The Centers for Medicare & Medicaid Services (CMS) has issued its specialty care models final rule establishing a mandatory radiation oncology payment model.
Under the radiation oncology model, participants treating beneficiaries with one of 16 types of cancer – including breast, lung, pancreatic, prostate, and colorectal cancer – will receive prospective, site-neutral, episode-based payment amounts for radiation therapy services furnished during a 90-day episode of care. These site-neutral bundled payments will be made instead of regular Medicare fee-for-service payments throughout the model performance period, which consists of five calendar years, from Jan. 1, 2021, through Dec. 31, 2025.
The radiation oncology model requires mandatory participation from radiation therapy providers and suppliers that furnish radiation therapy services within randomly selected core-based statistical areas to participate. CMS has provided a list of participating ZIP codes – CHA has prepared a spreadsheet that crosswalks CMS’ selected ZIP codes with cities in California. Any physician group practice, freestanding radiation therapy center, or hospital outpatient department that furnishes radiation therapy services in these ZIP codes will be included in the new model.
The final rule also creates the mandatory end-stage renal disease (ESRD) treatment choices model. Under this model, CMS will make certain payment adjustments intended to encourage participating ESRD facilities and managing clinicians to ensure beneficiaries have access to and receive education about their kidney disease treatment options. Specifically, CMS will positively adjust certain Medicare payments to participating ESRD facilities and managing clinicians for the first three years of the model for home dialysis and dialysis-related services. CMS has provided a list of participating geographic areas.
CHA is reviewing the final rule and will provide members with additional details in the coming weeks.