Per the Center for Medicare and Medicaid Services, “a transplant program is defined as a component within a transplant hospital that provides transplantation of a particular type of organ to include; heart, lung, liver, kidney, pancreas, or intestine” for both adults and pediatrics. The transplant programs must be located in a hospital that has a Medicare provider agreement and must meet the transplant Conditions of Participation (CoPs) specified in in 42 CFR §482.1 through §482.57. The current survey protocol and interpretative guidelines for organ transplant programs were established in March 2007 and became effective on June 28, 2007.
In order to apply for Medicare certification for a transplant program, a Medicare certified hospital should complete the following:
- A CMS-855 form submitted through the Medicare Administrative Contractor (MAC), indicating a new transplant program “practice location.” Once the MAC has approved this form, they will send a copy to the Illinois state survey agency.
- A letter from the hospital containing the information listed in QSO-19-11-Transplant Attachment A: Required Information for all Applications for Medicare Approval of Transplant Programs.
This letter should be emailed to Karen Senger (email@example.com) or mailed to:
Illinois Department of Public Health
Division of Health Care Facilities and Programs
525 West Jefferson Street, 4th Floor
Springfield, IL 62704
- Submit information to the Organ Procurement Transplant Network (OPTN) to comply with 42 CFR §482.80. This includes information on patient data, clinical experience, and outcome requirements. Once this information is submitted, CMS will review it and provide the results of that review to the Illinois state survey agency.
Please refer to QSO-19-11-Transplant for more information on the initial survey and certification process, as well as recertification of transplant programs.
Process for Requesting Consideration of Mitigating Factors in CMS' Determination of Medicare Approval of Organ Transplant Centers
A transplant program may send a request to CMS QSOG-Transplant Team at QSOG_TransplantTeam@cms.hhs.gov to consider mitigating factors in the initial approval and re-approval of a transplant program that does not meet §482.80 or §482.82. §488.61 describes three general areas that will be reviewed in determining whether a program can be approved based on mitigating factors. These areas include (but are not limited to):
- The extent to which outcome measures are met or exceeded;
- The availability of Medicare-approved transplant centers in the area; and
- Extenuating circumstances that may have a temporary effect on meeting the CoPs
Program Changes to Transplant Program
Ongoing changes (such as changes to a primary surgeon or physician for a given organ, as designated by the OPTN or to the contact person for the transplant program) should be reported in writing within 7 business days of the change occurring to Karen Senger at firstname.lastname@example.org.
The State must be notified when a transplant program intends to inactivate one any one of transplant program types at least 30 days prior to the planned inactivation. Please notify the State for processing to the Center for Medicare and Medicaid at DPH.HospitalReports@illinois.gov. Guidance for inactivation can be found at §482.74.
Illinois Transplant Programs
The following is a list (alphabetized by name) of Illinois hospitals that are approved to provide services for people seeking organ transplant and organ donors.