CurrentConnecticut Department of Social ServicesPolicy UP-10-07

Payment for Costs Associated with Organ Donations

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Governs ConnTRANS assistance for eligible medical and ancillary expenses related to organ transplantation, including certain costs incurred by organ donors and recipients' families.

Policy Summary

PayerConnecticut Department of Social Services

PolicyPayment for Costs Associated with Organ Donations

Policy CodePolicy UP-10-07

Change TypeRevised

Effective DateNovember 9, 2009

Next Review DateNot scheduled

Key ActionVerify the applicant's transplant status, assets, income, and all other sources of remuneration.

SourceLink

POLICY UPDATE CHANGES

ConnTRANS policy was revised to allow payments assisting organ donors with costs associated with donating an organ to a Connecticut resident, including transportation, accommodation, and lost wages.

12 monthsMaximum assistance period on any occasion

1/2 of available fundsMaximum benefit cap from the ConnTRANS account

60 daysMinimum Connecticut residency period

$500Provider payment threshold

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CurrentConnecticut Department of Social ServicesPolicy UP-10-07

Payment for Costs Associated with Organ Donations

Customize your policy alerts

Sign up for Connecticut Department of Social Services Policy UP-10-07 alerts

Get alerted when Policy UP-10-07 changes without checking for updates manually.

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Governs ConnTRANS assistance for eligible medical and ancillary expenses related to organ transplantation, including certain costs incurred by organ donors and recipients' families.

Policy Summary

PayerConnecticut Department of Social Services

PolicyPayment for Costs Associated with Organ Donations

Policy CodePolicy UP-10-07

Change TypeRevised

Effective DateNovember 9, 2009

Next Review DateNot scheduled

Key ActionVerify the applicant's transplant status, assets, income, and all other sources of remuneration.

SourceLink

POLICY UPDATE CHANGES

ConnTRANS policy was revised to allow payments assisting organ donors with costs associated with donating an organ to a Connecticut resident, including transportation, accommodation, and lost wages.

12 monthsMaximum assistance period on any occasion

1/2 of available fundsMaximum benefit cap from the ConnTRANS account

60 daysMinimum Connecticut residency period

$500Provider payment threshold

7Covered transplant types listed

Eligibility and Covered Expenses

Eligibility requirements

An applicant must satisfy all of the following eligibility requirements:

ALL of the following

Applicant has received or is a candidate to receive an organ transplant.
Applicant is a U.S. citizen or eligible non-citizen.
Applicant has been a bona fide Connecticut resident for at least 60 days.>= 60 days
Applicant discloses and verifies all assets, income, and sources of remuneration, including health insurance, charitable funds, fund raisers, and drug companies.
Applicant applies for and accepts all other benefits to which the applicant may be entitled from the Department and other agencies.
Failure to apply for or complete the application process may result in denial or discontinuation of ConnTRANS assistance.

Covered transplant-related expenses and limits

When eligibility is established, ConnTRANS may pay all or part of covered transplant-related medical and ancillary expenses when all of the following conditions are met:

ALL of the following

Expenses are related to the transplant and are not covered or payable by another source, such as medical insurance or private donations.
Payment is subject to Department discretion, family size, income and asset limits established by the Department, and availability of funds.
ONE of
- Medical services, including physician services, hospital services, x-ray and laboratory services, prescription drugs, and medical expenses of an organ donor.
- Ancillary services, including transportation and parking for the patient, family, and organ donor; child care expenses related to treatment; lodging for the patient, family, and organ donor related to treatment; non-prescription drugs; health insurance premiums; and lost wages of the organ donor due to participation in the transplant.

Program Limits and Payment Parameters

Minimum Connecticut Residency

ProgramConnTRANS

Residency standardBona fide resident of Connecticut

Minimum residencyAt least 60 days

Maximum Certification Period

Assistance periodOn any occasion assistance is granted

Maximum periodTwelve months

Certification limitThe period of assistance shall not exceed twelve months

Operational Requirements

Documentation Required

Verify transplant and financial eligibility

Verify that the applicant has received or is a candidate to receive an organ transplant. The applicant or recipient must also disclose and verify all assets, income, and every source of remuneration, including health insurance and charitable funds.

Confirm transplant status or candidacy.
Verify assets, income, health insurance, charitable funds, fund-raising proceeds, drug-company assistance, and other remuneration sources.

Denial Risk

Pursue all other available benefits

Require the applicant to apply for and accept all other benefits to which they may be entitled from the Department and other agencies. ConnTRANS will be denied or discontinued if an individual who appears eligible for another benefit fails to apply or complete the application process.

Policy Summary

PayerConnecticut Department of Social Services

PolicyPayment for Costs Associated with Organ Donations

Policy CodePolicy UP-10-07

Change TypeRevised

Effective DateNovember 9, 2009

Next Review DateNot scheduled

Key ActionVerify the applicant's transplant status, assets, income, and all other sources of remuneration.

SourceLink

On This Page

ConnTRANS Account Benefit Cap

Benefit limitThe maximum payable benefit cannot exceed one-half of the available funds in the ConnTRANS account

Maximum shareOne-half of available ConnTRANS funds

Funding basisThe benefit is subject to the availability of funds

Direct-Payment Provider Bill Threshold

Recipient direct paymentAn unpaid provider's bill less than $500.00 may be paid directly to the recipient when the recipient requests it

Provider payment thresholdBenefits are vendored to the provider when the payment is more than $500.00

Other direct-payment situationsBenefits are issued directly to the recipient for an anticipated recurring need or requested reimbursement of expenses already paid

Require application for other potentially available benefits.

Require completion of the application process and acceptance of benefits for which the applicant is eligible.

Billing Rule

Determine the payment amount

After income eligibility is determined, authorize payment based on the family’s applied income, incurred or anticipated medical and ancillary expenses, and the availability of funds. Consider expenses of the individual, organ donor, and family when determining the payment amount.

Family applied income
Individual’s incurred or anticipated medical and ancillary expenses
Organ donor’s incurred or anticipated medical and ancillary expenses
Family’s incurred or anticipated ancillary expenses
Availability of funds

Billing Rule

Apply benefit issuance rules

Issue ConnTRANS benefits directly to the recipient for anticipated recurring needs, reimbursement of medical or ancillary expenses already paid, or an unpaid provider bill of less than $500 when direct payment is requested. Vendor the payment to the provider when the payment is more than $500.

Direct payment: anticipated recurring need
Direct payment: requested reimbursement for expenses already paid
Direct payment: unpaid provider bill under $500 when requested
Vendor payment required for payments over $500