Meeting Request to Discuss Impact of Medicaid Coverage Restrictions on Patients Waiting for Organ Transplants

October 29, 2010
The Honorable Jan Brewer
Governor of Arizona
Office of the Governor
1700 West Washington
Phoenix, AZ 85007
VIA FAX: 602-542-1381

Re: Meeting Request to Discuss Impact of Medicaid Coverage Restrictions on Patients Waiting for Organ Transplants

Dear Governor Brewer;

As leaders of the two societies representing organ transplant providers throughout the United States and the non-profit organization that manages the nation's organ transplant system, the American Society of Transplant Surgeons (ASTS), the American Society of Transplantation (AST) and the United Network for Organ Sharing (UNOS), we are deeply concerned about the recent elimination of specified transplants from the benefits available to Arizona residents dependent on the AHCCCS (Arizona Health Care Cost Containment System) resulting from the benefit changes that became effective on October 1, 2010. We therefore request an opportunity to meet with you at your earliest opportunity to discuss these critical issues.

The exclusion of Medicaid transplant coverage for lung, pancreas only, pancreas after kidney, heart for non-ischemic cardiomyopathy, and liver for diagnosis of hepatitis C is unprecedented, contrary to medical practice long considered the standard of care, and breathtaking in its implications for Arizona residents in need of these treatments. As of October 22, 2010, 61 Arizona patients (i.e., 6 heart candidates, 5 lung candidates, 2 pancreas candidates, and 48 liver candidates) were on the national waitlist for these specific types of transplants. This baseless exclusion of coverage to Arizona citizens for services that represent the best treatment option for patients with endstage organ failure (to both improve survival and quality of life) represents an actual death sentence for many of these citizens of Arizona unless you and the legislature reconsider these coverage restrictions. We therefore strongly urge you to immediately reconsider these critical cuts in benefits and work with the Arizona legislature to reinstate coverage for these transplant procedures.

The transplant community recognizes the challenging fiscal situation that you and the legislature are forced to address. For this reason, four Arizona transplant centers have already engaged in a new effort to assist the AHCCCS with cost containment. The newly formed Medical Executive Advisory Committee, which includes representatives from each of the Arizona transplant centers, has proposed to collaborate with AHCCCS in on-going review of cost saving opportunities through the reform of health care delivery rather than through the outright elimination of these transplant benefits. Thus far, the Committee has developed specific recommendations based on current evidence published in the literature as consensus statements or national best practice guidelines (see enclosed Executive Summary).

The Committee and the four Arizona Transplant Centers have requested access to the documentation and the scientific data that supported the AHCCCS. They have also requested an emergency session to review the process through which this decision was undertaken, as well as the serious adverse impact it will have on Arizona patients.
Again, we strongly urge you to reconsider your decision to restrict access to transplantation for Arizona Medicaid beneficiaries. Although complex medical services such as organ transplantation require resources to provide for patients in need, they are often, in fact, more cost effective than alternative therapies because they prolong patients' productive lives and significantly reduce their hospitalization rates. Partnership between the AHCCCS and the Medical Executive Advisory Committee representing Arizona transplant centers should be pursued expeditiously in order to optimize cost containment and preserve access for the residents of Arizona to life-saving transplantation services.

We appreciate this opportunity to raise our profound concerns about the effect of these changes in transplant coverage on Arizona residents dependent on AHCCCS, and the signals these coverage restrictions send to other state Medicaid programs and private payors. Indeed, for these patients, organ transplantation represents their best, and in many cases, their only option for survival and improved quality of life.

For these reasons, we request an opportunity to meet with you at your earliest opportunity to discuss these issues in more depth. We stand ready to provide any assistance you may request as you, your administration, and the Arizona legislature reconsider this change in Medicaid transplant coverage.

Your staff may contact us at the phone numbers and email addresses below in order to arrange a meeting. Thank you in advance for your consideration of these important issues.


Michael M. Abecassis, MD, MBA Maryl R. Johnson, MD Charles E. Alexander, RN, MSN, MBA, CPTC
ASTS President AST President UNOS President
ASTS National Office AST National Office UNOS Headquarters
2461 S. Clark Street 15000 Commerce Parkway 700 North 4th Street
Suite 640 Suite C Richmond, VA 23219
Arlington, VA 22202 Mt. Laurel, NJ 08054 PH: 443 833-1026
PH: 703 414.7870 PH: 856 439.9986 Email: [email protected]
Email: [email protected] Email: [email protected] Email: [email protected]
Email: [email protected] Email: [email protected]
Enc: Executive Summary of Evidence Based Recommendations
Cc: Barry Straube, MD, CMS Chief Medical Officer & Director, Office of Clinical Standards & Quality
Richard Durbin, MBA, Director, Division of Transplantation, Health Resources and Services Administration