I
119THCONGRESS
1
STSESSION H. R. 2120
To 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 oncol-
ogy patients to receive radiation therapy services.
IN THE HOUSE OF REPRESENTATIVES
MARCH14, 2025
Mr. F
ITZPATRICK(for himself, Mr. PANETTA, Mr. JOYCEof Pennsylvania,
and Mr. T
ONKO) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee
on Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall within
the jurisdiction of the committee concerned
A BILL
To amend Title XVIII of the Social Security Act to create
a Radiation Oncology Case Rate Value Based Payment
Program exempt from budget neutrality adjustment re-
quirements, 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 transpor-
tation for radiation oncology patients to receive radiation
therapy services.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
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SECTION 1. SHORT TITLE. 1
This Act may be cited as the ‘‘Radiation Oncology 2
Case Rate Value Based Program Act of 2025’’ or the 3
‘‘ROCR Value Based Program Act’’. 4
SEC. 2. FINDINGS. 5
(a) F
INDINGS.—Congress finds the following: 6
(1) Radiation therapy is the careful use of var-7
ious forms of radiation, such as external beam radi-8
ation therapy, to treat cancer and other diseases 9
safely and effectively. Radiation oncologists develop 10
radiation treatment plans and coordinate with highly 11
specialized care teams to deliver radiation therapy. 12
Nearly 60 percent of cancer patients will receive ra-13
diation therapy during their treatment. 14
(2) In 2021, the Centers for Medicare & Med-15
icaid Services reported approximately 16
$4,200,000,000 in total spending for radiation on-17
cology services between the Medicare physician fee 18
schedule and hospital outpatient departments. 19
(3) The Centers for Medicare & Medicaid Serv-20
ices has historically faced challenges in determining 21
accurate pricing for services that involve costly cap-22
ital equipment, resulting in fluctuating payment 23
rates under the Medicare physician fee schedules for 24
services involving external beam radiation therapy. 25
Additionally, the Medicare physician fee schedule 26
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has inadequately recognized the professional exper-1
tise physicians and nonphysician professionals need 2
to deliver radiation therapy. 3
(4) The current payment systems incentivize 4
greater volumes of care while bundled payments 5
incentivize patient centered, efficient, and high value 6
care. 7
(5) In 2017, the Centers for Medicare & Med-8
icaid Services recognized that the Medicare payment 9
systems were not adequately addressing radiation 10
oncology services, and the Center for Medicare & 11
Medicaid Innovation released a congressionally re-12
quested report on the pursuit of an alternative pay-13
ment model for radiation oncology (referred to in 14
this section as the ‘‘Radiation Oncology Model’’) 15
that addresses the issues in the Medicare physician 16
fee schedule and the Medicare hospital outpatient 17
prospective payment system payment methods. 18
(6) Concerns regarding the proposed Radiation 19
Oncology Model included the significant payment re-20
ductions proposed in the model that would jeop-21
ardize access to high-quality radiation therapy serv-22
ices and the onerous reporting requirements for par-23
ticipating providers. The Radiation Oncology Model 24
saw indefinite implementation delays. 25
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(7) It is necessary, therefore, to create a pay-1
ment program for radiation oncology services that 2
appropriately recognizes the value of quality radi-3
ation oncology services through its financial incen-4
tives while containing costs and providing patient- 5
centered care. 6
SEC. 3. RADIATION ONCOLOGY CASE RATE VALUE BASED 7
PAYMENT PROGRAM. 8
(a) I
NGENERAL.—Title XVIII of the Social Security 9
Act (42 U.S.C. 1395 et seq.) is amended by adding at 10
the end the following: 11
‘‘SEC. 1899C. RADIATION ONCOLOGY CASE RATE VALUE 12
BASED PAYMENT PROGRAM. 13
‘‘(a) E
STABLISHMENT.— 14
‘‘(1) I
N GENERAL.—Not later than 1 year after 15
the date of enactment of the ROCR Value Based 16
Program Act, the Secretary shall promulgate regula-17
tions, using the procedures described in paragraph 18
(5), establishing a Radiation Oncology Case Rate 19
Value Based Payment Program (referred to in this 20
section as the ‘ROCR Program’) under which per 21
episode payments are provided to radiation therapy 22
providers or radiation therapy suppliers for covered 23
treatment furnished to a covered individual during 24
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an episode of care (as such terms are defined in sub-1
section (j)) in accordance with this section. 2
‘‘(2) M
AINTAINING PAYMENT RATES DURING 3
PERIOD PRIOR TO EFFECTIVE DATE OF REGULA -4
TIONS.—The Secretary shall not reduce the estab-5
lished payment rates for radiation therapy services 6
under the physician fee schedule under section 1848 7
or the hospital outpatient prospective payment sys-8
tem under section 1833(t) during the time period 9
beginning on the date of enactment of the ROCR 10
Value Based Program Act and ending on the date 11
that the regulations issued by the Secretary pursu-12
ant to paragraph (1) become effective. 13
‘‘(3) ROCR
PROGRAM GOALS .—The ROCR 14
Program shall seek to— 15
‘‘(A) create stable, unified payments for 16
radiation therapy services under this title; 17
‘‘(B) reduce disparities in radiation ther-18
apy care for Medicare beneficiaries by increas-19
ing access to radiation therapy services close to 20
the homes of beneficiaries; 21
‘‘(C) enhance quality of radiation therapy 22
care through practice accreditation and shorter 23
courses of treatment, when appropriate; 24
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‘‘(D) leverage and encourage the utilization 1
of state-of-the-art technology to improve care 2
and outcomes; and 3
‘‘(E) protect Medicare resources by achiev-4
ing reasonable spending reductions in Medicare 5
for radiation therapy services. 6
‘‘(4) P
AYMENTS.—Under this section, with re-7
spect to covered treatment furnished to covered indi-8
viduals, payments shall include— 9
‘‘(A) per episode payments, as described in 10
subsection (b), to radiation therapy providers or 11
radiation therapy suppliers of radiation therapy 12
services which meet such requirements as the 13
Secretary shall establish by regulation; and 14
‘‘(B) the health equity achievement in radi-15
ation therapy add-on payment described in sub-16
section (g). 17
‘‘(5) N
OTICE AND COMMENT RULEMAKING .— 18
The Secretary shall promulgate the regulations de-19
scribed in paragraph (1) in accordance with section 20
553 of title 5, United States Code, and issue an ad-21
vanced notice of proposed rulemaking and notice of 22
proposed rulemaking with a comment period of not 23
less than 60 days for each. 24
‘‘(b) P
EREPISODEPAYMENTS.— 25
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‘‘(1) IN GENERAL.— 1
‘‘(A) P
AYMENTS.—The Secretary shall pay 2
to a radiation therapy provider or radiation 3
therapy supplier an amount equal to 80 percent 4
of the per episode payment amount determined 5
under paragraph 3 (referred to in this section 6
as ‘the per episode payment amount’) for each 7
covered individual furnished covered treatment 8
for an included cancer type to cover all profes-9
sional and technical services furnished during 10
such treatment by the radiation therapy pro-11
vider or radiation therapy supplier during an 12
episode of care (as defined in subsection (j)). 13
‘‘(B) D
EDUCTIBLES AND COINSURANCE .— 14
Subject to subsection (e), the Secretary shall 15
pay the per episode payment amount (subject to 16
any deductible and coinsurance otherwise appli-17
cable under part B) to the radiation therapy 18
provider or radiation therapy supplier for an 19
episode of care, as described in subsection (c). 20
‘‘(2) P
ER EPISODE PAYMENT REQUIREMENTS 21
AND TIMING.— 22
‘‘(A) I
N GENERAL.—Subject to subpara-23
graph (B), for each episode of care furnished to 24
a covered individual: 25
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‘‘(i) FIRST-HALF OF PAYMENT .—The 1
Secretary shall issue
1
⁄2of the payment 2
amount under paragraph (1) prospectively 3
not later than 30 days after the day of the 4
first delivery of covered treatment. 5
‘‘(ii) S
ECOND-HALF OF PAYMENT .— 6
The Secretary shall issue, with the excep-7
tion of an episode of care for treatment of 8
bone or brain metastases and subject to 9
clause (iii), the remaining half of the pay-10
ment amount under paragraph (1) on the 11
date that is the earlier of— 12
‘‘(I) the day the course of cov-13
ered treatment is scheduled to end; or 14
‘‘(II) the 90th day of the episode 15
of care. 16
‘‘(iii) S
ECOND-HALF OF PAYMENT FOR 17
BONE AND BRAIN METASTASES .—The Sec-18
retary shall issue the remaining half of the 19
payment amount under paragraph (1) for 20
an episode of care for treatment of bone or 21
brain metastases on the date that is the 22
earlier of— 23
‘‘(I) the day the course of cov-24
ered treatment is scheduled to end; or 25
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‘‘(II) the 30th day of the episode 1
of care. 2
‘‘(B) P
ATIENT DEATH.—If a covered indi-3
vidual dies during treatment, both episode of 4
care payments under subparagraphs (A) and 5
(B) shall be paid to the radiation therapy pro-6
vider or radiation therapy supplier not later 7
than 30 days after the day of the final delivery 8
of radiation therapy treatment to the covered 9
individual. 10
‘‘(C) C
ONSISTENCY OF PAYMENT .— 11
‘‘(i) I
N GENERAL.—The per episode 12
payment amount shall not change depend-13
ing on the site of service. 14
‘‘(ii) S
ITE OF SERVICE DEFINED .— 15
For the purposes of this subparagraph, the 16
term ‘site of service’ means the hospital 17
outpatient department or physician office 18
in which radiation therapy treatment is 19
furnished by the radiation therapy provider 20
or radiation therapy supplier. 21
‘‘(3) D
ETERMINATION OF PER EPISODE PAY -22
MENT AMOUNT.— 23
‘‘(A) I
N GENERAL.—The Secretary shall 24
determine a per episode payment amount for 25
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the professional component and technical com-1
ponent of treatment for each included cancer 2
type. 3
‘‘(B) A
MOUNT.—The Secretary shall deter-4
mine the per episode payment amount based on 5
national base rates, as described in subsection 6
(d)(1) and as updated in subsection (d)(2). 7
‘‘(C) A
DJUSTMENTS.—The per episode 8
payment amount shall be subject to— 9
‘‘(i) the adjustments as described in 10
subsection (d)(2) and (d)(3); 11
‘‘(ii) a geographic adjustment, as de-12
scribed in subsection (d)(3)(A); 13
‘‘(iii) an inflation adjustment, pursu-14
ant to which the Secretary shall adjust the 15
per episode payment amount by the per-16
centage increase in the Medicare Economic 17
Index (as described in section 1842) for 18
the professional component payments and 19
the applicable percentage increase in the 20
Hospital Inpatient Market Basket Update 21
(as described in section 1886(b)(3)(B)(i)) 22
for the technical component payments dur-23
ing each 12-month period, and which var-24
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ies for the professional and technical com-1
ponents of the service; 2
‘‘(iv) a savings adjustment, as de-3
scribed in subsection (d)(3)(B); 4
‘‘(v) a health equity achievement in 5
radiation therapy adjustment applicable 6
only to the technical component payments, 7
as described in subsection (g); and 8
‘‘(vi) a practice accreditation adjust-9
ment, as described in subsection (h), that 10
is only applicable to technical component 11
payments. 12
‘‘(c) T
REATMENT OF INCOMPLETE EPISODES OF 13
C
ARE; CONCURRENTTREATMENT.— 14
‘‘(1) I
NCOMPLETE EPISODE OF CARE .—In the 15
case of an incomplete episode of care, payment shall 16
be made to the radiation therapy provider or radi-17
ation therapy supplier for services furnished under 18
the physician fee schedule under section 1848 or the 19
hospital outpatient prospective payment system 20
under section 1833(t), as applicable. 21
‘‘(2) M
ULTIPLE EPISODES OF CARE FOR THE 22
SAME COVERED INDIVIDUAL .—A radiation therapy 23
provider or radiation therapy supplier may initiate a 24
new episode of care for the same beneficiary for the 25
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same course of therapy by providing another radi-1
ation therapy treatment planning service and billing 2
under an applicable radiation therapy planning trig-3
ger code (as defined in subsection (j)). 4
‘‘(3) C
ONCURRENT TREATMENTS .—In the case 5
where a treatment modality described in subsection 6
(j)(4)(B)(i)(I) is furnished to a covered individual 7
during an episode of care for an included cancer 8
type, payment may be made concurrently for the 9
treatment modality under the applicable payment 10
system under this title with per episode payment 11
under this section for covered treatment during the 12
episode of care. 13
‘‘(d) N
ATIONALBASERATE.— 14
‘‘(1) D
ETERMINATION OF NATIONAL BASE 15
RATES.—For purposes of the Secretary determining 16
the per episode payment amount under subsection 17
(b)(3), the national base rates for the professional 18
component and technical component of radiation 19
therapy services for each included cancer type are 20
based on the M-Code national base rates identified 21
in table 75 (including HCPCS Codes for radiation 22
therapy services and supplies) of the Federal Reg-23
ister on November 16, 2021, 86 Fed. Reg. 63458, 24
63925. 25
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‘‘(2) UPDATES TO THE NATIONAL BASE 1
RATES.— 2
‘‘(A) A
NNUAL UPDATES.— 3
‘‘(i) I
N GENERAL.—Subject to clause 4
(ii), the Secretary shall annually update 5
the initial national base rates by— 6
‘‘(I) in the case of the profes-7
sional component of the covered treat-8
ment, the percentage increase in the 9
Medicare Economic Index; and 10
‘‘(II) in the case of the technical 11
component of the covered treatment, 12
the applicable percentage increase de-13
scribed in section 1886(b)(3)(B)(i). 14
‘‘(ii) P
AYMENT FLOOR.—For each an-15
nual update, the Secretary shall not reduce 16
the national base rates below the estab-17
lished rates from the prior year. 18
‘‘(B) P
ERIODIC UPDATES.— 19
‘‘(i) I
N GENERAL.—The Secretary 20
shall, through notice and comment rule-21
making, rebase or revise the national base 22
rates in 5-year intervals, beginning on the 23
day that is 5 years after the date the regu-24
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lations issued pursuant to subsection 1
(a)(1) become effective. 2
‘‘(ii) R
EBASING LIMIT.—The Sec-3
retary shall not reduce the national base 4
rates through the process of rebasing by 5
more than 1 percent every 5 years. 6
‘‘(iii) I
NPUT FROM PROVIDERS AND 7
SUPPLIERS.—In rebasing or revising the 8
national base rates pursuant to clause (i), 9
the Secretary shall seek significant input 10
from radiation therapy providers, radiation 11
therapy suppliers, and other stakeholders 12
to ensure that such rates are sufficient, 13
particularly for any new technology or 14
service and any treatment modality de-15
scribed in clause (i)(I) of subsection 16
(j)(4)(B) that is determined to be a cov-17
ered treatment by the Secretary under 18
clause (ii) of such subsection. 19
‘‘(C) R
EBASE AND REVISE DEFINED .—In 20
this subsection: 21
‘‘(i) R
EBASE.—The term ‘rebase’ 22
means to move the base year for the struc-23
ture of costs of the national base rates. 24
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‘‘(ii) REVISE.—The term ‘revise’ 1
means types of changes to national base 2
rates other than rebasing, such as using 3
different data sources, cost categories, or 4
price proxies in the national base rates 5
input. 6
‘‘(D) N
EW TECHNOLOGY OR SERVICES .— 7
‘‘(i) T
REATMENT UNDER THE NA -8
TIONAL BASE RATES.— 9
‘‘(I) E
XCLUSION DURING INITIAL 10
PERIOD.—The Secretary shall not in-11
corporate a radiation therapy service 12
that is a new technology or service (as 13
defined in subsection (j)) into the na-14
tional base rates for an included can-15
cer type prior to the date that is 12 16
years after such service is first identi-17
fied as a new technology or service. 18
‘‘(II) I
NCORPORATION AFTER INI -19
TIAL PERIOD.—After the date speci-20
fied in subclause (I) with respect to a 21
radiation therapy service that is a new 22
technology or service, the Secretary 23
shall, through stakeholder meetings, 24
requests for information, and notice 25
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and comment rulemaking, engage pro-1
viders, suppliers, radiation therapy 2
vendors, patient groups, and the pub-3
lic on possible incorporation of the 4
new technology or service into the na-5
tional base rates for included cancer 6
types under paragraph (1). 7
‘‘(ii) B
EFORE INCORPORATION INTO 8
THE NATIONAL BASE RATE .—Until incor-9
porated into the national base rates under 10
clause (i)(II), any new technology or serv-11
ice shall be paid under the applicable pay-12
ment system under this title. 13
‘‘(iii) D
EVELOPMENT AND TRANSI -14
TIONAL PAYMENT PERIOD FOR ADAPTIVE 15
RADIATION THERAPY PLANNING .— 16
‘‘(I) D
EVELOPMENT AND VALU -17
ATION FOR ADAPTIVE RADIATION 18
THERAPY PLANNING .—Not later than 19
the date the regulations issued pursu-20
ant to subsection (a)(1) become effec-21
tive and in consultation with the 22
American Medical Association’s Cur-23
rent Procedural Terminology Editorial 24
Panel and Specialty Society Relative 25
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Value Scale Update Committee, radi-1
ation oncology specialty societies, and 2
radiation oncology stakeholders, the 3
Secretary shall develop and value 4
codes for adaptive radiation therapy 5
planning (as defined in subsection 6
(j)). 7
‘‘(II) T
RANSITIONAL PAYMENT .— 8
‘‘(aa) I
N GENERAL.—During 9
the period beginning on the date 10
the regulations issued pursuant 11
to subsection (a)(1) become effec-12
tive and ending on the date any 13
adaptive radiation therapy plan-14
ning code is developed and val-15
ued, the Secretary shall provide a 16
separate payment under the ap-17
plicable payment system, in addi-18
tion to the per episode payment 19
amount, for any medically nec-20
essary online and offline adaptive 21
radiation therapy planning fur-22
nished to a covered individual 23
after the initial treatment plan 24
for a covered individual. 25
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‘‘(bb) MODIFIER.—The Sec-1
retary shall establish a modifier 2
to identify claims for the transi-3
tional payment for adaptive radi-4
ation therapy planning for a cov-5
ered individual. 6
‘‘(iv) A
SSESSMENT OF CERTAIN CRI -7
TERIA.—Prior to incorporating a new tech-8
nology or service into the national base 9
rates pursuant to clause (i)(II), the Sec-10
retary shall consider market penetration 11
and adoption, costs relative to base rates, 12
clinical benefits of the new technology or 13
service, and the clear consensus of the 14
stakeholder community. 15
‘‘(3) A
DJUSTMENTS TO NATIONAL BASE 16
RATES.— 17
‘‘(A) G
EOGRAPHIC ADJUSTMENT .—Prior to 18
applying the savings adjustment described in 19
subparagraph (B), the Secretary shall adjust 20
the national base rates for local cost and wage 21
indices based on where the radiation therapy 22
services are furnished— 23
‘‘(i) in the case of the professional 24
component payment rates, the geographic 25
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adjustment processes described in the 1
Medicare Physician Fee Schedule Geo-2
graphic Practice Cost Index; and 3
‘‘(ii) in the case of the technical com-4
ponent payment rates, the geographic ad-5
justment processes in the hospital out-6
patient prospective payment system under 7
section 1833(t). 8
‘‘(B) S
AVINGS ADJUSTMENT .— 9
‘‘(i) I
N GENERAL.—The Secretary 10
shall apply a savings adjustment under 11
this subparagraph after the geographic ad-12
justments have been applied under sub-13
paragraph (A). 14
‘‘(ii) S
AVINGS ADJUSTMENT DE -15
FINED.—The term ‘savings adjustment’ 16
means the percentage by which the profes-17
sional component and technical component 18
payment rates are each reduced to achieve 19
Medicare savings. 20
‘‘(e) A
VAILABILITY OFPAYMENTPLANS FORPAY-21
MENT OFCOINSURANCE.—Following the application of 22
the adjustments described in subsection (d), but before the 23
application of any sequestration order issued under the 24
Balanced Budget and Emergency Deficit Control Act of 25
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1985 (2 U.S.C. 900 et seq.), radiation therapy providers 1
and radiation therapy suppliers shall collect coinsurance 2
for services furnished under the ROCR Program subject 3
to the following rules: 4
‘‘(1) I
N GENERAL.—Radiation therapy pro-5
viders and radiation therapy suppliers may collect 6
coinsurance applicable under subsection (b)(1) for 7
covered treatment furnished to a covered individual 8
under the ROCR Program in multiple installments 9
under a payment plan. 10
‘‘(2) L
IMITATION ON USE AS A MARKETING 11
TOOL.—Radiation therapy providers and radiation 12
therapy suppliers may not use the availability of 13
payment plans for such coinsurance as a marketing 14
tool to influence the choice of health care provider 15
by covered individuals. 16
‘‘(3) T
IMING OF PROVISIONS OF INFORMA -17
TION.—Radiation therapy providers and radiation 18
therapy suppliers offering a payment plan for such 19
coinsurance may inform the covered individual of the 20
availability of the payment plan prior to or during 21
the initial treatment planning session and as nec-22
essary thereafter. 23
‘‘(4) B
ENEFICIARY COINSURANCE PAYMENT .— 24
The beneficiary coinsurance payment shall equal 20 25
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percent of the payment amount to be paid to the ra-1
diation therapy provider or radiation therapy sup-2
plier prior to the application of any sequestration 3
order issued under the Balanced Budget and Emer-4
gency Deficit Control Act of 1985 (2 U.S.C. 900 et 5
seq.) for the billed ROCR Program episode of care, 6
except as provided in paragraph (5). 7
‘‘(5) I
NCOMPLETE EPISODE OF CARE .—In the 8
case of an incomplete episode of care, the beneficiary 9
coinsurance payment shall equal 20 percent of the 10
amount that would have been paid in the absence of 11
the ROCR Program for the radiation therapy serv-12
ices furnished by the radiation therapy provider or 13
radiation therapy supplier that initiated the profes-14
sional component and, if applicable, the radiation 15
therapy provider or radiation therapy supplier that 16
initiated the technical component. 17
‘‘(f) M
ANDATORYPARTICIPATION.— 18
‘‘(1) I
N GENERAL.—Except as provided under 19
paragraph (2) or (3), a radiation therapy provider or 20
radiation therapy supplier that is participating in 21
the program under this title and furnishes a covered 22
treatment to a covered individual shall be required 23
to participate in the ROCR Program. 24
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‘‘(2) CONCURRENT PARTICIPATION IN THE 1
ROCR PROGRAM AND OTHER MODELS .—A radiation 2
therapy provider or radiation therapy supplier that 3
is participating in a State-based Center for Medicare 4
& Medicaid Innovation model— 5
‘‘(A) shall not be prohibited from also par-6
ticipating in the ROCR Program; and 7
‘‘(B) is not required to participate in the 8
ROCR Program. 9
‘‘(3) S
IGNIFICANT HARDSHIP EXEMPTION .— 10
‘‘(A) I
N GENERAL.—The Secretary may, 11
on a case-by-case basis, exempt a radiation 12
therapy provider or radiation therapy supplier 13
from the ROCR Program if the Secretary de-14
termines that application of the program would 15
result in a significant hardship, such as in the 16
case of a natural disaster, for such radiation 17
therapy provider or radiation therapy supplier 18
or for beneficiaries in the geographic area of 19
the radiation therapy provider or radiation ther-20
apy supplier. 21
‘‘(B) P
ROCEDURE.—The Secretary shall 22
promulgate regulations, using the procedures 23
described in subsection (a)(5), regarding eligi-24
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bility and the procedure for applying for a sig-1
nificant hardship exemption. 2
‘‘(g) H
EALTHEQUITYACHIEVEMENT INRADIATION 3
T
HERAPYADD-ONPAYMENT.— 4
‘‘(1) I
N GENERAL.—Pursuant to paragraph (2) 5
and subject to paragraph (7), the Secretary shall ad-6
just the per episode payment amount in the amount 7
of a health equity achievement in radiation therapy 8
add-on payment to advance health equity and sup-9
port covered individuals in accessing and completing 10
their radiation therapy treatments for covered treat-11
ments of included cancer types through the provision 12
of transportation services, subject to the succeeding 13
provisions of this subsection. 14
‘‘(2) E
LIGIBILITY.— 15
‘‘(A) I
N GENERAL.—The health equity 16
achievement in radiation therapy add-on pay-17
ment shall be made when the ICD–10 diagnosis 18
code Z59.82, transportation insecurity is re-19
ported pursuant to subparagraph (B). 20
‘‘(B) D
ETERMINATION OF REPORTING 21
CODE.—The radiation therapy provider or radi-22
ation therapy supplier shall follow the following 23
procedures to determine if the ICD–10 diag-24
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nosis code Z59.82, transportation insecurity 1
needs to be reported: 2
‘‘(i) The radiation therapy provider or 3
radiation therapy supplier shall ask the pa-4
tient at the time of patient intake during 5
the initial patient consultation if, within 6
the previous 2 months, a lack of reliable 7
transportation has kept the patient from 8
attending medical appointments, meetings, 9
or work, or from completing activities of 10
daily living. 11
‘‘(ii) If the patient answers yes to the 12
question in clause (i), ICD–10 diagnosis 13
code Z59.82 shall be reported. 14
‘‘(3) A
MOUNT.—The health equity achievement 15
in radiation therapy add-on payment shall be in the 16
amount of— 17
‘‘(A) for services furnished during the year 18
following the date the regulations issued pursu-19
ant to subsection (a)(1) become effective, $500 20
per patient per episode of care; and 21
‘‘(B) for services furnished in subsequent 22
years, the amount determined under this para-23
graph for the preceding year, increased by $10. 24
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‘‘(4) PAYMENT RECIPIENT.—The health equity 1
achievement in radiation therapy add-on payment 2
shall be paid to the radiation therapy provider or ra-3
diation therapy supplier that provides the technical 4
component of the radiation therapy services. 5
‘‘(5) N
OT TO BE USED IN ADDITION TO OR IN 6
LIEU OF OTHER SERVICES .—The health equity 7
achievement in radiation therapy add-on payment 8
shall not be made in addition to or in lieu of any 9
other State or Federal program benefits that may be 10
used for transportation services. 11
‘‘(6) D
OCUMENTATION.— 12
‘‘(A) I
N GENERAL.—Radiation therapy 13
providers and radiation therapy suppliers who 14
receive the health equity achievement in radi-15
ation therapy add-on payment shall maintain all 16
documentation related to the spending of such 17
payment on transportation services per covered 18
individual for a period of 5 years after the end 19
of the episode of care of the applicable covered 20
individual. 21
‘‘(B) A
VAILABILITY TO THE SECRETARY .— 22
The documentation described in subparagraph 23
(A) shall be made available to the Secretary 24
upon request. 25
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‘‘(7) NO MODIFICATION OF COINSURANCE .— 1
The Secretary may not modify any coinsurance obli-2
gation when implementing the health equity achieve-3
ment in radiation therapy add-on payment. 4
‘‘(h) Q
UALITYINCENTIVES IN THE ROCR VALUE 5
B
ASEDPAYMENTPROGRAM.— 6
‘‘(1) I
N GENERAL.— 7
‘‘(A) I
NITIAL INCREASE IN PAYMENT .— 8
With respect to covered treatment for an in-9
cluded cancer type furnished to a covered indi-10
vidual on or after the date the regulations 11
issued pursuant to subsection (a)(1) become ef-12
fective and before the date that is 2 years after 13
such date, in the case of a radiation therapy 14
provider or radiation therapy supplier that 15
meets the requirements described in paragraph 16
(2), payments otherwise made to such radiation 17
therapy provider or radiation therapy supplier 18
under the ROCR Program for the technical 19
component of such services shall be increased 20
by 1 percent (or 0.25 percent in the case of 21
such a provider or supplier that is a limited re-22
source radiation therapy supplier or limited re-23
source radiation therapy provider). 24
‘‘(B) R
EDUCTION IN PAYMENT .— 25
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‘‘(i) IN GENERAL.—Subject to clause 1
(ii), with respect to covered treatment for 2
an included cancer type furnished to a cov-3
ered individual on or after the date that is 4
2 years after the regulations issued pursu-5
ant to subsection (a)(1) become effective, 6
in the case of a radiation therapy provider 7
or radiation therapy supplier that does not 8
meet the requirements described in para-9
graph (2), the per episode payment to such 10
provider or supplier under the ROCR Pro-11
gram shall be reduced by 2.5 percent. 12
‘‘(ii) E
XCLUSION OF LIMITED RE -13
SOURCE RADIATION THERAPY PROVIDERS 14
AND LIMITED RESOURCE RADIATION THER -15
APY SUPPLIERS.—This subparagraph shall 16
not apply with respect to a limited resource 17
radiation therapy provider or a limited re-18
source radiation therapy supplier. 19
‘‘(C) D
EFINITION OF LIMITED RESOURCE 20
RADIATION THERAPY PROVIDER AND LIMITED 21
RESOURCE RADIATION THERAPY SUPPLIER .— 22
‘‘(i) I
N GENERAL.—In this subsection, 23
the terms ‘limited resource radiation ther-24
apy provider’ and ‘limited resource radi-25
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ation therapy supplier’ mean, with respect 1
to a radiation therapy provider or radiation 2
therapy supplier, a provider or supplier 3
that meets the criteria specified by the 4
Secretary that may include criteria relating 5
to the volume and socioeconomic status of 6
patients treated by the radiation therapy 7
provider or radiation therapy supplier, the 8
geographic area or medically-underserved 9
area served by the radiation therapy pro-10
vider or radiation therapy supplier, includ-11
ing rural areas, or such other criteria as 12
the Secretary determines is appropriate, 13
through notice and comment rulemaking 14
and in consultation with radiation therapy 15
stakeholder organizations. 16
‘‘(ii) C
AP ON NUMBER OF LIMITED 17
RESOURCE RADIATION THERAPY PRO -18
VIDERS AND LIMITED RESOURCE RADI -19
ATION THERAPY SUPPLIERS .—In speci-20
fying the criteria for limited resource radi-21
ation therapy providers and limited re-22
source radiation therapy suppliers under 23
clause (i), the Secretary shall ensure that 24
the total number of such providers and 25
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suppliers does not exceed 10 percent of the 1
total number of all radiation therapy pro-2
viders and radiation therapy suppliers. 3
‘‘(2) A
CCREDITATION REQUIREMENTS .— 4
‘‘(A) I
N GENERAL.—The requirements de-5
scribed in this subparagraph with respect to a 6
radiation therapy provider or radiation therapy 7
supplier (other than such a provider or supplier 8
that is a limited resource radiation therapy pro-9
vider or limited resource radiation therapy sup-10
plier) are that the supplier or provider must— 11
‘‘(i) maintain or be in the process of 12
obtaining accreditation by the American 13
College of Radiology, American College of 14
Radiation Oncology, or American Society 15
for Radiation Oncology (referred to in this 16
section as ‘covered radiation oncology ac-17
creditation organizations’); 18
‘‘(ii) comply with certified electronic 19
health record technology requirements as 20
determined by the Secretary with excep-21
tions that are consistent with those of the 22
Merit-Based Incentive Payment System es-23
tablished under section 1848(q); and 24
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‘‘(iii) submit to the Secretary proof of 1
the accreditation described in clause (i) in 2
such form and manner as specified by the 3
Secretary. 4
‘‘(B) R
EQUIREMENTS FOR LIMITED RE -5
SOURCE RADIATION THERAPY PROVIDERS AND 6
LIMITED RESOURCE RADIATION THERAPY SUP -7
PLIERS.—A radiation therapy provider or radi-8
ation therapy supplier that is a limited resource 9
radiation therapy provider or limited resource 10
radiation therapy supplier may elect to satisfy 11
the accreditation requirement under this para-12
graph by— 13
‘‘(i) meeting the requirements of sub-14
paragraph (A); 15
‘‘(ii) using an external audit that en-16
compasses similar criteria as a nationally 17
recognized radiation oncology accreditation 18
organization and submit the outcome of 19
such external audit to the Secretary; or 20
‘‘(iii) complying with certified elec-21
tronic health record technology require-22
ments as determined by the Secretary with 23
exceptions that are consistent with those of 24
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the Merit-Based Incentive Payment Sys-1
tem established under section 1848(q). 2
‘‘(C) N
EW PROVIDERS.—A new radiation 3
therapy provider or new radiation supplier shall 4
complete an initiation of accreditation or exter-5
nal audit not later than the date that is 1 year 6
after such provider or supplier begins fur-7
nishing covered treatment to covered individ-8
uals. 9
‘‘(D) R
ADIATION ONCOLOGY ACCREDITA -10
TION ORGANIZATION QUALITY STANDARDS .— 11
Each covered radiation oncology accreditation 12
organization (and any successor organization) 13
shall develop quality standards for radiation 14
therapy providers and radiation therapy sup-15
pliers to ensure covered treatments are deliv-16
ered using adequate and modern linear accel-17
erator technology, staffing, and other compo-18
nents that protect patient safety and quality 19
by— 20
‘‘(i) consulting with radiation therapy 21
manufacturers and key stakeholders; 22
‘‘(ii) soliciting public comment on pro-23
posed quality standards, including from 24
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physicians, medical physicists, and other 1
health professionals and experts; 2
‘‘(iii) updating quality standards not 3
later than every 5 to 7 years in partner-4
ship with stakeholders; 5
‘‘(iv) ensuring quality standards for 6
linear accelerator technology are adequate 7
and on par with current technological ad-8
vances and modern requirements for staff-9
ing and other procedures associated with 10
the delivery of safe and effective radiation 11
therapy; 12
‘‘(v) collecting timely information 13
from radiation therapy providers and radi-14
ation therapy suppliers for each linear ac-15
celerator owned or used on or after the ef-16
fective date of the regulations issued pur-17
suant to subsection (a)(1); and 18
‘‘(vi) giving sufficient weight to com-19
pliance with quality standards among other 20
accreditation standards in determining ac-21
creditation status for radiation therapy 22
providers or radiation therapy suppliers. 23
‘‘(i) R
EPORTINGREQUIREMENTS.— 24
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‘‘(1) REPORT ON THE ROCR PROGRAM .—Not 1
earlier than 7 years after the date of the enactment 2
of this section, the Comptroller General of the 3
United States (referred to in this subsection as the 4
‘Comptroller General’) shall, after seeking out the 5
perspectives of radiation oncology stakeholders, sub-6
mit to the appropriate committees of jurisdiction of 7
the Senate and the House of Representatives a re-8
port that— 9
‘‘(A) evaluates— 10
‘‘(i) the implementation of the ROCR 11
Program, and the impact such Program 12
has had on Federal healthcare spending; 13
‘‘(ii) the impact the ROCR Program 14
has had on the ability of covered individ-15
uals to access covered treatment; 16
‘‘(iii) whether any cancer types or ra-17
diation therapy services, such as 18
brachytherapy, proton therapy, or thera-19
peutic radiopharmaceuticals, should be 20
added or removed from the ROCR Pro-21
gram; and 22
‘‘(iv) the potential application of the 23
ROCR Program to benefits provided under 24
part C of this title; and 25
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‘‘(B) includes any recommendations for ad-1
ministrative and legislative changes. 2
‘‘(2) R
EPORT ON ACCESS TO RADIATION THER -3
APY IN RURAL AND UNDERSERVED AREAS .—Not 4
later than 3 years after the date of the enactment 5
of this section, the Comptroller General shall submit 6
a report to the appropriate committees of jurisdic-7
tion of the Senate and the House of Representatives 8
that identifies the following: 9
‘‘(A) Radiation therapy deserts. 10
‘‘(B) Methods to increase access to new ra-11
diation therapy technologies in rural and under-12
served areas, including technologies required for 13
clinical treatment planning, simulation, dosim-14
etry, medical radiation physics, radiation treat-15
ment devices, radiation treatment delivery, radi-16
ation treatment management, and such other 17
items as the Comptroller General may deter-18
mine are medically necessary. 19
‘‘(C) A program to provide assistance in 20
the form of grants or loans to radiation therapy 21
providers or radiation therapy suppliers for the 22
purpose of ensuring access to the most current 23
radiation therapy technology. 24
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‘‘(3) DETERMINATION AND DEFINITION OF RA -1
DIATION THERAPY DESERTS .— 2
‘‘(A) D
EFINITION.—For purposes of this 3
subsection, the term ‘radiation therapy desert’ 4
means a region determined by the Comptroller 5
General under subparagraph (B) with a mis-6
match between radiation therapy resources and 7
oncologic need. 8
‘‘(B) D
ETERMINATION.—In determining 9
whether a region qualifies as a radiation ther-10
apy desert, the Comptroller General shall take 11
into account the ratio or density of radiation 12
therapy providers and radiation therapy sup-13
pliers practicing in a geographic area as com-14
pared to the population size in that geographic 15
area. 16
‘‘(j) D
EFINITIONS.—In this section: 17
‘‘(1) A
DAPTIVE RADIATION THERAPY PLAN -18
NING.—The term ‘adaptive radiation therapy plan-19
ning’ means any new technology or services identi-20
fied, as of the date that the regulations issued pur-21
suant to subsection (a)(1) become effective, by the 22
following HCPCS codes (and as subsequently modi-23
fied by the Secretary) performed after the initial 24
treatment plan for a covered individual: 25
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‘‘(A) 77295, 3-dimensional radiotherapy 1
plan, including dose-volume histograms. 2
‘‘(B) 77300, basic radiation dosimetry cal-3
culation, central axis depth dose calculation, 4
TDF, NSD, gap calculation, off axis factor, tis-5
sue inhomogeneity factors, calculation of non- 6
ionizing radiation surface and depth dose, as re-7
quired during course of treatment, only when 8
prescribed by the treating physician. 9
‘‘(C) 77301, intensity modulated radio-10
therapy plan, including dose-volume histograms 11
for target and critical structure partial toler-12
ance specifications. 13
‘‘(D) 77338, multi-leaf collimator (MLC) 14
devices for intensity modulated radiation ther-15
apy (IMRT), design and construction per IMRT 16
plan. 17
‘‘(E) 77334, Treatment devices, design 18
and construction; complex (irregular blocks, 19
special shields, compensators, wedges, molds or 20
casts). 21
‘‘(F) 77293, Respiratory motion manage-22
ment simulation (List separately in addition to 23
code for primary procedure). 24
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‘‘(2) APPLICABLE RADIATION THERAPY PLAN -1
NING TRIGGER CODE .—The term ‘applicable radi-2
ation therapy planning trigger code’ means services 3
identified, as of the date that the regulations issued 4
pursuant to subsection (a)(1) become effective, by 5
the following HCPCS codes (and as subsequently 6
modified by the Secretary): 7
‘‘(A) 77261, therapeutic radiology treat-8
ment planning, simple. 9
‘‘(B) 77262, therapeutic radiology treat-10
ment planning, intermediate. 11
‘‘(C) 77263, therapeutic radiology treat-12
ment planning, complex. 13
‘‘(3) C
OVERED INDIVIDUAL .—The term ‘cov-14
ered individual’ means an individual who— 15
‘‘(A) is enrolled for benefits under part B; 16
‘‘(B) is not enrolled in a Medicare Advan-17
tage plan under part C or a PACE program 18
under section 1894; and 19
‘‘(C) is diagnosed with an included cancer 20
type. 21
‘‘(4) C
OVERED TREATMENT .— 22
‘‘(A) I
N GENERAL.—The term ‘covered 23
treatment’ means, subject to subparagraph (B), 24
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radiation therapy services furnished to a cov-1
ered individual. 2
‘‘(B) E
XCLUSIONS.— 3
‘‘(i) I
N GENERAL.—Such term does 4
not include— 5
‘‘(I) subject to clause (ii), during 6
the period beginning on the date on 7
which the regulation issued pursuant 8
to subsection (a)(1) become effective 9
and ending on the date that is 12 10
years after such date, brachytherapy, 11
proton beam radiation therapy serv-12
ices, intraoperative radiotherapy, su-13
perficial radiation therapy, 14
hyperthermia, and therapeutic radio-15
pharmaceuticals; 16
‘‘(II) inpatient radiation therapy 17
services furnished in a subsection (d) 18
hospital or ambulatory surgical center; 19
‘‘(III) radiation therapy services 20
furnished in cancer hospitals that are 21
exempt from the hospital outpatient 22
prospective payment system under 23
section 1833(t); 24
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‘‘(IV) physician services that are 1
furnished or supervised by the physi-2
cian or the physician practice fur-3
nishing radiation therapy or by an-4
other physician, including any surgical 5
procedures, chemotherapy, and other 6
services; 7
‘‘(V) physician and technical 8
services that are furnished using tech-9
nology represented by Healthcare 10
Common Procedure Coding System 11
codes that are not included in the M- 12
code national base rates identified in 13
table 75 (including in HCPCS Codes 14
for radiation therapy services and 15
supplies) of the Federal Register on 16
November 16, 2021, 86 Fed. Reg. 17
63485, 63925; or 18
‘‘(VI) durable medical equipment 19
(as defined in section 1861(n)). 20
‘‘(ii) I
NCLUSION OF CERTAIN TREAT -21
MENT.—After the date that is 12 years 22
after the date on which the regulation 23
issued pursuant to subsection (a)(1) be-24
come effective, the Secretary may deter-25
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mine by regulation to include any of the 1
treatment modalities described in clause 2
(i)(I) as covered treatment. Before making 3
such determination, the Secretary shall— 4
‘‘(I) consider— 5
‘‘(aa) market penetration; 6
‘‘(bb) the cost of such items 7
or services relative to base rates; 8
‘‘(cc) the clinical benefits of 9
such items or services; and 10
‘‘(dd) the clear consensus of 11
the stakeholder community; and 12
‘‘(II) publish a notice of a pro-13
posed determination under subsection 14
(b)(3)(B) regarding the payment 15
amount proposed to be established 16
with respect to such item or service. 17
‘‘(5) E
PISODE OF CARE.—The term ‘episode of 18
care’ means, with respect to a covered individual, the 19
period— 20
‘‘(A) beginning on the day radiation ther-21
apy planning for an included cancer type, billed 22
under an applicable radiation therapy planning 23
trigger code, is furnished to a covered indi-24
vidual if radiation therapy treatment is initiated 25
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not later than 30 days after the day such radi-1
ation therapy planning service is furnished; and 2
‘‘(B) ends— 3
‘‘(i) for treatment of all included can-4
cer types except bone and brain metastases 5
treatment, the day that is 90 days after 6
the day the episode of care begins under 7
clause (i); and 8
‘‘(ii) for bone and brain metastases 9
treatment, the day that is 30 days after 10
the day the episode of care begins under 11
clause (i). 12
‘‘(6) I
NCLUDED CANCER TYPES .—The term ‘in-13
cluded cancer type’ means any of the following types 14
of cancer: 15
‘‘(A) Anal. 16
‘‘(B) Bladder. 17
‘‘(C) Bone Metastases. 18
‘‘(D) Brain Metastases. 19
‘‘(E) Breast. 20
‘‘(F) Cervical. 21
‘‘(G) Central Nervous System Tumors. 22
‘‘(H) Colorectal. 23
‘‘(I) Head and Neck. 24
‘‘(J) Lung. 25
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‘‘(K) Lymphoma. 1
‘‘(L) Pancreatic. 2
‘‘(M) Prostate. 3
‘‘(N) Upper Gastrointestinal. 4
‘‘(O) Uterine. 5
‘‘(7) H
EALTHCARE COMMON PROCEDURE COD -6
ING SYSTEM.—The term ‘Healthcare Common Pro-7
cedure Coding System’ means the standardized cod-8
ing system used by Medicare and other health insur-9
ance programs to ensure that claims are processed 10
in an orderly and consistent manner. 11
‘‘(8) I
NCOMPLETE EPISODE OF CARE .—The 12
term ‘incomplete episode of care’ means, with re-13
spect to a covered individual, an episode of care that 14
is not completed because— 15
‘‘(A) the individual being treated ceases to 16
be a covered individual, including in the case 17
where the individual loses benefits under this 18
title, at any time after the initial treatment 19
planning service is furnished and before the epi-20
sode of care for the covered treatment is com-21
plete; or 22
‘‘(B) a covered individual switches radi-23
ation therapy provider or radiation therapy sup-24
plier before all included radiation therapy serv-25
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ices in the episode of care for the covered treat-1
ment have been furnished. 2
‘‘(9) N
EW TECHNOLOGY OR SERVICES .—The 3
term ‘new technology or services’ means any tech-4
nology or services that, after the date of enactment 5
of this section, receives a Category 1 Current Proce-6
dural Terminology code or is established in the year-7
ly update to the Medicare physician fee schedule di-8
rect practice expense inputs or any successor reposi-9
tory of the direct practice expense input for the de-10
livery of radiation therapy services. 11
‘‘(10) P
ROFESSIONAL COMPONENT .—The term 12
‘professional component’ means the included radi-13
ation therapy services that may only be furnished by 14
a physician. 15
‘‘(11) R
ADIATION THERAPY.—The term ‘radi-16
ation therapy’ means the careful use of various 17
forms of radiation, such as external beam radiation 18
therapy, to treat cancer and other diseases safely 19
and effectively. 20
‘‘(12) R
ADIATION THERAPY PROVIDER .—The 21
term ‘radiation therapy provider’ means a hospital 22
outpatient department enrolled under this title that 23
furnishes radiation therapy services. 24
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‘‘(13) RADIATION THERAPY SERVICES .—The 1
term ‘radiation therapy services’ means the treat-2
ment planning, technical preparation, special serv-3
ices (such as simulation), treatment delivery, and 4
treatment management services associated with can-5
cer treatment that uses high doses of radiation to 6
kill cancer cells and shrink tumors. 7
‘‘(14) R
ADIATION THERAPY SUPPLIER .—The 8
term ‘radiation therapy supplier’ means a physician 9
group practice or freestanding radiation therapy cen-10
ter enrolled under this title that furnishes radiation 11
therapy services. 12
‘‘(15) T
ECHNICAL COMPONENT .—The term 13
‘technical component’ means the included radiation 14
therapy services that are not furnished by a physi-15
cian, including the provision of equipment, supplies, 16
personnel, and administrative costs related to radi-17
ation therapy services. 18
‘‘(16) T
RANSPORTATION SERVICES .—The term 19
‘transportation services’ means the provision of free 20
or discounted transportation made available to cov-21
ered individuals furnished covered treatment which 22
are not air, luxury, or ambulance-level transpor-23
tation, but may include car services, ride shares, au-24
tonomous vehicles, or public transportation.’’. 25
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(b) EXCLUSION OF PARTICIPATINGRADIATION 1
T
HERAPYPROVIDERS, RADIATIONTHERAPYSUPPLIERS, 2
ANDPHYSICIANSFROM THEMERIT-BASEDINCENTIVE 3
P
AYMENTSYSTEM.—Section 1848(q)(1)(C)(ii) of the So-4
cial Security Act (42 U.S.C. 1395w–4(q)(1)(c)(II)) is 5
amended— 6
(1) in subclause (II), by striking ‘‘or’’ at the 7
end; 8
(2) in subclause (III), by striking the period at 9
the end and inserting ‘‘; or’’; and 10
(3) by adding at the end the following new sub-11
clause: 12
‘‘(IV) is a radiation therapy pro-13
vider or radiation therapy supplier (as 14
those terms are defined in subsection 15
(j) of section1899C) that is partici-16
pating in the Radiation Oncology Case 17
Rate Value Based Payment Program 18
established under that section.’’. 19
SEC. 4. REVISION TO CIVIL MONETARY PENALTIES RE-20
GARDING RADIATION ONCOLOGY CASE RATE 21
PATIENT TRANSPORTATION SERVICES. 22
Section 1128A of the Social Security Act (42 U.S.C. 23
1320a–7a) is amended— 24
(1) in subsection (i)(6)— 25
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(A) in subparagraph (I), by striking ‘‘or’’ 1
at the end; 2
(B) in subparagraph (J)(iii), by striking 3
the period at the end and inserting ‘‘; or’’; and 4
(C) by adding at the end the following new 5
subparagraph: 6
‘‘(K) the provision of transportation serv-7
ices by an eligible entity, as defined in sub-8
section (t), if— 9
‘‘(i) the availability of the transpor-10
tation services— 11
‘‘(I) is set forth in a policy that 12
the eligible entity, as defined in sub-13
section (t), applies uniformly and con-14
sistently; and 15
‘‘(II) is not determined in a man-16
ner related to the past or anticipated 17
volume or value of Federal health care 18
program business; 19
‘‘(ii) the eligible entity does not pub-20
licly market or advertise the transportation 21
services; 22
‘‘(iii) the driver who provides the 23
transportation services does not market 24
health care items or services during the 25
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course of the transportation or at any 1
time; 2
‘‘(iv) the driver or individual arrang-3
ing for the transportation services is not 4
paid on a per-beneficiary-transported basis; 5
‘‘(v) the eligible entity makes the 6
transportation services available only to an 7
individual who— 8
‘‘(I) is an established patient, as 9
defined in subsection (t), of the eligi-10
ble entity that is providing or facili-11
tating free or discounted transpor-12
tation; 13
‘‘(II) resides— 14
‘‘(aa) within a 75-mile ra-15
dius of the radiation therapy pro-16
vider or radiation therapy sup-17
plier to or from which the patient 18
would be transported; or 19
‘‘(bb) in a rural area, as de-20
fined in subsection (t); and 21
‘‘(III) is receiving radiation ther-22
apy services for the purpose of obtain-23
ing medically necessary items and 24
services; and 25
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‘‘(vi) the eligible entity that makes the 1
transportation services available bears the 2
costs of the transportation services and 3
does not shift the burden of those costs 4
onto any Federal health care program, 5
other payers, or individuals.’’; and 6
(2) by adding at the end the following new sub-7
section: 8
‘‘(t) For purposes of subsection (i)(6)(K), the fol-9
lowing definitions apply: 10
‘‘(1) The term ‘eligible entity’ means any indi-11
vidual or entity, or any individual or entity acting on 12
behalf of such individual or entity that does not sup-13
ply health care items as the primary occupation of 14
the individual or entity. 15
‘‘(2) The term ‘established patient’ means an 16
individual who— 17
‘‘(A) has selected and scheduled an ap-18
pointment with a radiation therapy provider or 19
radiation therapy supplier; or 20
‘‘(B) has attended an appointment with 21
such provider or supplier. 22
‘‘(3) The terms ‘radiation therapy provider’, 23
‘radiation therapy services’, and ‘radiation therapy 24
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supplier’ have the meaning given such terms in sec-1
tion 1866G(j). 2
‘‘(4) The term ‘rural area’ means an area that 3
is not an urban area. 4
‘‘(5) The term ‘transportation services’— 5
‘‘(A) means the provision of free or dis-6
counted transportation made available to Fed-7
eral health care program beneficiaries receiving 8
radiation therapy services; 9
‘‘(B) includes car services, ride shares, and 10
public transportation; and 11
‘‘(C) does not include air, luxury, or ambu-12
lance-level transportation. 13
‘‘(6) The term ‘urban area’ means— 14
‘‘(A) a Metropolitan Statistical Area or 15
New England County Metropolitan Area, as de-16
fined by the Office of Management and Budget; 17
‘‘(B) Litchfield County, Connecticut; 18
‘‘(C) York County, Maine; 19
‘‘(D) Sagadahoc County, Maine; 20
‘‘(E) Merrimack County, New Hampshire; 21
and 22
‘‘(F) Newport County, Rhode Island.’’. 23
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SEC. 5. EXEMPTION OF RADIATION ONCOLOGY CASE RATE 1
VALUE BASED PAYMENT PROGRAM FROM 2
BUDGET NEUTRALITY ADJUSTMENT RE-3
QUIREMENTS. 4
(a) P
AYMENT OFBENEFITS.—Section 1833(t) of the 5
Social Security Act (42 U.S.C. 1395l(t)) is amended by 6
adding at the end the following new paragraph: 7
‘‘(23) N
ON BUDGET NEUTRAL APPLICATION OF 8
REDUCED EXPENDITURES RESULTING FROM THE 9
RADIATION ONCOLOGY CASE RATE VALUE BASED 10
PAYMENT PROGRAM .—The Secretary shall not take 11
into account the reduced expenditures that result 12
from the implementation of section 1899C in making 13
any budget neutrality adjustments under this sub-14
section.’’. 15
(b) P
AYMENT FORPHYSICIANS’ SERVICES.—Section 16
1848(c)(2)(B) of the Social Security Act (42 U.S.C. 17
1395w–4(c)(2)(B)) is amended— 18
(1) in clause (iv)— 19
(A) in subclause (V), by striking ‘‘and’’ at 20
the end; 21
(B) in subclause (VI), by striking the pe-22
riod at the end and inserting ‘‘; and’’; and 23
(C) by adding at the end the following new 24
subclause: 25
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‘‘(VII) section 1899C shall not be 1
taken into account in applying clause 2
(ii)(II) for a year following the enact-3
ment of section 1899C.’’; and 4
(2) in clause (v), by adding at the end the fol-5
lowing new subclause: 6
‘‘(XII) R
EDUCED EXPENDITURES 7
ATTRIBUTABLE TO THE RADIATION 8
ONCOLOGY CASE RATE VALUE BASED 9
PAYMENT PROGRAM .—Effective for 10
fee schedules established following the 11
enactment of section 1899C, reduced 12
expenditures attributable to the Radi-13
ation Oncology Case Rate Value 14
Based Payment Program under sec-15
tion 1899C.’’. 16
Æ
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