26-814 Division of Financial Responsibility Guidelines for Post-Transplant Services

Date: 06/30/26

Financial responsibility across the post-transplant period

Under the Division of Financial Responsibility (DOFR), risk for post-transplant services is determined by the rendering provider and the timeframe following discharge. The Medi-Cal Provider Operations Manual has been updated to clarify existing guidance related to post-transplant services and the application of DOFR. The summary below reflects how financial responsibility is applied.

DOFR overview

Post-discharge timeframe	Type of service	Rendering provider	Financial responsibility
0–365 days	Transplant-related services Limited to care provided by the designated transplant team or transplant facility.	Transplant team or transplant facility	Health Net
0–365 days	Non-transplant-related services Includes all services provided by any other provider, regardless of diagnosis.	All other providers1	Participating physician group or Health Net, as applicable
More than 1 year post-discharge (standard DOFR applies)	All services After 1 year post-discharge, the special transplant categorization period ends, and all services fall under the respective category in accordance with the DOFR.	All providers2	Participating physician group or Health Net, as applicable

¹Providers not part of the transplant team or transplant facility.

²Includes transplant team and transplant facility providers.

Access the Medi-Cal Provider Operations Manual

For additional details on transplant-related services:

1. Go to the Provider Library and select Medi-Cal.
2. Select Provider Manual.
3. Navigate to the Benefits section.
4. Select Transplants.

Questions

For questions or additional clarification, please contact Community Health Plan of Imperial Valley at 833-236-4141.

 

This information applies to Physicians and Practitioners and Hospitals.

This information applies to Medi-Cal in Imperial County.