National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

Duplicate Transplant Registry Fees

Joint Signature Memorandum (JSM/TDL)-08029 October 26, 2007

This information applies specifically to hospitals with transplant centers (kidney, heart, liver, lung, intestine or pancreas).

Recently, a company known as MatchingDonors, Inc., operating through a Web site at www.matchingdonors.com, has been notifying transplant centers and physician organization members about its service. MatchingDonors is a Web-based donor-recipient matching service that lists individuals who potentially intend to donate an organ and individuals in need of a transplant. Another organization, the National Kidney Registry, also operates a living-donor/recipient matching service.

In the notifications sent by MatchingDonors to transplant centers, MatchingDonors states that Medicare will reimburse the fees paid by transplant centers for placing waiting list candidates on MatchingDonors’ Web site listing. MatchingDonors charges rates as high as $595 for a lifetime membership. The National Kidney Registry charges a $750 registry fee and states that potential recipients may be able to be reimbursed by Medicare. The MatchingDonors notifications also reference the Medicare Benefit Policy Manual, Chapter 11, Section 104.17, which states:

“A participating hospital which expects to perform a kidney transplant will be reimbursed for the reasonable cost incurred in listing the patient and the patient’s blood characteristics with a professionally recognized organization that maintains a registry of potential transplant candidates, and which provides a regular listing of such patients to hospitals engaged in kidney procurement.”

The policy noted above was instituted as a result of the Organ Transplant Act of 1984, as amended, (42 U.S.C. 273 et seq.) which created the Organ Procurement and Transplant Network (OPTN) to be operated by a private, nonprofit entity under contract with the Health Resources and Services Administration (HSRA). The United Network for Organ Sharing (UNOS) has been awarded the contract to operate OPTN. Our payment policy was written to allow payment for the fees to OPTN and UNOS. UNOS is professionally recognized throughout the transplant community as the single registry of individuals waiting for an organ transplant. It utilizes medical test results to match donors and recipients and allocate organs for transplantation on a national basis using a scientific methodology. To date, no other organization, including MatchingDonors and the National Kidney Registry, has been awarded a contract by HRSA.

Section 1861(v)(1)(A) of the Social Security Act states, in pertinent part, that the reasonable cost of any services should exclude costs that are unnecessary in the efficient delivery of needed health services. Payment for organ acquisition costs incurred by a hospital is made on a reasonable cost basis. See 42 CFR 413.113(d). The OPTN’s registry contains potential recipients for organs. Any person who wishes to make the altruistic donation of an organ may begin the process by contacting any OPTN member transplant hospital. Once a final decision to donate is made, a match with a suitable recipient determined by the transplant program is made.

The Centers for Medicare & Medicaid Services (CMS) pays for living donor and deceased donor transplants by the Diagnostic Related Group (DRG) and the organ acquisition cost. When an altruistic living donor is available, the program’s costs for assessing the donor and deciding on a suitable match are included in the organ acquisition cost center of cost report submitted by the transplant center. Accordingly, because potential recipients already have a means of being matched with altruistic donors by the functions of the OPTN member institutions and Medicare already reimburses hospitals for the cost of enrolling in the OPTN registry, paying MatchingDonors or the National Kidney Registry for this function would be unnecessary and duplicative, and would be inconsistent with section 1861(v)(1)(A).