Section R9-22-206. Organ and Tissue Transplant Services

A.      Organ and tissue transplant services are covered for a member if prior authorized and coordinated with the member’s contrac- tor, or the Administration. Only the following transplants are covered for individuals 21 years of age or older:

1.        Heart, including transplants for the treatment of non-isch- emic cardiomyopathy;

2.        Liver, including transplants for patients with hepatitis C;

3.        Kidney (cadaveric and live donor),

4.        Simultaneous Pancreas/Kidney (SPK),

5.        Autologous and Allogeneic related and unrelated Hema- topoietic Cell transplants;

6.        Cornea;

7.        Bone;

8.        Lung; and

9.        Pancreas after a kidney transplant (PAK).

B.       The following transplants are not covered for members 21 years of age or older:

1.        Pancreas only transplants if it is not performed simultane- ously with or following a kidney transplant. Partial pan- creas transplants and autologous and allogeneic pancreas islet cell transplants are not covered even if performed simultaneously with or following a kidney transplant,

2.        Intestine transplants, and

3.        Any other type of transplant not specifically listed in sub- section (A).

C.      When there is a transplant of multiple organs, reimbursement will only be made for those covered.

D.      Organ and tissue transplant services are not covered for non- qualified aliens or noncitizens members of FESP under A.R.S.

§ 36-2903.03(D).

Historical Note

Adopted as an emergency effective May 20, 1982 pursu- ant to A.R.S. § 41-1003, valid for only 90 days (Supp. 82- 3). Former Section R9-22-206 adopted as an emergency now adopted and amended as a permanent rule effective August 30, 1982 (Supp. 82-4). Amended effective Octo-

ber 1, 1985 (Supp. 85-5). Amended effective December

13, 1993 (Supp. 93-4). Former Section R9-22-206 renumbered to R9-22-218, new Section R9-22-206 adopted effective January 1, 1996, under an exemption from A.R.S. Title 41, Chapter 6, pursuant to Laws 1995, Third Special Session, Ch. 1, § 5; filed with the Office of the Secretary of State December 28, 1995 (Supp. 95-4).

Amended effective September 22, 1997 (Supp. 97-3). Amended by final rulemaking at 6 A.A.R. 2435, effective June 9, 2000 (Supp. 00-2). Amended by exempt rulemak-

ing at 7 A.A.R. 5701, effective December 1, 2001 (Supp. 01-4). Amended by exempt rulemaking at 10 A.A.R. 4588, effective October 12, 2004 (Supp. 04-4). Amended by exempt rulemaking at 16 A.A.R. 1386, effective July 15, 2010 (Supp. 10-3). Amended by exempt rulemaking

at 16 A.A.R. 1638, effective October 1, 2010 (Supp. 10-

3). Amended by exempt rulemaking at 17 A.A.R. 1122,

April 1, 2011 (Supp. 11-2).