THE LIVING BANK

America’s Original and Largest Organ and Tissue Donor Registry

GUIDELINES FOR TRAVEL,

LODGING AND/OR SUBSISTENCE ASSISTANCE

 

The Travel, Lodging and/or Subsistence Program is intended to provide reimbursement only in those circumstances when payment cannot reasonably be covered by other sources of reimbursement such as:

 

1)      Any state compensation program, an insurance policy, or any federal of state health benefits program;

2)      An entity that provides health services on a prepaid basis;

3)      In the case of a living donor, funding from The National Living Donor Assistance

Center (NLDAC) www.livingdonorassistance.org. (NLDAC provides up to $6,000

in support.  If you need assistance to apply for the NLDAC stipend, please contact The Living Bank.) 

 

In the case of a recipient/living donor, the parties must apply for assistance from the National Living Donor Assistance Center (NLDAC) prior to receiving a $1,000 stipend from TLB.  If the recipient or living donor receives assistance that exceeds more than $1,000 from NLDAC, then they will not be eligible for the TLB stipend.

 

For this program, a threshold of income eligibility will be 300 percent of the Department of Health and Human Services (HHS) Poverty Guidelines in effect at the time of eligibility determination. 

 

The program provides an exception to this rule for financial hardships. A transplant counselor with The Living Bank, in collaboration with the transplant center, based on a complete recipient evaluation, can provide an official statement, notwithstanding the recipient’s income level, that the organ recipient faces significant financial hardship if required to pay for his/her transplantation-related travel, accommodation and subsistence and/or that of the living donor.

 

Recipient’s financial hardship is defined as circumstances in which the recipient’s income exceeds 300 percent of the HHS Poverty Guidelines in effect at the time of the eligibility determination, but the individual will have difficulty paying his/her expenses or the living donor’s expenses due to other significant expenses.  Whether or not hardship exists in a particular case requires a fact-specific analysis; examples of significant expenses include paying for medical expenses not covered by insurance or providing significant financial support for a family member not living in the household (e.g., elderly parent). 

 

A waiver request by the transplant center, on behalf of the donor, shall be made in writing and shall clearly describe the circumstances for the waiver request.  TLB will review waiver requests and make a recommendation to the TLB Board of Directors to either approve or deny the request.  The TLB Board will make the final determination and communicate its final determination to the President/CEO of TLB who will notify the transplant center of the final determination.   TLB’s determination will be subject to appeal on a one-time basis.  The final decision by the TLB’s Board will not be subject to appeal.

 

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STIPEND PRIORITY DETERMINATION POLICY

Because of the limited funds available, prospective living donors who are most likely unable to cover these expenses will receive priority.  Donors will be given preference in the following order of priority:

Preference Category 1: The donor’s income and the recipient’s income are each 300 percent or less of HHS Poverty Guidelines in effect at the time of the eligibility determination in their respective states of primary residence.


Preference Category 2: Although the donor’s income exceeds 300 percent of the HHS Poverty Guidelines in effect in the State of primary residence at the time of the eligibility determination, the donor demonstrates financial hardship.  The recipient’s income is at or below 300 percent of the HHS Poverty Guidelines in effect in the State of primary residence at the time of the eligibility determination.

 

Preference Category 3: Any living organ donor, regardless of income or financial hardship, if the recipient’s income is at or below 300 percent of the HHS Poverty Guidelines in effect in the recipient’s State of primary residence at the time of the eligibility determination.


Preference Category 4: Any living organ donor, regardless of income or financial hardship, if the recipient (with income above 300 percent of the HHS Poverty Guidelines in effect in the State of primary residence at the time of the eligibility determination) demonstrates financial hardship.

TLB reserves the right to prioritize those most in financial need (based on income or other specified factors) if it receives large numbers of applications concerning donors meeting preference category 1.

 

 

The HHS Poverty Guidelines for 2007 (Federal Register, Vol. 72, No. 15, January 24, 2007, pp. 3147-3148) are shown in the table below.

<P2007 HHS Poverty Guidelines

Persons
in Family or Household

48 Contiguous
States and D.C.

Alaska

Hawaii

1

$10,210

$12,770

$11,750

2

13,690

17,120

15,750

3

17,170

21,470

19,750

4

20,650

25,820

23,750

5

24,130

30,170

27,750

6

27,610

34,520

31,750

7

31,090

38,870

35,750

8

34,570

43,220

39,750

For each additional person, add

 3,480

 4,350

 4,000

SOURCE:  Federal Register, Vol. 72, No. 15, January 24, 2007, pp. 3147–3148

For more information go to: http://aspe.hhs.gov/poverty/

Criteria for Donor Reimbursement

  1. Any individual who in good faith incurs travel and other qualifying expenses toward  transplantation of an organ before and after donation or an intended living donor.
  2. Donor and recipients of an organ are U.S. citizens or lawfully admitted residents of the U.S.
  3. Donor and recipients have primary residences in the U.S. or its territories.
  4. Travel is originating from the donor’s primary residence.
  5. Donor and recipient certify that they understand and are in compliance with Section 301 of NOTA (42 U.S.C. §274e) which states in part “…..It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce."
  6. The transplant center where the donation procedure occurs certifies to its status of good standing with the Organ Procurement and Transplantation Network (OPTN).

Qualifying Expenses
Qualifying expenses presently include only travel, lodging, and meals and incidental expenses incurred by the recipient, donor and/or his/her accompanying person(s) as part of:

(1) Recipient and/or donor evaluation, clinic visit or hospitalization,
(2) Hospitalization for the recipient and/or living donor surgical procedure, and/or
(3) Medical or surgical follow-up clinic visit or hospitalization one time per year.

The Program will pay for a total of up to five trips (up to $1,000 total), three for the donor and two for accompanying persons.  The accompanying persons need not be the same each trip.

The total reimbursement for qualified expenses during the donation process for recipients and living donor and accompanying individuals shall not exceed $1,000.00.  Reimbursement for qualifying expenses shall be provided at the Federal per-diem rate, except for hotel accommodation, which shall be reimbursed at no more than 150 percent of the Federal per diem rate.

For donor and recipient pairs participating in a paired exchange program, the applicable eligibility criteria for the originally intended recipient shall be considered for the purpose of reimbursement of qualifying donor expenses even though the final recipient of the donated organ may not be the recipient identified in the original donor-recipient pair.

Maximum Number of Prospective Living Donors per Recipient

Special Provisions
Many factors may prevent the intended and willing living donor from proceeding with the donation.  Circumstances that would prevent the transplant or donation from proceeding include: present health status of the intended donor or recipient, perceived long-term risks to the intended donor, justified circumstances such as acts of God (e.g., major storms or hurricanes), or a circumstance when an intended donor proceeds toward donation in good faith, subject to a case-by-case evaluation by the NLDAC, but then elects not to pursue donation.  In such cases, the intended donor and accompanying persons may receive reimbursement for qualified expenses incurred as if the donation had been completed.  Under Program policy, a form will be filed with the Internal Revenue Service (IRS) reporting funds disbursed as income for expenses not incurred.