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A new payment model targeted at improving Medicare cancer care will begin in mid-2023, the Centers for Medicare and Medicaid Services said Monday.
The voluntary model, known as the Enhancing Oncology Model, builds off the Oncology Care Model, which will end Thursday after six years.
The Center for Medicare and Medicaid Innovation will launch the new model on July 1, 2023, for a five-year test period.
Participating physician group practices will be responsible for patient health quality and total spending during six-month episodes of care. Participants will have the option to bill for a monthly enhanced payment if extra services including around-the-clock access to a clinician, patient navigation services and social-needs screenings are provided to eligible beneficiaries, according to a CMS news release.
Participants also will have to report patient demographic data, including race, ethnicity, language and gender identity. They will have to develop plans for addressing health equity gaps among their patients.
Oncology physician group practices that treat people undergoing chemotherapy for breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer and small intestine or colorectal cancer can apply beginning Monday. The application period ends Sept. 30.
Private payers, Medicare Advantage plans and Medicaid agencies can also apply to participate and enter into a memorandum of understanding with CMS. The model will have one track for traditional Medicare enrollees, and another run by payers for their own eligible enrollees.
“There are stark inequities in the ability of people with cancer across race, gender, region, and income to access cancer screening, diagnostics, and treatment,” CMS Administrator Chiquita Brooks-LaSure said in the news release. “CMS is working to advance President Biden’s Cancer Moonshot goals by helping Medicare cancer patients better navigate a challenging and often overwhelming journey.”
President Joe Biden in February announced an aim to reduce the cancer death rate by 50% in 25 years and improve the lives of people living with cancer.
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