HHS finalizes rule to expand kidney transplant access

Editor's Note

The US Department of Health and Human Services (HHS) finalized a new rule establishing the Increasing Organ Transplant Access Model, a 6-year, mandatory initiative to enhance access to kidney transplants, improve care quality, and reduce disparities. Managed by the Centers for Medicare & Medicaid Services (CMS), the program will involve 103 kidney transplant hospitals across diverse geographic regions, starting July 1, 2025.

According to a November 26 CMS press release, nearly 13 patients die daily awaiting transplants, and 30% of donor kidneys are discarded annually despite approximately 90,000 people on the waiting list. The model creates a representative national sample of kidney transplant hospitals, incentivizing participants to increase transplants while maintaining high standards for post-transplant outcomes through a two-sided risk arrangement tied to performance metrics.

Participating hospitals will earn payments based on achievement (number of transplants performed), efficiency (rates of accepting organ offers), and quality (post-transplant outcomes). According to the press release, “Based on its final performance score, a participating transplant hospital will either receive a payment from CMS; fall in a neutral zone in which it neither receives nor owes a payment; or, beginning in performance year two, owe a payment back to CMS. These performance-based payments are in addition to the traditional Medicare fee-for-service payment.”

Designed to align with broader HHS strategies to modernize the U.S. organ transplant system the model encourages hospitals to address access barriers by identifying underserved populations and implementing strategies to improve equity. Examples include offering transportation support, reducing out-of-pocket prescription costs, and supporting living donor education.

The full press release offers additional details on significant revisions to the final rule and how it synergizes with other initiatives, as well as links to additional resources.