CMS issues proposed rule for mandatory organ transplant payment model

The Centers for Medicare & Medicaid Services May 8 released a proposed rule for the Increasing Organ Transplant Access Model, a new payment model that would test whether performance-based incentives or penalties for participating transplant hospitals would increase access to kidney transplants for patients with end-stage renal disease, while preserving or enhancing quality of care, improving equitable access to kidney transplant care, and reducing Medicare expenditures. The model would run for six years, beginning Jan. 1, 2025. Hospitals eligible for participation would include non-pediatric transplant facilities conducting at least 11 kidney transplants during a three-year baseline period. It is anticipated that 90 hospitals would be required to participate. The agency states that the model would align with the Department of Health and Human Services’ efforts under the Organ Transplant Affinity Group, as well as the Health Resources and Services Administration’s organ procurement modernization initiative to improve equitable access to organ transplants, improve accountability in the U.S. organ transplant system, and increase the availability and use of donated organs.

The proposed rule also includes standard provisions that would be applicable across all new Center for Medicare and Medicaid Innovation models beginning Jan. 1, 2025, and after. CMS indicated that these provisions would be intended to address beneficiary protections, cooperation in model evaluation and monitoring, audits and record retention, rights in data and intellectual property, monitoring and compliance, remedial action, model termination by CMS, limitations on review, provisions on bankruptcy and other notifications, and the reconsideration review process.

CMS will accept comments on the proposed rule through July 8.