Georgia Medicare EOM Enhancing Oncology Model Guide 2026

If you receive cancer chemotherapy in Georgia under Original Medicare, or if you treat cancer patients at an oncology practice across the state, there is a CMS Innovation Center model running quietly in the background that is reshaping how Medicare pays for chemotherapy episodes, how oncology practices deliver care, and how patient navigation and health-equity planning happen. That model is the Enhancing Oncology Model (EOM).

EOM is the CMS Innovation Center's voluntary oncology bundled payment model, the direct successor to the Oncology Care Model (OCM), which transformed community oncology delivery nationwide. EOM launched in mid-2023 and runs through mid-2028, a five-year performance period during which participating oncology practices accept accountability for six-month episodes triggered by chemotherapy administration across seven cancer types, with two-sided risk from day one (no upside-only on-ramp like OCM had), Advanced APM status for the Higher Risk track, mandatory Health Equity Plans, and a Monthly Enhanced Oncology Services (MEOS) payment to support enhanced patient services.

For Georgia, EOM matters because the state hosts some of the country's largest community oncology footprints. Emory Winship Cancer Institute (NCI-designated comprehensive cancer center), Northside Hospital Cancer Institute (the single highest-volume community oncology organization in Georgia and one of the largest in the United States), Piedmont Cancer Institute, Wellstar Cancer Network, Georgia Cancer Specialists, Augusta University Georgia Cancer Center (NCI-designated), Memorial Health University Medical Center Curtis and Elizabeth Anderson Cancer Institute in Savannah, and Atrium Health Navicent Cancer Center in Macon all represent practices and systems where EOM participation decisions translate into real payment, real care-coordination, and real beneficiary-experience outcomes.

This guide walks Georgia oncology beneficiaries, families, practice leaders, billing teams, navigators, and policy stakeholders through every component of EOM: the statutory foundation, the performance period, the seven cancer types, the six-month episode structure, the two risk tracks, the MEOS payment, the performance-based payment reconciliation, the quality measures, the Health Equity Plan requirement, the Advanced APM treatment for Higher Risk participants, and the coordination with overlapping programs including MSSP, ACO REACH, and the 340B Drug Pricing Program.

By Brevy Care Team

What EOM is: the statutory and regulatory foundation

EOM rests on a five-layer statutory and regulatory stack:

Section 1115A of the Social Security Act gives the Secretary of HHS authority to test innovative payment and service-delivery models that have the potential to reduce Medicare spending while maintaining or improving quality. Added by the Patient Protection and Affordable Care Act, Section 1115A enables CMS to run voluntary and mandatory models without going back to Congress for new authority each time. EOM is one such Section 1115A model.

The OCM predecessor established the operational and analytic foundation EOM inherits. OCM enrolled oncology practices nationwide in voluntary risk-sharing arrangements for chemotherapy episodes, paid Monthly Enhanced Oncology Services (MEOS) payments, and covered multiple cancer types. OCM produced billions of dollars in care-transformation investments: patient navigators, after-hours triage lines, advance-care-planning conversations, palliative-care integration. EOM is the explicit redesign informed by OCM's experience.

The EOM Model Announcement defined EOM as a voluntary, five-year, two-sided risk oncology model with seven cancer types, six-month episodes, two risk tracks, mandatory Health Equity Plans, and monthly MEOS payments higher for dual-eligible beneficiaries than for non-dual-eligibles.

Section 1833(z) of the Social Security Act, added by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is the Advanced APM statutory framework. Section 1833(z) defines Advanced APM as a payment model under which participants bear more-than-nominal financial risk and use Certified EHR Technology (CEHRT). Qualifying participants (QPs) in Advanced APMs are exempt from MIPS and may receive APM incentive payments. EOM's Higher Risk Arrangement qualifies as Advanced APM; the Standard Risk Arrangement does not.

The 340B Drug Pricing Program interacts with EOM because most major Georgia cancer centers are 340B-eligible covered entities. 340B drug acquisition pricing changes the economics of chemotherapy episode total spend, and EOM benchmark and reconciliation calculations treat 340B drugs in specific ways that practices must understand.

These five authorities (Section 1115A SSA, the ACA, OCM operational precedent, the EOM Model Announcement, and Section 1833(z) SSA via MACRA) define everything about how EOM operates.

When EOM runs: performance period

EOM's five-year performance period runs mid-2023 through mid-2028:

• Performance Year 1 (PY1): 2023–2024
• Performance Year 2 (PY2): 2024–2025
• Performance Year 3 (PY3): 2025–2026
• Performance Year 4 (PY4): 2026–2027
• Performance Year 5 (PY5): 2027–2028

Performance years run mid-year-to-mid-year (July through June) rather than calendar year, reflecting OCM's calendar inheritance. Reconciliation for each performance year typically occurs roughly 12–18 months after PY close, once claims have fully matured.

For Georgia practices currently participating, PY3 is in progress in 2026, with PY2 reconciliation results becoming available in the latter half of 2026 and early 2027.

Who can participate: oncology practice eligibility

EOM is open to physician group practices (PGPs) that bill Medicare Part B for systemic chemotherapy administration. Practices apply to CMS to participate, and CMS evaluates applications based on:

• Oncology practice size and chemotherapy volume
• Capacity to deliver enhanced services (navigation, after-hours, advance care planning)
• Ability to accept two-sided risk
• Health equity capacity
• Quality-reporting infrastructure

Once selected, a practice signs a participation agreement, designates participating providers, identifies its episode initiators, and begins receiving MEOS payments effective the performance year start.

Practices may withdraw between performance years but generally not mid-year. CMS can terminate participation for non-compliance, fraud and abuse concerns, or failure to meet model requirements.

What EOM covers: the seven cancer types

EOM covers seven cancer types, narrower than OCM's scope. According to CMS, the seven EOM cancer types are:

1. Breast cancer
2. Lung cancer
3. Prostate cancer
4. Colorectal cancer
5. Lymphoma
6. Multiple myeloma
7. Small intestine cancer

(CMS framed prostate as "high-intensity prostate," meaning episodes triggered by chemotherapy administration for prostate, which is less common than hormone therapy and reflects more aggressive disease.)

The narrower scope reflects CMS's analysis that:

• These seven cancer types together account for a large majority of Medicare oncology spending
• These cancer types have sufficiently standardized treatment pathways to make benchmarking meaningful
• Less common cancers were excluded to reduce benchmark variability and reconciliation noise

For Georgia, the seven EOM cancer types align with Georgia's high-incidence cancer profile: lung, breast, prostate, and colorectal cancers are among the most diagnosed in the state, and lymphoma and multiple myeloma represent significant hematologic disease burden.

Episode structure: the six-month chemotherapy episode

The fundamental unit of EOM is the six-month episode.

Episode trigger: initiation of systemic chemotherapy administration for one of the seven cancer types. The episode-initiating event is identified through Part B claims for chemotherapy administration codes (J-codes for the drug plus administration codes for the infusion or injection).

Episode duration: six months from the trigger.

What's included in episode total spend:

• Chemotherapy drugs (Part B)
• Chemotherapy administration (Part B)
• Office visits and E&M (Part B)
• Imaging and labs (Part B)
• Radiation therapy (Part B)
• Inpatient admissions (Part A), including cancer-related and unrelated
• Outpatient hospital services (Part B)
• Skilled nursing facility (Part A)
• Home health (Part A)
• Hospice (Part A)
• Durable medical equipment (Part B)
• Part B oral chemotherapy
• Part D oral chemotherapy spend (calculated separately)

Episode total cost is the sum of all included Part A and Part B spending during the six-month episode, with separate calculation of Part D drug spend.

Multiple concurrent episodes: a single beneficiary may have multiple concurrent episodes across different cancer types if they have multiple primary diagnoses. Episodes can overlap.

Subsequent episodes: a beneficiary who begins a new chemotherapy regimen more than six months after the prior trigger initiates a new episode.

For Georgia practices, the six-month episode is operationally meaningful: it covers the bulk of initial chemotherapy treatment for most cancers (typically 4–6 cycles of cytotoxic chemotherapy over 12–24 weeks plus follow-up monitoring) plus a buffer for completion and surveillance.

The two risk tracks: Standard and Higher

EOM offers two risk arrangements, which practices choose at participation:

Standard Risk Arrangement

• Two-sided risk from day one
• Smaller stop-loss/stop-gain corridor
• NOT Advanced APM; does not qualify under Section 1833(z)
• Practice physicians remain in MIPS unless they qualify through another Advanced APM

Higher Risk Arrangement

• Two-sided risk from day one
• Larger stop-loss/stop-gain corridor (greater financial risk)
• QUALIFIES AS ADVANCED APM under Section 1833(z) SSA
• Practice physicians can achieve Qualifying APM Participant (QP) status
• QPs receive MIPS exemption and an APM incentive payment on Part B professional services

The Standard vs. Higher Risk choice involves a strategic tradeoff: Higher Risk practices accept more downside exposure but in exchange get Advanced APM status, meaning practice physicians can become QPs, exempt from MIPS, and earn incentive payments on all Part B professional services. For high-volume oncology groups where the Advanced APM bonus across all Medicare Part B is substantial, Higher Risk is often the rational choice.

A key change from OCM: OCM allowed upside-only participation for the first several years before requiring opt-in to two-sided risk. EOM is two-sided from day one, with no upside-only on-ramp. This reflects CMS's view that participants should have skin in the game from the start.

MEOS payment: Monthly Enhanced Oncology Services

EOM pays participating practices a Monthly Enhanced Oncology Services (MEOS) payment for each beneficiary with an active episode. The MEOS rate is higher for dual-eligible beneficiaries (those enrolled in both Medicare and Medicaid), recognizing that dual-eligible beneficiaries typically have greater social complexity, more limited access to care, and higher navigation needs.

MEOS is paid monthly for the duration of each beneficiary's episode (six months). For a Georgia oncology practice with a large active EOM episode census, MEOS revenue provides meaningful enhancement-services funding each month.

MEOS is intended to fund:

• Patient navigators
• After-hours triage lines (24/7 access)
• Advance care planning conversations
• Palliative care integration
• Care coordination with primary care, surgical oncology, radiation oncology
• Patient-reported outcomes collection
• Survivorship care planning

MEOS does NOT enter into the episode total spend calculation. MEOS is a separate enhancement-services payment, paid on top of fee-for-service.

The MEOS rate is lower than OCM's rate, reflecting CMS's analysis that some OCM-era enhancement services were either redundant with already-billable services or insufficiently impactful to justify continuation at the higher rate.

Performance-Based Payment (PBP) reconciliation

At the end of each performance year, CMS calculates a Performance-Based Payment (PBP) for each EOM participant by comparing actual episode spending to a benchmark price.

Benchmark methodology

• Historical claims-based benchmark adjusted for:
  • Cancer type
  • Stage and clinical characteristics
  • Patient demographics and risk
  • Regional cost factors
  • Trend factor
• Discount factor applied (CMS retains share of expected savings)

Episode total spend

• Sum of Part A + Part B during the six-month episode
• Separately measured Part D drug spend

NPRA-equivalent

• Actual spend below benchmark: reconciliation payment to practice
• Actual spend above benchmark: reconciliation repayment from practice
• Capped by stop-loss/stop-gain limits per risk arrangement

Quality adjustment

• Practice quality performance (see quality measures below) adjusts retained savings share
• Higher quality: larger share of savings retained
• Lower quality: smaller share or potentially no savings

Health equity adjustment

• Practices serving higher-deprivation populations may receive equity adjustments
• Beneficiary-level ADI data used for risk adjustment
• Mitigates participant disincentives for serving disadvantaged populations

PBP reconciliation results are typically delivered 12–18 months after PY close, given claims maturation requirements.

Quality measures

EOM uses a set of quality measures to adjust performance-based payments and to evaluate model impact:

• Patient-reported outcomes (functional status, symptoms, experience)
• Plan of care documentation (treatment plan, goals, surveillance)
• Hospitalization rates during chemotherapy episodes
• Emergency department visit rates during episodes
• Survival by cancer type and stage
• Hospice use and timing for end-of-life cancer care
• Patient experience (CAHPS-type measures)

These measures combine claims-derived and practice-reported data. Practices submit data through CMS portals; CMS independently validates against claims.

Advanced APM status: Higher Risk Track only

EOM's Higher Risk Arrangement qualifies as Advanced APM under Section 1833(z) SSA. This means:

• Practice physicians billing under the participating practice can become Qualifying APM Participants (QPs) if they meet the patient or payment threshold
• QPs are exempt from MIPS for the corresponding year
• QPs receive an APM incentive payment on Part B professional services (see current QPP rates at qpp.cms.gov; the incentive payment structure has evolved in recent years)
• After CY 2025, the APM incentive payment structure shifts to QP-conversion-factor pathway

The Standard Risk Arrangement does NOT qualify as Advanced APM. Practice physicians in Standard Risk EOM remain in MIPS and report through standard MIPS or APM Performance Pathway (APP).

For Georgia high-volume oncology practices, the Higher Risk Advanced APM pathway can mean millions of dollars annually in QP incentive payments across the practice's Medicare Part B professional revenue.

Health Equity Plan: a required participation element

A distinguishing feature of EOM versus OCM is that every EOM participant must develop and submit a Health Equity Plan.

The Health Equity Plan must:

• Identify disparities in the practice's patient population (by race, ethnicity, dual-eligibility, geographic, language, disability status)
• Specify interventions to reduce those disparities
• Set measurable goals
• Track progress over the performance period
• Report results to CMS

Practices must also collect and report beneficiary-level ADI (Area Deprivation Index) data, which CMS uses for risk-adjustment and equity-adjustment of benchmarks and reconciliation.

The Health Equity Plan requirement signals CMS's broader strategic priority: payment models should not just save money; they should reduce health disparities. EOM is one of the first CMMI models with mandatory Health Equity Plan submission.

For Georgia, where racial and geographic disparities in cancer outcomes are documented (Black patients have higher mortality for many cancer types; rural patients face access challenges), the Health Equity Plan requirement aligns naturally with practice priorities at major Georgia cancer centers serving diverse populations.

Coordination with concurrent programs

EOM operates alongside several other Medicare and federal programs, and the coordination rules matter.

MSSP / ACO REACH attribution overlap

• Beneficiaries attributed to MSSP ACOs or ACO REACH entities can also have EOM episodes at participating oncology practices
• Episode spending counts in both EOM reconciliation and ACO Total Cost of Care
• ACOs and EOM practices coordinate on shared beneficiaries
• Reconciliation methodologies adjust to avoid double-counting savings

340B Drug Pricing Program coordination

• Most major Georgia cancer centers are 340B-eligible
• 340B drug acquisition costs are below ASP+6% Medicare payment
• Episode total spend uses Medicare claims allowed amounts (not 340B acquisition)
• 340B savings remain with covered entities outside the EOM benchmark
• Practices must understand 340B vs. EOM economics carefully

TEAM coordination (cancer surgery)

• TEAM Major Bowel Procedure category may overlap with colorectal cancer chemotherapy episodes
• For a colorectal cancer patient: surgery is bundled under TEAM (30-day episode), chemotherapy is bundled under EOM (6-month episode)
• Different attribution rules; specific coordination guidance in EOM and TEAM rules

MIPS / MIPS APM / APP coordination

• Higher Risk track practices: physicians can become QPs and exempt from MIPS
• Standard Risk track practices: physicians remain in MIPS or report via APP if eligible
• APP Quality Reporting Pathway for ACOs and select APMs may apply

Hospice and palliative care

• Hospice election ends an EOM episode early
• Hospice spending counts in episode total
• EOM incentivizes appropriate hospice use through quality measures

Georgia oncology practice implications

Participating practices (publicly known and reasonably inferred)

Specific EOM participant lists are published by CMS. Georgia-based participants likely include or have included some combination of:

• Emory Winship Cancer Institute, NCI-designated comprehensive cancer center, Atlanta
• Northside Hospital Cancer Institute, largest community oncology in Georgia, multi-site
• Piedmont Cancer Institute, Piedmont Healthcare integrated oncology
• Wellstar Cancer Network, Wellstar Health System integrated oncology
• Georgia Cancer Specialists, major independent oncology practice
• Augusta University Georgia Cancer Center, NCI-designated, Augusta
• Atrium Health Navicent Cancer Center, Macon
• Memorial Health Curtis and Elizabeth Anderson Cancer Institute, Savannah

Practices should verify their EOM participation status directly with CMS Innovation Center.

Strategic considerations for Georgia practices

• Volume sufficiency for benchmarking: smaller practices with fewer episodes per cancer type face greater benchmark variability and reconciliation noise. Practices need enough volume per cancer type to make EOM economically rational.
• 340B economics: 340B-eligible covered entities (most major Georgia cancer centers) need detailed 340B vs. EOM modeling. 340B drug acquisition savings sit outside the benchmark, but Medicare allowed amounts (ASP+6%) flow into total spend.
• Health Equity Plan quality: practices serving more diverse and disadvantaged populations (Grady, Augusta University, urban Atlanta safety-net) should leverage Health Equity Plan as both regulatory compliance and clinical-strategic differentiation.
• Track selection: large high-volume practices typically benefit from Higher Risk Track Advanced APM status due to QP incentive payments across all Medicare Part B revenue. Smaller practices may prefer Standard Risk to limit downside exposure.
• MEOS deployment: MEOS payments must be deployed productively (navigators, after-hours, advance care planning) rather than absorbed into general overhead. Productive MEOS investment drives episode savings.

Non-participating Georgia practices

Many smaller Georgia oncology practices are not in EOM. They continue billing fee-for-service Part B for chemotherapy. They are still subject to MIPS unless they qualify through other Advanced APMs.

Beneficiary impact

• EOM beneficiaries receive enhanced services: navigation, after-hours triage, advance care planning, palliative integration
• EOM beneficiaries are NOT charged additional cost-sharing related to EOM (model does not change beneficiary out-of-pocket)
• Beneficiaries retain freedom of choice; EOM does not restrict where beneficiaries can receive care

Worked examples: six Georgia EOM scenarios

Example 1: Fulton 65, Atlanta EOM Breast Cancer at Emory Winship

Maria is 65, lives in Atlanta (Fulton County), and is newly diagnosed with HER2-positive breast cancer requiring chemotherapy. She begins treatment at Emory Winship Cancer Institute, an EOM participant.

When Emory administers her first chemotherapy infusion, her EOM breast cancer episode is triggered. It runs six months. During the episode:

• Emory receives monthly MEOS payments, funding her patient navigator, after-hours triage access, and advance care planning conversation
• Total spend (chemotherapy drugs ASP+6%, administration, supportive care drugs, imaging, labs, any inpatient admissions) is tracked against the breast cancer benchmark price
• Emory submits required quality data (plan of care, patient-reported outcomes)
• Maria's experience: she has a named navigator, can call 24/7 with side-effect concerns, and had a documented advance care planning conversation in cycle 2

At reconciliation 12–18 months later, Emory's actual total spend on Maria's episode is compared to benchmark. If under benchmark and Emory's quality is high, Emory earns shared savings. If over benchmark, Emory owes repayment (capped per Higher Risk track stop-loss).

Example 2: DeKalb 70, DeKalb EOM Lung Cancer at Northside

James is 70, lives in DeKalb County, and is diagnosed with stage III non-small cell lung cancer. He begins concurrent chemoradiation at Northside Hospital Cancer Institute, an EOM participant.

His EOM lung cancer episode is triggered when chemotherapy administration begins. Total spend includes chemotherapy, radiation oncology services, supportive care, any inpatient stays for treatment-related complications, and imaging. Northside receives MEOS payments and provides James with a thoracic-oncology navigator, advance care planning conversations, and integrated palliative care from week one.

Northside's MEOS-funded navigation and palliative integration drive lower-than-benchmark inpatient utilization for James and his lung-cancer cohort, leading to favorable reconciliation.

Example 3: Cobb 68, Cobb EOM Colorectal at Wellstar

Linda is 68, lives in Cobb County, and has stage III colon cancer. She has already had surgical resection (which would have been a TEAM Major Bowel Procedure episode if her hospital was a TEAM participant) and now needs adjuvant chemotherapy at Wellstar Cancer Network, an EOM participant.

When Wellstar administers her first FOLFOX infusion, her EOM colorectal cancer episode is triggered. Six months covers her full adjuvant FOLFOX regimen plus surveillance. Wellstar's navigator coordinates with the surgical team, primary care, and the patient's family. MEOS funding supports this care coordination infrastructure.

Note: Linda's surgical admission was a TEAM episode (30 days, separate). Her chemotherapy is an EOM episode (six months). Two separate model episodes for one patient.

Example 4: Worth County 72, Albany area patient considerations

Robert is 72, lives in rural Worth County (near Albany). His local hospital and oncology practice may or may not be EOM participants; smaller rural oncology practices often choose not to participate due to volume insufficiency.

If Robert receives care at a non-participating Albany-area practice, his care continues under standard fee-for-service Part B billing. No MEOS payments, no Health Equity Plan, no episode reconciliation. His physicians remain in MIPS.

If Robert chooses to travel to Atlanta for care at an EOM-participating practice (Emory, Northside, Wellstar, Piedmont, Georgia Cancer Specialists), he gains EOM enhanced services. Many rural Georgia cancer patients travel to Atlanta for complex cancer care.

Example 5: Bibb 75, Macon EOM Multiple Myeloma at Atrium Navicent

Patricia is 75, lives in Macon (Bibb County), and is diagnosed with multiple myeloma requiring chemotherapy at Atrium Health Navicent Cancer Center. If Atrium Navicent is an EOM participant:

• Her EOM multiple myeloma episode is triggered at first chemotherapy
• Monthly MEOS payments fund her navigator and advance care planning
• Episode covers six months of complex multi-agent myeloma chemotherapy regimen plus supportive care
• Quality measures include patient-reported outcomes (peripheral neuropathy is common in myeloma chemotherapy)

Example 6: Hall 60, Gainesville EOM Prostate at NGMC

Robert is 60, lives in Hall County (Gainesville, technically in Atlanta MSA), and has metastatic castration-resistant prostate cancer requiring chemotherapy (high-intensity prostate) at Northeast Georgia Medical Center. If NGMC's oncology program is EOM-participating:

• His EOM prostate cancer episode is triggered at chemotherapy initiation
• MEOS funds his navigation and advance care planning given metastatic disease
• Episode covers six months of taxane chemotherapy plus continued androgen deprivation

14 best practices for navigating Georgia EOM

1. Verify EOM participation status of your oncology practice: ask directly or check CMS Innovation Center participant list at innovation.cms.gov
2. Understand episode trigger: initiation of chemotherapy starts your six-month episode clock
3. Engage your navigator: EOM-participating practices have MEOS-funded navigators specifically for you; use them
4. Use the after-hours triage line: 24/7 access to oncology nursing through your EOM practice
5. Participate in advance care planning conversations: required for quality measures and helps your family
6. Complete patient-reported outcomes surveys: quality data improves your practice's reconciliation
7. Coordinate with primary care: EOM practices should communicate with your PCP regularly
8. Understand 340B status of your cancer center if it affects your drug costs
9. For Higher Risk track practices: your oncologist may be exempt from MIPS as a QP
10. Maintain freedom of choice: EOM does not restrict where you receive care
11. Use palliative care early: EOM quality measures incentivize timely palliative integration
12. Discuss hospice timing: appropriate hospice election is a quality metric
13. Know your Health Equity Plan: your practice has one; ask what disparities they target
14. Keep all your records: episode reconciliation requires complete claims data

14 common issues and how to handle them

1. "I don't know if my practice is in EOM": call your practice billing office; check CMS Innovation Center participant list
2. "I'm dual-eligible, am I in EOM?": yes if your oncology practice is an EOM participant; dual-eligible beneficiaries receive a higher MEOS rate than non-dual beneficiaries
3. "My oncologist switched practices mid-treatment": episode rules address provider changes; ask your new practice
4. "I started chemotherapy then stopped": episode still runs six months from trigger
5. "I have two cancers": separate concurrent episodes may apply
6. "My benchmark seems unfair": reconciliation methodology has appeal rights; practice raises through CMS
7. "My ED visits during chemotherapy are tracked": yes, episode total includes ED visits, hospitalizations
8. "My family member is in hospice now": hospice election typically ends EOM episode early
9. "I want to switch to a non-EOM practice": you can; freedom of choice is preserved
10. "My practice is in OCM still": OCM has ended; if your practice is in any oncology model, it's EOM (or no model)
11. "I was offered to enroll in EOM": EOM does not require beneficiary enrollment; you are automatically attributed when your oncology practice triggers your episode
12. "Out-of-pocket changed": EOM should not change your beneficiary cost-sharing; if it did, contact your practice
13. "I want my health equity data excluded": beneficiary-level data is used for risk adjustment; speak to your practice about specific concerns
14. "My oncologist's MIPS exempt now": if you're at a Higher Risk EOM practice, your oncologist may be a QP exempt from MIPS

25 frequently asked questions

1. What is the Enhancing Oncology Model (EOM)? The CMS Innovation Center's voluntary oncology bundled payment model, successor to OCM. Covers six-month chemotherapy episodes for seven cancer types.

2. Is EOM mandatory? No, EOM is voluntary. Oncology practices apply to participate; CMS selects.

3. When did EOM start? EOM's five-year performance period began in mid-2023.

4. When does EOM end? EOM's performance period runs through mid-2028. CMS may decide to extend, modify, or expand the model.

5. Which seven cancer types does EOM cover? Breast, lung, prostate, colorectal, lymphoma, multiple myeloma, and small intestine cancer.

6. How long is an EOM episode? Six months from initiation of chemotherapy.

7. What triggers an EOM episode? Administration of systemic chemotherapy for one of the seven cancer types at an EOM-participating practice.

8. What is the MEOS payment? Monthly Enhanced Oncology Services payment to participating practices, paid monthly per active beneficiary. The rate is higher for dual-eligible beneficiaries. See CMS Innovation Center for current rates.

9. What is the dual-eligible MEOS boost? Dual-eligible beneficiaries (enrolled in both Medicare and Medicaid) receive a higher MEOS rate than non-dual-eligibles, recognizing greater complexity.

10. What are the two risk tracks? Standard Risk Arrangement (smaller corridor, NOT Advanced APM) and Higher Risk Arrangement (larger corridor, qualifies as Advanced APM).

11. Is EOM an Advanced APM? The Higher Risk Arrangement qualifies as Advanced APM under Section 1833(z) SSA. The Standard Risk Arrangement does NOT.

12. What is OCM? Oncology Care Model, EOM's predecessor model that has ended.

13. Why is EOM narrower (seven cancer types) than OCM? CMS analysis concluded the seven types account for most oncology spend and have more standardized treatment pathways for meaningful benchmarking.

14. What is a Health Equity Plan? Required EOM submission: identifies disparities in practice's patient population, specifies interventions, sets measurable goals, tracks progress.

15. How is reconciliation calculated? Actual episode total spend vs. benchmark price (adjusted for cancer type, stage, demographics, regional factors, trend, discount). Quality and equity adjustments apply.

16. What spending counts in the episode? All Part A and Part B during the six-month episode: chemotherapy drugs, administration, visits, imaging, labs, radiation, inpatient, outpatient, SNF, home health, hospice, DME. Part D measured separately.

17. Does EOM change beneficiary cost-sharing? No. Beneficiary out-of-pocket follows standard Medicare rules.

18. Can I choose any oncologist? Yes. EOM does not restrict beneficiary choice.

19. How does EOM interact with my MSSP ACO? If your PCP is in an MSSP ACO and your oncologist is in EOM, your episode counts in both. Coordination rules adjust to avoid double-counting savings.

20. How does 340B affect EOM? 340B-eligible cancer centers acquire chemotherapy below Medicare ASP+6%. Medicare allowed amounts flow into episode total spend; 340B savings sit outside the benchmark.

21. What if I'm hospitalized during chemotherapy? Hospitalization counts in episode total spend. EOM incentivizes practices to minimize unnecessary hospitalizations through navigation and after-hours support.

22. What if I elect hospice mid-episode? Hospice election typically ends the EOM episode; hospice spending counts in episode total.

23. Are there specific quality measures? Patient-reported outcomes, plan of care, hospitalization rates, ED visit rates, survival, hospice timing, patient experience.

24. Which Georgia practices participate in EOM? Specific lists are published by CMS Innovation Center. Major Georgia oncology centers including Emory Winship, Northside Cancer Institute, Piedmont Cancer Institute, Wellstar Cancer Network, Georgia Cancer Specialists, Augusta University Georgia Cancer Center, Atrium Health Navicent Cancer Center, and Memorial Health Anderson Cancer Institute are likely candidates. Verify participation directly with each practice or CMS.

25. What if my practice isn't in EOM? You continue receiving standard fee-for-service oncology care. Your physicians remain in MIPS unless they qualify through another Advanced APM.

Why EOM matters for Georgia

EOM is the CMS Innovation Center's bet that two-sided risk plus enhanced services payments plus mandatory health equity planning can drive better cancer care delivery at lower total Medicare cost. The model's design choices (six-month episodes, seven cancer types, two-sided risk from day one, MEOS payments, Higher Risk Advanced APM status, mandatory Health Equity Plans) reflect specific lessons learned from OCM's experience.

For Georgia, EOM intersects directly with the state's high cancer burden, its concentration of high-volume community oncology practices in Atlanta plus regional cancer centers in Augusta, Savannah, Macon, and Columbus, its substantial 340B-eligible cancer center footprint, and its documented racial and geographic cancer-outcome disparities. Major Georgia oncology systems' participation decisions, Health Equity Plan content, MEOS-funded navigation deployment, and risk-track selection all play out within this framework.

EOM also bridges to the larger CMMI portfolio: it sits alongside MSSP and ACO REACH on the population-health side, alongside TEAM on the hospital bundled-payment side, and alongside MCP on the primary care side. Georgia oncology practices, hospitals, and primary care groups increasingly need to understand how all these models coordinate for shared patients; a single Georgia Medicare beneficiary may be attributed to an ACO, have a hospital episode under TEAM, have a chemotherapy episode under EOM, and have a primary care practice in MCP, all simultaneously.

Contacts

• Medicare: 1-800-MEDICARE (1-800-633-4227), www.medicare.gov
• CMS Innovation Center (EOM): innovation.cms.gov/innovation-models/enhancing-oncology-model
• QPP Service Center: 1-866-288-8292 (qpp.cms.gov)
• Palmetto GBA (Jurisdiction J MAC): 1-866-238-9650
• GeorgiaCares SHIP: 1-866-552-4464
• Medicare Rights Center: 1-800-333-4114
• Atlanta Legal Aid: 404-377-0701
• GA Legal Services: 1-800-498-9469
• 211 Georgia: dial 2-1-1
• Eldercare Locator: 1-800-677-1116
• Acentra Health QIO: 1-844-455-8708
• SSA: 1-800-772-1213
• NCI Cancer Information Service: 1-800-4-CANCER (1-800-422-6237)
• American Cancer Society: 1-800-227-2345
• LIVESTRONG (cancer navigation): 1-855-220-7777
• Emory Winship Cancer Institute: 404-778-1900
• Northside Hospital Cancer Institute: 404-851-8850

Find personalized help navigating cancer care and Medicare coverage options at brevy.com.

Last verified: May 14, 2026 Status: In review Pillar: Medicaid / Medicare (Georgia) Voice: Policy translator