Current through Register Vol. 24-18, September 15, 2024
This section applies to requirements for hospitals that
perform the medicaid agency-approved transplants described in WAC
182-550-1900(2).
(1) The agency requires instate transplant
hospitals to meet the following requirements to be paid for transplant services
provided to Washington apple health clients. A hospital must have:
(a) An approved certificate of need (CON)
from the state department of health (DOH) for the type of transplant procedure
to be performed, except that the agency does not require CON approval for a
hospital that provides peripheral stem cell (PSC), skin graft or corneal
transplant services;
(b) Approval
from the United Network of Organ Sharing (UNOS) to perform transplants, except
that the agency does not require UNOS approval for a hospital that provides
PSC, skin graft, or corneal transplant services; and
(c) Been approved by the agency as a center
of excellence transplant center for the specific organ or procedure the
hospital proposes to perform.
(2) The agency requires an out-of-state
transplant center, including bordering city and critical border hospitals, to
be a medicare-certified transplant center in a hospital participating in that
state's medicaid program. All out-of-state transplant services, excluding those
provided in agency-approved centers of excellence (COE) in bordering city and
critical border hospitals, must be prior authorized.
(3) The agency considers a hospital for
approval as a transplant center of excellence when the hospital submits to the
agency a copy of its DOH-approved CON for transplant services, or documentation
that it has, at a minimum:
(a) Organ-specific
transplant physicians for each organ or transplant team. The transplant surgeon
and other responsible team members must be experienced and board-certified or
board-eligible practitioners in their respective disciplines, including, but
not limited to, the fields of cardiology, cardiovascular surgery,
anesthesiology, hemodynamics and pulmonary function, hepatology, hematology,
immunology, oncology, and infectious diseases. The agency considers this
requirement met when the hospital submits to the agency a copy of its
DOH-approved CON for transplant services;
(b) Component teams which are integrated into
a comprehensive transplant team with clearly defined leadership and
responsibility. Transplant teams must include, but not be limited to:
(i) A team-specific transplant coordinator
for each type of organ;
(ii) An
anesthesia team available at all times; and
(iii) A nursing service team trained in the
hemodynamic support of the patient and in managing immunosuppressed
patients.
(c) Other
resources that the transplant hospital must have include:
(i) Pathology resources for studying and
reporting the pathological responses of transplantation;
(ii) Infectious disease services with both
the professional skills and the laboratory resources needed to identify and
manage a whole range of organisms; and
(iii) Social services resources.
(d) An organ procurement
coordinator;
(e) A method ensuring
that transplant team members are familiar with transplantation laws and
regulations;
(f) An
interdisciplinary body and procedures in place to evaluate and select
candidates for transplantation;
(g)
An interdisciplinary body and procedures in place to ensure distribution of
donated organs in a fair and equitable manner conducive to an optimal or
successful patient outcome;
(h)
Extensive blood bank support;
(i)
Patient management plans and protocols; and
(j) Written policies safeguarding the rights
and privacy of patients.
(4) In addition to the requirements of
subsection (3) of this section, the transplant hospital must:
(a) Satisfy the annual volume and survival
rates criteria for the particular transplant procedures performed at the
hospital, as specified in WAC
182-550-2200(2).
(b) Submit a copy of its approval from the
United Network for Organ Sharing (UNOS), or documentation showing that the
hospital:
(i) Participates in the national
donor procurement program and network; and
(ii) Systematically collects and shares data
on its transplant programs with the network.
(5) The agency applies the following specific
requirements to a PSC transplant hospital:
(a) A PSC transplant hospital must be an
agency-approved COE to perform any of the following PSC services:
(i) Harvesting, if it has its own apheresis
equipment which meets federal or American Association of Blood Banks (AABB)
requirements;
(ii) Processing, if
it meets AABB quality of care requirements for human tissue/tissue banking;
and
(iii) Reinfusion, if it meets
the criteria established by the Foundation for the Accreditation of
Hematopoietic Cell Therapy.
(b) A PSC transplant hospital may purchase
PSC processing and harvesting services from other agency-approved processing
providers.
(6) The
agency does not pay a PSC transplant hospital for AABB inspection and
certification fees related to PSC transplant services.
11-14-075, recodified as §182-550-2100, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.08.090,
74.09.500. 07-14-018, §
388-550-2100, filed 6/22/07, effective 8/1/07. Statutory Authority:
RCW
74.08.090,
74.09.730,
74.04.050,
70.01.010,
74.09.200, [74.09.]500,[74.09.]530
and 43.20B.020. 98-01-124, § 388-550-2100, filed 12/18/97, effective
1/18/98.
