IC 16-41-19.5
Chapter 19.5. Prevention and Treatment Programs: Post-Organ
Transplant 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 pay
recipients eligible under this chapter for costs of immunosuppressive
drugs prescribed exclusively for the maintenance of individuals who
undergo the transplant of an internal organ, including a heart, lung,
liver, or kidney, if the costs of the drugs are not reimbursed from
other 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 transplant
program. 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 is
eligible for the post-organ transplant program:
(1) The individual has submitted a properly completed
application on a form supplied by the state department.
(2) The individual has a household income that is not more than
two hundred fifty percent (250%) of the federal poverty level as
determined by the federal Office of Management and Budget.
(3) The individual is a resident of Indiana and has resided in
Indiana for twelve (12) months before submitting the
application. An individual is not excluded from the program for
receiving an organ transplant outside Indiana.
(4) The individual meets any other eligibility standards adopted
by 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 maximum
amount the state department will pay each eligible post-organ
transplant program applicant based on the following criteria:
(1) Available money.
(2) Covered immunosuppressive drugs.
(3) The terms of any contract between the state department and
the patient's health care provider.
(4) The reimbursement rate for a post-organ transplant drug
may not be greater than the Medicaid reimbursement rate for
the drug, minus a copayment by the recipient.
(b) The state health commissioner may restrict or categorize
payments for post-organ transplant drugs to meet budgetary
limitations. 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 state
department may not reimburse an eligible recipient under the
post-organ transplant program for drug costs that are reimbursed or
eligible for reimbursement by a governmental entity or other third
party, including Medicaid, Medicare, the Veterans Administration,
a health insurance company, or a health maintenance organization.
(b) The state health commissioner may waive the requirements of
subsection (a) on a case by case basis if the commissioner determines
that enforcement of subsection (a) will deny services to a class of
post-organ transplant patients because of conflicting state or federal
law.
(c) The state department shall adopt rules under IC 4-22-2 to
ensure that all required benefit payments for post-organ transplant
drugs 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 that
includes the drugs that are eligible for reimbursement under the
post-organ transplant program;
(2) establish an internal review procedure for updating the
formulary that includes procedures for adding and deleting
drugs 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 established
for the purpose of providing payment of immunosuppressive drugs
to eligible organ transplant recipients under this chapter. The fund
shall be administered by the state department.
(b) The expenses of administering the fund shall be paid from
money in the fund.
(c) The treasurer of state shall invest money in the fund not
currently needed to meet the obligations of the fund in the same
manner as other public money may be invested. Interest that accrues
from these investments shall be deposited in the fund.
(d) Money in the fund consists of appropriations, gifts, grants, and
donations from public or private sources. Money in the fund at the
end 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 that
are necessary to implement this chapter. As added by P.L.27-1999, SEC.2.
IC 16-41-19.5
Chapter 19.5. Prevention and Treatment Programs: Post-Organ
Transplant 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 pay
recipients eligible under this chapter for costs of immunosuppressive
drugs prescribed exclusively for the maintenance of individuals who
undergo the transplant of an internal organ, including a heart, lung,
liver, or kidney, if the costs of the drugs are not reimbursed from
other 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 transplant
program. 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 is
eligible for the post-organ transplant program:
(1) The individual has submitted a properly completed
application on a form supplied by the state department.
(2) The individual has a household income that is not more than
two hundred fifty percent (250%) of the federal poverty level as
determined by the federal Office of Management and Budget.
(3) The individual is a resident of Indiana and has resided in
Indiana for twelve (12) months before submitting the
application. An individual is not excluded from the program for
receiving an organ transplant outside Indiana.
(4) The individual meets any other eligibility standards adopted
by 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 maximum
amount the state department will pay each eligible post-organ
transplant program applicant based on the following criteria:
(1) Available money.
(2) Covered immunosuppressive drugs.
(3) The terms of any contract between the state department and
the patient's health care provider.
(4) The reimbursement rate for a post-organ transplant drug
may not be greater than the Medicaid reimbursement rate for
the drug, minus a copayment by the recipient.
(b) The state health commissioner may restrict or categorize
payments for post-organ transplant drugs to meet budgetary
limitations. 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 state
department may not reimburse an eligible recipient under the
post-organ transplant program for drug costs that are reimbursed or
eligible for reimbursement by a governmental entity or other third
party, including Medicaid, Medicare, the Veterans Administration,
a health insurance company, or a health maintenance organization.
(b) The state health commissioner may waive the requirements of
subsection (a) on a case by case basis if the commissioner determines
that enforcement of subsection (a) will deny services to a class of
post-organ transplant patients because of conflicting state or federal
law.
(c) The state department shall adopt rules under IC 4-22-2 to
ensure that all required benefit payments for post-organ transplant
drugs 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 that
includes the drugs that are eligible for reimbursement under the
post-organ transplant program;
(2) establish an internal review procedure for updating the
formulary that includes procedures for adding and deleting
drugs 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 established
for the purpose of providing payment of immunosuppressive drugs
to eligible organ transplant recipients under this chapter. The fund
shall be administered by the state department.
(b) The expenses of administering the fund shall be paid from
money in the fund.
(c) The treasurer of state shall invest money in the fund not
currently needed to meet the obligations of the fund in the same
manner as other public money may be invested. Interest that accrues
from these investments shall be deposited in the fund.
(d) Money in the fund consists of appropriations, gifts, grants, and
donations from public or private sources. Money in the fund at the
end 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 that
are necessary to implement this chapter. As added by P.L.27-1999, SEC.2.
IC 16-41-19.5
Chapter 19.5. Prevention and Treatment Programs: Post-Organ
Transplant 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 pay
recipients eligible under this chapter for costs of immunosuppressive
drugs prescribed exclusively for the maintenance of individuals who
undergo the transplant of an internal organ, including a heart, lung,
liver, or kidney, if the costs of the drugs are not reimbursed from
other 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 transplant
program. 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 is
eligible for the post-organ transplant program:
(1) The individual has submitted a properly completed
application on a form supplied by the state department.
(2) The individual has a household income that is not more than
two hundred fifty percent (250%) of the federal poverty level as
determined by the federal Office of Management and Budget.
(3) The individual is a resident of Indiana and has resided in
Indiana for twelve (12) months before submitting the
application. An individual is not excluded from the program for
receiving an organ transplant outside Indiana.
(4) The individual meets any other eligibility standards adopted
by 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 maximum
amount the state department will pay each eligible post-organ
transplant program applicant based on the following criteria:
(1) Available money.
(2) Covered immunosuppressive drugs.
(3) The terms of any contract between the state department and
the patient's health care provider.
(4) The reimbursement rate for a post-organ transplant drug
may not be greater than the Medicaid reimbursement rate for
the drug, minus a copayment by the recipient.
(b) The state health commissioner may restrict or categorize
payments for post-organ transplant drugs to meet budgetary
limitations. 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 state
department may not reimburse an eligible recipient under the
post-organ transplant program for drug costs that are reimbursed or
eligible for reimbursement by a governmental entity or other third
party, including Medicaid, Medicare, the Veterans Administration,
a health insurance company, or a health maintenance organization.
(b) The state health commissioner may waive the requirements of
subsection (a) on a case by case basis if the commissioner determines
that enforcement of subsection (a) will deny services to a class of
post-organ transplant patients because of conflicting state or federal
law.
(c) The state department shall adopt rules under IC 4-22-2 to
ensure that all required benefit payments for post-organ transplant
drugs 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 that
includes the drugs that are eligible for reimbursement under the
post-organ transplant program;
(2) establish an internal review procedure for updating the
formulary that includes procedures for adding and deleting
drugs 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 established
for the purpose of providing payment of immunosuppressive drugs
to eligible organ transplant recipients under this chapter. The fund
shall be administered by the state department.
(b) The expenses of administering the fund shall be paid from
money in the fund.
(c) The treasurer of state shall invest money in the fund not
currently needed to meet the obligations of the fund in the same
manner as other public money may be invested. Interest that accrues
from these investments shall be deposited in the fund.
(d) Money in the fund consists of appropriations, gifts, grants, and
donations from public or private sources. Money in the fund at the
end 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 that
are necessary to implement this chapter. As added by P.L.27-1999, SEC.2.
