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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsOctober 2014

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Delaware Health and Social Services ("Department") / Division of Medicaid and Medical Assistance (DMMA) initiated proceedings to submit a state plan amendment regarding Organ Transplants, specifically, standards for the coverage of organ and tissue transplant services. The Department's proceedings to amend its regulations were initiated pursuant to 29 Delaware Code Section 10114 and its authority as prescribed by 31 Delaware Code Section 512.
The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in the August 2014 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by August 31, 2014 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
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
THEREFORE, IT IS ORDERED, that the proposed regulation to amend the Medicaid state plan regarding Organ Transplants, specifically, standards for the coverage of organ and tissue transplant services is adopted and shall be final effective October 10, 2014.
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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