(a)
A bone marrow transplant for the treatment of cancer for beneficiaries who are eligible for full-scope benefits under this chapter, shall be reimbursable under this chapter, when all of the following conditions are met:(1)
The bone marrow transplant is recommended by the recipient’s physician.(2)
The bone marrow transplant is performed in a hospital that is approved for participation in the Medi-Cal program.(3)
The bone marrow transplant is a reasonable course of treatment and is approved by the hospital medical policy committee when there is an existing committee or a committee can be established.(4)
The bone marrow transplant has been deemed appropriate for the recipient by the program’s medical consultant. The medical consultant shall not disapprove the bone marrow transplant solely on the basis that it is classified as experimental or investigational.(b)
The program shall provide reimbursement for both donor and recipient surgery.(c)
The department may establish inpatient rates of reimbursement not in accordance with the state plan for those hospitals not under contract with the state pursuant to Article 2.6 (commencing with Section 14081), provided that the state plan is subsequently amended to reflect the method of reimbursement.(d)
This section shall not be construed as prohibiting reimbursement for any bone marrow transplants otherwise provided for under this chapter.(e)
Any bone marrow transplant authorized by the department pursuant to this section shall be subject to utilization controls.(f)
Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section by means of all-county letters, provider bulletins, or other instructions, without taking any further regulatory action.
Source:
Section 14133.8, https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14133.8..