IC 16-41-19.5
    Chapter 19.5. Prevention and Treatment Programs: Post-OrganTransplant Program

IC 16-41-19.5-1
"Post-organ transplant program" defined
    Sec. 1. As used in this chapter, "post-organ transplant program"refers to a program established by the state department to payrecipients eligible under this chapter for costs of immunosuppressivedrugs prescribed exclusively for the maintenance of individuals whoundergo the transplant of an internal organ, including a heart, lung,liver, or kidney, if the costs of the drugs are not reimbursed fromother sources.
As added by P.L.27-1999, SEC.2.

IC 16-41-19.5-2
Establishment
    Sec. 2. The state department shall establish a post-organ transplantprogram.
As added by P.L.27-1999, SEC.2.

IC 16-41-19.5-3
Eligibility
    Sec. 3. An individual who meets the following requirements iseligible for the post-organ transplant program:
        (1) The individual has submitted a properly completedapplication on a form supplied by the state department.
        (2) The individual has a household income that is not more thantwo hundred fifty percent (250%) of the federal poverty level asdetermined by the federal Office of Management and Budget.
        (3) The individual is a resident of Indiana and has resided inIndiana for twelve (12) months before submitting theapplication. An individual is not excluded from the program forreceiving an organ transplant outside Indiana.
        (4) The individual meets any other eligibility standards adoptedby the state department.
As added by P.L.27-1999, SEC.2.

IC 16-41-19.5-4
Amount paid by state department to applicants
    Sec. 4. (a) The state department shall determine the maximumamount the state department will pay each eligible post-organtransplant program applicant based on the following criteria:
        (1) Available money.
        (2) Covered immunosuppressive drugs.
        (3) The terms of any contract between the state department andthe patient's health care provider.
        (4) The reimbursement rate for a post-organ transplant drugmay not be greater than the Medicaid reimbursement rate forthe drug, minus a copayment by the recipient.    (b) The state health commissioner may restrict or categorizepayments for post-organ transplant drugs to meet budgetarylimitations.
As added by P.L.27-1999, SEC.2.

IC 16-41-19.5-5
Reimbursement of recipients by state department
    Sec. 5. (a) Except as provided in subsection (b), the statedepartment may not reimburse an eligible recipient under thepost-organ transplant program for drug costs that are reimbursed oreligible for reimbursement by a governmental entity or other thirdparty, including Medicaid, Medicare, the Veterans Administration,a health insurance company, or a health maintenance organization.
    (b) The state health commissioner may waive the requirements ofsubsection (a) on a case by case basis if the commissioner determinesthat enforcement of subsection (a) will deny services to a class ofpost-organ transplant patients because of conflicting state or federallaw.
    (c) The state department shall adopt rules under IC 4-22-2 toensure that all required benefit payments for post-organ transplantdrugs under subsection (a) are properly paid.
As added by P.L.27-1999, SEC.2.

IC 16-41-19.5-6
Duties of state department
    Sec. 6. The state department shall:
        (1) maintain an immunosuppressive drug formulary thatincludes the drugs that are eligible for reimbursement under thepost-organ transplant program;
        (2) establish an internal review procedure for updating theformulary that includes procedures for adding and deletingdrugs from the formulary; and
        (3) review the formulary at least quarterly each year.
As added by P.L.27-1999, SEC.2.

IC 16-41-19.5-7
Post-organ transplant program fund
    Sec. 7. (a) The post-organ transplant program fund is establishedfor the purpose of providing payment of immunosuppressive drugsto eligible organ transplant recipients under this chapter. The fundshall be administered by the state department.
    (b) The expenses of administering the fund shall be paid frommoney in the fund.
    (c) The treasurer of state shall invest money in the fund notcurrently needed to meet the obligations of the fund in the samemanner as other public money may be invested. Interest that accruesfrom these investments shall be deposited in the fund.
    (d) Money in the fund consists of appropriations, gifts, grants, anddonations from public or private sources. Money in the fund at theend of a state fiscal year does not revert to the state general fund.As added by P.L.27-1999, SEC.2.

IC 16-41-19.5-8
Rules
    Sec. 8. The state department may adopt rules under IC 4-22-2 thatare necessary to implement this chapter.
As added by P.L.27-1999, SEC.2.