Rule2022-15062
Medicare Program; MIPS Payment Adjustment Exception Applicable for Enhancing Oncology Model Monthly Enhanced Oncology Services (MEOS) Payments
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
July 14, 2022
Effective
August 15, 2022
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This advisory is to inform potential Enhancing Oncology Model (EOM) applicants and participants that the Merit-based Incentive Payment System (MIPS) payment adjustment factors will not apply to Monthly Enhanced Oncology Services (MEOS) payments in EOM.
Full Text
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<title>Federal Register, Volume 87 Issue 134 (Thursday, July 14, 2022)</title>
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[Federal Register Volume 87, Number 134 (Thursday, July 14, 2022)]
[Rules and Regulations]
[Pages 42096-42097]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-15062]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 414
[CMS-5536-N]
Medicare Program; MIPS Payment Adjustment Exception Applicable
for Enhancing Oncology Model Monthly Enhanced Oncology Services (MEOS)
Payments
AGENCY: Centers for Medicare & Medicaid Services (CMS), Health and
Human Services (HHS).
ACTION: Payment advisory.
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SUMMARY: This advisory is to inform potential Enhancing Oncology Model
(EOM) applicants and participants that the Merit-based Incentive
Payment System (MIPS) payment adjustment factors will not apply to
Monthly Enhanced Oncology Services (MEOS) payments in EOM.
DATES: This action is effective on August 15, 2022.
FOR FURTHER INFORMATION CONTACT: Alexandra Chong, (410) 786-8988.
SUPPLEMENTARY INFORMATION:
I. Background
In the calendar year (CY) 2019 Physician Fee Schedule (PFS) final
rule (83 FR 59887), we finalized amendments to 42 CFR 414.1405(e)
effective January 1, 2019 such that Merit-based Incentive Payment
System (MIPS) payment adjustment factors would apply to Part B payments
for covered professional services as defined in section 1848(k)(3)(A)
of the Social Security Act (the Act).
In the CY 2019 PFS final rule, per the authority in section
1115A(d)(1) of the Act to waive the requirement to apply the MIPS
payment adjustment factors under section 1848(q)(6)(E) of the Act and
Sec. 414.1405(e) because the waiver is necessary solely for purposes
of testing models that involve such payments, we also finalized an
exception to Sec. 414.1405(e) at Sec. 414.1405(f), such that the MIPS
payment adjustment factors do not apply to model-specific payments that
meet all the following conditions:
<bullet> Are made only to participants in a model tested under
section 1115A of the Act.
<bullet> Would otherwise be subject to the requirement to apply the
MIPS payment adjustment factors if the payment is made with respect to
a MIPS eligible clinician participating in a section 1115A model.
<bullet> Either have a specified payment amount or are paid
according to a methodology for calculating a model-specific payment
that is applied in a consistent manner to all model participants, such
that application of the MIPS payment adjustment factors would
potentially interfere with CMS's ability to effectively evaluate the
impact of the APM.
In the CY 2019 PFS final rule, we also finalized that we would
provide public notice of the applicability of this waiver for a
particular model by: (1) updating the Quality Payment Program website
(<a href="http://www.qpp.cms.gov">www.qpp.cms.gov</a>) when new model-specific payments subject to this
waiver are announced; and (2) providing notification in the Federal
Register to update the public on any new model-specific payments to
which this waiver will apply.
The Enhancing Oncology Model (EOM) and associated Request for
[[Page 42097]]
Application (RFA) was announced on [June 27, 2022]. Under EOM, which
builds on lessons learned to date from the Oncology Care Model (OCM),
participating physician practices will take on financial and
performance accountability for episodes of care surrounding systemic
chemotherapy administration to cancer patients who are EOM
beneficiaries, by way of a potential lump-sum performance-based payment
or performance-based recoupment, and will have the opportunity to
submit claims for an EOM Monthly Enhanced Oncology Services (MEOS)
payment for Enhanced Services furnished to EOM beneficiaries. EOM is a
5-year voluntary model tested per the authority under section 1115A of
the Act that aims to improve quality and reduce costs through its
payment methodology being aligned with care quality, and through EOM
participants' opportunities to redesign care and improve the quality of
care furnished to beneficiaries receiving care for certain cancers,
including requirements to implement participant redesign activities and
to engage in activities that promote health equity. More information
regarding EOM, and a link the EOM RFA, can be found at <a href="https://innovation.cms.gov/innovation-models/enhancing-oncology-model">https://innovation.cms.gov/innovation-models/enhancing-oncology-model</a>.
EOM will include an EOM MEOS payment for non-dually eligible
beneficiaries and an EOM MEOS payment for dually-eligible
beneficiaries, and each will be a per beneficiary per month (PBPM)
payment under EOM only with a model-specific Healthcare Common
Procedure Coding System (HCPCS) code paid through the Medicare fee-for-
service claims system for the provision of Enhanced Services, as
outlined in the section V.C.ii. of the EOM RFA.
II. Applicability to EOM MEOS Payments
This payment advisory serves to notify potential EOM applicants and
participants that the MIPS payment adjustment factors will not apply to
the EOM MEOS payments. The EOM MEOS payments meet the criteria
described in Sec. 414.1405(f)(1) through (3) for the following
reasons:
<bullet> The EOM MEOS payments will only be made to EOM
participants and EOM is a model tested under section 1115A of the Act.
<bullet> The EOM MEOS payments may be subject to the requirement to
apply the MIPS payment adjustment factors as the EOM MEOS payments
would be made to MIPS eligible clinicians participating in EOM.
<bullet> The EOM MEOS payments will be one of two specified payment
amounts that will be offered in a consistent manner to all EOM
participants, a fixed PBPM payment for non-dually eligible
beneficiaries (currently planned to be $70 PBPM) and a fixed PBPM
payment for dually eligible beneficiaries (currently planned to be $100
PBPM), to support the provision of Enhanced Services to EOM
beneficiaries.
As such, the application of the MIPS payment adjustment factors to
the EOM MEOS payments would introduce variation in the EOM MEOS amounts
paid to different EOM participants which could potentially interfere
with our ability to effectively evaluate the impact of EOM and
therefore potentially compromise the model test.
This waiver would begin at the beginning of EOM and continue for
the duration of EOM. In addition to this Federal Register document, we
will also provide public notice that 42 CFR 414.1405(e) will not apply
to the EOM MEOS payment on the Quality Payment Program website, at
<a href="http://www.qpp.cms.gov">www.qpp.cms.gov</a>.
The Administrator of the Centers for Medicare & Medicaid Services
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this
document, authorizes Trenesha Fultz-Mimms, who is the Federal Register
Liaison, to electronically sign this document for purposes of
publication in the Federal Register.
Trenesha Fultz-Mimms,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2022-15062 Filed 7-13-22; 8:45 am]
BILLING CODE 4120-01-P
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</html>Indexed from Federal Register on July 14, 2022.
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