Summary


All requirements of the repealed rule are reenacted in the proposed rule to reflect current practices. For example, the proposed rule includes certain references to the "Social Security Act" and Utah Code that better authorize transplantation services and adds and updates certain definitions for better clarification. The proposed rule also updates and clarifies terminology and requirements for prior authorization, updates and clarifies service coverage, and uses the term "Medicare-approved" to appropriately classify centers for transplant services and to describe their responsibilities. Additionally, the proposed rule includes new sections that clarify covered and non-covered services for both solid organ transplants and hematopoietic stem cell transplants and includes a section that clarifies requirements for requests of non-covered transplantation services. The proposed rule also makes other technical changes and clarifications.