Living Donor Support Program Reimbursement Guidelines

*Companion documents include Guidance Definitions and Eligibility and Application Guidance

A. Reimbursement of Eligible Living Donor Expenses Whose Donation Occurred After April 1, 2023, and Prior to Living Donor Support Program Launch.

1. Eligible living donors who made their organ donation during the period of April 1, 2023, and Living Donor Support Program Launch (Legacy group).
   1. Must submit their application to determine eligibility with supporting documentation within three months of program launch.
   2. Upon notification of program eligibility, applicant must submit required reimbursement documentation within 90 days.

B. Expenses Eligible for Reimbursement by the Living Donor Support Program

1. All reimbursements to be paid through the New York State Living Donor Support Program for expenses incurred will be subject to budgetary appropriations for state budget fiscal year of April 1 through March 31.
2. All eligible travel, lodging and meal expenses will be paid, with verified receipts, up to the outlined General Services Administration (GSA) rates or the maximum value of the receipts.
3. Travel, Lodging and Meals
   1. In all instances, funding or reimbursement of travel, lodging and meals expenses will be limited to those rates set by the Internal Revenue Service (IRS) and the United States General Services Administration (GSA). See Appendix A for further information on travel, lodging and meals rates (PDF).
   2. Meals will be reimbursed only with overnight travel that is eligible. The amount received on the first and last day of travel equals 75% of the meals and incidental expenses (M&IE) total.
   3. In all circumstances efforts should be made to utilize the most economical route of transportation, lodging and meals.
4. Lost wages (including demonstrated lost non-employment income); OR the economic value of sick or vacation days expended;
   1. Reimbursement for lost wages (including lost non-employment income) or expended sick or vacation days related to the act of making a living donation will not exceed four weeks unless special circumstances are demonstrated, such as the nature of the living donors job involving physical labor. See definitions for additional special circumstances identified by the program. In no event will reimbursement of lost wages (including demonstrated lost non-employment income) or expended sick or vacation time exceed eight weeks.
   2. Wages will be calculated on an hourly basis consistent with a paid time off model. See Appendix B for further information on wage reimbursement (PDF).
5. Dependent care expenses (childcare, child with a disability, dependent adult care, or elder care expenses.
   1. The Living Donor Support Program will reimburse childcare, child with a disability, dependent adult, and elder care expenses incurred as a result of the living donation process.
   2. Childcare-Costs will be reimbursed in accordance with Living Donor Support Program standard rates as posted in Appendix C-Child Care, Child with a Disability, Dependent Adult Care and Elder Care assistance rates (PDF) for reimbursement for the Living Donor Support Program.
   3. Child with a Disability. Dependent Adult, and Elder Care-Costs will be reimbursed in accordance with Living Donor Support Program standard rates as posted in Appendix C-Child Care, Child with a Disability, Dependent Adult Care and Elder Care Assistance Rates for Reimbursement (PDF).
   4. Reimbursement for childcare, child with a disability, dependent adult and elder care will be consistent with the county the claimant resides in.
6. Costs of medications and medical care associated with the living donation process that are not covered by health insurance and, when applicable, consequences of the act of making a living donation, that are not covered by donor or recipient health insurance.
   1. Qualifying medication and the medical care costs directly related to the living donor's donation not covered by health insurance will be reimbursed for twelve months after the living donor surgery.
      1. Living donor copays and deductibles would be covered expenses.
   2. Consequences of the act of making a living donation include events or occurrences that fall outside the usual and expected post-operative course.
7. Support person(s)-The New York State-Living Donor Support Program will provide a flat rate of $100 per day (up to 20 days) for a support person to accompany the living donor during the living donation process.

C. Process and Requirements of Requesting Reimbursement

1. All program participants will have a vendor profile in the New York State Statewide Financial System (SFS) to receive reimbursement from the Living Donor Support Program.
   1. In order to receive reimbursement each accepted donor applicant will be provided a vendor identification profile in the New York Statewide Financial Services. Any payee from a New York State program must complete a Substitute Form W-9. The Substitute W9 will be used to create a vendor profile in the Statewide Financial System (SFS).
   2. Reimbursement documents will be submitted via a custom hyperlink using SendVault (New York State Department of Health's secure file transfer application).
   3. Users can use this hyperlink multiple times throughout their living donation process for reimbursement submission claims.
2. Eligible living donors must submit claims for lost time/lost wages, dependent care, travel, or medication/medical expenses using designated New York State-Living Donor Support Program expense vouchering forms and providing itemized receipts within 90 days of the date of service in order to receive reimbursement consideration for approval determination.
   1. Acceptable required forms of documentation and itemized receipts include:
      1. Lost wages or the economic value of sick or vacation days expended
         1. Verification of days/hours out of work associated with Living Donation Process provided by employer
         2. W2 (gross income) from previous year, and
         3. 1099 (gross income) from previous year, and
         4. K1 dividend from previous year, where applicable and/or
         5. Proof of current income, where applicable (adjusted gross income as shown on paystubs for the past 4 weeks)
      2. Travel, lodging, and meals
         1. Hotel receipts
         2. Airbnb or VBRO receipts
         3. Receipts for rail or airline tickets
         4. Meal receipts (with the exception of any alcoholic beverages)
      3. Child, child with a disability, dependent adult or elder
   2. Receipts and/or attestation of hours worked by child, child with a disability, adult dependent and/or elder care providers.
      1. Documentation for child with a disability and adult dependent includes qualifying diagnoses by a physician, licensed, or certified psychologist or other professional with the appropriate credentials to make such diagnosis and documentation.
      2. Costs of medications and medical care associated with the living donation surgery
         1. Evidence of medication prescription by authorized practitioner and receipts of purchase.
         2. Evidence of payment denial by health care insurance
         3. The Living Donor Support Program shall not be obligated to pay claims more than 90 days after the date of service. Claims submitted later than 90 days with written justification may be considered for payment if funds are available.

D. General Rules of Living Donor Support Program Management and Evaluation of Claims for Reimbursement

1. Living donors determined to be eligible for program participation may seek reimbursement for eligible expenses in any or all the eligible expense categories.
2. Participants that do not ultimately make a living organ donation through no decision or judgement of their own, after incurring eligible expenses during the evaluation process, will be reimbursed for these expenses.
3. Participants who initially apply, are accepted to the program, and ultimately do not make a living organ donation may reapply at a later date for consideration.
4. The Living Donor Support Program official will review and verify information received for all claims submissions. Documentation, validation of dates of service by the transplant center, validation of non-payment by a third-party payor and personal interviews are all means of verification of information supplied that may be used.
5. The New York State-Living Donor Support Program will not reimburse expenses paid or required to be paid by any third-party payor, such as an insurance policy, an employer benefit, State compensation program, a Federal or State health benefits program, or an entity that provides health insurance on a prepaid basis.
6. Living donor expenses shall be reimbursed as close in time as possible to their being incurred by the donor, including making pre-authorized payments where practicable.
7. The maximum amount of eligible living donor expenses the program will reimburse to any single living donor per donated organ determined to be eligible for program participation will be $14,000.00 (fourteen thousand dollars).

E. Internal Controls, Program Audits and Fraud and Abuse

1. Any person who, with intent to defraud, presents for allowance or payment any false or fraudulent claim for reimbursement of living donor expenses, or knowingly submits false information for the purpose of obtaining reimbursement or greater reimbursement than that to which they are legally entitled for reimbursement of living donor expenses or knowingly submits false information for the purpose of obtaining authorization for reimbursement for living donor expenses under this title.
2. Good faith efforts by persons to seek reimbursement of eligible living donor expenses shall not be subject to recovery by the Living Donor Support Program.