Reviews

Online Review System

Instructions for Submitting Candidate Clinical Reviews to the OSOTC

Instructions for Non-Ohio Transplant Center Seeking OSOTC Approval for Medicaid Purposes

Tutorials

OSOTC Candidate Review System

Instructions for All Patient Summary Forms

Potential transplant candidates must be reviewed by the respective organ-specific Patient Selection Committee. Each Patient Selection Committee consists of one representative from each appropriate member hospital, a representative from the Ohio Department of Health, an ethicist or bioethicist, and a lay representative who may be an attorney. Upon hospital approval for transplantation, a representative of the hospital’s organ-specific pre-transplantation department will submit the clinical summary to the Consortium by uploading the clinical summary to the OSOTC secure online review system at https://review.osotc.org.

The clinical summary must be typed, accurate, and submitted on the approved form as a MS Word document (the approved forms can be found under the Forms section on www.osotc.org.) If a summary is deemed unacceptable due to inadequate information, the Consortium office shall notify the presenting center of the problem, remove the inadequate submission from the system, and wait for the clinical summary to be resubmitted by the presenting institution. The clinical summary is used to verify that the patient meets the statewide patient criteria and must include:

  1. Adequate medical history
  2. Complete lab data as designated on the form
  3. A thorough psychosocial evaluation including the patient’s support system, any psychosocial issues, attitude toward and understanding of transplant, and informed consent as well as a chemical dependency history, if appropriate.
  4. Liver programs: if the patient has a BMI >40, the summary will contain a more detailed physical description, including an estimate of the ascites, location of masses, and if either hypertension or renal insufficiency is a problem.
  5. Lung programs: if the patient has a BMI >30 but <35, the summary will contain a more detailed physical description.

When a center submits a clinical summary to the online review system it is considered a pending candidate and can only be viewed by the Consortium and the presenting center. After the clinical summary is submitted as a pending candidate the Consortium will process the document, which consists of entering all pertinent information into the Consortium database, remove identifying information, converting the de-identified patient summary from a Word document to a non-modifiable PDF document, and finally, registering the new PDF document onto the review system where it can be viewed by the voting representatives.

Reviewers have the option of unconditionally approving, conditionally approving, or rejecting a patient. With all three options, the reviewer may also post a question to the referring program, open for all reviewers to see. The referring program will answer the question, again posting for all reviewers to view. Once all members of the committee have voted and there are no outstanding discussion items, the OSOTC office will certify that the review has been completed and post the OSOTC determination letter. The referring program will be notified via email that a determination has been made regarding their candidate. The presenting center can then log on to the online review system to retrieve the OSOTC determination letter. A majority approval is required for the patient to be accepted as a transplant candidate.

Instructions for Non-Ohio transplant Centers Seeking OSOTC Approval for Ohio Medicaid purposes

1

All forms are required and must be emailed to [email protected].

2

The approved forms can be found under the Forms section on www.osotc.org.

3

All sections of each form need to be completed. Attachments are not acceptable.

  1. Submit the organ-specific patient summary form in a Microsoft Word document.
    1. Adequate medical history
    2. Complete lab data as designated on the form
    3. A thorough psychosocial evaluation including the patient’s support system, any psychosocial issues, attitude toward and understanding of transplant, and informed consent as well as a chemical dependency history, if appropriate
    4. Liver programs: if the patient has a BMI >40, the summary will contain a more detailed physical description, including an estimate of the ascites, location of masses and if either hypertension or renal insufficiency is a problem
    5. Lung programs: if the patient has a BMI >30 but <35, the summary will contain a more detailed physical description
    6. All candidates must meet  Chemical Disorder Criteria.
    7. All heart and lung candidates must meet  tobacco abstinence criteria.
  2. Submit the Out of State Justification FormPer the Ohio Department of Job and Family Services contract for services C-1213-07-0043, Article 1, A(4), in accordance with Ohio Administrative Code 5101:3-2-07, only extra renal organ transplants to Ohio Medicaid consumers, that cannot reasonably be performed in Ohio, will be sent out-of-state. The following information is needed as justification for your Ohio Medicaid patient seeking extra renal organ transplantation outside the state of Ohio. This form must be submitted to the OSOTC as a Word document.
  3. Submit the Ohio Medicaid Required Information FormThis information is required by Ohio Medicaid for patients seeking prior authorization for extra renal transplants. All information indicated is required. Ohio Medicaid will not issue a prior authorization without this required information. This form must be submitted to the OSOTC as a Word document.

Comment for non-Ohio transplant centers seeking OSOTC approval for Ohio Medicaid purposes

  1. Please note that Consortium approval is not required when the patient’s primary insurer is Medicare and Ohio Medicaid is secondary.