On May 17, CMS proposed increasing organ transplant access model.
CMS proposed rule re new mandatory Medicare payment model, Increasing organ transplant access model (IOTA Model), to test performance-based incentive payments.
Specifically, whether such payments paid to or owed by kidney transplant hospitals increase access to transplants for patients with end-stage renal disease (ESRD).
While preserving or enhancing the quality of care and reducing Medicare expenditures.
Proposed Mandatory Model
Mandatory model would begin on Jan. 1, 2025 and end on Dec. 31, 2030, resulting in 6 year model performance period comprised of 6 individual performance years (PY).
CMS would select kidney transplant hospitals to participate in the IOTA Model, would measure and assess the participating kidney transplant hospitals' performance.
During each PY across 3 performance domains, achievement, efficiency, and quality.
Includes standard provisions, would apply to innovation center models whose first performance period begins on or after Jan. 1, 2025, before Jan. 1, 2025 in situations.
Proposal to increase transparency, efficiency, clarity in operation and governance of innovation center models, avoid restating provisions in governing documentation.
Consultation
Comments must be received by Jul. 16, 2024.
Nov. 2024 CMS Finalized Model
On Nov. 26, 2024, CMS finalized a rule establishing a new, six-year mandatory model aimed at increasing access to kidney transplants and reducing health disparities.
IOTA model creates a representative national sample of kidney transplant hospitals.
CMS made significant revisions to the final rule based on comments received, and will delay model start date to July 1, 2025, to allow participants additional time to prepare.
Changes increase the maximum amount a transplant hospital may receive from CMS based on performance score from $8,000 to $15,000 per Medicare kidney transplant.
Removes the requirement for providers to review organ offers declined on behalf of the patient, adjusts transplant target to reflect the average number of donor transplants.
Also adjusts quality strategy to allow for additional time for measure identification and stakeholder input, including removing three quality measures from the quality domain.
Removes health equity payment adjustment, allows health equity plans as voluntary.
The final regulations are effective 30 days after date of publication in federal register.
Dec. 4, 2024 Fed Reg CMS Final Rule
On Dec. 4, 2024, CMS issued final rule on model in fed register, effective Jan. 3, 2025.
