Medicare Tweaks Kidney Transplant Payment Model Through 2031
Published Date: 6/1/2026
Rule
Summary
Starting July 1, 2026, Medicare is updating the Increasing Organ Transplant Access (IOTA) Model to help kidney transplant hospitals do even better at getting more people transplanted and improving care quality. These changes affect hospitals involved in kidney transplants and aim to make the process smoother and more effective, with new payment rules that reward success. This update is part of a 6-year plan running through 2031 to save more lives and boost patient experience.
Analyzed Economic Effects
11 provisions identified: 6 benefits, 3 costs, 2 mixed.
Performance-Based Payment Formula
An IOTA participant with a final performance score greater than 60 receives an upside payment calculated as: (final score − 60) ÷ 40 × $15,000 × (number of kidney transplants furnished to attributed Medicare patients during the performance year). Downside payments apply for final scores of 40 or lower beginning in Performance Year 2.
Medicare Advantage Included in Payments
CMS will include Medicare Advantage (MA) beneficiaries in the calculations for the IOTA Model's upside and downside risk payments. This change is finalized for Performance Year 2 and later, so counts of Medicare patients used to determine payments now include MA beneficiaries as well as Medicare FFS.
Downside Payment Due Within 60 Days
IOTA participants that owe a downside risk payment must remit the full payment to CMS in a single payment within 60 days after the date on which the demand letter is issued. If full payment is not received within 60 days, the remaining amount will be considered a delinquent debt.
Medicare Patient Notifications and Reviews
IOTA participants must inform their IOTA waitlist patients who are Medicare beneficiaries about individualized organ offer acceptance criteria at least once every 6 months while on the waitlist. They must notify Medicare beneficiaries when their waitlist status changes in a way that affects organ offers, include the reason and how to become active again, notify the dialysis facility and managing clinician where applicable, and send status-change notices within 10 days. Notices may be electronic if the patient has opted for electronic communications.
Updated Quality Metric Scoring Rules
CMS updated the composite graft survival rate metric by adding a modified risk-adjustment framework based on the Scientific Registry of Transplant Recipients, excluding multi-organ transplants from the metric, and changing how points are allocated for performance on this metric. These updates feed into participants' quality-domain scores used for payments.
Termination and Monitoring Enhancements
CMS may monitor the transparency provisions (such as review of acceptance criteria, semiannual reviews, and status-change notifications) and may terminate an IOTA participant if the Department of Health and Human Services (HHS) or the Organ Procurement and Transplantation Network (OPTN) determines the participant violated OPTN policies or certain HHS regulations. CMS updated its termination sources and monitoring authority in this rule.
Estimated Federal Savings of $60 Million
CMS estimates that the finalized changes to the IOTA Model will increase net Federal savings by $60,000,000. This estimate is presented in the rule's analysis of costs and benefits.
Higher Minimum Transplant Volume
To be eligible for the IOTA Model, a kidney transplant hospital must have performed at least 15 kidney transplants per year for adults during each baseline year. This raises the previous minimum from 11 to 15 transplants per year and takes effect for Performance Year 2 beginning July 1, 2026.
Exclude VA and Military Facilities
Department of Veterans Affairs (VA) medical facilities and military medical treatment facilities (MTFs) are excluded from eligibility to participate in the IOTA Model for Performance Years 2 through 6. CMS finalized this exclusion because Medicare generally does not pay for services furnished by those federal facilities.
Public Posting of Waitlist and Donor Criteria
IOTA participants must publicly post their patient waitlist selection criteria on a website and keep it up to date by the end of each performance year. Hospitals that perform living donor transplants must post living donor selection criteria by the end of Performance Year 2 and update it each subsequent year; the IOTA Model website will publish these items by the end of the second quarter of each subsequent performance year.
Health Equity Plan Requirement Removed
CMS is removing the voluntary Health Equity Plan (HEP) submission option for IOTA participants. CMS explained the voluntary HEPs require participant time and resources and are being removed so resources can be focused on the model's core objectives and mandatory requirements.
Your PRIA Score
Personalized for You
How does this regulation affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this federal register document and every other regulation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Key Dates
Department and Agencies
Related Federal Register Documents
2026-10292 — Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments
This proposed rule changes how states can pay Medicaid managed care plans and certain doctors to make sure payments are fair, efficient, and encourage enough providers to offer quality care. It affects states, Medicaid managed care organizations, and targeted Medicaid practitioners, aiming to keep payments balanced and services available. Comments on these changes are open until July 21, 2026, so stakeholders have time to weigh in before it’s finalized.
2026-10050 — Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program
Starting in 2027, health insurance plans on federal and state marketplaces will see new rules to make coverage fairer and easier to use. These changes affect insurance companies, agents, and people buying plans, including new fees, penalties, and better protections for those with hardships. Expect updates on plan quality, dental coverage limits, and longer-term catastrophic plans, all aiming to keep your health coverage solid and affordable.
2026-07205 — Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges
This new rule will help Medicare, Medicaid, CHIP, and health plan companies share patient info more easily and speed up drug approval requests. It affects Medicare Advantage, Medicaid, CHIP, and health plans on federal exchanges, aiming to make care smoother and faster. These changes will start soon and could save time and money by cutting red tape.
2026-04797 — Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program; Correction
This document fixes some typos and technical mistakes in the Medicare and Medicaid payment rules for 2026. It affects doctors, healthcare providers, and anyone using Medicare Part B by clarifying payment policies and program requirements starting January 1, 2026. These corrections help make sure payments and coverage rules are clear and accurate, so everyone gets paid right and on time.
2026-04467 — Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Correction
This correction fixes some missing labels in important tables from the 2027 health insurance rules under the Affordable Care Act. It mainly affects insurance companies and people using marketplace plans by clarifying how risk and payments are calculated. These fixes take effect right away on March 6, 2026, ensuring everyone has clear info before the 2027 plan year starts.
2025-23081 — Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2026 and Updates to the IRF Quality Reporting Program; Correction
This correction fixes some math and typo mistakes in the Medicare payment rules for inpatient rehab facilities starting October 1, 2025. It mainly affects rehab centers by updating their payment rates and quality reporting details to be fair and accurate. These changes ensure providers get the right money and info for the 2026 fiscal year.
Previous / Next Documents
Previous: 2026-10889 — Fisheries of the Caribbean, Gulf of America, and South Atlantic; Reef Fish Fishery of the Gulf of America; 2026-2027 Recreational Closure for Greater Amberjack
Starting September 1, 2026, recreational fishers in the Gulf of America can catch greater amberjack, but the season will close early on October 14, 2026, to protect the fish population. This temporary closure lasts until July 31, 2027, helping keep amberjack numbers healthy for future fun. If you love fishing, plan your trips before mid-October to avoid missing out!
Next: 2026-10891 — Atlantic Highly Migratory Species; Atlantic Bluefin Tuna Fisheries; Harpoon Category Retention Limit Adjustment
Starting June 1, 2026, fishermen using harpoons to catch Atlantic bluefin tuna can only keep up to 5 big tuna per day instead of 10. This rule helps protect tuna populations and lasts until November 15, 2026, unless changed earlier. It affects all vessels with Harpoon category permits and aims to balance fishing fun with smart conservation.