Organ Procurement Organizations (OPOs) play a crucial role in ensuring that an immensely valuable, but scarce resource—transplantable human organs—becomes available to seriously ill patients who are on a waiting list for an organ transplant. OPOs are responsible for identifying potential organ donors and for obtaining as many organs as possible from those donors. They are also responsible for ensuring that the organs they obtain are properly preserved and quickly delivered to a suitable recipient awaiting transplantation. Therefore OPO performance is a critical element of the organ transplantation system in the United States. 71 Fed. Reg. 30892 (May 31, 2006).
Section 1138 of the Social Security Act (the Act) (42 U.S.C. 1320b–8) provides the statutory qualifications and requirements that an OPO must meet in order for organ procurement costs to be reimbursed under the Medicare or Medicaid programs. Section 1138(b) of the Act also specifies that an OPO must operate under a grant made under section 371(a) of the PHS Act or must be certified or re-certified by the Secretary as meeting the standards to be a qualified OPO. Id.
Medicare’s share of organ acquisition costs is based on a ratio of Medicare usable organs to total usable organs. Medicare usable organs are those transplanted into Medicare beneficiaries as well as organs that are excised at the transplant center and furnished to an OPO. Organs transplanted into individuals for whom Medicare is the secondary payor will usually be treated as Medicare usable organs.
The Medicare share is calculated by multiplying the organ acquisition costs for each organ cost center by the Medicare percentage and then offsetting revenue obtained from the provision of organs to OPOs and payments made by primary payors for Medicare patients. Transplant centers may charge an OPO either a standard acquisition charge or departmental charges actually incurred for the organ retrieval services.
Excerpt from Rebecca Burke, Issues in Transplant Center Reimbursement, 6 HOSPITALS & HEALTH SYSTEMS RX 1, 12-13 (Spring 2004).