Organ and Tissue Transplantations. MCO enrollees receiving services for transplantation of organs or tissues, other than corneal transplants, are covered under FFS Medicaid for the entire duration of their treatment. The MCO must have the ability to notify the State of any past, present, or future transplant recipient and request transfer to FFS Medicaid. BMS will coordinate with Utilization Management vendor and Medicaid Management Information Systems (MMIS) vendor to transition enrollees to the FFS system and coordinate care at that time. The enrollee will be covered under FFS retroactively to the beginning of the month that the MCO notifies the State. Capitation will be recouped for this month. Any claims paid during the month by the MCO may be reversed and directed to the fiscal agent for payment.
Organ and Tissue Transplantations. MCO enrollees receiving services for transplantation of organs or tissues, other than corneal transplants, are covered under FFS Medicaid for the entire duration of their treatment. Additionally, MCO enrollees who, as living donors, provide organs or tissues for transplantation, other than corneal transplants, will receive services for such transplantation and be covered under FFS Medicaid for the entire duration of their treatment. The MCO must have the ability to notify the State of any past, present, or future transplant recipient or living donor and request transfer to FFS Medicaid. The Department will coordinate with Utilization Management vendor and MMIS vendor to transition enrollees to the FFS system and coordinate care at that time. The enrollee will be covered under FFS retroactively to the beginning of the month that the MCO notifies the State. Capitation will be recouped for this month. Any claims paid during the month by the MCO may be reversed and directed to the fiscal agent for payment.
Organ and Tissue Transplantations. MCO enrollees receiving services for transplantation of organs or tissues, other than corneal transplants, are covered under FFS Medicaid or WVCHIP for the entire duration of their treatment. Additionally, managed care enrollees who, as living donors, provide organs or tissues for transplantation, other than corneal transplants, will receive services for such transplantation and be covered under FFS Medicaid or WVCHIP for the entire duration of their treatment. The MCO must have the ability to notify the State of any past, present, or future transplant recipient or living donor and request transfer to FFS Medicaid or WVCHIP. BMS will coordinate with Utilization Management vendor and Medicaid Management Information Systems (MMIS) vendor to transition enrollees to the FFS system and coordinate care at that time. The enrollee will be covered under FFS retroactively to the beginning of the month that the MCO notifies the State. Capitation will be recouped for this month. Any claims paid during the month by the MCO may be reversed and directed to the fiscal agent for payment.
Organ and Tissue Transplantations. MCO members receiving services for transplantation of organs or tissues are covered under the fee-for-service Medicaid for the entire duration of their treatment. The MCO must notify the Department within three business days of member being placed on the transplant list. The Department will coordinate with Utilization Management vendor and Medicaid Management Information Systems (MMIS) vendor to transition member to the fee- for-service system and coordinate care at that time. MCO is responsible for all services for the member until such time as the member is no longer appears on the MCO enrollment roster.
