Sponsors (35)
The bill promotes more coordinated, locally accessible, and value‑focused radiation oncology care (with transportation and equity supports) and stabilizes provider payment incentives — but it raises out‑of‑pocket costs for many beneficiaries, excludes some advanced treatments, increases administrative burdens, and may shift costs onto taxpayers and providers.
Medicare beneficiaries receiving radiation therapy are more likely to get coordinated, higher-quality care through a 90‑day episode payment and case-rate model that ties payments to quality and encourages completion and continuity of treatment.
Patients in underserved and rural areas, plus low-income beneficiaries, may gain better local access to radiation therapy through grants, GAO study-driven actions to address 'radiation therapy deserts', and transportation supports that reduce travel burden.
Hospitals and physician groups can get more predictable reimbursement and face less immediate fee‑schedule downside risk, creating stronger incentives to invest in quality, complete courses of therapy, and participate in the new payment model.
Medicare beneficiaries will still owe 20% coinsurance on episode payments, which can raise out‑of‑pocket costs and make treatment more expensive for many seniors compared with some bundled-care alternatives.
The program temporarily excludes several advanced radiation modalities (brachytherapy, proton therapy, radiopharmaceuticals) for up to 12 years, which could limit access to newer or specialized treatments for some cancer patients enrolled in Medicare.
Some providers may face payment reductions (including 2.5% penalties or aggregate payment cuts) or revenue pressure from site-neutral rules, which could reduce local provider capacity, push consolidation, or shift where patients receive care.
Based on analysis of 5 sections of legislative text.
Establishes a voluntary 5-year Medicare 90-day bundled payment model for radiation oncology, adds a transportation safe-harbor, and exempts model savings from Medicare budget-neutrality reductions.
Official title: To amend Title XVIII of the Social Security Act to create a Radiation Oncology Case Rate Value Based Payment Program exempt from budget neutrality adjustment requirements, and to amend section 1128A of title XI of the Social Security Act to create a new statutory exception for the provision of free or discounted transportation for radiation oncology patients to receive radiation therapy services.
Introduced March 14, 2025 by Brian K. Fitzpatrick · Last progress March 14, 2025
Creates a voluntary 5-year Medicare demonstration that bundles radiation oncology services into 90-day case-rate episodes tied to quality and cost performance, establishes rulemaking and reporting requirements, and protects certain patient transportation programs from anti-kickback penalties. It also prevents savings from the new radiation oncology payment model from reducing other Medicare fee schedule payments when budget-neutrality adjustments are calculated. The Secretary of HHS must issue an advance notice and proposed rule within a year and run the model with prospective payments, retrospective reconciliation, public reporting, and interim and final evaluations.