HR2120-119

What This Bill Does

The ROCR Value Based Program Act creates a Medicare episode-based payment model for radiation oncology. Congress finds that nearly 60 percent of cancer patients receive radiation therapy and that Medicare spent about $4.2 billion on radiation oncology services in 2021, while current payment systems can create unstable rates and volume incentives. Within one year, CMS must establish a Radiation Oncology Case Rate Value Based Payment Program providing per-episode payments to radiation therapy providers and suppliers for covered treatment to Part B beneficiaries who are not in Medicare Advantage or PACE and have included cancer types such as breast, prostate, lung, colorectal, head and neck, cervical, uterine, pancreatic, lymphoma, anal, bladder, brain metastases, and bone metastases. Episodes begin with radiation therapy planning and last 90 days for most cancers and 30 days for bone and brain metastases if treatment starts within 30 days. The program excludes specified modalities such as brachytherapy, proton therapy, intraoperative radiotherapy, superficial radiation therapy, hyperthermia, and therapeutic radiopharmaceuticals for 12 years, with later inclusion by regulation after considering market penetration, cost, clinical benefit, and stakeholder consensus. CMS may not reduce physician-fee-schedule or outpatient payment rates before program regulations take effect. Accreditation organizations must maintain modern quality standards for linear accelerator technology, staffing, safety, and public comment, updated every five to seven years. GAO must report after seven years on implementation, spending, access, cancer-type and modality scope, and Medicare Advantage application, and within three years on radiation therapy deserts and grants or loans for modern technology. The bill also creates a civil monetary penalty safe harbor for free or discounted non-luxury transportation for established radiation therapy patients within 75 miles or in rural areas under uniform, non-marketed policies, and prevents reduced ROCR expenditures from triggering budget-neutrality cuts under OPPS or the physician fee schedule.

Who Benefits and How

Medicare radiation therapy patients benefit from a payment model intended to stabilize access and reduce disparities in radiation oncology care. Radiation oncology providers benefit from unified case-rate payments and a freeze on rate reductions until program regulations take effect. Rural cancer patients benefit from GAO review of radiation therapy deserts and compliant free or discounted transportation services. Radiation therapy technology suppliers benefit if accreditation standards and GAO recommendations support modern equipment access.

Who Bears the Burden and How

CMS must design episode payments, covered cancer types, quality rules, exclusions, accreditation requirements, and budget-neutrality treatment. Radiation therapy providers and suppliers must comply with accreditation, quality, data, and case-rate payment rules. Accreditation organizations must update radiation therapy quality standards every five to seven years with stakeholder input. GAO must produce access, technology, and implementation reports. Federal taxpayers and Medicare financing sources bear program design, payment, transportation-safe-harbor, and non-budget-neutral savings effects.

Key Provisions

• Creates a Medicare Radiation Oncology Case Rate Value Based Payment Program within one year.
• Provides episode-based payments for included cancer types and Part B beneficiaries outside Medicare Advantage and PACE.
• Excludes selected modalities for 12 years unless later included by regulation after statutory review.
• Requires modern accreditation standards for linear accelerator technology, staffing, patient safety, and quality.
• Provides a compliant transportation services safe harbor for established radiation therapy patients.
• Bars ROCR savings from triggering OPPS or physician fee schedule budget-neutrality adjustments.