Medicare Program; Oncology Care Model: Request for Applications, 8323-8324 [2015-03060]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 80, Number 31 (Tuesday, February 17, 2015)]
[Notices]
[Pages 8323-8324]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2015-03060]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-5514-N]


Medicare Program; Oncology Care Model: Request for Applications

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

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SUMMARY: This notice announces a request for applications (RFA) for 
organizations to participate in the Oncology Care Model (OCM) beginning 
in 2016.

DATES: Letter of Intent Submission Deadline: As described on the CMS 
Innovation Center Web site at https://innovation.cms.gov/initiatives/Oncology-Care/, interested payers must submit a nonbinding letter of 
intent by 5:00 p.m. Eastern Daylight Time (EDT) on March 19, 2015. 
Interested practices must submit a nonbinding letter of intent by 5:00 
p.m. EDT on April 23, 2015.
    Application Submission Deadline: Applications for payers and 
practices must be received by 5:00 p.m. EDT on June 18, 2015. 
Application materials and instructions are available at https://innovation.cms.gov/initiatives/Oncology-Care/.

ADDRESSES: Letter of Intent forms must be submitted electronically in 
the PDF fillable format to OncologyCareModel@cms.hhs.gov. Letters of 
Intent will only be accepted via email. Applicants that submit a 
timely, complete Letter of Intent will be sent an authenticated web 
link and password with which to access the electronic, web-based 
application.

FOR FURTHER INFORMATION CONTACT: OncologyCareModel@cms.hhs.gov for 
questions regarding the application process of OCM.

SUPPLEMENTARY INFORMATION: 

I. Background

    The Center for Medicare and Medicaid Innovation (Innovation 
Center), within the Centers for Medicare & Medicaid Services (CMS), was 
created to test innovative payment and service delivery models to 
reduce program expenditures while preserving or enhancing the quality 
of care for Medicare, Medicaid, and Children's Health Insurance Program 
(CHIP) beneficiaries.
    We are committed to continuous improvement for Medicare, Medicaid 
and CHIP beneficiaries. The goal of the Oncology Care Model (OCM) is to 
improve the health outcomes for people with cancer, improve the quality 
of cancer care, and reduce spending for cancer treatment. We expect 
that physician practices selected for participation in the model will 
be able to transform care delivery for their patients undergoing 
chemotherapy, leading to improved quality of care for beneficiaries at 
a decreased cost to payers. Through this care transformation, practices 
participating in OCM can reduce Medicare expenditures while improving 
cancer care for Medicare Fee-for-Service (FFS) beneficiaries.
    Beneficiaries can experience improved health outcomes when health 
care providers work in a coordinated and person-centered manner. We are 
interested in partnering with payers and practitioners who are working 
to redesign care to deliver these aims. Episode-based payment 
approaches that reward practitioners who improve the quality of care 
they deliver, lower costs, and engage with quality and cost data that 
will inform their provision of care are potential mechanisms for CMS to 
further emphasize care coordination and enhanced care through practice 
transformation.
    OCM will test episode-based payment for oncology care, using a 
retrospective performance-based payment for an episode of chemotherapy. 
The request for applications (RFA) requests applications to test a 
model centered around a chemotherapy episode of care. For more details, 
see the RFA available on the Innovation Center Web site at https://innovation.cms.gov/initiatives/Oncology-Care/.

II. Provisions of the Notice

    The Innovation Center is operating this model under the authority 
of section 1115A of the Social Security Act (the Act). This RFA is 
directed to physician practices that provide oncology care as well as 
public and other health care payers. The Innovation Center hopes to 
engage at least 100 physician practices that, in aggregate, will 
furnish care for approximately 175,000 cancer care episodes for 
Medicare beneficiaries over the course of this 5-year model.
    The Innovation Center sees the following as key opportunities 
within OCM:
     Promote shared decision-making, person-centered 
communication, evidence-based care, beneficiary access to care, and 
coordination across providers and settings.
     Reduce complications of cancer and cancer treatments, as 
well as associated costs, through advanced care planning, increased use 
of high-value treatments, and reduction of inappropriate payment 
incentives.
     Collect structured clinical data and integrate clinical 
trial enrollment into processes of care to facilitate quality 
improvement and accelerate clinical research.
     Support the development and reporting of meaningful 
outcome measures.
     Develop and monitor refined approaches to care delivery, 
which may improve the research infrastructure (for example, by 
facilitating improvement in the quality of evidence for existing 
therapies).
     Encourage delivery of care in the lowest-cost medically-
appropriate setting.
     Refine a value-based payment system that encourages team-
based care and workforce innovation.
    Participating practices must be able to meet the following practice 
requirements during the performance period:
    1. Treat patients with therapies consistent with nationally 
recognized clinical guidelines.
    2. Provide and attest to 24 hours a day, 7 days a week patient 
access to an appropriate clinician who has real-time access to 
practice's medical records.
    3. Use of ONC-certified electronic health record (EHR) technology 
as described in the RFA.
    4. Utilize data for continuous quality improvement.
    5. Provide core functions of patient navigation.
    6. Document a care plan that contains the 13 components in the 
Institute of Medicine Care Management Plan.
    Participating practices in OCM will continue to receive standard 
Medicare FFS payments during OCM episodes.

[[Page 8324]]

OCM will also provide an opportunity for participating practices to 
receive retrospective episode-based performance payments. After 
calculating the benchmark for each OCM participant, CMS will set a 
target price for chemotherapy episodes, which includes a discount. 
Participants whose Medicare expenditures are below the target price may 
receive semi-annual lump-sum performance-based payments, subject to the 
achievement of quality measures. In addition to the performance-based 
payments, participants will receive a Per-Beneficiary-Per-Month payment 
(PBPM) for Medicare beneficiaries with nearly all cancer types for each 
of the 6 months of the episode. The monthly PBPM payment is intended to 
pay for the enhanced services driven by the practice requirements, 
aimed at transforming practices towards comprehensive, person-centered, 
and coordinated care. The OCM PBPM is $160 per OCM beneficiary per 
month for the duration of each 6-month episode, and will remain 
constant for the 5-year model.
    OCM also aims to incorporate other payers in addition to Medicare, 
such as commercial insurers and state Medicaid agencies. Payers must 
also be able to meet the following requirements for participation in 
the model:
    1. Commit to participation in OCM for its 5-year duration, and 
start performance period no later than 90 days after OCM-FFS' 
performance period.
    2. Sign a Memorandum of Understanding with the Innovation Center.
    3. Enter into agreements with physician practices participating in 
OCM that include requirements to provide high quality care.
    4. Share model methodologies with the Innovation Center.
    5. Provide payments to practices for enhanced services and 
performance as required in the RFA.
    6. Align practice quality and performance measures with OCM, when 
possible.
    7. Provide participating practices with aggregate and patient-level 
data about payment and utilization for their patients receiving care in 
OCM, at regular intervals.
    The OCM start date is expected to be in spring 2016.
    For more specific details regarding OCM (including the RFA), we 
refer applicants to the informational materials on the Innovation 
Center Web site at: https://innovation.cms.gov/initiatives/Oncology-Care/. Applicants are responsible for monitoring the Web site to obtain 
the most current information available.

III. Collection of Information Requirements

    Section 1115A(d)(3) of the Act, as added by section 3021 of the 
Affordable Care Act (Pub. L. 111-148), states that chapter 35 of title 
44, United States Code (the Paperwork Reduction Act of 1995), shall not 
apply to the testing and evaluation of models or expansion of such 
models under this section. Consequently, this document need not be 
reviewed by the Office of Management and Budget under the authority of 
the Paperwork Reduction Act of 1995 (44 U.S.C. 35).

    Dated: December 22, 2014.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2015-03060 Filed 2-12-15; 11:15 am]
BILLING CODE 4120-01-P