the time of admission with an option to indicate not applicable if question #20(f) had a yes response.

Provide clarity as to why a patient isn’t choosing home dialysis as a modality option

Section B #40

Add: Responses that assist in clarifying the reason a patient did not choose a home modality as an option

Gain insight into how providers are working toward the CMS goal of ESRD patients utilizing a home modality

Section C #48

Revise: “Type of Donor” to “Type of Transplant”

Add: “Multi-organ” and “Paired Exchange” as options for kidney transplant types

Gain insight into types to transplants receive

Section C # 50

Add: Transitional Care Unit as an option

Include all dialysis care areas in the options

Section F

Add: Options for Lost to Follow-up, Moved out of the United States and territories, and Death as reasons a CMS-2728 for has not been signed

Provide an avenue to close a form that cannot be signed by a patient

LIST OF PRIMARY CAUSES OF RENAL DISEASE

Add: E11.21 Type 2 diabetes mellitus with diabetic nephropathy

Provide updated option for the cause of renal disease

LIST OF PRIMARY CAUSES OF RENAL DISEASE

Add: I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease

Provide updated option for the cause of renal disease

LIST OF PRIMARY CAUSES OF RENAL DISEASE

Add: U07.1 COVID19

Provide updated option for the cause of renal disease

The remainder are updates on the accompanying Instructions for Completion based on the suggestions from ESRD Networks, ESRD providers, and other stakeholders.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleCrosswalk for Changes to Section 226A of the Social Security Act
SubjectChanges to CMS-2728 and Section 226A of the Social Security Act
AuthorCMS
File Modified0000-00-00
File Created2023-12-14

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