The Center for Medicare and Medicaid Innovation (CMMI) released exciting updates to the Enhancing Oncology Model (EOM) along with a new opportunity for a second cohort of participants.
The EOM aims to enhance the quality of care for cancer patients while reducing costs under the Medicare fee-for-service program. The updates come on the heels of lower-than-expected model participation.
This blog will discuss key EOM updates, application details, eligibility requirements and important deadlines.
Second cohort start date: July 1, 2025
Second cohort end date: June 30, 2030
Initial performance period start date: July 1, 2023
Model test end date for all participants: June 30, 2030 (extended from June 30, 2028)
Model extension: The model's duration is extended by two years, to June 30, 2030.
Higher monthly payment for enhanced services: Monthly Enhanced Oncology Services payments will increase:
from $70 to $110 per individual per month; and
from $70 to $140 per month for dually eligible individuals.
Higher threshold for recoupment: The threshold for recoupment will rise from 98% to 100% of the benchmark amount for new episodes initiated, starting Jan. 1, 2025.
Medicare-enrolled oncology physician group practices identifiable by a unique federal taxpayer identification number. Participants must implement eight “participant redesign activities” to improve care quality. Participants are financially responsible for the total cost of care for each attributed episode (a six-month period following a Medicare recipient's qualifying cancer-related chemotherapy administration).
private payers
Medicare Advantage plans
State Medicaid agencies
Medicaid-managed care organizations
Detailed EOM cohort 2 eligibility criteria are available in the RFA.
Application portal open date: July 1, 2024
Application portal close date: Sept. 16, 2024
Details on how to apply will be provided soon.
These updates to the EOM reaffirm CMS' commitment to improving oncology care while managing healthcare costs effectively. The increased MEOS payments and higher recoupment thresholds reflect a significant step forward in supporting oncology practices in delivering high-quality, cost-effective care.
For those interested in participating, mark your calendars for the application period starting July 1, 2024. CMS will have several webinar sessions with more model details this summer. DataGen’s EOM solution can help oncology practices evaluate risks and opportunities under the EOM specifications. Contact us today to get a free consultation.
Stay tuned for more detailed information on how to apply.
