Sponsors (6)
Official title: 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 13, 2025 by Thomas Roland Tillis · Last progress March 13, 2025
The bill aims to improve radiation oncology quality, simplify payments, and expand transportation supports while containing Medicare costs — but those cost controls, accreditation and reporting rules, and program carve‑outs risk higher patient cost‑sharing, strained small/rural providers, access reductions in some areas, and added administrative burden.
Medicare beneficiaries receiving radiation therapy will see payments tied to bundled/value‑based care and quality measures, which is likely to improve care coordination, safety, and treatment outcomes.
Medicare beneficiaries and providers will get a simplified, single per‑episode payment with predictable base rates and updates, reducing surprise billing and helping providers plan revenue.
Patients with transportation or access barriers (including rural and low‑income beneficiaries) will gain new supports — a $500 per‑episode health equity add‑on (indexed) and the ability for eligible entities to provide free/discounted rides — improving treatment completion.
Medicare beneficiaries and patients in some areas could face reduced access or fewer local treatment options if payment reductions or program savings lower provider revenue, causing clinic closures or longer travel times.
Medicare beneficiaries may face higher out‑of‑pocket costs because coinsurance remains 20% of the episode payment, which could be more than under itemized billing for some patients.
Small, rural, or under‑resourced providers risk exclusion or financial strain due to accreditation, EHR/certification, and reporting requirements (including potential 2.5% payment cuts), which could reduce local access.
Based on analysis of 5 sections of legislative text.
Establishes a Medicare bundled per-episode payment program for radiation oncology, adds a patient-transportation safe-harbor, and excludes program savings from certain Medicare budget-neutrality adjustments.
Creates a new Medicare bundled payment program that pays per radiation therapy episode, ties payments to quality and cost performance, and directs HHS to implement the Radiation Oncology Case Rate Value Based Payment (ROCR) Program within one year by notice-and-comment rulemaking. The bill also adds a health-equity add-on, allows waivers and data-sharing, protects existing fee schedule and outpatient payments until ROCR rules take effect, and requires evaluation and reporting. Adds a safe-harbor to federal civil monetary penalty rules permitting certain eligible entities to provide free or discounted patient transportation for radiation therapy patients under strict conditions, and changes Medicare budgeting rules so savings from the ROCR Program are excluded from certain budget-neutrality and fee-schedule reduction calculations.