OAR 410-124-0005
Donor Services
(1)
Living and cadaver donor search and procurement services are covered for covered transplants.(2)
All living or cadaver donor services are payable under the recipient’s Medicaid identification number and not under the donor.(3)
Living donor services — prior authorization requirements for fee-for-service and Primary Care Case Manager (PCCM) clients:(a)
Bone marrow, stem cells and cord blood:(A)
Screening of potential living related donors does not require prior authorization;(B)
Unrelated/voluntary donor search requires prior authorization;(C)
Collection and testing of related cord blood requires prior authorization;(D)
Donor search costs up to the maximum amount of $15,000 are covered only if donor search is prior authorized;(E)
Procurement requires prior authorization of the transplant.(b)
Kidney alone — no prior authorization required for testing of or procurement from living or cadaver donors;(c)
Other solid organs — testing and procurement are covered if transplant is prior authorized;(d)
Payment is limited to donor expenses incurred directly in connection with the transplant. Complications of the donor that are directly and immediately related or attributable to the donation procedure are covered.(4)
Cadaver procurement services — prior authorization requirements for fee-for-service and PCCM clients:(a)
Covered if transplant is prior authorized;(b)
Procurement charges are included in the Organ Procurement Organization (OPO) charges to the transplant facility;(c)
Payable only to the transplant facility per contract.(5)
For Fully Capitated Health Plan (FCHP) clients, contact the client’s FCHP for authorization requirements.
Source:
Rule 410-124-0005 — Donor Services, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-124-0005.