Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 202 - Hospital Services
Chapter 4 - Organ Transplants
Rule 23-202-4.10 - Heart Transplant
Universal Citation: MS Code of Rules 23-202-4.10
Current through September 24, 2024
A. Prior authorization is required.
B. Heart transplants are covered when all the following criteria are met:
1. Candidate is less than sixty-six (66)
years of age.
2. New York Heart
Association (NYHA) Class III or IV on maximal medical therapy.
3. Meets transplanting facility's blood and
tissue-type compatibility standards.
4. Infections are controlled for at least
forty-eight (48) hours prior to transplant.
5. Pulmonary Functions studies of FEV1 of
>1.5 liter, PVR of <3 Wood units (if >3, prior to vasodilators, <3
after), Pulmonary artery systolic pressure <65-70 mm Hg.
6. Absence of irreversible and severe end
organ dysfunction, such as hepatic, renal, peripheral vascular, or
cerebrovascular, as well as, refractory hypertension, or uncontrolled
malignancy.
7. All other treatments
have been attempted or considered and none will prevent progressive disability
and/or death.
8. The candidate
and/or legal representative understands the transplant risks and benefits,
gives informed consent, and has the capacity and is willing to comply with
needed care, including immunosuppressive therapy.
9. The candidate has been approved by the
transplant review team.
10.
Required serology studies have been completed for HIV, Hepatitis A, B, and C,
Cytomegalovirus (CMV), and Varicella.
11. Immunizations have been administered as
follows:
a) All immunizations for children
age two (2) to six (6) are up-to-date in accordance with the most current
recommended childhood immunization schedule developed and endorsed by the
Advisory Committee on Immunization Practices (ACIP), the American Academy of
Pediatrics (AAP), and the American Academy of Family Physicians
(AAFP),
b) Hepatitis A, if serology
does not indicate immunity,
c)
Hepatitis B, if serology does not indicate immunity,
d) Pneumococcal, and
e) Influenza, annually.
12. A psychosocial evaluation has been
performed for the adult candidate or, if the candidate is a child, for the
family, with the following results:
a)
Candidate's psychiatric disorders, if present, are being treated,
b) Candidate's social
support system has been evaluated and found to be adequate, and
c) Candidate has no previous history of
significant non-compliance to medical treatment.
13. Specific diagnostic inclusion criteria
include the following conditions if expected to limit the candidate's survival
rate to less than twelve (12) months:
a)
Congestive, restrictive, or ischemic cardiomyopathy,
b) Valvular, congenital and other organic
heart disease,
c) Recurrent and
refractory life-threatening ventricular dysrhythmias, or
d) Refractory severe angina
pectoris.
14. The
facility is approved for heart transplants.
C. Transplants are not covered when the candidate has one (1) of the following:
1.
Active chemical dependency, drugs or alcohol, within the preceding six (6)
months.
2. Gastrointestinal
hemorrhage.
3. Severe and
irreversible pulmonary, for instance FEV1 < 1 liter, or other non-cardiac
organ dysfunction.
4. Recent or
unresolved pulmonary infarction, not embolism.
5. Uncorrectable absence of an essential
psychosocial support system.
6.
Unmanageable psychiatric disorder felt to significantly compromise compliance
with the post-transplant regimen.
7. HIV.
8. Hepatitis B or Hepatitis C.
9. Systemic malignancy.
Miss. Code Ann. § 43-13-121; 42 CFR 482.90 -104; 52 FR 10935
Disclaimer: These regulations may not be the most recent version. Mississippi may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
