RISE summarizes recent regulatory news.

HHS, CMS launch new model to improve cancer care for Medicare patients

The Biden administration this week announced a new model, known as the Enhancing Oncology Model (EOM), to test how to improve cancer care, address inequities, and provide patients with treatments that address their unique needs. The new model supports President Joe Biden’s Cancer Moonshot initiative to improve the experience of people and their families living with and surviving cancer.

“There are stark inequities in the ability of people with cancer across race, gender, region, and income to access cancer screening, diagnostics, and treatment,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “CMS is working to advance President Biden’s Cancer Moonshot goals by helping Medicare cancer patients better navigate a challenging and often overwhelming journey. The Enhancing Oncology Model will incentivize participating oncology practices–including those in rural and underserved areas–to improve the provision of high quality, coordinated care that addresses patients’ social needs and improves patient and caregiver support.”

The voluntary model will run for five years, from July 2023 through June 2028. Model participants will include oncology practices that treat people with Medicare undergoing chemotherapy for breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer. Participating providers will also offer services such as patient navigation, care planning, collection of electronic patient-reported outcomes, and screening for social needs that may affect treatment, such as transportation issues and nutritional needs. The model will also encourage other payers (e.g., commercial payers, state Medicaid agencies) to align with its core concepts to promote a consistent approach across payers and EOM participants’ patient population.

To learn more, click here for more information about the model and here for a fact sheet.

OIG: 91% of nursing home staff nationwide received COVID-19 vaccine doses

A new Office of Inspector General (OIG) report explores the COVID-19 vaccination status of nursing home staff as of March 27. The investigation was launched after the Centers for Medicare & Medicaid Services amended the infection control requirements for nursing homes to include a requirement for nursing homes to ensure that staff received all the required COVID-19 vaccine doses except for individuals granted an exemption from receiving the vaccine or individuals whose vaccination had to be delayed.

The OIG used a stratified sampling frame of 15,224 nursing homes nationwide into 10 strata based on the nursing homes' locations and randomly selected 10 nursing homes from each stratum. From each of the 100 sampled nursing homes, it obtained a list of staff members who were subject to the vaccination requirements and randomly selected 10 staff members. For each of the 1,000 sampled staff members, the OIG reviewed documentation that nursing homes provided to determine whether the staff member had received the required vaccine doses, had received a booster dose, or had requested or had been granted an exemption from receiving the vaccine.

Researchers determined that as of March 27, for the 1,000 nursing home staff members in the sample that 884 had received the required vaccine doses (506 of these staff members had also received a booster dose); 78 had been granted an exemption from receiving the vaccine based on a sincerely held religious belief, practice, or observance (religious exemption); 12 were partially vaccinated; three had been granted an exemption from receiving the vaccine based on a medical condition (medical exemption); and three had applied for an exemption that was being reviewed by a nursing home.

Based on the sample, OIG estimated that 91 percent of staff nationwide had received the required vaccine doses, 56 percent of staff nationwide had received a booster dose, and six percent of staff nationwide had been granted a religious exemption. Researchers did not estimate the percentages among the 38 staff members (who were partially vaccinated, who were granted a medical exemption, who applied for an exemption that was being reviewed, or for whom the vaccination status could not be determined.

HHS seeks comment on plan to strengthen primary health care

HHS’ new initiative aims to develop a federal foundation for primary health care for all that supports improved health outcomes and advanced health equity.

Access to high-quality primary health care has been shown to improve health equity and health outcomes, and is essential for addressing key priorities, including: the COVID-19 pandemic; mental and substance use disorder prevention and care; prevention and management of chronic conditions; addressing the impact of gender-based violence; and maternal and child health and well-being. 

Unfortunately, HHS said in a fact sheet, the nation’s primary health care foundation is weakening and in need of support: primary health care is under-resourced; the workforce is shrinking; workforce well-being is in peril; and many practices face reimbursement challenges that may result in financial instability.

HHS intends to produce an initial action plan in 2022.

To help coordinate the action plan, the Office of the Assistant Secretary for Health is seeking input about innovations, models, solutions to barriers, and possible HHS actions that may strengthen primary health care to promote health equity, reduce health disparities, improve health care access, and improve health outcomes. Comments will be open through August 1.