DATE: October 11, 2024

By Amy Lotven / October 11, 2024
InsideHealthPolicy

CMS should consider reimbursing living donors’ out-of-pocket expenses and should fund staff dedicated to navigating the transplantation process as part of its demonstration model that aims to drive up the kidney transplant rate, a bipartisan group of 47 lawmakers say in a Sept. 19 letter to CMS administrator Chiquita Brooks LaSure and CMS Innovation Center Director Liz Fowler. The letter was immediately cheered by organ transplant stakeholders that also back the changes to the Increasing Organ Transplant Access (IOTA) (CHECK) OTA demonstration.

The lawmakers, led by Reps. Suzan Del Bene(D-WA), Carol Miller (R-WV), Brad Schneider (D-IL) and Larry Bucshon (R-IN), say they’re optimistic about the model but worry that it doesn’t include specific waivers or incentives to increase living donors, and especially preemptive donations that help patients avoid costly, painful dialysis.

First, they say, CMS should fund navigators who can work with donors and transplant recipients. “Medicare has recently initiated coverage for Principal Illness Navigators, demonstrating a pathway for this model enhancement,’ the lawmakers add. The agency could also look to scale up some of the smaller navigator programs run by universities and non-profits around the country.

Secondly, the lawmakers say, because of the well-documented financial barriers to living donations CMS should consider reimbursing patients for costs that are not covered under Medicare — or by another agency or third-party — as part of the model. Currently, the National Living Donor Assistance Center (NLDAC), funded by the Health Resources and Services Administration (HRSA), offers help for low-income individuals to cover follow-up visits as well as lodging, meals, lost wages and caregiver costs. But that program is means-tested.

Reimbursing other living donors under the model at no cost to the transplant centers would “ensure that these living donor heroes are not financially penalized or disincentivized for their generous act,” the lawmakers say. They also underscore what they view as an urgent need for CMS to address disparities in transplants.

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