Common use of Organ and Tissue Transplantations Clause in Contracts

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 for the entire duration of their treatment. Additionally, MCO 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 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 BMS will coordinate with Utilization Management vendor and MMIS 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.