Sponsors (5)
The bill aims to shift radiation oncology toward coordinated, quality-driven payments and patient transportation supports, improving predictability and oversight for many providers and patients, but it risks higher out-of-pocket costs for beneficiaries, increased administrative burdens, exclusion of some advanced therapies, and reduced access in low-margin or rural settings while potentially raising Medicare/taxpayer costs.
Medicare beneficiaries (patients with cancer and chronic conditions) may receive higher-quality, more coordinated radiation therapy through value-based payment models that reward quality over volume.
Hospitals and radiation oncology practices gain more predictable, upfront and value-based payments and can retain savings from the program, improving cash flow and incentives for care coordination and investment in expensive equipment.
Medicare and Medicaid patients (especially rural and low-income beneficiaries) get transportation supports — a $500 health-equity add-on and free/discounted rides — reducing missed appointments and travel burden.
Providers—especially low-margin, rural, or small centers—could see reduced revenue under bundled per-episode payments and savings adjustments, risking service closures, reduced local access, and consolidation that would harm patients who rely on nearby radiation therapy.
Medicare beneficiaries may face higher out-of-pocket costs because the per-episode model carries a 20% coinsurance on the episode payment, which can be more costly than current per-service cost-sharing.
The 12-year exclusion of certain advanced modalities (e.g., proton therapy, brachytherapy) could limit access to newer or clinically appropriate treatments for Medicare beneficiaries who would benefit from them.
Based on analysis of 5 sections of legislative text.
Creates a Medicare per-episode value-based payment program for radiation oncology, sets payment and quality rules, permits certain free patient transportation, and excludes program savings from budget-neutrality offsets.
Introduced March 13, 2025 by Thomas Roland Tillis · Last progress March 13, 2025
Creates a new Medicare value-based payment program that pays radiation oncology providers a per-episode case rate for radiation therapy, requires HHS to set payment methods and quality measures, and protects certain program savings from automatic Medicare budget-neutrality offsets. It also adds a narrowly tailored anti-kickback/civil monetary penalty safe harbor for free or discounted patient transportation to radiation therapy under specific rules. Requires the Department of Health and Human Services to issue rules and implement the Radiation Oncology Case Rate Value Based Payment Program within one year of enactment, to collect quality and utilization data, and to report to Congress; and it excludes savings from this program when CMS calculates budget-neutrality adjustments to other Medicare payment rates.