The Centers for Medicare & Medicaid Services (CMS) has released a request for applications for the new Enhancing Oncology Model (EOM), a five-year voluntary model that builds on the Oncology Care Model that ended June 30. The EOM model holds participants accountable for the total cost and quality of care over six-month episodes. It offers two risk-sharing arrangements: one with upside and downside risk of 4% and 2%, respectively, and the other with upside and downside risk of 12% and 6%, respectively. Participating providers will be required to implement defined participant redesign activities and will have the option to bill for Monthly Enhanced Oncology Services (MEOS) to support the implementation of the following enhanced services:
- 24/7 access to a clinician, with real-time access to medical records
- Patient navigation services
- Documentation of care plans containing all 13 components of the Institute of Medicine’s care management plan
- Treatment with therapies aligned with nationally recognized clinical guidelines
- Identification of beneficiary social needs using a health-related social needs screening tool
- Implementation of electronic patient-reported outcomes
- Use of data for continuous quality improvement
- Use of certified electronic health record technology
Supplemental MEOS payments for dual-eligible beneficiaries will be sent to participants to encourage safety net providers to join.
To be eligible for EOM participation, an applicant must be a Medicare-enrolled oncology physician group practice (PGP) identified by a unique Federal taxpayer identification number (TIN) that includes at least one Medicare-enrolled practitioner who furnishes evaluation and management services to Medicare beneficiaries receiving chemotherapy for an included cancer diagnosis. Applicants also must bill under the participant’s TIN and have reassigned their right to receive Medicare payments to the PGP TIN. EOM applications will be accepted until September 30, 2022, and can be submitted via the CMS Innovation Center’s EOM website.