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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsAugust 2014

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Section 1903(i) of the Social Security Act, Payment to States, State Plan Requirement, Organ Transplant Procedures
42 CFR 441.35, Organ Transplants
Section 1138 of the Social Security Act, Hospital Protocols for Organ Procurement and Standards for Organ Procurement Agencies
42 CFR Subpart G, Requirements for Certification and Designation and Conditions for Coverage: Organ Procurement Organizations
STATE: DELAWARE
STANDARDS FOR THE COVERAGE OF ORGAN AND TISSUE TRANSPLANT SERVICES
The following types of medically necessary organ and tissue transplantation procedures are covered as specified in the Delaware Medical Assistance Program (DMAP) Provider Specific Policy Manuals:
Liver (any age)
Bone Marrow and Peripheral Blood Stem Cell
Coverage is limited to transplant services that are specified in the Delaware Medical Assistance Program (DMAP) Provider Specific Policy Manuals. Additionally, the criteria for determining a recipient’s clinical eligibility for transplantation are specified in the DMAP Manuals, as well. The Delaware Medical Assistance Program Provider Specific Policy Manuals, including all updates to the manuals, are available on the DMAP website at: http://www.dmap.state.de.us/downloads/manuals.html.
Services considered experimental and/or investigational are not a benefit of the Delaware Medical Assistance Program.
All transplants require prior authorization. Specific prior authorization requirements, including the Prior Authorization Request Form, may be found in the Delaware Medical Assistance Program Provider Manuals located on: http://www.dmap.state.de.us/downloads/manuals.html
The following standards and criteria must be met before transplantation services are payable under the Delaware Medical Assistance Program:
Facility -The transplant facility must meet the requirements contained in Section 1138 of the Social Security Act, Hospital Protocols for Organ Procurement and Standards for Organ Procurement Agencies. The transplant facility performing the transplant must have approval for performing the surgery through the Certification of Need (CON) process and must supply supporting documentation of this.
Patient - Documentation from an appropriate attending specialist and admitting facility that all of the following conditions are met:
Last Updated: December 31 1969 19:00:00.
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