Sponsors (30)
Introduced March 14, 2025 by Brian K. Fitzpatrick · Last progress March 14, 2025
The bill seeks to improve coordination, quality, and access for Medicare radiation therapy through episode payments, incentives, and targeted transportation supports, but does so at the cost of added provider administrative burden, potential provider revenue cuts and local service consolidation, limited coverage of some advanced therapies, higher beneficiary cost‑sharing, and potential increases in Medicare spending.
Medicare beneficiaries receiving radiation therapy will see payments tied to 90-day, quality‑linked episodes, promoting more coordinated, patient‑centered care and continuity of treatment.
Hospitals, physician groups, and radiation practices gain more predictable reimbursement and targeted payment incentives (including technical‑component increases) that reduce payment volatility and encourage investment in quality and therapy completion.
Patients in underserved and rural areas, and low‑income beneficiaries, may gain better local access to radiation therapy through grants, a GAO study of ‘radiation therapy deserts,’ a $500 annual health‑equity add‑on for transportation‑insecure patients, and other access incentives.
Local patient access and capacity could shrink because some providers may face aggregate payment reductions or 2.5% penalties for not meeting requirements, prompting service consolidation or reduced local availability.
Medicare beneficiaries will still owe 20% coinsurance on episode payments, which can raise out‑of‑pocket costs compared with some other bundled payment options.
Excluding advanced modalities (brachytherapy, proton therapy, radiopharmaceuticals) from the program for up to 12 years may limit Medicare patients' access to certain treatments and disincentivize their use.
Based on analysis of 5 sections of legislative text.
Establishes a voluntary 5‑year Medicare case‑rate model bundling 90‑day radiation oncology episodes with quality‑based payments, reporting, a health‑equity add‑on, and a budget‑neutrality exemption for program savings.
Creates a voluntary 5‑year Medicare payment demonstration that bundles radiation oncology services into 90‑day case‑rate episodes, ties payments to quality and cost performance (including a health‑equity add‑on), requires data reporting and evaluations, and permits certain statutory waivers to support implementation. It also adds a safe harbor allowing specified entities to offer free or discounted non‑emergency patient transportation for radiation therapy under conditions, and instructs CMS not to treat any program savings as part of usual budget‑neutrality offsets when adjusting fee schedules.