Us Congress 2025-2026 Regular Session

Us Congress House Bill HB2120 Compare Versions

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Old	New	Differences
1	1	I
2	2	119THCONGRESS
3	3	1
4	4	STSESSION H. R. 2120
5	5	To amend Title XVIII of the Social Security Act to create a Radiation
6	6	Oncology Case Rate Value Based Payment Program exempt from budget
7	7	neutrality adjustment requirements, and to amend section 1128A of
8	8	title XI of the Social Security Act to create a new statutory exception
9	9	for the provision of free or discounted transportation for radiation oncol-
10	10	ogy patients to receive radiation therapy services.
11	11	IN THE HOUSE OF REPRESENTATIVES
12	12	MARCH14, 2025
13	13	Mr. F
14	14	ITZPATRICK(for himself, Mr. PANETTA, Mr. JOYCEof Pennsylvania,
15	15	and Mr. T
16	16	ONKO) introduced the following bill; which was referred to the
17	17	Committee on Energy and Commerce, and in addition to the Committee
18	18	on Ways and Means, for a period to be subsequently determined by the
19	19	Speaker, in each case for consideration of such provisions as fall within
20	20	the jurisdiction of the committee concerned
21	21	A BILL
22	22	To amend Title XVIII of the Social Security Act to create
23	23	a Radiation Oncology Case Rate Value Based Payment
24	24	Program exempt from budget neutrality adjustment re-
25	25	quirements, and to amend section 1128A of title XI
26	26	of the Social Security Act to create a new statutory
27	27	exception for the provision of free or discounted transpor-
28	28	tation for radiation oncology patients to receive radiation
29	29	therapy services.
30	30	Be it enacted by the Senate and House of Representa-1
31	31	tives of the United States of America in Congress assembled, 2
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35	35	SECTION 1. SHORT TITLE. 1
36	36	This Act may be cited as the ‘‘Radiation Oncology 2
37	37	Case Rate Value Based Program Act of 2025’’ or the 3
38	38	‘‘ROCR Value Based Program Act’’. 4
39	39	SEC. 2. FINDINGS. 5
40	40	(a) F
41	41	INDINGS.—Congress finds the following: 6
42	42	(1) Radiation therapy is the careful use of var-7
43	43	ious forms of radiation, such as external beam radi-8
44	44	ation therapy, to treat cancer and other diseases 9
45	45	safely and effectively. Radiation oncologists develop 10
46	46	radiation treatment plans and coordinate with highly 11
47	47	specialized care teams to deliver radiation therapy. 12
48	48	Nearly 60 percent of cancer patients will receive ra-13
49	49	diation therapy during their treatment. 14
50	50	(2) In 2021, the Centers for Medicare & Med-15
51	51	icaid Services reported approximately 16
52	52	$4,200,000,000 in total spending for radiation on-17
53	53	cology services between the Medicare physician fee 18
54	54	schedule and hospital outpatient departments. 19
55	55	(3) The Centers for Medicare & Medicaid Serv-20
56	56	ices has historically faced challenges in determining 21
57	57	accurate pricing for services that involve costly cap-22
58	58	ital equipment, resulting in fluctuating payment 23
59	59	rates under the Medicare physician fee schedules for 24
60	60	services involving external beam radiation therapy. 25
61	61	Additionally, the Medicare physician fee schedule 26
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65	65	has inadequately recognized the professional exper-1
66	66	tise physicians and nonphysician professionals need 2
67	67	to deliver radiation therapy. 3
68	68	(4) The current payment systems incentivize 4
69	69	greater volumes of care while bundled payments 5
70	70	incentivize patient centered, efficient, and high value 6
71	71	care. 7
72	72	(5) In 2017, the Centers for Medicare & Med-8
73	73	icaid Services recognized that the Medicare payment 9
74	74	systems were not adequately addressing radiation 10
75	75	oncology services, and the Center for Medicare & 11
76	76	Medicaid Innovation released a congressionally re-12
77	77	quested report on the pursuit of an alternative pay-13
78	78	ment model for radiation oncology (referred to in 14
79	79	this section as the ‘‘Radiation Oncology Model’’) 15
80	80	that addresses the issues in the Medicare physician 16
81	81	fee schedule and the Medicare hospital outpatient 17
82	82	prospective payment system payment methods. 18
83	83	(6) Concerns regarding the proposed Radiation 19
84	84	Oncology Model included the significant payment re-20
85	85	ductions proposed in the model that would jeop-21
86	86	ardize access to high-quality radiation therapy serv-22
87	87	ices and the onerous reporting requirements for par-23
88	88	ticipating providers. The Radiation Oncology Model 24
89	89	saw indefinite implementation delays. 25
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93	93	(7) It is necessary, therefore, to create a pay-1
94	94	ment program for radiation oncology services that 2
95	95	appropriately recognizes the value of quality radi-3
96	96	ation oncology services through its financial incen-4
97	97	tives while containing costs and providing patient- 5
98	98	centered care. 6
99	99	SEC. 3. RADIATION ONCOLOGY CASE RATE VALUE BASED 7
100	100	PAYMENT PROGRAM. 8
101	101	(a) I
102	102	NGENERAL.—Title XVIII of the Social Security 9
103	103	Act (42 U.S.C. 1395 et seq.) is amended by adding at 10
104	104	the end the following: 11
105	105	‘‘SEC. 1899C. RADIATION ONCOLOGY CASE RATE VALUE 12
106	106	BASED PAYMENT PROGRAM. 13
107	107	‘‘(a) E
108	108	STABLISHMENT.— 14
109	109	‘‘(1) I
110	110	N GENERAL.—Not later than 1 year after 15
111	111	the date of enactment of the ROCR Value Based 16
112	112	Program Act, the Secretary shall promulgate regula-17
113	113	tions, using the procedures described in paragraph 18
114	114	(5), establishing a Radiation Oncology Case Rate 19
115	115	Value Based Payment Program (referred to in this 20
116	116	section as the ‘ROCR Program’) under which per 21
117	117	episode payments are provided to radiation therapy 22
118	118	providers or radiation therapy suppliers for covered 23
119	119	treatment furnished to a covered individual during 24
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123	123	an episode of care (as such terms are defined in sub-1
124	124	section (j)) in accordance with this section. 2
125	125	‘‘(2) M
126	126	AINTAINING PAYMENT RATES DURING 3
127	127	PERIOD PRIOR TO EFFECTIVE DATE OF REGULA -4
128	128	TIONS.—The Secretary shall not reduce the estab-5
129	129	lished payment rates for radiation therapy services 6
130	130	under the physician fee schedule under section 1848 7
131	131	or the hospital outpatient prospective payment sys-8
132	132	tem under section 1833(t) during the time period 9
133	133	beginning on the date of enactment of the ROCR 10
134	134	Value Based Program Act and ending on the date 11
135	135	that the regulations issued by the Secretary pursu-12
136	136	ant to paragraph (1) become effective. 13
137	137	‘‘(3) ROCR
138	138	PROGRAM GOALS .—The ROCR 14
139	139	Program shall seek to— 15
140	140	‘‘(A) create stable, unified payments for 16
141	141	radiation therapy services under this title; 17
142	142	‘‘(B) reduce disparities in radiation ther-18
143	143	apy care for Medicare beneficiaries by increas-19
144	144	ing access to radiation therapy services close to 20
145	145	the homes of beneficiaries; 21
146	146	‘‘(C) enhance quality of radiation therapy 22
147	147	care through practice accreditation and shorter 23
148	148	courses of treatment, when appropriate; 24
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152	152	‘‘(D) leverage and encourage the utilization 1
153	153	of state-of-the-art technology to improve care 2
154	154	and outcomes; and 3
155	155	‘‘(E) protect Medicare resources by achiev-4
156	156	ing reasonable spending reductions in Medicare 5
157	157	for radiation therapy services. 6
158	158	‘‘(4) P
159	159	AYMENTS.—Under this section, with re-7
160	160	spect to covered treatment furnished to covered indi-8
161	161	viduals, payments shall include— 9
162	162	‘‘(A) per episode payments, as described in 10
163	163	subsection (b), to radiation therapy providers or 11
164	164	radiation therapy suppliers of radiation therapy 12
165	165	services which meet such requirements as the 13
166	166	Secretary shall establish by regulation; and 14
167	167	‘‘(B) the health equity achievement in radi-15
168	168	ation therapy add-on payment described in sub-16
169	169	section (g). 17
170	170	‘‘(5) N
171	171	OTICE AND COMMENT RULEMAKING .— 18
172	172	The Secretary shall promulgate the regulations de-19
173	173	scribed in paragraph (1) in accordance with section 20
174	174	553 of title 5, United States Code, and issue an ad-21
175	175	vanced notice of proposed rulemaking and notice of 22
176	176	proposed rulemaking with a comment period of not 23
177	177	less than 60 days for each. 24
178	178	‘‘(b) P
179	179	EREPISODEPAYMENTS.— 25
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183	183	‘‘(1) IN GENERAL.— 1
184	184	‘‘(A) P
185	185	AYMENTS.—The Secretary shall pay 2
186	186	to a radiation therapy provider or radiation 3
187	187	therapy supplier an amount equal to 80 percent 4
188	188	of the per episode payment amount determined 5
189	189	under paragraph 3 (referred to in this section 6
190	190	as ‘the per episode payment amount’) for each 7
191	191	covered individual furnished covered treatment 8
192	192	for an included cancer type to cover all profes-9
193	193	sional and technical services furnished during 10
194	194	such treatment by the radiation therapy pro-11
195	195	vider or radiation therapy supplier during an 12
196	196	episode of care (as defined in subsection (j)). 13
197	197	‘‘(B) D
198	198	EDUCTIBLES AND COINSURANCE .— 14
199	199	Subject to subsection (e), the Secretary shall 15
200	200	pay the per episode payment amount (subject to 16
201	201	any deductible and coinsurance otherwise appli-17
202	202	cable under part B) to the radiation therapy 18
203	203	provider or radiation therapy supplier for an 19
204	204	episode of care, as described in subsection (c). 20
205	205	‘‘(2) P
206	206	ER EPISODE PAYMENT REQUIREMENTS 21
207	207	AND TIMING.— 22
208	208	‘‘(A) I
209	209	N GENERAL.—Subject to subpara-23
210	210	graph (B), for each episode of care furnished to 24
211	211	a covered individual: 25
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215	215	‘‘(i) FIRST-HALF OF PAYMENT .—The 1
216	216	Secretary shall issue
217	217	1
218	218	⁄2of the payment 2
219	219	amount under paragraph (1) prospectively 3
220	220	not later than 30 days after the day of the 4
221	221	first delivery of covered treatment. 5
222	222	‘‘(ii) S
223	223	ECOND-HALF OF PAYMENT .— 6
224	224	The Secretary shall issue, with the excep-7
225	225	tion of an episode of care for treatment of 8
226	226	bone or brain metastases and subject to 9
227	227	clause (iii), the remaining half of the pay-10
228	228	ment amount under paragraph (1) on the 11
229	229	date that is the earlier of— 12
230	230	‘‘(I) the day the course of cov-13
231	231	ered treatment is scheduled to end; or 14
232	232	‘‘(II) the 90th day of the episode 15
233	233	of care. 16
234	234	‘‘(iii) S
235	235	ECOND-HALF OF PAYMENT FOR 17
236	236	BONE AND BRAIN METASTASES .—The Sec-18
237	237	retary shall issue the remaining half of the 19
238	238	payment amount under paragraph (1) for 20
239	239	an episode of care for treatment of bone or 21
240	240	brain metastases on the date that is the 22
241	241	earlier of— 23
242	242	‘‘(I) the day the course of cov-24
243	243	ered treatment is scheduled to end; or 25
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247	247	‘‘(II) the 30th day of the episode 1
248	248	of care. 2
249	249	‘‘(B) P
250	250	ATIENT DEATH.—If a covered indi-3
251	251	vidual dies during treatment, both episode of 4
252	252	care payments under subparagraphs (A) and 5
253	253	(B) shall be paid to the radiation therapy pro-6
254	254	vider or radiation therapy supplier not later 7
255	255	than 30 days after the day of the final delivery 8
256	256	of radiation therapy treatment to the covered 9
257	257	individual. 10
258	258	‘‘(C) C
259	259	ONSISTENCY OF PAYMENT .— 11
260	260	‘‘(i) I
261	261	N GENERAL.—The per episode 12
262	262	payment amount shall not change depend-13
263	263	ing on the site of service. 14
264	264	‘‘(ii) S
265	265	ITE OF SERVICE DEFINED .— 15
266	266	For the purposes of this subparagraph, the 16
267	267	term ‘site of service’ means the hospital 17
268	268	outpatient department or physician office 18
269	269	in which radiation therapy treatment is 19
270	270	furnished by the radiation therapy provider 20
271	271	or radiation therapy supplier. 21
272	272	‘‘(3) D
273	273	ETERMINATION OF PER EPISODE PAY -22
274	274	MENT AMOUNT.— 23
275	275	‘‘(A) I
276	276	N GENERAL.—The Secretary shall 24
277	277	determine a per episode payment amount for 25
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281	281	the professional component and technical com-1
282	282	ponent of treatment for each included cancer 2
283	283	type. 3
284	284	‘‘(B) A
285	285	MOUNT.—The Secretary shall deter-4
286	286	mine the per episode payment amount based on 5
287	287	national base rates, as described in subsection 6
288	288	(d)(1) and as updated in subsection (d)(2). 7
289	289	‘‘(C) A
290	290	DJUSTMENTS.—The per episode 8
291	291	payment amount shall be subject to— 9
292	292	‘‘(i) the adjustments as described in 10
293	293	subsection (d)(2) and (d)(3); 11
294	294	‘‘(ii) a geographic adjustment, as de-12
295	295	scribed in subsection (d)(3)(A); 13
296	296	‘‘(iii) an inflation adjustment, pursu-14
297	297	ant to which the Secretary shall adjust the 15
298	298	per episode payment amount by the per-16
299	299	centage increase in the Medicare Economic 17
300	300	Index (as described in section 1842) for 18
301	301	the professional component payments and 19
302	302	the applicable percentage increase in the 20
303	303	Hospital Inpatient Market Basket Update 21
304	304	(as described in section 1886(b)(3)(B)(i)) 22
305	305	for the technical component payments dur-23
306	306	ing each 12-month period, and which var-24
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310	310	ies for the professional and technical com-1
311	311	ponents of the service; 2
312	312	‘‘(iv) a savings adjustment, as de-3
313	313	scribed in subsection (d)(3)(B); 4
314	314	‘‘(v) a health equity achievement in 5
315	315	radiation therapy adjustment applicable 6
316	316	only to the technical component payments, 7
317	317	as described in subsection (g); and 8
318	318	‘‘(vi) a practice accreditation adjust-9
319	319	ment, as described in subsection (h), that 10
320	320	is only applicable to technical component 11
321	321	payments. 12
322	322	‘‘(c) T
323	323	REATMENT OF INCOMPLETE EPISODES OF 13
324	324	C
325	325	ARE; CONCURRENTTREATMENT.— 14
326	326	‘‘(1) I
327	327	NCOMPLETE EPISODE OF CARE .—In the 15
328	328	case of an incomplete episode of care, payment shall 16
329	329	be made to the radiation therapy provider or radi-17
330	330	ation therapy supplier for services furnished under 18
331	331	the physician fee schedule under section 1848 or the 19
332	332	hospital outpatient prospective payment system 20
333	333	under section 1833(t), as applicable. 21
334	334	‘‘(2) M
335	335	ULTIPLE EPISODES OF CARE FOR THE 22
336	336	SAME COVERED INDIVIDUAL .—A radiation therapy 23
337	337	provider or radiation therapy supplier may initiate a 24
338	338	new episode of care for the same beneficiary for the 25
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342	342	same course of therapy by providing another radi-1
343	343	ation therapy treatment planning service and billing 2
344	344	under an applicable radiation therapy planning trig-3
345	345	ger code (as defined in subsection (j)). 4
346	346	‘‘(3) C
347	347	ONCURRENT TREATMENTS .—In the case 5
348	348	where a treatment modality described in subsection 6
349	349	(j)(4)(B)(i)(I) is furnished to a covered individual 7
350	350	during an episode of care for an included cancer 8
351	351	type, payment may be made concurrently for the 9
352	352	treatment modality under the applicable payment 10
353	353	system under this title with per episode payment 11
354	354	under this section for covered treatment during the 12
355	355	episode of care. 13
356	356	‘‘(d) N
357	357	ATIONALBASERATE.— 14
358	358	‘‘(1) D
359	359	ETERMINATION OF NATIONAL BASE 15
360	360	RATES.—For purposes of the Secretary determining 16
361	361	the per episode payment amount under subsection 17
362	362	(b)(3), the national base rates for the professional 18
363	363	component and technical component of radiation 19
364	364	therapy services for each included cancer type are 20
365	365	based on the M-Code national base rates identified 21
366	366	in table 75 (including HCPCS Codes for radiation 22
367	367	therapy services and supplies) of the Federal Reg-23
368	368	ister on November 16, 2021, 86 Fed. Reg. 63458, 24
369	369	63925. 25
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373	373	‘‘(2) UPDATES TO THE NATIONAL BASE 1
374	374	RATES.— 2
375	375	‘‘(A) A
376	376	NNUAL UPDATES.— 3
377	377	‘‘(i) I
378	378	N GENERAL.—Subject to clause 4
379	379	(ii), the Secretary shall annually update 5
380	380	the initial national base rates by— 6
381	381	‘‘(I) in the case of the profes-7
382	382	sional component of the covered treat-8
383	383	ment, the percentage increase in the 9
384	384	Medicare Economic Index; and 10
385	385	‘‘(II) in the case of the technical 11
386	386	component of the covered treatment, 12
387	387	the applicable percentage increase de-13
388	388	scribed in section 1886(b)(3)(B)(i). 14
389	389	‘‘(ii) P
390	390	AYMENT FLOOR.—For each an-15
391	391	nual update, the Secretary shall not reduce 16
392	392	the national base rates below the estab-17
393	393	lished rates from the prior year. 18
394	394	‘‘(B) P
395	395	ERIODIC UPDATES.— 19
396	396	‘‘(i) I
397	397	N GENERAL.—The Secretary 20
398	398	shall, through notice and comment rule-21
399	399	making, rebase or revise the national base 22
400	400	rates in 5-year intervals, beginning on the 23
401	401	day that is 5 years after the date the regu-24
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405	405	lations issued pursuant to subsection 1
406	406	(a)(1) become effective. 2
407	407	‘‘(ii) R
408	408	EBASING LIMIT.—The Sec-3
409	409	retary shall not reduce the national base 4
410	410	rates through the process of rebasing by 5
411	411	more than 1 percent every 5 years. 6
412	412	‘‘(iii) I
413	413	NPUT FROM PROVIDERS AND 7
414	414	SUPPLIERS.—In rebasing or revising the 8
415	415	national base rates pursuant to clause (i), 9
416	416	the Secretary shall seek significant input 10
417	417	from radiation therapy providers, radiation 11
418	418	therapy suppliers, and other stakeholders 12
419	419	to ensure that such rates are sufficient, 13
420	420	particularly for any new technology or 14
421	421	service and any treatment modality de-15
422	422	scribed in clause (i)(I) of subsection 16
423	423	(j)(4)(B) that is determined to be a cov-17
424	424	ered treatment by the Secretary under 18
425	425	clause (ii) of such subsection. 19
426	426	‘‘(C) R
427	427	EBASE AND REVISE DEFINED .—In 20
428	428	this subsection: 21
429	429	‘‘(i) R
430	430	EBASE.—The term ‘rebase’ 22
431	431	means to move the base year for the struc-23
432	432	ture of costs of the national base rates. 24
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436	436	‘‘(ii) REVISE.—The term ‘revise’ 1
437	437	means types of changes to national base 2
438	438	rates other than rebasing, such as using 3
439	439	different data sources, cost categories, or 4
440	440	price proxies in the national base rates 5
441	441	input. 6
442	442	‘‘(D) N
443	443	EW TECHNOLOGY OR SERVICES .— 7
444	444	‘‘(i) T
445	445	REATMENT UNDER THE NA -8
446	446	TIONAL BASE RATES.— 9
447	447	‘‘(I) E
448	448	XCLUSION DURING INITIAL 10
449	449	PERIOD.—The Secretary shall not in-11
450	450	corporate a radiation therapy service 12
451	451	that is a new technology or service (as 13
452	452	defined in subsection (j)) into the na-14
453	453	tional base rates for an included can-15
454	454	cer type prior to the date that is 12 16
455	455	years after such service is first identi-17
456	456	fied as a new technology or service. 18
457	457	‘‘(II) I
458	458	NCORPORATION AFTER INI -19
459	459	TIAL PERIOD.—After the date speci-20
460	460	fied in subclause (I) with respect to a 21
461	461	radiation therapy service that is a new 22
462	462	technology or service, the Secretary 23
463	463	shall, through stakeholder meetings, 24
464	464	requests for information, and notice 25
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468	468	and comment rulemaking, engage pro-1
469	469	viders, suppliers, radiation therapy 2
470	470	vendors, patient groups, and the pub-3
471	471	lic on possible incorporation of the 4
472	472	new technology or service into the na-5
473	473	tional base rates for included cancer 6
474	474	types under paragraph (1). 7
475	475	‘‘(ii) B
476	476	EFORE INCORPORATION INTO 8
477	477	THE NATIONAL BASE RATE .—Until incor-9
478	478	porated into the national base rates under 10
479	479	clause (i)(II), any new technology or serv-11
480	480	ice shall be paid under the applicable pay-12
481	481	ment system under this title. 13
482	482	‘‘(iii) D
483	483	EVELOPMENT AND TRANSI -14
484	484	TIONAL PAYMENT PERIOD FOR ADAPTIVE 15
485	485	RADIATION THERAPY PLANNING .— 16
486	486	‘‘(I) D
487	487	EVELOPMENT AND VALU -17
488	488	ATION FOR ADAPTIVE RADIATION 18
489	489	THERAPY PLANNING .—Not later than 19
490	490	the date the regulations issued pursu-20
491	491	ant to subsection (a)(1) become effec-21
492	492	tive and in consultation with the 22
493	493	American Medical Association’s Cur-23
494	494	rent Procedural Terminology Editorial 24
495	495	Panel and Specialty Society Relative 25
496	496	VerDate Sep 11 2014 16:11 Apr 05, 2025 Jkt 059200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H2120.IH H2120
497	497	ssavage on LAPJG3WLY3PROD with BILLS 17
498	498	•HR 2120 IH
499	499	Value Scale Update Committee, radi-1
500	500	ation oncology specialty societies, and 2
501	501	radiation oncology stakeholders, the 3
502	502	Secretary shall develop and value 4
503	503	codes for adaptive radiation therapy 5
504	504	planning (as defined in subsection 6
505	505	(j)). 7
506	506	‘‘(II) T
507	507	RANSITIONAL PAYMENT .— 8
508	508	‘‘(aa) I
509	509	N GENERAL.—During 9
510	510	the period beginning on the date 10
511	511	the regulations issued pursuant 11
512	512	to subsection (a)(1) become effec-12
513	513	tive and ending on the date any 13
514	514	adaptive radiation therapy plan-14
515	515	ning code is developed and val-15
516	516	ued, the Secretary shall provide a 16
517	517	separate payment under the ap-17
518	518	plicable payment system, in addi-18
519	519	tion to the per episode payment 19
520	520	amount, for any medically nec-20
521	521	essary online and offline adaptive 21
522	522	radiation therapy planning fur-22
523	523	nished to a covered individual 23
524	524	after the initial treatment plan 24
525	525	for a covered individual. 25
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528	528	•HR 2120 IH
529	529	‘‘(bb) MODIFIER.—The Sec-1
530	530	retary shall establish a modifier 2
531	531	to identify claims for the transi-3
532	532	tional payment for adaptive radi-4
533	533	ation therapy planning for a cov-5
534	534	ered individual. 6
535	535	‘‘(iv) A
536	536	SSESSMENT OF CERTAIN CRI -7
537	537	TERIA.—Prior to incorporating a new tech-8
538	538	nology or service into the national base 9
539	539	rates pursuant to clause (i)(II), the Sec-10
540	540	retary shall consider market penetration 11
541	541	and adoption, costs relative to base rates, 12
542	542	clinical benefits of the new technology or 13
543	543	service, and the clear consensus of the 14
544	544	stakeholder community. 15
545	545	‘‘(3) A
546	546	DJUSTMENTS TO NATIONAL BASE 16
547	547	RATES.— 17
548	548	‘‘(A) G
549	549	EOGRAPHIC ADJUSTMENT .—Prior to 18
550	550	applying the savings adjustment described in 19
551	551	subparagraph (B), the Secretary shall adjust 20
552	552	the national base rates for local cost and wage 21
553	553	indices based on where the radiation therapy 22
554	554	services are furnished— 23
555	555	‘‘(i) in the case of the professional 24
556	556	component payment rates, the geographic 25
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558	558	ssavage on LAPJG3WLY3PROD with BILLS 19
559	559	•HR 2120 IH
560	560	adjustment processes described in the 1
561	561	Medicare Physician Fee Schedule Geo-2
562	562	graphic Practice Cost Index; and 3
563	563	‘‘(ii) in the case of the technical com-4
564	564	ponent payment rates, the geographic ad-5
565	565	justment processes in the hospital out-6
566	566	patient prospective payment system under 7
567	567	section 1833(t). 8
568	568	‘‘(B) S
569	569	AVINGS ADJUSTMENT .— 9
570	570	‘‘(i) I
571	571	N GENERAL.—The Secretary 10
572	572	shall apply a savings adjustment under 11
573	573	this subparagraph after the geographic ad-12
574	574	justments have been applied under sub-13
575	575	paragraph (A). 14
576	576	‘‘(ii) S
577	577	AVINGS ADJUSTMENT DE -15
578	578	FINED.—The term ‘savings adjustment’ 16
579	579	means the percentage by which the profes-17
580	580	sional component and technical component 18
581	581	payment rates are each reduced to achieve 19
582	582	Medicare savings. 20
583	583	‘‘(e) A
584	584	VAILABILITY OFPAYMENTPLANS FORPAY-21
585	585	MENT OFCOINSURANCE.—Following the application of 22
586	586	the adjustments described in subsection (d), but before the 23
587	587	application of any sequestration order issued under the 24
588	588	Balanced Budget and Emergency Deficit Control Act of 25
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590	590	ssavage on LAPJG3WLY3PROD with BILLS 20
591	591	•HR 2120 IH
592	592	1985 (2 U.S.C. 900 et seq.), radiation therapy providers 1
593	593	and radiation therapy suppliers shall collect coinsurance 2
594	594	for services furnished under the ROCR Program subject 3
595	595	to the following rules: 4
596	596	‘‘(1) I
597	597	N GENERAL.—Radiation therapy pro-5
598	598	viders and radiation therapy suppliers may collect 6
599	599	coinsurance applicable under subsection (b)(1) for 7
600	600	covered treatment furnished to a covered individual 8
601	601	under the ROCR Program in multiple installments 9
602	602	under a payment plan. 10
603	603	‘‘(2) L
604	604	IMITATION ON USE AS A MARKETING 11
605	605	TOOL.—Radiation therapy providers and radiation 12
606	606	therapy suppliers may not use the availability of 13
607	607	payment plans for such coinsurance as a marketing 14
608	608	tool to influence the choice of health care provider 15
609	609	by covered individuals. 16
610	610	‘‘(3) T
611	611	IMING OF PROVISIONS OF INFORMA -17
612	612	TION.—Radiation therapy providers and radiation 18
613	613	therapy suppliers offering a payment plan for such 19
614	614	coinsurance may inform the covered individual of the 20
615	615	availability of the payment plan prior to or during 21
616	616	the initial treatment planning session and as nec-22
617	617	essary thereafter. 23
618	618	‘‘(4) B
619	619	ENEFICIARY COINSURANCE PAYMENT .— 24
620	620	The beneficiary coinsurance payment shall equal 20 25
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622	622	ssavage on LAPJG3WLY3PROD with BILLS 21
623	623	•HR 2120 IH
624	624	percent of the payment amount to be paid to the ra-1
625	625	diation therapy provider or radiation therapy sup-2
626	626	plier prior to the application of any sequestration 3
627	627	order issued under the Balanced Budget and Emer-4
628	628	gency Deficit Control Act of 1985 (2 U.S.C. 900 et 5
629	629	seq.) for the billed ROCR Program episode of care, 6
630	630	except as provided in paragraph (5). 7
631	631	‘‘(5) I
632	632	NCOMPLETE EPISODE OF CARE .—In the 8
633	633	case of an incomplete episode of care, the beneficiary 9
634	634	coinsurance payment shall equal 20 percent of the 10
635	635	amount that would have been paid in the absence of 11
636	636	the ROCR Program for the radiation therapy serv-12
637	637	ices furnished by the radiation therapy provider or 13
638	638	radiation therapy supplier that initiated the profes-14
639	639	sional component and, if applicable, the radiation 15
640	640	therapy provider or radiation therapy supplier that 16
641	641	initiated the technical component. 17
642	642	‘‘(f) M
643	643	ANDATORYPARTICIPATION.— 18
644	644	‘‘(1) I
645	645	N GENERAL.—Except as provided under 19
646	646	paragraph (2) or (3), a radiation therapy provider or 20
647	647	radiation therapy supplier that is participating in 21
648	648	the program under this title and furnishes a covered 22
649	649	treatment to a covered individual shall be required 23
650	650	to participate in the ROCR Program. 24
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653	653	•HR 2120 IH
654	654	‘‘(2) CONCURRENT PARTICIPATION IN THE 1
655	655	ROCR PROGRAM AND OTHER MODELS .—A radiation 2
656	656	therapy provider or radiation therapy supplier that 3
657	657	is participating in a State-based Center for Medicare 4
658	658	& Medicaid Innovation model— 5
659	659	‘‘(A) shall not be prohibited from also par-6
660	660	ticipating in the ROCR Program; and 7
661	661	‘‘(B) is not required to participate in the 8
662	662	ROCR Program. 9
663	663	‘‘(3) S
664	664	IGNIFICANT HARDSHIP EXEMPTION .— 10
665	665	‘‘(A) I
666	666	N GENERAL.—The Secretary may, 11
667	667	on a case-by-case basis, exempt a radiation 12
668	668	therapy provider or radiation therapy supplier 13
669	669	from the ROCR Program if the Secretary de-14
670	670	termines that application of the program would 15
671	671	result in a significant hardship, such as in the 16
672	672	case of a natural disaster, for such radiation 17
673	673	therapy provider or radiation therapy supplier 18
674	674	or for beneficiaries in the geographic area of 19
675	675	the radiation therapy provider or radiation ther-20
676	676	apy supplier. 21
677	677	‘‘(B) P
678	678	ROCEDURE.—The Secretary shall 22
679	679	promulgate regulations, using the procedures 23
680	680	described in subsection (a)(5), regarding eligi-24
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682	682	ssavage on LAPJG3WLY3PROD with BILLS 23
683	683	•HR 2120 IH
684	684	bility and the procedure for applying for a sig-1
685	685	nificant hardship exemption. 2
686	686	‘‘(g) H
687	687	EALTHEQUITYACHIEVEMENT INRADIATION 3
688	688	T
689	689	HERAPYADD-ONPAYMENT.— 4
690	690	‘‘(1) I
691	691	N GENERAL.—Pursuant to paragraph (2) 5
692	692	and subject to paragraph (7), the Secretary shall ad-6
693	693	just the per episode payment amount in the amount 7
694	694	of a health equity achievement in radiation therapy 8
695	695	add-on payment to advance health equity and sup-9
696	696	port covered individuals in accessing and completing 10
697	697	their radiation therapy treatments for covered treat-11
698	698	ments of included cancer types through the provision 12
699	699	of transportation services, subject to the succeeding 13
700	700	provisions of this subsection. 14
701	701	‘‘(2) E
702	702	LIGIBILITY.— 15
703	703	‘‘(A) I
704	704	N GENERAL.—The health equity 16
705	705	achievement in radiation therapy add-on pay-17
706	706	ment shall be made when the ICD–10 diagnosis 18
707	707	code Z59.82, transportation insecurity is re-19
708	708	ported pursuant to subparagraph (B). 20
709	709	‘‘(B) D
710	710	ETERMINATION OF REPORTING 21
711	711	CODE.—The radiation therapy provider or radi-22
712	712	ation therapy supplier shall follow the following 23
713	713	procedures to determine if the ICD–10 diag-24
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715	715	ssavage on LAPJG3WLY3PROD with BILLS 24
716	716	•HR 2120 IH
717	717	nosis code Z59.82, transportation insecurity 1
718	718	needs to be reported: 2
719	719	‘‘(i) The radiation therapy provider or 3
720	720	radiation therapy supplier shall ask the pa-4
721	721	tient at the time of patient intake during 5
722	722	the initial patient consultation if, within 6
723	723	the previous 2 months, a lack of reliable 7
724	724	transportation has kept the patient from 8
725	725	attending medical appointments, meetings, 9
726	726	or work, or from completing activities of 10
727	727	daily living. 11
728	728	‘‘(ii) If the patient answers yes to the 12
729	729	question in clause (i), ICD–10 diagnosis 13
730	730	code Z59.82 shall be reported. 14
731	731	‘‘(3) A
732	732	MOUNT.—The health equity achievement 15
733	733	in radiation therapy add-on payment shall be in the 16
734	734	amount of— 17
735	735	‘‘(A) for services furnished during the year 18
736	736	following the date the regulations issued pursu-19
737	737	ant to subsection (a)(1) become effective, $500 20
738	738	per patient per episode of care; and 21
739	739	‘‘(B) for services furnished in subsequent 22
740	740	years, the amount determined under this para-23
741	741	graph for the preceding year, increased by $10. 24
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744	744	•HR 2120 IH
745	745	‘‘(4) PAYMENT RECIPIENT.—The health equity 1
746	746	achievement in radiation therapy add-on payment 2
747	747	shall be paid to the radiation therapy provider or ra-3
748	748	diation therapy supplier that provides the technical 4
749	749	component of the radiation therapy services. 5
750	750	‘‘(5) N
751	751	OT TO BE USED IN ADDITION TO OR IN 6
752	752	LIEU OF OTHER SERVICES .—The health equity 7
753	753	achievement in radiation therapy add-on payment 8
754	754	shall not be made in addition to or in lieu of any 9
755	755	other State or Federal program benefits that may be 10
756	756	used for transportation services. 11
757	757	‘‘(6) D
758	758	OCUMENTATION.— 12
759	759	‘‘(A) I
760	760	N GENERAL.—Radiation therapy 13
761	761	providers and radiation therapy suppliers who 14
762	762	receive the health equity achievement in radi-15
763	763	ation therapy add-on payment shall maintain all 16
764	764	documentation related to the spending of such 17
765	765	payment on transportation services per covered 18
766	766	individual for a period of 5 years after the end 19
767	767	of the episode of care of the applicable covered 20
768	768	individual. 21
769	769	‘‘(B) A
770	770	VAILABILITY TO THE SECRETARY .— 22
771	771	The documentation described in subparagraph 23
772	772	(A) shall be made available to the Secretary 24
773	773	upon request. 25
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776	776	•HR 2120 IH
777	777	‘‘(7) NO MODIFICATION OF COINSURANCE .— 1
778	778	The Secretary may not modify any coinsurance obli-2
779	779	gation when implementing the health equity achieve-3
780	780	ment in radiation therapy add-on payment. 4
781	781	‘‘(h) Q
782	782	UALITYINCENTIVES IN THE ROCR VALUE 5
783	783	B
784	784	ASEDPAYMENTPROGRAM.— 6
785	785	‘‘(1) I
786	786	N GENERAL.— 7
787	787	‘‘(A) I
788	788	NITIAL INCREASE IN PAYMENT .— 8
789	789	With respect to covered treatment for an in-9
790	790	cluded cancer type furnished to a covered indi-10
791	791	vidual on or after the date the regulations 11
792	792	issued pursuant to subsection (a)(1) become ef-12
793	793	fective and before the date that is 2 years after 13
794	794	such date, in the case of a radiation therapy 14
795	795	provider or radiation therapy supplier that 15
796	796	meets the requirements described in paragraph 16
797	797	(2), payments otherwise made to such radiation 17
798	798	therapy provider or radiation therapy supplier 18
799	799	under the ROCR Program for the technical 19
800	800	component of such services shall be increased 20
801	801	by 1 percent (or 0.25 percent in the case of 21
802	802	such a provider or supplier that is a limited re-22
803	803	source radiation therapy supplier or limited re-23
804	804	source radiation therapy provider). 24
805	805	‘‘(B) R
806	806	EDUCTION IN PAYMENT .— 25
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808	808	ssavage on LAPJG3WLY3PROD with BILLS 27
809	809	•HR 2120 IH
810	810	‘‘(i) IN GENERAL.—Subject to clause 1
811	811	(ii), with respect to covered treatment for 2
812	812	an included cancer type furnished to a cov-3
813	813	ered individual on or after the date that is 4
814	814	2 years after the regulations issued pursu-5
815	815	ant to subsection (a)(1) become effective, 6
816	816	in the case of a radiation therapy provider 7
817	817	or radiation therapy supplier that does not 8
818	818	meet the requirements described in para-9
819	819	graph (2), the per episode payment to such 10
820	820	provider or supplier under the ROCR Pro-11
821	821	gram shall be reduced by 2.5 percent. 12
822	822	‘‘(ii) E
823	823	XCLUSION OF LIMITED RE -13
824	824	SOURCE RADIATION THERAPY PROVIDERS 14
825	825	AND LIMITED RESOURCE RADIATION THER -15
826	826	APY SUPPLIERS.—This subparagraph shall 16
827	827	not apply with respect to a limited resource 17
828	828	radiation therapy provider or a limited re-18
829	829	source radiation therapy supplier. 19
830	830	‘‘(C) D
831	831	EFINITION OF LIMITED RESOURCE 20
832	832	RADIATION THERAPY PROVIDER AND LIMITED 21
833	833	RESOURCE RADIATION THERAPY SUPPLIER .— 22
834	834	‘‘(i) I
835	835	N GENERAL.—In this subsection, 23
836	836	the terms ‘limited resource radiation ther-24
837	837	apy provider’ and ‘limited resource radi-25
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839	839	ssavage on LAPJG3WLY3PROD with BILLS 28
840	840	•HR 2120 IH
841	841	ation therapy supplier’ mean, with respect 1
842	842	to a radiation therapy provider or radiation 2
843	843	therapy supplier, a provider or supplier 3
844	844	that meets the criteria specified by the 4
845	845	Secretary that may include criteria relating 5
846	846	to the volume and socioeconomic status of 6
847	847	patients treated by the radiation therapy 7
848	848	provider or radiation therapy supplier, the 8
849	849	geographic area or medically-underserved 9
850	850	area served by the radiation therapy pro-10
851	851	vider or radiation therapy supplier, includ-11
852	852	ing rural areas, or such other criteria as 12
853	853	the Secretary determines is appropriate, 13
854	854	through notice and comment rulemaking 14
855	855	and in consultation with radiation therapy 15
856	856	stakeholder organizations. 16
857	857	‘‘(ii) C
858	858	AP ON NUMBER OF LIMITED 17
859	859	RESOURCE RADIATION THERAPY PRO -18
860	860	VIDERS AND LIMITED RESOURCE RADI -19
861	861	ATION THERAPY SUPPLIERS .—In speci-20
862	862	fying the criteria for limited resource radi-21
863	863	ation therapy providers and limited re-22
864	864	source radiation therapy suppliers under 23
865	865	clause (i), the Secretary shall ensure that 24
866	866	the total number of such providers and 25
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869	869	•HR 2120 IH
870	870	suppliers does not exceed 10 percent of the 1
871	871	total number of all radiation therapy pro-2
872	872	viders and radiation therapy suppliers. 3
873	873	‘‘(2) A
874	874	CCREDITATION REQUIREMENTS .— 4
875	875	‘‘(A) I
876	876	N GENERAL.—The requirements de-5
877	877	scribed in this subparagraph with respect to a 6
878	878	radiation therapy provider or radiation therapy 7
879	879	supplier (other than such a provider or supplier 8
880	880	that is a limited resource radiation therapy pro-9
881	881	vider or limited resource radiation therapy sup-10
882	882	plier) are that the supplier or provider must— 11
883	883	‘‘(i) maintain or be in the process of 12
884	884	obtaining accreditation by the American 13
885	885	College of Radiology, American College of 14
886	886	Radiation Oncology, or American Society 15
887	887	for Radiation Oncology (referred to in this 16
888	888	section as ‘covered radiation oncology ac-17
889	889	creditation organizations’); 18
890	890	‘‘(ii) comply with certified electronic 19
891	891	health record technology requirements as 20
892	892	determined by the Secretary with excep-21
893	893	tions that are consistent with those of the 22
894	894	Merit-Based Incentive Payment System es-23
895	895	tablished under section 1848(q); and 24
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898	898	•HR 2120 IH
899	899	‘‘(iii) submit to the Secretary proof of 1
900	900	the accreditation described in clause (i) in 2
901	901	such form and manner as specified by the 3
902	902	Secretary. 4
903	903	‘‘(B) R
904	904	EQUIREMENTS FOR LIMITED RE -5
905	905	SOURCE RADIATION THERAPY PROVIDERS AND 6
906	906	LIMITED RESOURCE RADIATION THERAPY SUP -7
907	907	PLIERS.—A radiation therapy provider or radi-8
908	908	ation therapy supplier that is a limited resource 9
909	909	radiation therapy provider or limited resource 10
910	910	radiation therapy supplier may elect to satisfy 11
911	911	the accreditation requirement under this para-12
912	912	graph by— 13
913	913	‘‘(i) meeting the requirements of sub-14
914	914	paragraph (A); 15
915	915	‘‘(ii) using an external audit that en-16
916	916	compasses similar criteria as a nationally 17
917	917	recognized radiation oncology accreditation 18
918	918	organization and submit the outcome of 19
919	919	such external audit to the Secretary; or 20
920	920	‘‘(iii) complying with certified elec-21
921	921	tronic health record technology require-22
922	922	ments as determined by the Secretary with 23
923	923	exceptions that are consistent with those of 24
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925	925	ssavage on LAPJG3WLY3PROD with BILLS 31
926	926	•HR 2120 IH
927	927	the Merit-Based Incentive Payment Sys-1
928	928	tem established under section 1848(q). 2
929	929	‘‘(C) N
930	930	EW PROVIDERS.—A new radiation 3
931	931	therapy provider or new radiation supplier shall 4
932	932	complete an initiation of accreditation or exter-5
933	933	nal audit not later than the date that is 1 year 6
934	934	after such provider or supplier begins fur-7
935	935	nishing covered treatment to covered individ-8
936	936	uals. 9
937	937	‘‘(D) R
938	938	ADIATION ONCOLOGY ACCREDITA -10
939	939	TION ORGANIZATION QUALITY STANDARDS .— 11
940	940	Each covered radiation oncology accreditation 12
941	941	organization (and any successor organization) 13
942	942	shall develop quality standards for radiation 14
943	943	therapy providers and radiation therapy sup-15
944	944	pliers to ensure covered treatments are deliv-16
945	945	ered using adequate and modern linear accel-17
946	946	erator technology, staffing, and other compo-18
947	947	nents that protect patient safety and quality 19
948	948	by— 20
949	949	‘‘(i) consulting with radiation therapy 21
950	950	manufacturers and key stakeholders; 22
951	951	‘‘(ii) soliciting public comment on pro-23
952	952	posed quality standards, including from 24
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955	955	•HR 2120 IH
956	956	physicians, medical physicists, and other 1
957	957	health professionals and experts; 2
958	958	‘‘(iii) updating quality standards not 3
959	959	later than every 5 to 7 years in partner-4
960	960	ship with stakeholders; 5
961	961	‘‘(iv) ensuring quality standards for 6
962	962	linear accelerator technology are adequate 7
963	963	and on par with current technological ad-8
964	964	vances and modern requirements for staff-9
965	965	ing and other procedures associated with 10
966	966	the delivery of safe and effective radiation 11
967	967	therapy; 12
968	968	‘‘(v) collecting timely information 13
969	969	from radiation therapy providers and radi-14
970	970	ation therapy suppliers for each linear ac-15
971	971	celerator owned or used on or after the ef-16
972	972	fective date of the regulations issued pur-17
973	973	suant to subsection (a)(1); and 18
974	974	‘‘(vi) giving sufficient weight to com-19
975	975	pliance with quality standards among other 20
976	976	accreditation standards in determining ac-21
977	977	creditation status for radiation therapy 22
978	978	providers or radiation therapy suppliers. 23
979	979	‘‘(i) R
980	980	EPORTINGREQUIREMENTS.— 24
981	981	VerDate Sep 11 2014 16:11 Apr 05, 2025 Jkt 059200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H2120.IH H2120
982	982	ssavage on LAPJG3WLY3PROD with BILLS 33
983	983	•HR 2120 IH
984	984	‘‘(1) REPORT ON THE ROCR PROGRAM .—Not 1
985	985	earlier than 7 years after the date of the enactment 2
986	986	of this section, the Comptroller General of the 3
987	987	United States (referred to in this subsection as the 4
988	988	‘Comptroller General’) shall, after seeking out the 5
989	989	perspectives of radiation oncology stakeholders, sub-6
990	990	mit to the appropriate committees of jurisdiction of 7
991	991	the Senate and the House of Representatives a re-8
992	992	port that— 9
993	993	‘‘(A) evaluates— 10
994	994	‘‘(i) the implementation of the ROCR 11
995	995	Program, and the impact such Program 12
996	996	has had on Federal healthcare spending; 13
997	997	‘‘(ii) the impact the ROCR Program 14
998	998	has had on the ability of covered individ-15
999	999	uals to access covered treatment; 16
1000	1000	‘‘(iii) whether any cancer types or ra-17
1001	1001	diation therapy services, such as 18
1002	1002	brachytherapy, proton therapy, or thera-19
1003	1003	peutic radiopharmaceuticals, should be 20
1004	1004	added or removed from the ROCR Pro-21
1005	1005	gram; and 22
1006	1006	‘‘(iv) the potential application of the 23
1007	1007	ROCR Program to benefits provided under 24
1008	1008	part C of this title; and 25
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1010	1010	ssavage on LAPJG3WLY3PROD with BILLS 34
1011	1011	•HR 2120 IH
1012	1012	‘‘(B) includes any recommendations for ad-1
1013	1013	ministrative and legislative changes. 2
1014	1014	‘‘(2) R
1015	1015	EPORT ON ACCESS TO RADIATION THER -3
1016	1016	APY IN RURAL AND UNDERSERVED AREAS .—Not 4
1017	1017	later than 3 years after the date of the enactment 5
1018	1018	of this section, the Comptroller General shall submit 6
1019	1019	a report to the appropriate committees of jurisdic-7
1020	1020	tion of the Senate and the House of Representatives 8
1021	1021	that identifies the following: 9
1022	1022	‘‘(A) Radiation therapy deserts. 10
1023	1023	‘‘(B) Methods to increase access to new ra-11
1024	1024	diation therapy technologies in rural and under-12
1025	1025	served areas, including technologies required for 13
1026	1026	clinical treatment planning, simulation, dosim-14
1027	1027	etry, medical radiation physics, radiation treat-15
1028	1028	ment devices, radiation treatment delivery, radi-16
1029	1029	ation treatment management, and such other 17
1030	1030	items as the Comptroller General may deter-18
1031	1031	mine are medically necessary. 19
1032	1032	‘‘(C) A program to provide assistance in 20
1033	1033	the form of grants or loans to radiation therapy 21
1034	1034	providers or radiation therapy suppliers for the 22
1035	1035	purpose of ensuring access to the most current 23
1036	1036	radiation therapy technology. 24
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1038	1038	ssavage on LAPJG3WLY3PROD with BILLS 35
1039	1039	•HR 2120 IH
1040	1040	‘‘(3) DETERMINATION AND DEFINITION OF RA -1
1041	1041	DIATION THERAPY DESERTS .— 2
1042	1042	‘‘(A) D
1043	1043	EFINITION.—For purposes of this 3
1044	1044	subsection, the term ‘radiation therapy desert’ 4
1045	1045	means a region determined by the Comptroller 5
1046	1046	General under subparagraph (B) with a mis-6
1047	1047	match between radiation therapy resources and 7
1048	1048	oncologic need. 8
1049	1049	‘‘(B) D
1050	1050	ETERMINATION.—In determining 9
1051	1051	whether a region qualifies as a radiation ther-10
1052	1052	apy desert, the Comptroller General shall take 11
1053	1053	into account the ratio or density of radiation 12
1054	1054	therapy providers and radiation therapy sup-13
1055	1055	pliers practicing in a geographic area as com-14
1056	1056	pared to the population size in that geographic 15
1057	1057	area. 16
1058	1058	‘‘(j) D
1059	1059	EFINITIONS.—In this section: 17
1060	1060	‘‘(1) A
1061	1061	DAPTIVE RADIATION THERAPY PLAN -18
1062	1062	NING.—The term ‘adaptive radiation therapy plan-19
1063	1063	ning’ means any new technology or services identi-20
1064	1064	fied, as of the date that the regulations issued pur-21
1065	1065	suant to subsection (a)(1) become effective, by the 22
1066	1066	following HCPCS codes (and as subsequently modi-23
1067	1067	fied by the Secretary) performed after the initial 24
1068	1068	treatment plan for a covered individual: 25
1069	1069	VerDate Sep 11 2014 16:11 Apr 05, 2025 Jkt 059200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H2120.IH H2120
1070	1070	ssavage on LAPJG3WLY3PROD with BILLS 36
1071	1071	•HR 2120 IH
1072	1072	‘‘(A) 77295, 3-dimensional radiotherapy 1
1073	1073	plan, including dose-volume histograms. 2
1074	1074	‘‘(B) 77300, basic radiation dosimetry cal-3
1075	1075	culation, central axis depth dose calculation, 4
1076	1076	TDF, NSD, gap calculation, off axis factor, tis-5
1077	1077	sue inhomogeneity factors, calculation of non- 6
1078	1078	ionizing radiation surface and depth dose, as re-7
1079	1079	quired during course of treatment, only when 8
1080	1080	prescribed by the treating physician. 9
1081	1081	‘‘(C) 77301, intensity modulated radio-10
1082	1082	therapy plan, including dose-volume histograms 11
1083	1083	for target and critical structure partial toler-12
1084	1084	ance specifications. 13
1085	1085	‘‘(D) 77338, multi-leaf collimator (MLC) 14
1086	1086	devices for intensity modulated radiation ther-15
1087	1087	apy (IMRT), design and construction per IMRT 16
1088	1088	plan. 17
1089	1089	‘‘(E) 77334, Treatment devices, design 18
1090	1090	and construction; complex (irregular blocks, 19
1091	1091	special shields, compensators, wedges, molds or 20
1092	1092	casts). 21
1093	1093	‘‘(F) 77293, Respiratory motion manage-22
1094	1094	ment simulation (List separately in addition to 23
1095	1095	code for primary procedure). 24
1096	1096	VerDate Sep 11 2014 16:11 Apr 05, 2025 Jkt 059200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\H2120.IH H2120
1097	1097	ssavage on LAPJG3WLY3PROD with BILLS 37
1098	1098	•HR 2120 IH
1099	1099	‘‘(2) APPLICABLE RADIATION THERAPY PLAN -1
1100	1100	NING TRIGGER CODE .—The term ‘applicable radi-2
1101	1101	ation therapy planning trigger code’ means services 3
1102	1102	identified, as of the date that the regulations issued 4
1103	1103	pursuant to subsection (a)(1) become effective, by 5
1104	1104	the following HCPCS codes (and as subsequently 6
1105	1105	modified by the Secretary): 7
1106	1106	‘‘(A) 77261, therapeutic radiology treat-8
1107	1107	ment planning, simple. 9
1108	1108	‘‘(B) 77262, therapeutic radiology treat-10
1109	1109	ment planning, intermediate. 11
1110	1110	‘‘(C) 77263, therapeutic radiology treat-12
1111	1111	ment planning, complex. 13
1112	1112	‘‘(3) C
1113	1113	OVERED INDIVIDUAL .—The term ‘cov-14
1114	1114	ered individual’ means an individual who— 15
1115	1115	‘‘(A) is enrolled for benefits under part B; 16
1116	1116	‘‘(B) is not enrolled in a Medicare Advan-17
1117	1117	tage plan under part C or a PACE program 18
1118	1118	under section 1894; and 19
1119	1119	‘‘(C) is diagnosed with an included cancer 20
1120	1120	type. 21
1121	1121	‘‘(4) C
1122	1122	OVERED TREATMENT .— 22
1123	1123	‘‘(A) I
1124	1124	N GENERAL.—The term ‘covered 23
1125	1125	treatment’ means, subject to subparagraph (B), 24
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1127	1127	ssavage on LAPJG3WLY3PROD with BILLS 38
1128	1128	•HR 2120 IH
1129	1129	radiation therapy services furnished to a cov-1
1130	1130	ered individual. 2
1131	1131	‘‘(B) E
1132	1132	XCLUSIONS.— 3
1133	1133	‘‘(i) I
1134	1134	N GENERAL.—Such term does 4
1135	1135	not include— 5
1136	1136	‘‘(I) subject to clause (ii), during 6
1137	1137	the period beginning on the date on 7
1138	1138	which the regulation issued pursuant 8
1139	1139	to subsection (a)(1) become effective 9
1140	1140	and ending on the date that is 12 10
1141	1141	years after such date, brachytherapy, 11
1142	1142	proton beam radiation therapy serv-12
1143	1143	ices, intraoperative radiotherapy, su-13
1144	1144	perficial radiation therapy, 14
1145	1145	hyperthermia, and therapeutic radio-15
1146	1146	pharmaceuticals; 16
1147	1147	‘‘(II) inpatient radiation therapy 17
1148	1148	services furnished in a subsection (d) 18
1149	1149	hospital or ambulatory surgical center; 19
1150	1150	‘‘(III) radiation therapy services 20
1151	1151	furnished in cancer hospitals that are 21
1152	1152	exempt from the hospital outpatient 22
1153	1153	prospective payment system under 23
1154	1154	section 1833(t); 24
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1156	1156	ssavage on LAPJG3WLY3PROD with BILLS 39
1157	1157	•HR 2120 IH
1158	1158	‘‘(IV) physician services that are 1
1159	1159	furnished or supervised by the physi-2
1160	1160	cian or the physician practice fur-3
1161	1161	nishing radiation therapy or by an-4
1162	1162	other physician, including any surgical 5
1163	1163	procedures, chemotherapy, and other 6
1164	1164	services; 7
1165	1165	‘‘(V) physician and technical 8
1166	1166	services that are furnished using tech-9
1167	1167	nology represented by Healthcare 10
1168	1168	Common Procedure Coding System 11
1169	1169	codes that are not included in the M- 12
1170	1170	code national base rates identified in 13
1171	1171	table 75 (including in HCPCS Codes 14
1172	1172	for radiation therapy services and 15
1173	1173	supplies) of the Federal Register on 16
1174	1174	November 16, 2021, 86 Fed. Reg. 17
1175	1175	63485, 63925; or 18
1176	1176	‘‘(VI) durable medical equipment 19
1177	1177	(as defined in section 1861(n)). 20
1178	1178	‘‘(ii) I
1179	1179	NCLUSION OF CERTAIN TREAT -21
1180	1180	MENT.—After the date that is 12 years 22
1181	1181	after the date on which the regulation 23
1182	1182	issued pursuant to subsection (a)(1) be-24
1183	1183	come effective, the Secretary may deter-25
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1185	1185	ssavage on LAPJG3WLY3PROD with BILLS 40
1186	1186	•HR 2120 IH
1187	1187	mine by regulation to include any of the 1
1188	1188	treatment modalities described in clause 2
1189	1189	(i)(I) as covered treatment. Before making 3
1190	1190	such determination, the Secretary shall— 4
1191	1191	‘‘(I) consider— 5
1192	1192	‘‘(aa) market penetration; 6
1193	1193	‘‘(bb) the cost of such items 7
1194	1194	or services relative to base rates; 8
1195	1195	‘‘(cc) the clinical benefits of 9
1196	1196	such items or services; and 10
1197	1197	‘‘(dd) the clear consensus of 11
1198	1198	the stakeholder community; and 12
1199	1199	‘‘(II) publish a notice of a pro-13
1200	1200	posed determination under subsection 14
1201	1201	(b)(3)(B) regarding the payment 15
1202	1202	amount proposed to be established 16
1203	1203	with respect to such item or service. 17
1204	1204	‘‘(5) E
1205	1205	PISODE OF CARE.—The term ‘episode of 18
1206	1206	care’ means, with respect to a covered individual, the 19
1207	1207	period— 20
1208	1208	‘‘(A) beginning on the day radiation ther-21
1209	1209	apy planning for an included cancer type, billed 22
1210	1210	under an applicable radiation therapy planning 23
1211	1211	trigger code, is furnished to a covered indi-24
1212	1212	vidual if radiation therapy treatment is initiated 25
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1215	1215	•HR 2120 IH
1216	1216	not later than 30 days after the day such radi-1
1217	1217	ation therapy planning service is furnished; and 2
1218	1218	‘‘(B) ends— 3
1219	1219	‘‘(i) for treatment of all included can-4
1220	1220	cer types except bone and brain metastases 5
1221	1221	treatment, the day that is 90 days after 6
1222	1222	the day the episode of care begins under 7
1223	1223	clause (i); and 8
1224	1224	‘‘(ii) for bone and brain metastases 9
1225	1225	treatment, the day that is 30 days after 10
1226	1226	the day the episode of care begins under 11
1227	1227	clause (i). 12
1228	1228	‘‘(6) I
1229	1229	NCLUDED CANCER TYPES .—The term ‘in-13
1230	1230	cluded cancer type’ means any of the following types 14
1231	1231	of cancer: 15
1232	1232	‘‘(A) Anal. 16
1233	1233	‘‘(B) Bladder. 17
1234	1234	‘‘(C) Bone Metastases. 18
1235	1235	‘‘(D) Brain Metastases. 19
1236	1236	‘‘(E) Breast. 20
1237	1237	‘‘(F) Cervical. 21
1238	1238	‘‘(G) Central Nervous System Tumors. 22
1239	1239	‘‘(H) Colorectal. 23
1240	1240	‘‘(I) Head and Neck. 24
1241	1241	‘‘(J) Lung. 25
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1243	1243	ssavage on LAPJG3WLY3PROD with BILLS 42
1244	1244	•HR 2120 IH
1245	1245	‘‘(K) Lymphoma. 1
1246	1246	‘‘(L) Pancreatic. 2
1247	1247	‘‘(M) Prostate. 3
1248	1248	‘‘(N) Upper Gastrointestinal. 4
1249	1249	‘‘(O) Uterine. 5
1250	1250	‘‘(7) H
1251	1251	EALTHCARE COMMON PROCEDURE COD -6
1252	1252	ING SYSTEM.—The term ‘Healthcare Common Pro-7
1253	1253	cedure Coding System’ means the standardized cod-8
1254	1254	ing system used by Medicare and other health insur-9
1255	1255	ance programs to ensure that claims are processed 10
1256	1256	in an orderly and consistent manner. 11
1257	1257	‘‘(8) I
1258	1258	NCOMPLETE EPISODE OF CARE .—The 12
1259	1259	term ‘incomplete episode of care’ means, with re-13
1260	1260	spect to a covered individual, an episode of care that 14
1261	1261	is not completed because— 15
1262	1262	‘‘(A) the individual being treated ceases to 16
1263	1263	be a covered individual, including in the case 17
1264	1264	where the individual loses benefits under this 18
1265	1265	title, at any time after the initial treatment 19
1266	1266	planning service is furnished and before the epi-20
1267	1267	sode of care for the covered treatment is com-21
1268	1268	plete; or 22
1269	1269	‘‘(B) a covered individual switches radi-23
1270	1270	ation therapy provider or radiation therapy sup-24
1271	1271	plier before all included radiation therapy serv-25
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1274	1274	•HR 2120 IH
1275	1275	ices in the episode of care for the covered treat-1
1276	1276	ment have been furnished. 2
1277	1277	‘‘(9) N
1278	1278	EW TECHNOLOGY OR SERVICES .—The 3
1279	1279	term ‘new technology or services’ means any tech-4
1280	1280	nology or services that, after the date of enactment 5
1281	1281	of this section, receives a Category 1 Current Proce-6
1282	1282	dural Terminology code or is established in the year-7
1283	1283	ly update to the Medicare physician fee schedule di-8
1284	1284	rect practice expense inputs or any successor reposi-9
1285	1285	tory of the direct practice expense input for the de-10
1286	1286	livery of radiation therapy services. 11
1287	1287	‘‘(10) P
1288	1288	ROFESSIONAL COMPONENT .—The term 12
1289	1289	‘professional component’ means the included radi-13
1290	1290	ation therapy services that may only be furnished by 14
1291	1291	a physician. 15
1292	1292	‘‘(11) R
1293	1293	ADIATION THERAPY.—The term ‘radi-16
1294	1294	ation therapy’ means the careful use of various 17
1295	1295	forms of radiation, such as external beam radiation 18
1296	1296	therapy, to treat cancer and other diseases safely 19
1297	1297	and effectively. 20
1298	1298	‘‘(12) R
1299	1299	ADIATION THERAPY PROVIDER .—The 21
1300	1300	term ‘radiation therapy provider’ means a hospital 22
1301	1301	outpatient department enrolled under this title that 23
1302	1302	furnishes radiation therapy services. 24
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1305	1305	•HR 2120 IH
1306	1306	‘‘(13) RADIATION THERAPY SERVICES .—The 1
1307	1307	term ‘radiation therapy services’ means the treat-2
1308	1308	ment planning, technical preparation, special serv-3
1309	1309	ices (such as simulation), treatment delivery, and 4
1310	1310	treatment management services associated with can-5
1311	1311	cer treatment that uses high doses of radiation to 6
1312	1312	kill cancer cells and shrink tumors. 7
1313	1313	‘‘(14) R
1314	1314	ADIATION THERAPY SUPPLIER .—The 8
1315	1315	term ‘radiation therapy supplier’ means a physician 9
1316	1316	group practice or freestanding radiation therapy cen-10
1317	1317	ter enrolled under this title that furnishes radiation 11
1318	1318	therapy services. 12
1319	1319	‘‘(15) T
1320	1320	ECHNICAL COMPONENT .—The term 13
1321	1321	‘technical component’ means the included radiation 14
1322	1322	therapy services that are not furnished by a physi-15
1323	1323	cian, including the provision of equipment, supplies, 16
1324	1324	personnel, and administrative costs related to radi-17
1325	1325	ation therapy services. 18
1326	1326	‘‘(16) T
1327	1327	RANSPORTATION SERVICES .—The term 19
1328	1328	‘transportation services’ means the provision of free 20
1329	1329	or discounted transportation made available to cov-21
1330	1330	ered individuals furnished covered treatment which 22
1331	1331	are not air, luxury, or ambulance-level transpor-23
1332	1332	tation, but may include car services, ride shares, au-24
1333	1333	tonomous vehicles, or public transportation.’’. 25
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1335	1335	ssavage on LAPJG3WLY3PROD with BILLS 45
1336	1336	•HR 2120 IH
1337	1337	(b) EXCLUSION OF PARTICIPATINGRADIATION 1
1338	1338	T
1339	1339	HERAPYPROVIDERS, RADIATIONTHERAPYSUPPLIERS, 2
1340	1340	ANDPHYSICIANSFROM THEMERIT-BASEDINCENTIVE 3
1341	1341	P
1342	1342	AYMENTSYSTEM.—Section 1848(q)(1)(C)(ii) of the So-4
1343	1343	cial Security Act (42 U.S.C. 1395w–4(q)(1)(c)(II)) is 5
1344	1344	amended— 6
1345	1345	(1) in subclause (II), by striking ‘‘or’’ at the 7
1346	1346	end; 8
1347	1347	(2) in subclause (III), by striking the period at 9
1348	1348	the end and inserting ‘‘; or’’; and 10
1349	1349	(3) by adding at the end the following new sub-11
1350	1350	clause: 12
1351	1351	‘‘(IV) is a radiation therapy pro-13
1352	1352	vider or radiation therapy supplier (as 14
1353	1353	those terms are defined in subsection 15
1354	1354	(j) of section1899C) that is partici-16
1355	1355	pating in the Radiation Oncology Case 17
1356	1356	Rate Value Based Payment Program 18
1357	1357	established under that section.’’. 19
1358	1358	SEC. 4. REVISION TO CIVIL MONETARY PENALTIES RE-20
1359	1359	GARDING RADIATION ONCOLOGY CASE RATE 21
1360	1360	PATIENT TRANSPORTATION SERVICES. 22
1361	1361	Section 1128A of the Social Security Act (42 U.S.C. 23
1362	1362	1320a–7a) is amended— 24
1363	1363	(1) in subsection (i)(6)— 25
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1366	1366	•HR 2120 IH
1367	1367	(A) in subparagraph (I), by striking ‘‘or’’ 1
1368	1368	at the end; 2
1369	1369	(B) in subparagraph (J)(iii), by striking 3
1370	1370	the period at the end and inserting ‘‘; or’’; and 4
1371	1371	(C) by adding at the end the following new 5
1372	1372	subparagraph: 6
1373	1373	‘‘(K) the provision of transportation serv-7
1374	1374	ices by an eligible entity, as defined in sub-8
1375	1375	section (t), if— 9
1376	1376	‘‘(i) the availability of the transpor-10
1377	1377	tation services— 11
1378	1378	‘‘(I) is set forth in a policy that 12
1379	1379	the eligible entity, as defined in sub-13
1380	1380	section (t), applies uniformly and con-14
1381	1381	sistently; and 15
1382	1382	‘‘(II) is not determined in a man-16
1383	1383	ner related to the past or anticipated 17
1384	1384	volume or value of Federal health care 18
1385	1385	program business; 19
1386	1386	‘‘(ii) the eligible entity does not pub-20
1387	1387	licly market or advertise the transportation 21
1388	1388	services; 22
1389	1389	‘‘(iii) the driver who provides the 23
1390	1390	transportation services does not market 24
1391	1391	health care items or services during the 25
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1394	1394	•HR 2120 IH
1395	1395	course of the transportation or at any 1
1396	1396	time; 2
1397	1397	‘‘(iv) the driver or individual arrang-3
1398	1398	ing for the transportation services is not 4
1399	1399	paid on a per-beneficiary-transported basis; 5
1400	1400	‘‘(v) the eligible entity makes the 6
1401	1401	transportation services available only to an 7
1402	1402	individual who— 8
1403	1403	‘‘(I) is an established patient, as 9
1404	1404	defined in subsection (t), of the eligi-10
1405	1405	ble entity that is providing or facili-11
1406	1406	tating free or discounted transpor-12
1407	1407	tation; 13
1408	1408	‘‘(II) resides— 14
1409	1409	‘‘(aa) within a 75-mile ra-15
1410	1410	dius of the radiation therapy pro-16
1411	1411	vider or radiation therapy sup-17
1412	1412	plier to or from which the patient 18
1413	1413	would be transported; or 19
1414	1414	‘‘(bb) in a rural area, as de-20
1415	1415	fined in subsection (t); and 21
1416	1416	‘‘(III) is receiving radiation ther-22
1417	1417	apy services for the purpose of obtain-23
1418	1418	ing medically necessary items and 24
1419	1419	services; and 25
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1422	1422	•HR 2120 IH
1423	1423	‘‘(vi) the eligible entity that makes the 1
1424	1424	transportation services available bears the 2
1425	1425	costs of the transportation services and 3
1426	1426	does not shift the burden of those costs 4
1427	1427	onto any Federal health care program, 5
1428	1428	other payers, or individuals.’’; and 6
1429	1429	(2) by adding at the end the following new sub-7
1430	1430	section: 8
1431	1431	‘‘(t) For purposes of subsection (i)(6)(K), the fol-9
1432	1432	lowing definitions apply: 10
1433	1433	‘‘(1) The term ‘eligible entity’ means any indi-11
1434	1434	vidual or entity, or any individual or entity acting on 12
1435	1435	behalf of such individual or entity that does not sup-13
1436	1436	ply health care items as the primary occupation of 14
1437	1437	the individual or entity. 15
1438	1438	‘‘(2) The term ‘established patient’ means an 16
1439	1439	individual who— 17
1440	1440	‘‘(A) has selected and scheduled an ap-18
1441	1441	pointment with a radiation therapy provider or 19
1442	1442	radiation therapy supplier; or 20
1443	1443	‘‘(B) has attended an appointment with 21
1444	1444	such provider or supplier. 22
1445	1445	‘‘(3) The terms ‘radiation therapy provider’, 23
1446	1446	‘radiation therapy services’, and ‘radiation therapy 24
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1449	1449	•HR 2120 IH
1450	1450	supplier’ have the meaning given such terms in sec-1
1451	1451	tion 1866G(j). 2
1452	1452	‘‘(4) The term ‘rural area’ means an area that 3
1453	1453	is not an urban area. 4
1454	1454	‘‘(5) The term ‘transportation services’— 5
1455	1455	‘‘(A) means the provision of free or dis-6
1456	1456	counted transportation made available to Fed-7
1457	1457	eral health care program beneficiaries receiving 8
1458	1458	radiation therapy services; 9
1459	1459	‘‘(B) includes car services, ride shares, and 10
1460	1460	public transportation; and 11
1461	1461	‘‘(C) does not include air, luxury, or ambu-12
1462	1462	lance-level transportation. 13
1463	1463	‘‘(6) The term ‘urban area’ means— 14
1464	1464	‘‘(A) a Metropolitan Statistical Area or 15
1465	1465	New England County Metropolitan Area, as de-16
1466	1466	fined by the Office of Management and Budget; 17
1467	1467	‘‘(B) Litchfield County, Connecticut; 18
1468	1468	‘‘(C) York County, Maine; 19
1469	1469	‘‘(D) Sagadahoc County, Maine; 20
1470	1470	‘‘(E) Merrimack County, New Hampshire; 21
1471	1471	and 22
1472	1472	‘‘(F) Newport County, Rhode Island.’’. 23
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1475	1475	•HR 2120 IH
1476	1476	SEC. 5. EXEMPTION OF RADIATION ONCOLOGY CASE RATE 1
1477	1477	VALUE BASED PAYMENT PROGRAM FROM 2
1478	1478	BUDGET NEUTRALITY ADJUSTMENT RE-3
1479	1479	QUIREMENTS. 4
1480	1480	(a) P
1481	1481	AYMENT OFBENEFITS.—Section 1833(t) of the 5
1482	1482	Social Security Act (42 U.S.C. 1395l(t)) is amended by 6
1483	1483	adding at the end the following new paragraph: 7
1484	1484	‘‘(23) N
1485	1485	ON BUDGET NEUTRAL APPLICATION OF 8
1486	1486	REDUCED EXPENDITURES RESULTING FROM THE 9
1487	1487	RADIATION ONCOLOGY CASE RATE VALUE BASED 10
1488	1488	PAYMENT PROGRAM .—The Secretary shall not take 11
1489	1489	into account the reduced expenditures that result 12
1490	1490	from the implementation of section 1899C in making 13
1491	1491	any budget neutrality adjustments under this sub-14
1492	1492	section.’’. 15
1493	1493	(b) P
1494	1494	AYMENT FORPHYSICIANS’ SERVICES.—Section 16
1495	1495	1848(c)(2)(B) of the Social Security Act (42 U.S.C. 17
1496	1496	1395w–4(c)(2)(B)) is amended— 18
1497	1497	(1) in clause (iv)— 19
1498	1498	(A) in subclause (V), by striking ‘‘and’’ at 20
1499	1499	the end; 21
1500	1500	(B) in subclause (VI), by striking the pe-22
1501	1501	riod at the end and inserting ‘‘; and’’; and 23
1502	1502	(C) by adding at the end the following new 24
1503	1503	subclause: 25
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1506	1506	•HR 2120 IH
1507	1507	‘‘(VII) section 1899C shall not be 1
1508	1508	taken into account in applying clause 2
1509	1509	(ii)(II) for a year following the enact-3
1510	1510	ment of section 1899C.’’; and 4
1511	1511	(2) in clause (v), by adding at the end the fol-5
1512	1512	lowing new subclause: 6
1513	1513	‘‘(XII) R
1514	1514	EDUCED EXPENDITURES 7
1515	1515	ATTRIBUTABLE TO THE RADIATION 8
1516	1516	ONCOLOGY CASE RATE VALUE BASED 9
1517	1517	PAYMENT PROGRAM .—Effective for 10
1518	1518	fee schedules established following the 11
1519	1519	enactment of section 1899C, reduced 12
1520	1520	expenditures attributable to the Radi-13
1521	1521	ation Oncology Case Rate Value 14
1522	1522	Based Payment Program under sec-15
1523	1523	tion 1899C.’’. 16
1524	1524	Æ
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