Our Stance | HEiTC

The critical issues compounding the transplant crisis are clear. Unfortunately, solutions have been stalled due to bureaucratic red tape that make it difficult for providers, insurers and regulators to implement cohesive policies that effectively increase the availability of organ donations, and improve post-procedural care.

One of these issues is protecting insurance coverage for innovative diagnostics tools for post-transplant care. HEiTC successfully rallied stakeholders, key lawmakers on Capitol Hill, patients and providers to raise attention about a harmful Centers for Medicare and Medicaid Services (CMS) policy that severely limited Medicare coverage for a life saving blood test that allows kidney transplant patients to monitor for early signs of rejection. In August 2024, CMS reversed the decision by rescinding a local coverage determination which restored coverage for regular surveillance use. However, CMS has since launched a new LCD process that may restore this harmful and limiting policy. This is just one of the priority areas we are focused on that can ensure common sense practices to improve health outcomes for the transplantation community.

We are committed to finding pragmatic and bipartisan solutions that address the transplant crisis by working with decision makers in Washington and the private sector to focus on the following key issue areas:

1. Ensure Full and Equitable Access to Post-Transplant Care

HEiTC has pushed for Medicare coverage for non-invasive blood tests for regular surveillance of transplanted organs since its inception in November 2023. In August, the Centers for Medicare and Medicaid Services (CMS) clarified these tests are covered for regular monitoring in order to catch early signs of a rejection. Privately owned Medicare Administrative Contractors (MACs) to CMS are currently determining whether this coverage should change in a new draft Local Coverage Determination (LCD). HEiTC will continue to work with the transplant community to ensure tests are covered for regular surveillance, as part of a greater push to guarantee access to post-transplant care.