Legislation & Regulatory Updates
AST is your voice and seat at the table on Capitol Hill, within the Executive Branch, Federal Agencies and in many state capitols and legislatures. These governmental agencies dictate and have direct oversight of most aspects of transplant patient care and medical research. From clinical to research, the field of organ transplantation is heavily regulated and frequently addressed by both our elected and un-elected federal and state leaders.
AST maintains a strong bipartisan and bicameral presence to educate, cultivate and mobilize support for the Society's public policy agenda. Members of Congress, their staff, and senior HHS officials know the Society well and work with its members and the Washington, DC, government relations staff on a daily basis.
Twice a year, the Organ Procurement and Transplant Network (OPTN) releases proposed new policy for public comment (http://optn.transplant.hrsa.gov/governance/public-comment/). Members of the transplant community and the interested public are encouraged to provide feedback on the proposals. As part of its larger advocacy goals, the American Society of Transplantation reviews the policies and provides feedback, where appropriate. The Society seeks input from key constituencies to inform our commentary as follows:
1. The AST OPTN/UNOS Policy Committee and AST President review each proposed policy released for comment to identify specific Communities of Practice (COP) or Committees to review the proposals and suggest comments.
2. COPs and/or Committees develop suggested comments that they forward to the AST's OPTN/UNOS Policy Committee. Any COP may draft a reply for consideration, even if not identified as a key reviewer. Notification is also put out to the general membership.
3. The AST OPTN/UNOS Policy Committee reviews all of the comments and feedback received in order to generate a single comment for each policy that shares specific thoughts or concerns and states the position of the Society where appropriate.
4. The AST OPTN/UNOS Policy Committee Chair presents draft responses to the Board for approval or amendment before submission to the OPTN.
AST comments on OPTN/UNOS Policy Proposals:
- March 23, 2020, comments on 11 proposals
- December 5, 2019, special public comment period on 1 proposal
- November 14, 2019, special public comment period on 1 proposal
- October 1, 2019, comments on 8 proposals
- March 22, 2019, comments on 10 proposals
- October 31, 2018, special public comment period on 1 proposal (11/9/18 - The AST Board has issued a statement on this public comment)
- October 1, 2018, comments on 6 proposals
- March 8, 2018, comments on 15 proposals
- January 30, 2018, special comment period on 1 proposal
- October 2, 2017, comments on 13 proposals
- March 25, 2017, special comment period on 1 proposal
- January 23, 2017, Comments on 6 proposals
- October 11, 2016, Comments on 15 proposals
- March 23, 2016, Comments on 9 proposals and one concept paper
AST Feedback on Pending Legislation
- The AST joined the kidney community in signing a letter to leaders of the House and Senate Appropriations Committees. The letter requests and increase for the National Institutes of Health (NIH) of $3 billion above the FY 2020 level of funding, including a robust increase for the National Institute of Diabetes and Digestive Kidney Diseases (NIDDK) that is at least proportional (March 2020).
- The AST signed on to a stakeholder letter sent to all 435 Members of the House of Representatives on January 7, 2020, in support of H.R. 5534, the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019. The Society awaits Senate introduction of this important legislation.
- The AST joined more than 20 other signatories in continuing to voice concerns related to the Dialysis PATIENTS Demonstration act to both House and Senate (October 2018).
- The AST partnered with AAKP, ASN, and ASTS on a joint letter of continuing concern related to an updated draft of the Dialysis PATIENTS Demonstration Act of 2017 (revisions to H.R. 4143) and its impact of access to kidney transplantation. (October 2018)
- The AST joined other partners in the transplant community in drafting a letter of thanks for inclusion of the Veterans Transplant Coverage Act of 2017 and elements of the Veterans Increased Choice for Transplanted Organs and Recovery (VICTOR) Act in VA MISSION legislation, offering additional assistance in helping the VA develop an open and transparent process to ensure that veterans are given choices and opportunities for organ transplantation. (May 2018)
- The AST drafted a letter of support for the Veterans Increased Choice for Transplanted Organs and Recovery (VICTOR) Act (January 2018)
- The AST joined other partners in the transplant community in drafting letters to the House and Senate regarding the Dialysis PATIENTS Demonstration Act of 2017. The Society continues to have significant concerns about the potential impact of this legislation on Medicare beneficiaries' continued access to kidney transplantation. (December 2017)
- The AST joined with other partners in the transplant community to draft a letter in support of the Veterans Transplant Coverage Act of 2017 (October 2017).
- The AST drafted a coalition letter regarding the issues of chronic care and pre-existing conditions as addressed in the current Repeal and Replace efforts ongoing in the US Senate. (September 2017)
- AST signed on to a coalition letter urging legislators to ensure that all members of the healthcare workforce with Deferred Action of Childhood Arrivals (DACA) status are able to continue their employment, education, training, and research, with passage of a permanent legislative remedy, such as the Dream Act of 2017 (September 2017)
- The Society signed on to a community letter expressing concerns regarding the FY2018 funding proposal for NIH, including drastic reductions to NIH support for facilities and administrative expenses. (August 2017)
- The AST signs a coalition letter of support for the Living Donor Protection Act (July 2017)
- AST signs joint letter noting concern related to Dialysis Patient Demonstration Act in addition to submitting our own letter on this topic (June 2017)
- The Living Organ Donor Protection Act of 2017 has been reintroduced by Congressman Jerrold Nadler and Congresswoman Jaime Herrera Beutler. (February 2017)
- AST signs joint letter regarding President Trump's immigration executive order. (February 2017)
- A letter noting concern related to the ESRD Integrated Care Act's negative impact on kidney transplantation.
- Helping Hospitals Improve Patient Care Act of 2016 (H.R. 5273) endorsed by the AST
- Living Donor Protection Act of 2016 - coalition letter spearheaded by AST and signed by more than 25 other organizations in support of this legislation that will protect living organ donors from job loss and other discrimination
- Concerns regarding the MedPAC's suggestion to remove immunosuppressant medications from the category of "protected drug class" on Medicare Part C and D formularies
Other Regulatory Updates
- The AST signed on to a coalition letter recommending additional funding for discretionary Health Resources and Services Administration programs in the FY 2021 Labor, Health and Human Services, Education, and Related Agencies appropriations bill (February 2020).
- The Society submitted comments on a proposed rule by CMS to revise Organ Procurement Organization (OPO) Conditions for Coverage (February 2020).
- The AST submitted comments on a proposed rule by HHS on Removing Financial Disincentives to Living Organ Donation (February 2020).
- AST joined other organizations on a stakeholder letter to HHS regarding access to dental care for transplant candidates and recipients (February 2020).
- The Society submitted comments on the RFI for Revisions to the PHS Guidelines on Reducing HIV, Hepatitis B, and Hepatitis C Through Organ Transplantation (October 2019).
- The AST and the ASTS submitted a joint response to CMS regarding proposed revisions of organ procurement organizations conditions of coverage (September 2019).
- The AST submitted a response CMS regarding its proposed ESRD Prospective Payment system and its connection to kidney transplantation (September 2019).
- AST joined other organizations in a letter to CMS voicing concern regarding beneficiaries' barriers to accessing off-label treatments in Medicare Part D (September 2019).
- The AST submitted two memos to CMS to voice concerns related to new Transplant Center interpretive guidelines. One memo is specific to concerns related to the independent living donor advocate and the second includes comments and concerns related to a number of specific guidelines. (July 2019)
- AST President Emily Blumberg joined a number of other kidney patient advocates and health professionals on July 10, 2019, in Washington DC to watch President Donald Trump sign an executive order aimed at improving kidney health.
- The Society sent a letter to Truven Health Analytics/IBM Watson Health requesting a review of Micromedex DRUGDEX content on a number of transplant-related drugs with a request for expansion of "Non-FDA Uses" section to include off label indications as listed. (April 2019)
- The Society joined a number of other kidney patient advocates and health professionals in a coalition letter to request increased funding for the NIH in 2020, including an increase for the NIDDK and a Special Statutory Funding Program for kidney research. (Mar 2019)
- The AST joined a number of other organizations in sending letters to CMS to voice concern related to a change in the codes that significantly reduced DRG reimbursement for ECMO in October 2018 (Jan 2019)
- The AST commented on "Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses", voicing concern regarding potential restriction of access to lifesaving and life-sustaining therapies in transplant recipients. (Jan 2019)
- The AST joined over 100 other organizations on a coalition letter to HHS Secretary Azar, noting concern that funding is being drawn directly from money appropriated for public health and medical research to fund care for immigrant children forcibly separated from their parents and the border. The letter urges HHS to make public its plan to respond to and recover from this public health crisis, and avoid potential future transfers driven by the administration. (Oct 2018)
- The AST and IDSA drafted a joint letter to offer feedback on the draft Diagnostic Accuracy and Innovation Act (DAIA) and corresponding FDA technical assistance document. (Sept 2018)
- The AST signed on to a coalition letter to HHS Secretary Azar, requesting continued support of the Medicare Part D program's six protected classes and its value in bringing down costs to patients while not reducing access (April 2018).
- The Society signed on to a coalition letter requesting increased funding for the NIDDK in 2019 (March 2018).
- The AST's Transplant Administrators and Transplant Pharmacy Communities of Practices provided input on revised Interpretive Guidelines for the CMS Conditions of Participation for Transplant Centers (October 2017)
- The AST and AAKP sent a joint letter of concern regarding regional coverage changes for IVIg therapy for kidney recipients in June 2017.
- The AST comments on U.S. Senate Majority Party Leadership Release of Healthcare Reform Discussion-Draft in June 2017.
- AST signed on to a Friends of HRSA coalition letter, encouraging appropriate HHS funding in March 2017.
- The AST signed on to a coalition letter regarding impacts of hiring freeze on public health services in February 2017.
- The AST signed on to a coalition letter in January 2017 noting concerns regarding delays in reimbursement for home infusion therapies that were inadvertently created as part of the 21st Century Cures Act.
- The AST comments on recently passed American Health Care Act (AHCA).
- The AST comments on proposed modifications to CMS Transplant Outcome Measures and Documentation Requirements released on July 14, 2016
- The AST comments on revised CMS Interpretive Guidelines for the Organ Transplant Conditions of Participation for Transplant Centers released on April 11, 2016. Additional comments and suggested language changes were shared with CMS on May 26, 2016.
- The AST response to the National Institute of Health (NIH) call for comment on proposed "Human Immunodeficiency Virus (HIV) Organ Policy Equity (HOPE) Act Safeguards and Research Criteria for Transplantation of Organs Infected With HIV.
Public Health Service (PHS) Guidelines
AST has provided the following comments on the PHS Guideline for Reducing the Transmission of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) through Organ Transplantation:
- Understanding OPTN/UNOS PHS Guideline: Effective Oct. 1, 2013, a new policy created to define PHS Guidelines, will allow members to use either the 1994 or 2013 version
- September 12, 2012 - Comments on most recent draft of the guideline
- June 15, 2012 - Letter to James Berger, Senior Advisor for Blood Policy, Re: Transplant Community Questions and PHS Revised Guidelines for Reducing HIV, HBV, and HCV through Organ Transplantation
- November 17, 2011 - Letter to the Honorable Thomas Frieden, MD, MHP, Director, Centers for Disease Control and Prevention, Re: Docket No. CDC-2011-0011
- August 23, 2011 - Letter to the Honorable Howard Koh, MD, MPH, Assistant Secretary for Health, Department of Health and Human Services from AST, ASTS, AOPO, and NATCO expressing concerns with the proposed PHS Guideline for Reducing HIV/HBV/HCV Transmission