CMS Increasing Organ Transplant Access


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.

Regulators CMS
Entity Types Ins
Reference 2024-27841, 12/4/2024; PR, 11/26/2024; 89 FR 43518, 5/17/2024; RIN 0938-AU51; CMS-5535-P;
Functions Operations; Reporting
Countries United States of America
Category
State
Products Insurance; Insurance-Health; Medicare
Regions Am
Rule Type Final
Rule Date 5/17/2024
Effective Date 12/26/2024
Rule Id 212580
Linked to N/A
Reg. Last Update 11/26/2024
Report Section US Investment

Last substantive update on 11/29/2024