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CMS Releases FY 2022 IPPS Final Rule on Organ Acquisition and Other Policies

January 7, 2022

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CONTACTS
Andrew Amari, Hospital Policy and Regulatory Specialist

On Dec. 17, 2021, the Centers for Medicare & Medicaid Services (CMS) released a second fiscal year (FY) 2022 Inpatient Prospective Payment System (IPPS) final rule addressing Medicare’s payment for organ acquisition, treatment of Section 1115 waiver days in the Medicare Disproportionate Share Hospital (DSH) payment calculation, and distribution of the 1,000 new graduate medical education (GME) slots (for details on the finalized GME policies, refer to related story). The CMS did not address these policies in the first FY 2022 IPPS final rule on Aug. 2, 2021, due to the number and nature of the comments it received on the implementation of the proposals [refer to Washington Highlights, Aug. 6, 2021].

Notably, in this second IPPS final rule, the CMS did not finalize its proposal to revise Medicare’s usable organ policy to count only organs transplanted into Medicare beneficiaries in the calculation of Medicare’s share of organ acquisition costs. The AAMC and other commenters urged the CMS not to finalize the organ acquisition proposals and to instead engage all transplantation stakeholders to evaluate the impact of the proposed changes to ensure continued availability of and access to scarce organs [refer to Washington Highlights, July 1, 2021]. However, the final rule noted that the CMS may reconsider the policy for future rule-making, but the agency further explained that it would conduct additional analyses of the impacts on transplant hospitals, children's hospitals, and organ procurement organizations before it considers revising this policy in future rule-making. Additionally, although the CMS did not finalize its proposed policy to modify how organs are counted in the organ acquisition calculation, the agency did finalize several technical changes, modifications, and clarifications to the existing organ acquisition policies that were addressed in the proposed rule. These changes include policies on accounting for services related to living kidney donors, provisions on Medicare as a secondary payor for organ acquisition costs, and charges for kidney paired exchanges, among others.

The CMS also did not finalize its proposal to modify treatment of Medicaid Section 1115 waiver days in the Medicare DSH payment calculation. The CMS proposed to revise its regulations to state that a patient would only be included in the numerator of the Medicaid fraction if the patient is eligible for inpatient hospital services under an approved state Medicaid plan that includes coverage for inpatient hospital care on that day or directly receives inpatient hospital insurance coverage on that day under an 1115 waiver. The AAMC and other commenters urged the CMS not to finalize the proposal, which would have excluded certain low-income Medicaid beneficiaries that should be counted in the numerator; the 1115 waivers make these individuals eligible for Medicaid, which is the requirement for being counted in the numerator. Although the CMS did not finalize the policy, the agency noted that it will consider the policy in future rule-making.

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