A Transplant Share of Cost Initial Determination

A Transplant Share of Cost - Initial Determination

Program

Manual Section

Transplant Extended Eligibility Program

Procedures

Due to health needs of transplant customers and the often very short period of time before they lose MA coverage, the following procedures are completed on a priority basis.

When notified that a customer on a transplant waiting list is losing eligibility for AHCCCS, the CEU takes the following steps:

Step	Action
1	Confirm the customer‘s current transplant status with DMCS. Is the customer still active on the transplant waiting list? If NO, STOP. The customer does not qualify for the Transplant Extended Eligibility Program. IF YES, continue to Step 2.
2	Check the customer’s current MA eligibility category. Is the customer eligible for full services MA in any group other than the Adult group? If NO, STOP. The customer does not qualify for the Transplant Extended Eligibility Program. IF YES, continue to Step 3.
3	Check the reason that the customer is losing MA eligibility for their current category. Is the customer’s losing eligibility because his or her income is over the income limit? If NO, STOP. The customer does not qualify for the Transplant Extended Eligibility Program. Advise the transplant coordinator of the reason the person is losing eligibility and of any steps the customer needs to take to remain eligible. NOTE A common example is when a person is losing eligibility because of failure to respond to a renewal or to provide proof needed. Advise the customer and the transplant coordinator as needed of what the customer needs to do to complete the renewal or provide proof. If YES, continue to Step 4.
4	Review the customer’s file and any updated information for potential eligibility in any other category except KidsCare. Does the customer qualify for any other MA category? If YES, STOP. Approve the customer in the other MA category. If NO, continue to Step 5.
5	Collect information about and proof of any allowable medical expenses for the Three-month Expense Period.
6	Determine the customer’s total family income for the Three-month Income Period.
7	Determine the monthly 40% FPL amount for the customer’s family size and multiply by 3.
8	Enter the results from Steps 5-7 on the AHCCCS Notification of Transplant Share of Cost (DE-406) form and calculate the transplant share of cost amount.
9	Send a copy of the DE-406 with the transplant share of cost amount to the financial coordinator at the transplant facility.
10	Tell the customer that he or she must contact the transplant facility to discuss the two Transplant Extended Eligibility options and the contract for the transplant share of cost.
11	When a copy of the signed contract has been received from the transplant facility, determine which option the customer chose. If the customer chose Option 1,continue to Step 12. If the customer chose Option 2, skip to Step 13.
12	Send an AI to MDMA to post a 12-month block of eligibility under the 581 key code beginning the first day of the month following the end of the customer’s previous MA eligibility.
13	Note in file that the customer chose Option 2, and that eligibility and the TSOC must be redetermined at the time the transplant is scheduled (see MAP1205B below for details).