Crosswalk

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.