Section 1005.1 - Supporting Living Donors
Effective Date
Section 1005.1 Supporting Living Donors. Qualified living donors, subject to an application and approval by the Department of Health or its designee, may seek reimbursement for eligible expenses, compensated in line with rates determined by the department, up to a maximum of $14,000 dollars for any single living donor.
(a) Eligible expenses. The following list shall be deemed eligible expenses, provided they are directly associated with a living donation as defined by section 4370 of the Public Health Law:
(1) either lost wages including demonstrated lost non-employment income or the economic value of sick or vacation days expended. This category of eligible expenses shall not exceed four weeks unless special circumstances are demonstrated, such as the nature of physical labor required for the living donor's employment provided that the total period shall in no event exceed eight weeks;
(2) travel, food and lodging;
(3) child or other dependent care expenses;
(4) elder care expenses;
(5) costs of medications and care associated with the living donation surgery that are not covered by health insurance including the medical assistance program; and
(6) support person costs.
(b) Process for applying and submitting claims. Applicants shall submit a program eligibility application, request for preauthorization and claims for reimbursement using a form(s) and following a process designated by the department or its designee.
(c) The department or its designee shall review and if applicable, approve or disapprove the eligibility application, request for preauthorization and claims for reimbursement.
(d) In the event an application is withdrawn by the applicant, the application will be considered withdrawn. In the event an applicant does not respond to requests for additional information in a timely manner, the department may deem that application withdrawn.
(e) The department or its designee, may conduct ongoing reviews and audit a participant or provider's conduct, and recover funds as appropriate.
(1) Any person who receives reimbursement under this section for which they are not legally entitled, shall be liable to the department for such compensation plus interest as set forth is section 5004 of the Civil Practice Law and Rules.
(2) Good faith efforts by persons to seek reimbursement of eligible living donor expenses shall not be subject to recovery by the department.