CMS Releases Final Rule to the Radiation Oncology Model

On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the CY 2022 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems final rule (CMS-1753-F). This announcement includes the finalized modifications to the Radiation Oncology (RO) Model.

The RO Model is set to begin January 1, 2022, and end December 31, 2026. The proposed rule includes the summarized modifications below:

• Adjustment to the pricing methodology (updated baseline period is 2017 to 2019 and lowered discounts to 3.5 and 4.5) for the professional component and technical component, respectively
• Removal of brachytherapy from included modalities
• Removal of liver cancer from included cancer types
• Finalization of cases in which a beneficiary switches from traditional fee-for-service (FFS) to Medicare Advantage during an episode and before treatment is complete. CMS will consider this an incomplete episode and radiation therapy services will be paid under FFS.
• Modification to the current Pennsylvania Rural Health Model (PARHM) overlap policy to only exclude hospitals participating in the model, no just PARHM-eligible hospitals
• Addition of an overlap policy for the Community Track of the CHART Model
• Addition of an extreme and uncontrollable circumstances policy.

For additional information on the RO Model and CMS' final rules, visit the RO Model website or read more on thefinal rule. For questions on the model or for participants needing their model ID, contact RadiationTherapy@cms.hhs.gov.

Posted 11/3/2021