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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
The bill shifts radiation oncology toward quality‑tied, episode‑based payments and adds targeted transportation and access supports to help patients — but it also creates administrative burdens, risks provider revenue cuts and service limitations (including exclusions of some advanced therapies), may raise patient cost‑sharing, and could increase Medicare spending for taxpayers.
Medicare beneficiaries with cancer receive more coordinated, higher‑quality radiation therapy through unified 90‑day episode payments tied to quality, encouraging continuity of care.
Patients in underserved and rural areas — including low‑income Medicare beneficiaries — gain better local access and support for completing radiation therapy via grants/GAO study, a health‑equity transportation add‑on, and transportation assistance.
Hospitals and physician groups get more predictable reimbursement and incentives (including technical‑component increases and protections from immediate fee‑schedule offsets), lowering financial uncertainty and encouraging participation in value‑based care.
Some providers may face reduced revenue or specific payment penalties (including potential aggregate payment cuts and a 2.5% penalty for noncompliance), which could reduce local provider capacity, limit access, or drive consolidation.
The program may increase Medicare spending for taxpayers because identified program savings are excluded from fee‑schedule offsets, and this uneven treatment could advantage radiation oncology over other specialties.
New reporting, accreditation, and rulemaking requirements add administrative burden and compliance costs for providers (EHR upgrades, accreditation), increasing overhead for hospitals and clinicians.
Based on analysis of 5 sections of legislative text.
Creates a voluntary 5-year Medicare 90-day bundled episode payment program for radiation oncology, adds a patient-transportation safe-harbor, and exempts resulting savings from certain budget-neutrality offsets.
Creates a voluntary five-year Medicare case-rate value-based payment demonstration for radiation oncology that bundles services into 90-day episodes, ties payments to quality and cost performance, and requires data collection, reporting, and evaluations. Requires HHS to promulgate regulations within one year, permits participation by hospitals, physician groups, and certain ACOs, and includes a health-equity add-on and retrospective reconciliation of prospective episode payments. Adds a safe-harbor allowing certain eligible entities to provide free or discounted patient transportation to radiation therapy patients under narrow conditions, and directs that cost savings from the new program not be counted when applying Medicare budget-neutrality adjustments to fee schedules for a limited period following enactment.