Aetna Institutes of Excellence™ Transplant Facilities — Criteria for IOE Designation
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Defines criteria and process by which transplant facilities are considered for Aetna's Institutes of Excellence network, including certification, volume, outcomes, data reporting, contracting, and program requirements; applies to facilities seeking IOE designation and to Aetna's network decision-makers.
No material clinical or coverage changes in this revision.
Institutes of Excellence — Transplant Facility Eligibility
IOE transplant facility consideration criteria
Facilities seeking Aetna IOE transplant designation must satisfy the following program, certification, data, staffing, process, volume, and outcomes requirements. Aetna’s IOE Oversight Committee (IOEOC) retains sole discretion and other business considerations apply.
ALL of the following
- Submit a completed, current-year standardized response to the RFI.
- Facility must have a fully executed hospital services agreement and an IOE amendment covering pre- and post-transplant care, facilities, physicians, and related inpatient and outpatient costs; all physicians providing transplant services must be fully contracted with Aetna.
ALL of the following
- Must have Medicare certification and funding and be a United Network for Organ Sharing (UNOS) member in good standing.
- Must be fully accredited by FACT and/or AABB and be a National Marrow Donor Program (NMDP) transplant center; National Cancer Institute (NCI) designation is preferred but not mandatory.
ALL of the following
- Provide written notice to Aetna of any changes in the facility's ability to deliver services and disclose/explain any history of closure or suspension to the satisfaction of the IOEOC.
- Maintain and share staffing and protocol lists with Aetna upon request and permit site visits by appropriate National Medical Excellence (NME) staff.
- Maintain general and professional liability and other insurance as necessary.
ALL of the following
- Each solid organ program must have a UNOS-approved primary surgeon and primary physician.
- All facility staff must be properly credentialed by Aetna, privileged, and reappointed within the scope of their specialty at the facility.
ALL of the following
- 90-day graft failure rate and conditional 1-year graft failure rate are tracked and must not be 'statistically higher' as determined by Scientific Registry of Transplant Recipients (SRTR) public data.
- Two consecutive years' (rolling) survival must not be unfavorable (-1) as determined by the most recently available CIBMTR Center-Specific Survival Report.
ALL of the following
- The adult lung program must be accepted into Aetna's IOE network; the adult heart program must be Medicare certified/funded and have UNOS membership in good standing.
- The pediatric lung program must be accepted into the IOE network; the pediatric heart program must be active (a facility with zero transplants in the prior year is considered inactive) and have UNOS membership in good standing.
- A facility that performs adult kidney transplants and seeks consideration for pediatric kidneys must demonstrate that at least 25% of its reported pediatric cases occur in patients aged 0–10 years.
- Adult pancreas/SPK programs require the adult kidney transplant program to be accepted into the IOE network; the pancreas transplant program must be Medicare certified/funded and have UNOS membership in good standing.
Coding and Volume Thresholds
| No codes listed |
Submission, Contracting, and Operational Requirements
Initial submission, contracting, and physician contracting requirements
Facility must submit a completed, current-year, standardized response to Aetna's Request for Information (RFI); ensure a fully executed hospital services agreement and execution of the IOE amendment covering pre- and post-transplant care before designation; and confirm that all physicians providing transplant services are fully contracted with Aetna.
- Submit a completed, current-year standardized RFI response to Aetna.
- Maintain a fully executed hospital services agreement; IOE designation follows execution of an IOE amendment covering pre- and post-transplant care, facilities, physicians, and related inpatient/outpatient costs.
- Ensure all physicians providing transplant services are fully contracted with Aetna.
- Aetna will also assess whether it has a need for the facility's specific transplant services in its IOE network.
Key Definitions and Accreditation Requirements
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