CMS issues final rule on mandatory payment model for organ transplants

The Centers for Medicare and Medicaid Services released it on Nov. 26. final rule On models for increasing organ transplant access. This new mandatory payment model will provide performance-based incentives and penalties for participating transplant hospitals to increase access to kidney transplant care for patients with end-stage renal disease, while maintaining or improving quality of care. It would test whether to improve equitable access and reduce Medicare. Expenses. The model is expected to run for six years. Participation will be mandatory for all eligible hospitals (i.e., non-pediatric kidney transplant hospitals that meet minimum volume criteria) within half of the nation's contributing service areas. Posted by CMS List of 103 hospitals required to participate on their website.

In response to stakeholder feedback, including concerns raised by AHA, AHA made several adjustments to the model. These adjustments include deferring the start date to July 1, 2025, increasing the maximum cap per case from $8,000 to $15,000, and increasing the average number of deaths or surviving transplants during the base year. (compared to the proposed maximum). and remove the three quality criteria. The agency also did not finalize transparency requirements that would require IOTA participants to notify beneficiaries of the number of times they have been denied organ donation on behalf of a Medicare beneficiary and why.

AHA will provide additional details regarding the IOTA Final Rule in a special bulletin.