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Language Clarification to Medicaid Benefit of Solid Organ Transplants Effective December 1, 2023

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after December 1, 2023, solid organ transplant benefit language will be updated for Texas Medicaid.

This update is mandated by Senate Bill 1040, 88th Legislature, Regular Session, 2023. According to the update, the following will be clarified as expressly not covered by Texas Medicaid:

  • Transplant or post-transplant care procedures from any country outside the United States
  • Organs that were not harvested willingly
  • Organs obtained from any country outside the United States
  • Organs harvested for a fee or sponsorship

According to the update, the following will continue to be covered by Texas Medicaid:

  • Solid organ transplants and post-transplant care if the organ procurement is in alignment with the National Organ Transplant Act (NOTA)
  • Organs harvested voluntarily from within the United States and overseen by the Health Resources and Services Administration (HRSA) and the United Network of Organ Sharing (UNOS)

For more information, call the TMHP Contact Center at 800-925-9126.