Common use of Transplants Clause in Contracts

Transplants. The Health Plan shall provide medically necessary transplants and related services as outlined in the chart below for applicable Reform and non-Reform populations. 1. For transplant services specified with one (1) asterisk, Reform capitated Health Plans are paid by the Agency through kick payments. See Attachment I and Attachment II, Section XIII, Method of Payment, for payment details. 2. Transplant services specified with two (2) asterisks, as well as pre- and post-transplant follow-up care, are covered through fee-for-service Medicaid and not by the Health Plan. If at the conclusion of the transplant evaluation, the enrollee is listed with the United Network for Organ Sharing (UNOS) as a level 1A, 1B, or 2 candidate for a heart or lung transplant, or with a Model End Stage Liver Disease (MELD) score of 11-25 for a liver transplant, then the Health Plan must submit a copy of the UNOS form to BMHC with a request to disenroll the member from the Health Plan. The recipient cannot re-enroll with the Health Plan until at least one (1) year post transplant. This re-enrollment is not automatic. 3. Transplant evaluation services are transplant-related services up to placement on the UNOS list. Evaluation Health Plan Health Plan Health Plan Health Plan Bone Marrow Health Plan Health Plan Health Plan Health Plan Cornea Health Plan Health Plan Health Plan Health Plan Heart Health Plan* Health Plan* Medicaid** Medicaid** Intestinal/ Multivisceral Medicaid** Medicaid** Medicaid** Medicaid** Kidney Health Plan Health Plan Health Plan Health Plan Liver Health Plan* Health Plan* Medicaid** Medicaid** Back to 10-Q Exhibit 10.3 Lung Health Plan* Health Plan* Medicaid** Medicaid** Pancreas Health Plan Health Plan Health Plan Health Plan Pre- and Post-Transplant Care, including Transplants Not Covered by Medicaid Health Plan Health Plan Health Plan(except heart, lung, or liver) Health Plan(except heart, lung, or liver) Other Transplants Not Covered by Medicaid Not Covered Not Covered Not Covered Not Covered 14. Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions, sub-item 15.h.

Transplants. The Health Plan shall provide medically necessary transplants and related services as outlined in the chart below for applicable Reform and non-Reform populations. 1. For transplant services specified with one (1) an asterisk, Reform capitated Health Plans are paid by the Agency through kick payments. See Attachment I and Attachment II, Section XIII, Method of Payment, for payment details. 2. Transplant services specified with two (2) asterisks, as well as pre- and post-post- transplant follow-up care, are covered through fee-for-service Medicaid and not by the Health Plan. If at the conclusion of the transplant evaluation, the enrollee is listed with the United Network for Organ Sharing (UNOS) as a level 1A, 1B, or 2 candidate for a heart or lung transplant, or with a Model End Stage Liver Disease (MELD) score of 11-25 for a liver transplant, then the Health Plan must submit a copy of the UNOS form to BMHC with a request to disenroll the member from the Health Plan. The recipient cannot re-enroll with the Health Plan until at least one (1) year post transplant. This re-enrollment is not automatic. 3. Transplant evaluation services are transplantAMERIGROUP Florida, Inc. d/b/a Medicaid Non-related services up to placement on the UNOS list. Reform and Reform AMERIGROUP Community Care HMO Contract Evaluation Health Plan Health Plan Health Plan Health Plan Bone Marrow Health Plan Health Plan Health Plan Health Plan Cornea Health Plan Health Plan Health Plan Health Plan Heart Health Plan* Health Plan* Medicaid** Medicaid** Intestinal/ Intestinal/Multivisceral Medicaid** Medicaid** Medicaid** Medicaid** Health Plan Health Plan Health Plan Health Plan Kidney Health Plan Health Plan Health Plan Health Plan Liver Health Plan* Health Plan* Medicaid** Medicaid** Back to 10-Q Exhibit 10.3 Lung Health Plan* Health Plan* Medicaid** Medicaid** Pancreas Health Plan Health Plan Health Plan Health Plan Pre- and Post-Transplant Care, including Transplants Not Covered by Medicaid Health Plan Health Plan Health Plan(except Plan (except heart, lung, or liver) Health Plan(except Plan (except heart, lung, or liver) Other Transplants Not Covered by Medicaid Not Covered Not Covered Not Covered Not Covered 14. Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions, sub-item 15.h.

Transplants. The Health Plan shall provide medically necessary transplants and related services as outlined in the chart below for applicable Reform and non-Reform populations. 1. For transplant services specified with one (1) an asterisk, Reform capitated Health Plans are paid by the Agency through kick payments. See Attachment I and Attachment II, Section XIII, Method of Payment, for payment details. 2. Transplant services specified with two (2) asterisks, as well as pre- and post-transplant follow-up care, are covered through fee-for-service Medicaid and not by the Health Plan. If at the conclusion of the transplant evaluation, the enrollee is listed with the United Network for Organ Sharing (UNOS) as a level 1A, 1B, or 2 candidate for a heart or lung transplant, or with a Model End Stage Liver Disease (MELD) score of 11-25 for a liver transplant, then the Health Plan must submit a copy of the UNOS form to BMHC with a request to disenroll the member from the Health Plan. The recipient cannot re-enroll with the Health Plan until at least one (1) year post transplant. This re-enrollment is not automatic. 3. Transplant evaluation services are transplantHealthEase of Florida, Inc. Medicaid HMO Non-related services up to placement on the UNOS list. Reform Contract Evaluation Health Plan Health Plan Health Plan Health Plan Bone Marrow Health Plan Health Plan Health Plan Health Plan Cornea Health Plan Health Plan Health Plan Health Plan Heart Health Plan* Health Plan* Medicaid** Medicaid** Intestinal/ Multivisceral Medicaid** Medicaid** Medicaid** Medicaid** Health Plan Health Plan Health Plan Health Plan Kidney Health Plan Health Plan Health Plan Health Plan Liver Health Plan* Health Plan* Medicaid** Medicaid** Back to 10-Q Exhibit 10.3 Lung Health Plan* Health Plan* Medicaid** Medicaid** Pancreas Health Plan Health Plan Health Plan Health Plan Pre- and Post-Transplant Care, including Transplants Not Covered by Medicaid Health Plan Health Plan Health Plan(except Plan (except heart, lung, or liver) Health Plan(except Plan (except heart, lung, or liver) Other Transplants Not Covered by Medicaid Not Covered Not Covered Not Covered Not Covered 14. Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions, sub-item 15.h.

Transplants. The Health Plan shall provide medically necessary transplants and related services as outlined in the chart below for applicable Reform and non-Reform populations. 1. For transplant services specified with one (1) an asterisk, Reform capitated Health Plans are paid by the Agency through kick payments. See Attachment I and Attachment II, Section XIII, Method of Payment, for payment details. 2. Transplant services specified with two (2) asterisks, as well as pre- and post-transplant follow-up care, are covered through fee-for-service Medicaid and not by the Health Plan. If at the conclusion of the transplant evaluation, the enrollee is listed with the United Network for Organ Sharing (UNOS) as a level 1A, 1B, or 2 candidate for a heart or lung transplant, or with a Model End Stage Liver Disease (MELD) score of 11-25 for a liver transplant, then the Health Plan must submit a copy of the UNOS form to BMHC with a request to disenroll the member from the Health Plan. The recipient cannot re-enroll with the Health Plan until at least one (1) year post transplant. This re-enrollment is not automatic. 3. Transplant evaluation services are transplantWellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-related services up to placement on the UNOS list. Reform Contract Evaluation Health Plan Health Plan Health Plan Health Plan Bone Marrow Health Plan Health Plan Health Plan Health Plan Cornea Health Plan Health Plan Health Plan Health Plan Heart Health Plan* Health Plan* Medicaid** Medicaid** Intestinal/ Multivisceral Medicaid** Medicaid** Medicaid** Medicaid** Kidney Health Plan Health Plan Health Plan Health Plan Liver Health Plan* Health Plan* Medicaid** Medicaid** Back to 10-Q Exhibit 10.3 Lung Health Plan* Health Plan* Medicaid** Medicaid** Pancreas Health Plan Health Plan Health Plan Health Plan Pre- and Post-Transplant Care, including Transplants Not Covered by Medicaid Health Plan Health Plan Health Plan(except Plan (except heart, lung, or liver) Health Plan(except Plan (except heart, lung, or liver) Other Transplants Not Covered by Medicaid Not Covered Not Covered Not Covered Not Covered 14. Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions, sub-item 15.h.

Transplants. The Health Plan shall provide medically necessary transplants and related services as outlined in the chart below for applicable Reform and non-Reform populations. 1. For transplant services specified with one (1) asterisk, Reform capitated Health Plans are paid by the Agency through kick payments. See Attachment I and Attachment II, Section XIII, Method of Payment, for payment details. 2. Transplant services specified with two (2) asterisks, as well as pre- and post-transplant follow-up care, are covered through fee-for-service Medicaid and not by the Health Plan. If at the conclusion of the transplant evaluation, the enrollee is listed with the United Network for Organ Sharing (UNOS) as a level 1A, 1B, or 2 candidate for a heart or lung transplant, or with a Model End Stage Liver Disease (MELD) score of 11-25 for a liver transplant, then the Health Plan must submit a copy of the UNOS form to BMHC with a request to disenroll the member from the Health Plan. The recipient cannot re-enroll with the Health Plan until at least one (1) year post transplant. This re-enrollment is not automatic. 3. Transplant evaluation services are transplant-related services up to placement on the UNOS list. Evaluation Health Plan Health Plan Health Plan Health Plan Bone Marrow Health Plan Health Plan Health Plan Health Plan Cornea Health Plan Health Plan Health Plan Health Plan Heart Health Plan* Health Plan* Medicaid** Medicaid** Intestinal/ Multivisceral Medicaid** Medicaid** Medicaid** Medicaid** Kidney Health Plan Health Plan Health Plan Health Plan Back to 10-Q Exhibit 10.4 Liver Health Plan* Health Plan* Medicaid** Medicaid** Back to 10-Q Exhibit 10.3 Lung Health Plan* Health Plan* Medicaid** Medicaid** Pancreas Health Plan Health Plan Health Plan Health Plan Pre- and Post-Transplant Care, including Transplants Not Covered by Medicaid Health Plan Health Plan Health Plan(except heart, lung, or liver) Health Plan(except heart, lung, or liver) Other Transplants Not Covered by Medicaid Not Covered Not Covered Not Covered Not Covered 14. Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions, sub-item 15.h.