ROCR Value Based Program Act

Summary

Creates a new Medicare bundled, value-based payment program for radiation oncology that pays per episode of care, ties payments to quality and cost performance, and includes a health-equity add-on. It also creates a limited safe-harbor for free or discounted patient transportation to radiation therapy and prevents the usual Medicare budget-neutrality offsets from counting savings generated by the new payment model. The Secretary of HHS must set up the program by rulemaking within one year, define episodes, set case rates, require data sharing and quality measurement, permit certain waivers, and evaluate results. The bill also amends civil monetary penalty rules to allow eligible entities to provide non-marketed, non-volume-based transportation to established radiation therapy patients without triggering penalties, and it excludes program savings from automatic Medicare payment offsets under existing budget-neutrality rules.

• Establishes a Medicare bundled case-rate, value-based payment program for radiation oncology to pay per episode of care and link payments to quality and cost.
• Requires HHS to implement the program by notice-and-comment rulemaking within one year and to define episodes, case rates, risk adjustment, outlier protections, and quality measures.
• Includes a health equity add-on payment to encourage reduced access disparities for radiation therapy patients.
• Adds a narrow safe-harbor in the civil monetary penalty statute allowing eligible entities to offer non-marketed, non-volume-based transportation to established radiation therapy patients.
• Prevents Medicare from using savings from this radiation oncology program to trigger automatic budget-neutrality reductions in other Part B or physician fee-schedule payments.
• Authorizes waivers, data-sharing, evaluation, and public reporting; gives the Secretary broad authority to phase in, expand, or end the model.
• Prohibits cuts to existing radiation therapy payment rates under certain Medicare payment systems during the rulemaking period before the new program is effective.
• Amends multiple Medicare statutory provisions to create the program, the transportation safe-harbor, and to change how program savings are counted in payment adjustments.