DAR File No. 39134

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-10B

Children's Organ Transplants

Notice of Proposed Rule

(Repeal)

DAR File No.: 39134
Filed: 02/09/2015 12:50:55 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Division of Medicaid and Health Financing (DMHF) will repeal this rule because the Kurt Oscarson Children's Organ Transplant Fund resides with the Division of Family Health and Preparedness (DFHP), thus giving DFHP rulemaking authority. DFHP, therefore, will file a new rule to keep requirements for children's organ transplants ongoing and effective.

Summary of the rule or change:

DMHF has no authority over this rule. It will be reenacted under DFHP. This rule is repealed in its entirety. (DAR NOTE: The proposed new Rule R398-30 is under DAR No. 39133 in this issue, March 1, 2015, of the Bulletin.)

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

This rule repeal does not affect the state budget because the new rule will continue to implement current requirements and future changes to organ transplant policy.

local governments:

There is no impact to local governments because they neither fund nor provide Medicaid services to Medicaid recipients.

small businesses:

This rule repeal does not affect small businesses because the new rule will continue to implement current requirements and future changes to organ transplant policy.

persons other than small businesses, businesses, or local governmental entities:

This rule repeal does not affect Medicaid providers, Medicaid recipients, CHIP providers, and CHIP recipients because the new rule will continue to implement current requirements and future changes to organ transplant policy.

Compliance costs for affected persons:

This rule repeal does not affect a single Medicaid provider, Medicaid recipient, CHIP provider, or CHIP recipient because the new rule will continue to implement current requirements and future changes to organ transplant policy.

Comments by the department head on the fiscal impact the rule may have on businesses:

There is no impact to business because the new rule will continue to implement current requirements.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/31/2015

This rule may become effective on:

04/07/2015

Authorized by:

David Patton, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

[R414-10B. Children's Organ Transplants.

R414-10B-1. Authority and Purpose.

(1) Authority for this rule is found in Title 63G, Chapter 3.

(2) The purpose of this rule is to set forth criteria to determine eligibility for and the awarding of financial assistance to children who need organ transplants.

 

R414-10B-2. Definitions.

(1) "Eligible recipient" means a person who is 18 years of age or younger at the time an application for financial assistance is made and who has resided, or whose legal guardian has resided, within the state for at least six months prior to applying for financial assistance.

(2) "Initial Medical Expenses" include assessments and evaluations of prospective organ transplant recipients and potential organ donors, actual surgical costs, post-operative care or treatment, COBRA payments, and spenddowns or other related costs for Medicaid or other public assistance eligibility, but does not include travel and living expenses for recipients or families.

 

R414-10B-3. Allowable Medical Expenses and Organ Transplants.

Eligible recipients may apply for financial assistance for eligible medical expenses for any type of organ transplant. Each recipient shall have a maximum lifetime benefit of $10,000.

 

R414-10B-4. Determining Eligibility.

Eligibility for awarding financial assistance shall be based on:

(1) whether the person is an eligible recipient; and

(2) documentation, through physician assessment and evaluation, of the need for the organ transplant.

 

R414-10B-5. Awarding Financial Assistance to Eligible Recipients.

(1) Prior to awarding financial assistance the committee shall review the recipient's request for assistance to determine:

(a) the needs of the eligible recipient both physically and financially; and

(b) the existence of other financial assistance including availability of insurance or other state aid.

(2) Each eligible recipient must apply for applicable Medicaid, Medicaid disability, and Children's Health Insurance Program assistance before the committee agrees to award any financial assistance. This does not preclude the committee from using funds to negotiate with transplant centers or hospitals to place the name of the eligible recipient on a waiting list for an organ transplant.

(3) As part of the review process a legal guardian of the eligible recipient must sign a release to allow all medical records of the child to be released to the Department of Health. The Department of Health shall provide assistance to the committee by determining:

(a) that the proposed organ transplant is not experimental; and

(b) the extent of the threat to the child's life without the organ transplant.

(4) In addition, the committee must consider the availability of funds in the Children's Organ Transplant trust account before awarding financial assistance.

 

R414-10B-6. Terms for Repayment of Financial Assistance Loans.

Financial assistance shall be given in the form of an interest free loan. Terms, including amount and time frame for repayment of loans shall be set forth in a contract as agreed to by both parties.

 

R414-10B-7. Waiver of Loan Repayment.

Applicants may request that all or part of the repayment due under the contract for financial assistance be waived by the committee. As a condition of granting a waiver, the committee shall make a finding that repayment of the financial assistance would impose an undue financial burden on the child.

 

R414-10B-8. Organ Donor Awareness Activities.

The committee shall adopt policies for the award of funds from the Children's Organ Transplant trust account for Organ Donor Awareness Activities.

 

KEY: organ transplants

Date of Enactment or Last Substantive Amendment: February 17, 2000

Notice of Continuation: December 2, 2013

Authorizing, and Implemented or Interpreted Law: 26-1-5]