びびなび : ワシントンDC : (アメリカ合衆国) Washington DC

Centers for Medicare & Medicaid Services
The CMS Innovation Center is Announcing Updates to the Enhancing Oncology Model and a New Cohort Opportunity

Today, the CMS Innovation Center released a Request for Applications (RFA) to solicit applications for a second cohort of participants in the Enhancing Oncology Model (EOM). In addition, for both the current and new cohort, CMS will make notable changes to the model, including extending the model by two years, making a higher monthly payment for enhanced services, and establishing a higher threshold for recoupment (the level of spending at which an EOM participant will owe a performance-based recoupment to CMS). These policy changes will become effective for the current cohort of EOM participants starting on January 1, 2025.

The purpose of EOM is to drive transformation in oncology care by preserving or enhancing the quality of care furnished to individuals undergoing treatment for cancer while reducing program spending under Medicare fee-for-service.

This RFA is for a second cohort of EOM participants and payers. The second cohort will begin participation in EOM on July 1, 2025, and end on June 30, 2030, for a 5-year model performance period. The first performance period began on July 1, 2023, and the model test will end on June 30, 2030, for all participants, which is a two-year extension from the original end date of June 30, 2028.

Eligible participants are Medicare-enrolled oncology physician group practices identifiable by a unique federal taxpayer identification number. Practices that participate in EOM are required to implement eight Participant Redesign Activities to improve quality of care and will have the option to bill a Monthly Enhanced Oncology Services (MEOS) payment. MEOS payments will increase from $70 to $110 per individual per month (and to $140 per month for dually eligible individuals). EOM participants are financially responsible for the total cost of care for each attributed episode, which is the six-month period following an eligible Medicare individual’s receipt of a qualifying cancer therapy.

Participants may earn a performance-based payment by meeting a risk-adjusted spending target for their attributed episodes; conversely, they will owe a performance-based recoupment to CMS if total spending in these episodes exceeds a specified percentage of their benchmark amount. For all participants, this threshold for recoupment will increase from 98% of the benchmark amount to 100% of the benchmark amount, beginning for episodes initiating on or after January 1, 2025.

Private payers, Medicare Advantage plans, state Medicaid agencies, and Medicaid MCOs are eligible to apply to partner with CMS in EOM.

For more detailed eligibility criteria, please read the RFA [ https://www.cms.gov/priorities/innovation/media/document/eom-rfa-2024 ]. The application portal for interested applicants will be open from July 1, 2024, to September 16, 2024. Further details on how to apply are forthcoming.

For more information about the model, visit the model web page [ https://www.cms.gov/priorities/innovation/innovation-models/enhancing-oncology-model ].

Follow us on X (formerly Twitter [ https://twitter.com/CMSinnovates ])  | Visit the CMS Innovation Center website [ https://www.cms.gov/priorities/innovation/overview ]

Centers for Medicare & Medicaid Services (CMS) has sent this update. To contact Centers for Medicare & Medicaid Services (CMS) go to our contact us [ http://www.cms.gov/About-CMS/Agency-Information/ContactCMS/index.html ] page.

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