Organ Transplants. MCPs must ensure coverage for organ transplants and related services in accordance with OAC 5101-3-2- 07.1 (B)(4)&(5). Coverage for all organ transplant services, except kidney transplants, is contingent upon review and recommendation by the “Ohio Solid Organ Transplant Consortium” based on criteria established by Ohio organ transplant surgeons and authorization from the ODJFS prior authorization unit. Reimbursement for bone marrow transplant and hematapoietic stem cell transplant services, as defined in OAC 3701:84-01, is contingent upon review and recommendation by the “Ohio Hematapoietic Stem Cell Transplant Consortium” again based on criteria established by Ohio experts in the field of bone marrow transplant. While MCPs may require prior authorization for these transplant services, the approval criteria would be limited to confirming the consumer is being considered and/or has been recommended for a transplant by either consortium and authorized by ODJFS. Additionally, in accordance with OAC 5101:3-2-03 (A)(4) all services related to organ donations are covered for the donor recipient when the consumer is Medicaid eligible.
Appears in 4 contracts
Samples: Medical Assistance Provider Agreement (Molina Healthcare Inc), Provider Agreement (Wellcare Health Plans, Inc.), Molina Healthcare Inc
Organ Transplants. MCPs must ensure coverage for organ transplants and related services in accordance with OAC 51015160-32-2- 07.1 (B)(4)&(5B)(4) & (5). Coverage for all organ transplant services, except kidney transplants, is contingent upon review and recommendation by the “Ohio Solid Organ Transplant Consortium” based on criteria established by Ohio organ transplant surgeons and authorization from the ODJFS ODM prior authorization unit. Reimbursement for bone marrow transplant and hematapoietic stem cell transplant services, as defined in OAC 3701:84-01, is contingent upon review and recommendation by the “Ohio Hematapoietic Stem Cell Transplant Consortium” again based on criteria established by Ohio experts in the field of bone marrow transplant. While MCPs may require prior authorization for these transplant services, the approval criteria would be limited to confirming the consumer is being considered and/or has been recommended for a transplant by either consortium and authorized by ODJFSconsortium. Additionally, in accordance with OAC 5101:35160-2-2- 03 (A)(4) all services related to organ donations are covered for the donor recipient when the consumer is Medicaid eligible.
Appears in 2 contracts
Samples: Provider Agreement, Provider Agreement
Organ Transplants. MCPs must ensure coverage for organ transplants organtransplants and related services in accordance with OAC 5101-3-2- 2-07.1 (B)(4)&(5). Coverage for all organ transplant services, except kidney exceptkidney transplants, is contingent upon review and recommendation by the “Ohio Solid Organ Transplant Consortium” based on criteria established by Ohio organ transplant surgeons and authorization from the ODJFS prior authorization unit. Reimbursement for bone marrow transplant and hematapoietic stem cell transplant services, as defined in OAC 3701:84-01, is contingent iscontingent upon review and recommendation by the “Ohio Hematapoietic OhioHematapoietic Stem Cell Transplant Consortium” again based on criteria oncriteria established by Ohio experts in the field of bone marrow transplant. While MCPs may require prior authorization for these transplant services, the approval criteria would be limited to confirming the consumer is being considered and/or has been recommended for a transplant by either consortium and authorized by ODJFS. Additionally, in accordance with OAC 5101:3-2-03 (A)(4) all services related to organ donations are covered for the donor recipient when the consumer is Medicaid eligible.
Appears in 1 contract
Samples: Assistance Provider Agreement (Wellcare Health Plans, Inc.)
Organ Transplants. MCPs must ensure coverage for organ transplants and related services in accordance with OAC 5101-3-2- 2-07.1 (B)(4)&(5). Coverage for all organ transplant services, except kidney transplants, is contingent upon review and recommendation by the “"Ohio Solid Organ Transplant Consortium” " based on criteria established by Ohio organ transplant surgeons and authorization from the ODJFS prior authorization unit. Reimbursement for bone marrow transplant and hematapoietic stem cell transplant services, as defined in OAC 3701:84-01, . is contingent upon review and recommendation by the “"Ohio Hematapoietic Stem Cell Transplant Consortium” " again based on criteria established by Ohio experts in the field of bone marrow transplant. While MCPs may require prior authorization for these transplant services, the approval criteria would be limited to confirming the consumer is being considered and/or has been recommended for a transplant by either consortium and authorized by ODJFS. Additionally, in accordance with OAC 5101:3-2-03 (A)(4) all services related to organ donations are covered for the donor recipient when the consumer is Medicaid eligible.
Appears in 1 contract
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan (Wellcare Health Plans, Inc.)
Organ Transplants. MCPs must ensure coverage for organ transplants and related services in accordance with OAC 5101-3-2- 2-07.1 (B)(4)&(5). Coverage for all organ transplant services, except kidney transplants, is contingent upon review and recommendation by the “"Ohio Solid Organ Transplant Consortium” " based on criteria established by Ohio organ transplant surgeons and authorization from the ODJFS prior authorization unit. Reimbursement for bone marrow transplant and hematapoietic stem cell transplant services, as defined in OAC 3701:84-01, is contingent upon review and recommendation by the “"Ohio Hematapoietic Stem Cell Transplant Consortium” " again based on criteria established by Ohio experts in the field of bone marrow transplant. While MCPs may require prior authorization for these transplant services, the approval criteria would be limited to confirming the consumer is being considered and/or has been recommended for a transplant by either consortium and authorized by ODJFS. Additionally, in accordance with OAC 5101:3-2-03 (A)(4) all services related to organ donations are covered for the donor recipient when the consumer is Medicaid eligible.
Appears in 1 contract
Organ Transplants. MCPs must ensure coverage for organ transplants and related services in accordance with OAC 5101-3-2- 2-07.1 (B)(4)&(5). Coverage for all organ transplant services, except kidney transplants, is contingent upon review and recommendation by the “"Ohio Solid Organ Transplant Consortium” " based on criteria established by Ohio organ transplant surgeons and authorization from the ODJFS prior authorization unit. Reimbursement for bone marrow transplant and hematapoietic stem cell transplant services, as defined in OAC 3701:84-01, is contingent upon review and recommendation by the “"Ohio Hematapoietic Stem Cell Transplant Consortium” " again based on criteria established by Ohio experts in the field of bone marrow transplant. While MCPs may require prior authorization for these transplant services, the approval criteria would be limited to confirming the consumer is being considered and/or has been recommended for a transplant by either consortium and authorized by ODJFS. Additionally, in accordance with OAC 5101:3-2-03 (A)(4) all services related to organ donations are covered for the donor recipient when the consumer is Medicaid eligible.. Care Coordination
Appears in 1 contract
Samples: Ohio Medical Assistance Provider Agreement (Wellcare Health Plans, Inc.)
Organ Transplants. MCPs must ensure coverage for organ transplants and related services in accordance with OAC 5101-3-2- 2-07.1 (B)(4)&(5). Coverage for all organ transplant services, except kidney transplants, is contingent upon review and recommendation by the “Ohio Solid Organ Transplant Consortium” based on criteria established by Ohio organ transplant surgeons and authorization from the ODJFS prior authorization unit. Reimbursement for bone marrow transplant and hematapoietic stem cell transplant services, as defined in OAC 3701:84-01, is contingent upon review and recommendation by the “Ohio Hematapoietic Stem Cell Transplant Consortium” again based on criteria established by Ohio experts in the field of bone marrow transplant. While MCPs may require prior authorization for these transplant services, the approval criteria would be limited to confirming the consumer is being considered and/or has been recommended for a transplant by either consortium and authorized by ODJFS. Additionally, in accordance with OAC 5101:3-2-03 (A)(4) all services related to organ donations are covered for the donor recipient when the consumer is Medicaid eligible.. Appendix G Covered Families and Children (CFC) population
Appears in 1 contract
Samples: Wellcare Health Plans, Inc.
Organ Transplants. MCPs must ensure coverage for organ transplants and related services in accordance with OAC 5101-3-2- 2-07.1 (B)(4)&(5B)(4)& (5). Coverage for all organ transplant services, except kidney transplants, is contingent upon review and recommendation by the “Ohio Solid Organ Transplant Consortium” based on criteria established by Ohio organ transplant surgeons and authorization from the ODJFS prior authorization unit. Reimbursement for bone marrow transplant and hematapoietic stem cell transplant services, as defined in OAC 3701:84-01, is contingent upon review and recommendation by the “Ohio Hematapoietic Stem Cell Transplant Consortium” again based on criteria established by Ohio experts in the field of bone marrow transplant. While MCPs may require prior authorization for these transplant services, the approval criteria would be limited to confirming the consumer is being considered and/or has been recommended for a transplant by either consortium and authorized by ODJFS. Additionally, in accordance with OAC 5101:3-2-03 (A)(4) all services related to organ donations are covered for the donor recipient when the consumer is Medicaid eligible.. Appendix G Covered Families and Children (CFC) population
Appears in 1 contract
Samples: CFC Provider Agreement (Wellcare Health Plans, Inc.)
Organ Transplants. MCPs must ensure coverage for organ transplants organtransplants and related services in accordance with OAC 5101-3-2- 2-07.1 (B)(4)&(5). Coverage for all organ transplant services, except kidney exceptkidney transplants, is contingent upon review and recommendation by the “Ohio Solid Organ Transplant Consortium” based on criteria established by Ohio organ transplant surgeons and authorization from the ODJFS prior authorization unit. Reimbursement for bone marrow transplant and hematapoietic stem cell transplant services, as defined in OAC 3701:84-01, is contingent upon review and recommendation by the “Ohio Hematapoietic Stem Cell Transplant Consortium” again based on criteria established by Ohio experts in the field of bone marrow transplantmarrowtransplant. While MCPs may require prior authorization for these transplant thesetransplant services, the approval criteria would be limited to confirming toconfirming the consumer is being considered and/or has been recommended for a transplant by either consortium and authorized by ODJFS. Additionally, in accordance with OAC 5101:3-2-03 (A)(4) all services related to organ donations are covered for the donor recipient when the consumer is Medicaid eligible.
Appears in 1 contract
Samples: Medical Assistance Provider Agreement (Wellcare Health Plans, Inc.)