CMS Releases Notice of Proposed Rulemaking for the RO Model

On July 19, 2021, the Centers for Medicare & Medicaid Services (CMS) released the CY2022 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems (OPPS/ASC) Notice of Proposed Rulemaking (CMS-1753-P). The proposal includes items related to the Radiation Oncology (RO) Model.

The RO Model is proposed to start January 1, 2022, and run for five performance years.

The proposed CY2022 OPPS/ASC rules include the following RO Model proposals:

• Changing the baseline period from 2016-2018 to 2017-2019.
  
• Lowering the discount to 3.5 percent for the professional component and to 4.5 percent for the technical component.
• Removing brachytherapy from the list of included modalities, which would still be paid by fee-for-service.
• Proposing that in cases where a beneficiary switches from traditional Medicare to Medicare Advantage during an episode before treatment is complete, CMS would consider this an incomplete episode and RT services will be paid by the traditional Medicare rate.
• Adding an extreme and uncontrollable circumstances policy to give flexibility to reduce administrative burden of Model participation, including reporting requirements, and/or adjust the payment methodology as necessary when extreme and uncontrollable circumstances exist.
• Removing liver cancer from the Model.

Read the full CMS Notice online. For more information on the RO Model, visit its website.

Posted 7/20/2021