Us Congress 2025-2026 Regular Session

Us Congress Senate Bill SB1031 Compare Versions

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Old	New	Differences
1	1	II
2	2	119THCONGRESS
3	3	1
4	4	STSESSION S. 1031
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 SENATE OF THE UNITED STATES
12	12	MARCH13, 2025
13	13	Mr. T
14	14	ILLIS(for himself and Mr. PETERS) introduced the following bill; which
15	15	was read twice and referred to the Committee on Finance
16	16	A BILL
17	17	To amend Title XVIII of the Social Security Act to create
18	18	a Radiation Oncology Case Rate Value Based Payment
19	19	Program exempt from budget neutrality adjustment re-
20	20	quirements, and to amend section 1128A of title XI
21	21	of the Social Security Act to create a new statutory
22	22	exception for the provision of free or discounted transpor-
23	23	tation for radiation oncology patients to receive radiation
24	24	therapy services.
25	25	Be it enacted by the Senate and House of Representa-1
26	26	tives of the United States of America in Congress assembled, 2
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30	30	SECTION 1. SHORT TITLE. 1
31	31	This Act may be cited as the ‘‘Radiation Oncology 2
32	32	Case Rate Value Based Program Act of 2025’’ or the 3
33	33	‘‘ROCR Value Based Program Act’’. 4
34	34	SEC. 2. FINDINGS. 5
35	35	(a) F
36	36	INDINGS.—Congress finds the following: 6
37	37	(1) Radiation therapy is the careful use of var-7
38	38	ious forms of radiation, such as external beam radi-8
39	39	ation therapy, to treat cancer and other diseases 9
40	40	safely and effectively. Radiation oncologists develop 10
41	41	radiation treatment plans and coordinate with highly 11
42	42	specialized care teams to deliver radiation therapy. 12
43	43	Nearly 60 percent of cancer patients will receive ra-13
44	44	diation therapy during their treatment. 14
45	45	(2) In 2021, the Centers for Medicare & Med-15
46	46	icaid Services reported approximately 16
47	47	$4,200,000,000 in total spending for radiation on-17
48	48	cology services between the Medicare physician fee 18
49	49	schedule and hospital outpatient departments. 19
50	50	(3) The Centers for Medicare & Medicaid Serv-20
51	51	ices has historically faced challenges in determining 21
52	52	accurate pricing for services that involve costly cap-22
53	53	ital equipment, resulting in fluctuating payment 23
54	54	rates under the Medicare physician fee schedules for 24
55	55	services involving external beam radiation therapy. 25
56	56	Additionally, the Medicare physician fee schedule 26
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60	60	has inadequately recognized the professional exper-1
61	61	tise physicians and nonphysician professionals need 2
62	62	to deliver radiation therapy. 3
63	63	(4) The current payment systems incentivize 4
64	64	greater volumes of care while bundled payments 5
65	65	incentivize patient centered, efficient, and high value 6
66	66	care. 7
67	67	(5) In 2017, the Centers for Medicare & Med-8
68	68	icaid Services recognized that the Medicare payment 9
69	69	systems were not adequately addressing radiation 10
70	70	oncology services, and the Center for Medicare & 11
71	71	Medicaid Innovation released a congressionally re-12
72	72	quested report on the pursuit of an alternative pay-13
73	73	ment model for radiation oncology (referred to in 14
74	74	this section as the ‘‘Radiation Oncology Model’’) 15
75	75	that addresses the issues in the Medicare physician 16
76	76	fee schedule and the Medicare hospital outpatient 17
77	77	prospective payment system payment methods. 18
78	78	(6) Concerns regarding the proposed Radiation 19
79	79	Oncology Model included the significant payment re-20
80	80	ductions proposed in the model that would jeop-21
81	81	ardize access to high-quality radiation therapy serv-22
82	82	ices and the onerous reporting requirements for par-23
83	83	ticipating providers. The Radiation Oncology Model 24
84	84	saw indefinite implementation delays. 25
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88	88	(7) It is necessary, therefore, to create a pay-1
89	89	ment program for radiation oncology services that 2
90	90	appropriately recognizes the value of quality radi-3
91	91	ation oncology services through its financial incen-4
92	92	tives while containing costs and providing patient- 5
93	93	centered care. 6
94	94	SEC. 3. RADIATION ONCOLOGY CASE RATE VALUE BASED 7
95	95	PAYMENT PROGRAM. 8
96	96	(a) I
97	97	NGENERAL.—Title XVIII of the Social Security 9
98	98	Act (42 U.S.C. 1395 et seq.) is amended by adding at 10
99	99	the end the following: 11
100	100	‘‘SEC. 1899C. RADIATION ONCOLOGY CASE RATE VALUE 12
101	101	BASED PAYMENT PROGRAM. 13
102	102	‘‘(a) E
103	103	STABLISHMENT.— 14
104	104	‘‘(1) I
105	105	N GENERAL.—Not later than 1 year after 15
106	106	the date of enactment of the ROCR Value Based 16
107	107	Program Act, the Secretary shall promulgate regula-17
108	108	tions, using the procedures described in paragraph 18
109	109	(5), establishing a Radiation Oncology Case Rate 19
110	110	Value Based Payment Program (referred to in this 20
111	111	section as the ‘ROCR Program’) under which per 21
112	112	episode payments are provided to radiation therapy 22
113	113	providers or radiation therapy suppliers for covered 23
114	114	treatment furnished to a covered individual during 24
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118	118	an episode of care (as such terms are defined in sub-1
119	119	section (j)) in accordance with this section. 2
120	120	‘‘(2) M
121	121	AINTAINING PAYMENT RATES DURING 3
122	122	PERIOD PRIOR TO EFFECTIVE DATE OF REGULA -4
123	123	TIONS.—The Secretary shall not reduce the estab-5
124	124	lished payment rates for radiation therapy services 6
125	125	under the physician fee schedule under section 1848 7
126	126	or the hospital outpatient prospective payment sys-8
127	127	tem under section 1833(t) during the time period 9
128	128	beginning on the date of enactment of the ROCR 10
129	129	Value Based Program Act and ending on the date 11
130	130	that the regulations issued by the Secretary pursu-12
131	131	ant to paragraph (1) become effective. 13
132	132	‘‘(3) ROCR
133	133	PROGRAM GOALS .—The ROCR 14
134	134	Program shall seek to— 15
135	135	‘‘(A) create stable, unified payments for 16
136	136	radiation therapy services under this title; 17
137	137	‘‘(B) reduce disparities in radiation ther-18
138	138	apy care for Medicare beneficiaries by increas-19
139	139	ing access to radiation therapy services close to 20
140	140	the homes of beneficiaries; 21
141	141	‘‘(C) enhance quality of radiation therapy 22
142	142	care through practice accreditation and shorter 23
143	143	courses of treatment, when appropriate; 24
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147	147	‘‘(D) leverage and encourage the utilization 1
148	148	of state-of-the-art technology to improve care 2
149	149	and outcomes; and 3
150	150	‘‘(E) protect Medicare resources by achiev-4
151	151	ing reasonable spending reductions in Medicare 5
152	152	for radiation therapy services. 6
153	153	‘‘(4) P
154	154	AYMENTS.—Under this section, with re-7
155	155	spect to covered treatment furnished to covered indi-8
156	156	viduals, payments shall include— 9
157	157	‘‘(A) per episode payments, as described in 10
158	158	subsection (b), to radiation therapy providers or 11
159	159	radiation therapy suppliers of radiation therapy 12
160	160	services which meet such requirements as the 13
161	161	Secretary shall establish by regulation; and 14
162	162	‘‘(B) the health equity achievement in radi-15
163	163	ation therapy add-on payment described in sub-16
164	164	section (g). 17
165	165	‘‘(5) N
166	166	OTICE AND COMMENT RULEMAKING .— 18
167	167	The Secretary shall promulgate the regulations de-19
168	168	scribed in paragraph (1) in accordance with section 20
169	169	553 of title 5, United States Code, and issue an ad-21
170	170	vanced notice of proposed rulemaking and notice of 22
171	171	proposed rulemaking with a comment period of not 23
172	172	less than 60 days for each. 24
173	173	‘‘(b) P
174	174	EREPISODEPAYMENTS.— 25
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178	178	‘‘(1) IN GENERAL.— 1
179	179	‘‘(A) P
180	180	AYMENTS.—The Secretary shall pay 2
181	181	to a radiation therapy provider or radiation 3
182	182	therapy supplier an amount equal to 80 percent 4
183	183	of the per episode payment amount determined 5
184	184	under paragraph 3 (referred to in this section 6
185	185	as ‘the per episode payment amount’) for each 7
186	186	covered individual furnished covered treatment 8
187	187	for an included cancer type to cover all profes-9
188	188	sional and technical services furnished during 10
189	189	such treatment by the radiation therapy pro-11
190	190	vider or radiation therapy supplier during an 12
191	191	episode of care (as defined in subsection (j)). 13
192	192	‘‘(B) D
193	193	EDUCTIBLES AND COINSURANCE .— 14
194	194	Subject to subsection (e), the Secretary shall 15
195	195	pay the per episode payment amount (subject to 16
196	196	any deductible and coinsurance otherwise appli-17
197	197	cable under part B) to the radiation therapy 18
198	198	provider or radiation therapy supplier for an 19
199	199	episode of care, as described in subsection (c). 20
200	200	‘‘(2) P
201	201	ER EPISODE PAYMENT REQUIREMENTS 21
202	202	AND TIMING.— 22
203	203	‘‘(A) I
204	204	N GENERAL.—Subject to subpara-23
205	205	graph (B), for each episode of care furnished to 24
206	206	a covered individual: 25
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210	210	‘‘(i) FIRST-HALF OF PAYMENT .—The 1
211	211	Secretary shall issue
212	212	1
213	213	⁄2of the payment 2
214	214	amount under paragraph (1) prospectively 3
215	215	not later than 30 days after the day of the 4
216	216	first delivery of covered treatment. 5
217	217	‘‘(ii) S
218	218	ECOND-HALF OF PAYMENT .— 6
219	219	The Secretary shall issue, with the excep-7
220	220	tion of an episode of care for treatment of 8
221	221	bone or brain metastases and subject to 9
222	222	clause (iii), the remaining half of the pay-10
223	223	ment amount under paragraph (1) on the 11
224	224	date that is the earlier of— 12
225	225	‘‘(I) the day the course of cov-13
226	226	ered treatment is scheduled to end; or 14
227	227	‘‘(II) the 90th day of the episode 15
228	228	of care. 16
229	229	‘‘(iii) S
230	230	ECOND-HALF OF PAYMENT FOR 17
231	231	BONE AND BRAIN METASTASES .—The Sec-18
232	232	retary shall issue the remaining half of the 19
233	233	payment amount under paragraph (1) for 20
234	234	an episode of care for treatment of bone or 21
235	235	brain metastases on the date that is the 22
236	236	earlier of— 23
237	237	‘‘(I) the day the course of cov-24
238	238	ered treatment is scheduled to end; or 25
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242	242	‘‘(II) the 30th day of the episode 1
243	243	of care. 2
244	244	‘‘(B) P
245	245	ATIENT DEATH.—If a covered indi-3
246	246	vidual dies during treatment, both episode of 4
247	247	care payments under subparagraphs (A) and 5
248	248	(B) shall be paid to the radiation therapy pro-6
249	249	vider or radiation therapy supplier not later 7
250	250	than 30 days after the day of the final delivery 8
251	251	of radiation therapy treatment to the covered 9
252	252	individual. 10
253	253	‘‘(C) C
254	254	ONSISTENCY OF PAYMENT .— 11
255	255	‘‘(i) I
256	256	N GENERAL.—The per episode 12
257	257	payment amount shall not change depend-13
258	258	ing on the site of service. 14
259	259	‘‘(ii) S
260	260	ITE OF SERVICE DEFINED .— 15
261	261	For the purposes of this subparagraph, the 16
262	262	term ‘site of service’ means the hospital 17
263	263	outpatient department or physician office 18
264	264	in which radiation therapy treatment is 19
265	265	furnished by the radiation therapy provider 20
266	266	or radiation therapy supplier. 21
267	267	‘‘(3) D
268	268	ETERMINATION OF PER EPISODE PAY -22
269	269	MENT AMOUNT.— 23
270	270	‘‘(A) I
271	271	N GENERAL.—The Secretary shall 24
272	272	determine a per episode payment amount for 25
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276	276	the professional component and technical com-1
277	277	ponent of treatment for each included cancer 2
278	278	type. 3
279	279	‘‘(B) A
280	280	MOUNT.—The Secretary shall deter-4
281	281	mine the per episode payment amount based on 5
282	282	national base rates, as described in subsection 6
283	283	(d)(1) and as updated in subsection (d)(2). 7
284	284	‘‘(C) A
285	285	DJUSTMENTS.—The per episode 8
286	286	payment amount shall be subject to— 9
287	287	‘‘(i) the adjustments as described in 10
288	288	subsection (d)(2) and (d)(3); 11
289	289	‘‘(ii) a geographic adjustment, as de-12
290	290	scribed in subsection (d)(3)(A); 13
291	291	‘‘(iii) an inflation adjustment, pursu-14
292	292	ant to which the Secretary shall adjust the 15
293	293	per episode payment amount by the per-16
294	294	centage increase in the Medicare Economic 17
295	295	Index (as described in section 1842 for the 18
296	296	professional component payments and the 19
297	297	applicable percentage increase in the Hos-20
298	298	pital Inpatient Market Basket Update (as 21
299	299	described in section 1886(b)(3)(B)(i)) for 22
300	300	the technical component payments during 23
301	301	each 12-month period, and which varies for 24
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305	305	the professional and technical components 1
306	306	of the service; 2
307	307	‘‘(iv) a savings adjustment, as de-3
308	308	scribed in subsection (d)(3)(B); 4
309	309	‘‘(v) a health equity achievement in 5
310	310	radiation therapy adjustment applicable 6
311	311	only to the technical component payments, 7
312	312	as described in subsection (g); and 8
313	313	‘‘(vi) a practice accreditation adjust-9
314	314	ment, as described in subsection (h), that 10
315	315	is only applicable to technical component 11
316	316	payments. 12
317	317	‘‘(c) T
318	318	REATMENT OF INCOMPLETE EPISODES OF 13
319	319	C
320	320	ARE; CONCURRENTTREATMENT.— 14
321	321	‘‘(1) I
322	322	NCOMPLETE EPISODE OF CARE .—In the 15
323	323	case of an incomplete episode of care, payment shall 16
324	324	be made to the radiation therapy provider or radi-17
325	325	ation therapy supplier for services furnished under 18
326	326	the physician fee schedule under section 1848 or the 19
327	327	hospital outpatient prospective payment system 20
328	328	under section 1833(t), as applicable. 21
329	329	‘‘(2) M
330	330	ULTIPLE EPISODES OF CARE FOR THE 22
331	331	SAME COVERED INDIVIDUAL .—A radiation therapy 23
332	332	provider or radiation therapy supplier may initiate a 24
333	333	new episode of care for the same beneficiary for the 25
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337	337	same course of therapy by providing another radi-1
338	338	ation therapy treatment planning service and billing 2
339	339	under an applicable radiation therapy planning trig-3
340	340	ger code (as defined in subsection (j)). 4
341	341	‘‘(3) C
342	342	ONCURRENT TREATMENTS .—In the case 5
343	343	where a treatment modality described in subsection 6
344	344	(j)(4)(B)(i)(I) is furnished to a covered individual 7
345	345	during an episode of care for an included cancer 8
346	346	type, payment may be made concurrently for the 9
347	347	treatment modality under the applicable payment 10
348	348	system under this title with per episode payment 11
349	349	under this section for covered treatment during the 12
350	350	episode of care. 13
351	351	‘‘(d) N
352	352	ATIONALBASERATE.— 14
353	353	‘‘(1) D
354	354	ETERMINATION OF NATIONAL BASE 15
355	355	RATES.—For purposes of the Secretary determining 16
356	356	the per episode payment amount under subsection 17
357	357	(b)(3), the national base rates for the professional 18
358	358	component and technical component of radiation 19
359	359	therapy services for each included cancer type are 20
360	360	based on the M-Code national base rates identified 21
361	361	in table 75 (including HCPCS Codes for radiation 22
362	362	therapy services and supplies) of the Federal Reg-23
363	363	ister on November 16, 2021, 86 Fed. Reg. 63458, 24
364	364	63925. 25
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368	368	‘‘(2) UPDATES TO THE NATIONAL BASE 1
369	369	RATES.— 2
370	370	‘‘(A) A
371	371	NNUAL UPDATES.— 3
372	372	‘‘(i) I
373	373	N GENERAL.—Subject to clause 4
374	374	(ii), the Secretary shall annually update 5
375	375	the initial national base rates by— 6
376	376	‘‘(I) in the case of the profes-7
377	377	sional component of the covered treat-8
378	378	ment, the percentage increase in the 9
379	379	Medicare Economic Index; and 10
380	380	‘‘(II) in the case of the technical 11
381	381	component of the covered treatment, 12
382	382	the applicable percentage increase de-13
383	383	scribed in section 1886(b)(3)(B)(i). 14
384	384	‘‘(ii) P
385	385	AYMENT FLOOR.—For each an-15
386	386	nual update, the Secretary shall not reduce 16
387	387	the national base rates below the estab-17
388	388	lished rates from the prior year. 18
389	389	‘‘(B) P
390	390	ERIODIC UPDATES.— 19
391	391	‘‘(i) I
392	392	N GENERAL.—The Secretary 20
393	393	shall, through notice and comment rule-21
394	394	making, rebase or revise the national base 22
395	395	rates in 5-year intervals, beginning on the 23
396	396	day that is 5 years after the date the regu-24
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400	400	lations issued pursuant to subsection 1
401	401	(a)(1) become effective. 2
402	402	‘‘(ii) R
403	403	EBASING LIMIT.—The Sec-3
404	404	retary shall not reduce the national base 4
405	405	rates through the process of rebasing by 5
406	406	more than 1 percent every 5 years. 6
407	407	‘‘(iii) I
408	408	NPUT FROM PROVIDERS AND 7
409	409	SUPPLIERS.—In rebasing or revising the 8
410	410	national base rates pursuant to clause (i), 9
411	411	the Secretary shall seek significant input 10
412	412	from radiation therapy providers, radiation 11
413	413	therapy suppliers, and other stakeholders 12
414	414	to ensure that such rates are sufficient, 13
415	415	particularly for any new technology or 14
416	416	service and any treatment modality de-15
417	417	scribed in clause (i)(I) of subsection 16
418	418	(j)(4)(B) that is determined to be a cov-17
419	419	ered treatment by the Secretary under 18
420	420	clause (ii) of such subsection. 19
421	421	‘‘(C) R
422	422	EBASE AND REVISE DEFINED .—In 20
423	423	this subsection: 21
424	424	‘‘(i) R
425	425	EBASE.—The term ‘rebase’ 22
426	426	means to move the base year for the struc-23
427	427	ture of costs of the national base rates. 24
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431	431	‘‘(ii) REVISE.—The term ‘revise’ 1
432	432	means types of changes to national base 2
433	433	rates other than rebasing, such as using 3
434	434	different data sources, cost categories, or 4
435	435	price proxies in the national base rates 5
436	436	input. 6
437	437	‘‘(D) N
438	438	EW TECHNOLOGY OR SERVICES .— 7
439	439	‘‘(i) T
440	440	REATMENT UNDER THE NA -8
441	441	TIONAL BASE RATES.— 9
442	442	‘‘(I) E
443	443	XCLUSION DURING INITIAL 10
444	444	PERIOD.—The Secretary shall not in-11
445	445	corporate a radiation therapy service 12
446	446	that is a new technology or service (as 13
447	447	defined in subsection (j)) into the na-14
448	448	tional base rates for an included can-15
449	449	cer type prior to the date that is 12 16
450	450	years after such service is first identi-17
451	451	fied as a new technology or service. 18
452	452	‘‘(II) I
453	453	NCORPORATION AFTER INI -19
454	454	TIAL PERIOD.—After the date speci-20
455	455	fied in subclause (I) with respect to a 21
456	456	radiation therapy service that is a new 22
457	457	technology or service, the Secretary 23
458	458	shall, through stakeholder meetings, 24
459	459	requests for information, and notice 25
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463	463	and comment rulemaking, engage pro-1
464	464	viders, suppliers, radiation therapy 2
465	465	vendors, patient groups, and the pub-3
466	466	lic on possible incorporation of the 4
467	467	new technology or service into the na-5
468	468	tional base rates for included cancer 6
469	469	types under paragraph (1). 7
470	470	‘‘(ii) B
471	471	EFORE INCORPORATION INTO 8
472	472	THE NATIONAL BASE RATE .—Until incor-9
473	473	porated into the national base rates under 10
474	474	clause (i)(II), any new technology or serv-11
475	475	ice shall be paid under the applicable pay-12
476	476	ment system under this title. 13
477	477	‘‘(iii) D
478	478	EVELOPMENT AND TRANSI -14
479	479	TIONAL PAYMENT PERIOD FOR ADAPTIVE 15
480	480	RADIATION THERAPY PLANNING .— 16
481	481	‘‘(I) D
482	482	EVELOPMENT AND VALU -17
483	483	ATION FOR ADAPTIVE RADIATION 18
484	484	THERAPY PLANNING .—Not later than 19
485	485	the date the regulations issued pursu-20
486	486	ant to subsection (a)(1) become effec-21
487	487	tive and in consultation with the 22
488	488	American Medical Association’s Cur-23
489	489	rent Procedural Terminology Editorial 24
490	490	Panel and Specialty Society Relative 25
491	491	VerDate Sep 11 2014 21:00 Mar 28, 2025 Jkt 059200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031
492	492	ssavage on LAPJG3WLY3PROD with BILLS 17
493	493	•S 1031 IS
494	494	Value Scale Update Committee, radi-1
495	495	ation oncology specialty societies, and 2
496	496	radiation oncology stakeholders, the 3
497	497	Secretary shall develop and value 4
498	498	codes for adaptive radiation therapy 5
499	499	planning (as defined in subsection 6
500	500	(j)). 7
501	501	‘‘(II) T
502	502	RANSITIONAL PAYMENT .— 8
503	503	‘‘(aa) I
504	504	N GENERAL.—During 9
505	505	the period beginning on the date 10
506	506	the regulations issued pursuant 11
507	507	to subsection (a)(1) become effec-12
508	508	tive and ending on the date any 13
509	509	adaptive radiation therapy plan-14
510	510	ning code is developed and val-15
511	511	ued, the Secretary shall provide a 16
512	512	separate payment under the ap-17
513	513	plicable payment system, in addi-18
514	514	tion to the per episode payment 19
515	515	amount, for any medically nec-20
516	516	essary online and offline adaptive 21
517	517	radiation therapy planning fur-22
518	518	nished to a covered individual 23
519	519	after the initial treatment plan 24
520	520	for a covered individual. 25
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522	522	ssavage on LAPJG3WLY3PROD with BILLS 18
523	523	•S 1031 IS
524	524	‘‘(bb) MODIFIER.—The Sec-1
525	525	retary shall establish a modifier 2
526	526	to identify claims for the transi-3
527	527	tional payment for adaptive radi-4
528	528	ation therapy planning for a cov-5
529	529	ered individual. 6
530	530	‘‘(iv) A
531	531	SSESSMENT OF CERTAIN CRI -7
532	532	TERIA.—Prior to incorporating a new tech-8
533	533	nology or service into the national base 9
534	534	rates pursuant to clause (i)(II), the Sec-10
535	535	retary shall consider market penetration 11
536	536	and adoption, costs relative to base rates, 12
537	537	clinical benefits of the new technology or 13
538	538	service, and the clear consensus of the 14
539	539	stakeholder community. 15
540	540	‘‘(3) A
541	541	DJUSTMENTS TO NATIONAL BASE 16
542	542	RATES.— 17
543	543	‘‘(A) G
544	544	EOGRAPHIC ADJUSTMENT .—Prior to 18
545	545	applying the savings adjustment described in 19
546	546	subparagraph (B), the Secretary shall adjust 20
547	547	the national base rates for local cost and wage 21
548	548	indices based on where the radiation therapy 22
549	549	services are furnished— 23
550	550	‘‘(i) in the case of the professional 24
551	551	component payment rates, the geographic 25
552	552	VerDate Sep 11 2014 21:00 Mar 28, 2025 Jkt 059200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031
553	553	ssavage on LAPJG3WLY3PROD with BILLS 19
554	554	•S 1031 IS
555	555	adjustment processes described in the 1
556	556	Medicare Physician Fee Schedule Geo-2
557	557	graphic Practice Cost Index; and 3
558	558	‘‘(ii) in the case of the technical com-4
559	559	ponent payment rates, the geographic ad-5
560	560	justment processes in the hospital out-6
561	561	patient prospective payment system under 7
562	562	section 1833(t). 8
563	563	‘‘(B) S
564	564	AVINGS ADJUSTMENT .— 9
565	565	‘‘(i) I
566	566	N GENERAL.—The Secretary 10
567	567	shall apply a savings adjustment under 11
568	568	this subparagraph after the geographic ad-12
569	569	justments have been applied under sub-13
570	570	paragraph (A). 14
571	571	‘‘(ii) S
572	572	AVINGS ADJUSTMENT DE -15
573	573	FINED.—The term ‘savings adjustment’ 16
574	574	means the percentage by which the profes-17
575	575	sional component and technical component 18
576	576	payment rates are each reduced to achieve 19
577	577	Medicare savings. 20
578	578	‘‘(e) A
579	579	VAILABILITY OFPAYMENTPLANS FORPAY-21
580	580	MENT OFCOINSURANCE.—Following the application of 22
581	581	the adjustments described in subsection (d), but before the 23
582	582	application of any sequestration order issued under the 24
583	583	Balanced Budget and Emergency Deficit Control Act of 25
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585	585	ssavage on LAPJG3WLY3PROD with BILLS 20
586	586	•S 1031 IS
587	587	1985 (2 U.S.C. 900 et seq.), radiation therapy providers 1
588	588	and radiation therapy suppliers shall collect coinsurance 2
589	589	for services furnished under the ROCR Program subject 3
590	590	to the following rules: 4
591	591	‘‘(1) I
592	592	N GENERAL.—Radiation therapy pro-5
593	593	viders and radiation therapy suppliers may collect 6
594	594	coinsurance applicable under subsection (b)(1) for 7
595	595	covered treatment furnished to a covered individual 8
596	596	under the ROCR Program in multiple installments 9
597	597	under a payment plan. 10
598	598	‘‘(2) L
599	599	IMITATION ON USE AS A MARKETING 11
600	600	TOOL.—Radiation therapy providers and radiation 12
601	601	therapy suppliers may not use the availability of 13
602	602	payment plans for such coinsurance as a marketing 14
603	603	tool to influence the choice of health care provider 15
604	604	by covered individuals. 16
605	605	‘‘(3) T
606	606	IMING OF PROVISIONS OF INFORMA -17
607	607	TION.—Radiation therapy providers and radiation 18
608	608	therapy suppliers offering a payment plan for such 19
609	609	coinsurance may inform the covered individual of the 20
610	610	availability of the payment plan prior to or during 21
611	611	the initial treatment planning session and as nec-22
612	612	essary thereafter. 23
613	613	‘‘(4) B
614	614	ENEFICIARY COINSURANCE PAYMENT .— 24
615	615	The beneficiary coinsurance payment shall equal 20 25
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617	617	ssavage on LAPJG3WLY3PROD with BILLS 21
618	618	•S 1031 IS
619	619	percent of the payment amount to be paid to the ra-1
620	620	diation therapy provider or radiation therapy sup-2
621	621	plier prior to the application of any sequestration 3
622	622	order issued under the Balanced Budget and Emer-4
623	623	gency Deficit Control Act of 1985 (2 U.S.C. 900 et 5
624	624	seq.) for the billed ROCR Program episode of care, 6
625	625	except as provided in paragraph (5). 7
626	626	‘‘(5) I
627	627	NCOMPLETE EPISODE OF CARE .—In the 8
628	628	case of an incomplete episode of care, the beneficiary 9
629	629	coinsurance payment shall equal 20 percent of the 10
630	630	amount that would have been paid in the absence of 11
631	631	the ROCR Program for the radiation therapy serv-12
632	632	ices furnished by the radiation therapy provider or 13
633	633	radiation therapy supplier that initiated the profes-14
634	634	sional component and, if applicable, the radiation 15
635	635	therapy provider or radiation therapy supplier that 16
636	636	initiated the technical component. 17
637	637	‘‘(f) M
638	638	ANDATORYPARTICIPATION.— 18
639	639	‘‘(1) I
640	640	N GENERAL.—Except as provided under 19
641	641	paragraph (2) or (3), a radiation therapy provider or 20
642	642	radiation therapy supplier that is participating in 21
643	643	the program under this title and furnishes a covered 22
644	644	treatment to a covered individual shall be required 23
645	645	to participate in the ROCR Program. 24
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647	647	ssavage on LAPJG3WLY3PROD with BILLS 22
648	648	•S 1031 IS
649	649	‘‘(2) CONCURRENT PARTICIPATION IN THE 1
650	650	ROCR PROGRAM AND OTHER MODELS .—A radiation 2
651	651	therapy provider or radiation therapy supplier that 3
652	652	is participating in a State-based Center for Medicare 4
653	653	& Medicaid Innovation model— 5
654	654	‘‘(A) shall not be prohibited from also par-6
655	655	ticipating in the ROCR Program; and 7
656	656	‘‘(B) is not required to participate in the 8
657	657	ROCR Program. 9
658	658	‘‘(3) S
659	659	IGNIFICANT HARDSHIP EXEMPTION .— 10
660	660	‘‘(A) I
661	661	N GENERAL.—The Secretary may, 11
662	662	on a case-by-case basis, exempt a radiation 12
663	663	therapy provider or radiation therapy supplier 13
664	664	from the ROCR Program if the Secretary de-14
665	665	termines that application of the program would 15
666	666	result in a significant hardship, such as in the 16
667	667	case of a natural disaster, for such radiation 17
668	668	therapy provider or radiation therapy supplier 18
669	669	or for beneficiaries in the geographic area of 19
670	670	the radiation therapy provider or radiation ther-20
671	671	apy supplier. 21
672	672	‘‘(B) P
673	673	ROCEDURE.—The Secretary shall 22
674	674	promulgate regulations, using the procedures 23
675	675	described in subsection (a)(5), regarding eligi-24
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677	677	ssavage on LAPJG3WLY3PROD with BILLS 23
678	678	•S 1031 IS
679	679	bility and the procedure for applying for a sig-1
680	680	nificant hardship exemption. 2
681	681	‘‘(g) H
682	682	EALTHEQUITYACHIEVEMENT INRADIATION 3
683	683	T
684	684	HERAPYADD-ONPAYMENT.— 4
685	685	‘‘(1) I
686	686	N GENERAL.—Pursuant to paragraph (2) 5
687	687	and subject to paragraph (7), the Secretary shall ad-6
688	688	just the per episode payment amount in the amount 7
689	689	of a health equity achievement in radiation therapy 8
690	690	add-on payment to advance health equity and sup-9
691	691	port covered individuals in accessing and completing 10
692	692	their radiation therapy treatments for covered treat-11
693	693	ments of included cancer types through the provision 12
694	694	of transportation services, subject to the succeeding 13
695	695	provisions of this subsection. 14
696	696	‘‘(2) E
697	697	LIGIBILITY.— 15
698	698	‘‘(A) I
699	699	N GENERAL.—The health equity 16
700	700	achievement in radiation therapy add-on pay-17
701	701	ment shall be made when the ICD–10 diagnosis 18
702	702	code Z59.82, transportation insecurity is re-19
703	703	ported pursuant to subparagraph (B). 20
704	704	‘‘(B) D
705	705	ETERMINATION OF REPORTING 21
706	706	CODE.—The radiation therapy provider or radi-22
707	707	ation therapy supplier shall follow the following 23
708	708	procedures to determine if the ICD–10 diag-24
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710	710	ssavage on LAPJG3WLY3PROD with BILLS 24
711	711	•S 1031 IS
712	712	nosis code Z59.82, transportation insecurity 1
713	713	needs to be reported: 2
714	714	‘‘(i) The radiation therapy provider or 3
715	715	radiation therapy supplier shall ask the pa-4
716	716	tient at the time of patient intake during 5
717	717	the initial patient consultation if, within 6
718	718	the previous 2 months, a lack of reliable 7
719	719	transportation has kept the patient from 8
720	720	attending medical appointments, meetings, 9
721	721	or work, or from completing activities of 10
722	722	daily living. 11
723	723	‘‘(ii) If the patient answers yes to the 12
724	724	question in clause (i), ICD–10 diagnosis 13
725	725	code Z59.82 shall be reported. 14
726	726	‘‘(3) A
727	727	MOUNT.—The health equity achievement 15
728	728	in radiation therapy add-on payment shall be in the 16
729	729	amount of— 17
730	730	‘‘(A) for services furnished during the year 18
731	731	following the date the regulations issued pursu-19
732	732	ant to subsection (a)(1) become effective, $500 20
733	733	per patient per episode of care; and 21
734	734	‘‘(B) for services furnished in subsequent 22
735	735	years, the amount determined under this para-23
736	736	graph for the preceding year, increased by $10. 24
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738	738	ssavage on LAPJG3WLY3PROD with BILLS 25
739	739	•S 1031 IS
740	740	‘‘(4) PAYMENT RECIPIENT.—The health equity 1
741	741	achievement in radiation therapy add-on payment 2
742	742	shall be paid to the radiation therapy provider or ra-3
743	743	diation therapy supplier that provides the technical 4
744	744	component of the radiation therapy services. 5
745	745	‘‘(5) N
746	746	OT TO BE USED IN ADDITION TO OR IN 6
747	747	LIEU OF OTHER SERVICES .—The health equity 7
748	748	achievement in radiation therapy add-on payment 8
749	749	shall not be made in addition to or in lieu of any 9
750	750	other State or Federal program benefits that may be 10
751	751	used for transportation services. 11
752	752	‘‘(6) D
753	753	OCUMENTATION.— 12
754	754	‘‘(A) I
755	755	N GENERAL.—Radiation therapy 13
756	756	providers and radiation therapy suppliers who 14
757	757	receive the health equity achievement in radi-15
758	758	ation therapy add-on payment shall maintain all 16
759	759	documentation related to the spending of such 17
760	760	payment on transportation services per covered 18
761	761	individual for a period of 5 years after the end 19
762	762	of the episode of care of the applicable covered 20
763	763	individual. 21
764	764	‘‘(B) A
765	765	VAILABILITY TO THE SECRETARY .— 22
766	766	The documentation described in subparagraph 23
767	767	(A) shall be made available to the Secretary 24
768	768	upon request. 25
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771	771	•S 1031 IS
772	772	‘‘(7) NO MODIFICATION OF COINSURANCE .— 1
773	773	The Secretary may not modify any coinsurance obli-2
774	774	gation when implementing the health equity achieve-3
775	775	ment in radiation therapy add-on payment. 4
776	776	‘‘(h) Q
777	777	UALITYINCENTIVES IN THE ROCR VALUE 5
778	778	B
779	779	ASEDPAYMENTPROGRAM.— 6
780	780	‘‘(1) I
781	781	N GENERAL.— 7
782	782	‘‘(A) I
783	783	NITIAL INCREASE IN PAYMENT .— 8
784	784	With respect to covered treatment for an in-9
785	785	cluded cancer type furnished to a covered indi-10
786	786	vidual on or after the date the regulations 11
787	787	issued pursuant to subsection (a)(1) become ef-12
788	788	fective and before the date that is 2 years after 13
789	789	such date, in the case of a radiation therapy 14
790	790	provider or radiation therapy supplier that 15
791	791	meets the requirements described in paragraph 16
792	792	(2), payments otherwise made to such radiation 17
793	793	therapy provider or radiation therapy supplier 18
794	794	under the ROCR Program for the technical 19
795	795	component of such services shall be increased 20
796	796	by 1 percent (or 0.25 percent in the case of 21
797	797	such a provider or supplier that is a limited re-22
798	798	source radiation therapy supplier or limited re-23
799	799	source radiation therapy provider). 24
800	800	‘‘(B) R
801	801	EDUCTION IN PAYMENT .— 25
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803	803	ssavage on LAPJG3WLY3PROD with BILLS 27
804	804	•S 1031 IS
805	805	‘‘(i) IN GENERAL.—Subject to clause 1
806	806	(ii), with respect to covered treatment for 2
807	807	an included cancer type furnished to a cov-3
808	808	ered individual on or after the date that is 4
809	809	2 years after the regulations issued pursu-5
810	810	ant to subsection (a)(1) become effective, 6
811	811	in the case of a radiation therapy provider 7
812	812	or radiation therapy supplier that does not 8
813	813	meet the requirements described in para-9
814	814	graph (2), the per episode payment to such 10
815	815	provider or supplier under the ROCR Pro-11
816	816	gram shall be reduced by 2.5 percent. 12
817	817	‘‘(ii) E
818	818	XCLUSION OF LIMITED RE -13
819	819	SOURCE RADIATION THERAPY PROVIDERS 14
820	820	AND LIMITED RESOURCE RADIATION THER -15
821	821	APY SUPPLIERS.—This subparagraph shall 16
822	822	not apply with respect to a limited resource 17
823	823	radiation therapy provider or a limited re-18
824	824	source radiation therapy supplier. 19
825	825	‘‘(C) D
826	826	EFINITION OF LIMITED RESOURCE 20
827	827	RADIATION THERAPY PROVIDER AND LIMITED 21
828	828	RESOURCE RADIATION THERAPY SUPPLIER .— 22
829	829	‘‘(i) I
830	830	N GENERAL.—In this subsection, 23
831	831	the terms ‘limited resource radiation ther-24
832	832	apy provider’ and ‘limited resource radi-25
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835	835	•S 1031 IS
836	836	ation therapy supplier’ mean, with respect 1
837	837	to a radiation therapy provider or radiation 2
838	838	therapy supplier, a provider or supplier 3
839	839	that meets the criteria specified by the 4
840	840	Secretary that may include criteria relating 5
841	841	to the volume and socioeconomic status of 6
842	842	patients treated by the radiation therapy 7
843	843	provider or radiation therapy supplier, the 8
844	844	geographic area or medically-underserved 9
845	845	area served by the radiation therapy pro-10
846	846	vider or radiation therapy supplier, includ-11
847	847	ing rural areas, or such other criteria as 12
848	848	the Secretary determines is appropriate, 13
849	849	through notice and comment rulemaking 14
850	850	and in consultation with radiation therapy 15
851	851	stakeholder organizations. 16
852	852	‘‘(ii) C
853	853	AP ON NUMBER OF LIMITED 17
854	854	RESOURCE RADIATION THERAPY PRO -18
855	855	VIDERS AND LIMITED RESOURCE RADI -19
856	856	ATION THERAPY SUPPLIERS .—In speci-20
857	857	fying the criteria for limited resource radi-21
858	858	ation therapy providers and limited re-22
859	859	source radiation therapy suppliers under 23
860	860	clause (i), the Secretary shall ensure that 24
861	861	the total number of such providers and 25
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864	864	•S 1031 IS
865	865	suppliers does not exceed 10 percent of the 1
866	866	total number of all radiation therapy pro-2
867	867	viders and radiation therapy suppliers. 3
868	868	‘‘(2) A
869	869	CCREDITATION REQUIREMENTS .— 4
870	870	‘‘(A) I
871	871	N GENERAL.—The requirements de-5
872	872	scribed in this subparagraph with respect to a 6
873	873	radiation therapy provider or radiation therapy 7
874	874	supplier (other than such a provider or supplier 8
875	875	that is a limited resource radiation therapy pro-9
876	876	vider or limited resource radiation therapy sup-10
877	877	plier) are that the supplier or provider must— 11
878	878	‘‘(i) maintain or be in the process of 12
879	879	obtaining accreditation by the American 13
880	880	College of Radiology, American College of 14
881	881	Radiation Oncology, or American Society 15
882	882	for Radiation Oncology (referred to in this 16
883	883	section as ‘covered radiation oncology ac-17
884	884	creditation organizations’); 18
885	885	‘‘(ii) comply with certified electronic 19
886	886	health record technology requirements as 20
887	887	determined by the Secretary with excep-21
888	888	tions that are consistent with those of the 22
889	889	Merit-Based Incentive Payment System es-23
890	890	tablished under section 1848(q); and 24
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893	893	•S 1031 IS
894	894	‘‘(iii) submit to the Secretary proof of 1
895	895	the accreditation described in clause (i) in 2
896	896	such form and manner as specified by the 3
897	897	Secretary. 4
898	898	‘‘(B) R
899	899	EQUIREMENTS FOR LIMITED RE -5
900	900	SOURCE RADIATION THERAPY PROVIDERS AND 6
901	901	LIMITED RESOURCE RADIATION THERAPY SUP -7
902	902	PLIERS.—A radiation therapy provider or radi-8
903	903	ation therapy supplier that is a limited resource 9
904	904	radiation therapy provider or limited resource 10
905	905	radiation therapy supplier may elect to satisfy 11
906	906	the accreditation requirement under this para-12
907	907	graph by— 13
908	908	‘‘(i) meeting the requirements of sub-14
909	909	paragraph (A); 15
910	910	‘‘(ii) using an external audit that en-16
911	911	compasses similar criteria as a nationally 17
912	912	recognized radiation oncology accreditation 18
913	913	organization and submit the outcome of 19
914	914	such external audit to the Secretary; or 20
915	915	‘‘(iii) complying with certified elec-21
916	916	tronic health record technology require-22
917	917	ments as determined by the Secretary with 23
918	918	exceptions that are consistent with those of 24
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920	920	ssavage on LAPJG3WLY3PROD with BILLS 31
921	921	•S 1031 IS
922	922	the Merit-Based Incentives Payment Sys-1
923	923	tem established under section 1848(q). 2
924	924	‘‘(C) N
925	925	EW PROVIDERS.—A new radiation 3
926	926	therapy provider or new radiation supplier shall 4
927	927	complete an initiation of accreditation or exter-5
928	928	nal audit not later than the date that is 1 year 6
929	929	after such provider or supplier begins fur-7
930	930	nishing covered treatment to covered individ-8
931	931	uals. 9
932	932	‘‘(D) R
933	933	ADIATION ONCOLOGY ACCREDITA -10
934	934	TION ORGANIZATION QUALITY STANDARDS .— 11
935	935	Each covered radiation oncology accreditation 12
936	936	organization (and any successor organization) 13
937	937	shall develop quality standards for radiation 14
938	938	therapy providers and radiation therapy sup-15
939	939	pliers to ensure covered treatments are deliv-16
940	940	ered using adequate and modern linear accel-17
941	941	erator technology, staffing, and other compo-18
942	942	nents that protect patient safety and quality 19
943	943	by— 20
944	944	‘‘(i) consulting with radiation therapy 21
945	945	manufacturers and key stakeholders; 22
946	946	‘‘(ii) soliciting public comment on pro-23
947	947	posed quality standards, including from 24
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950	950	•S 1031 IS
951	951	physicians, medical physicists, and other 1
952	952	health professionals and experts; 2
953	953	‘‘(iii) updating quality standards not 3
954	954	later than every 5 to 7 years in partner-4
955	955	ship with stakeholders; 5
956	956	‘‘(iv) ensuring quality standards for 6
957	957	linear accelerator technology are adequate 7
958	958	and on par with current technological ad-8
959	959	vances and modern requirements for staff-9
960	960	ing and other procedures associated with 10
961	961	the delivery of safe and effective radiation 11
962	962	therapy; 12
963	963	‘‘(v) collecting timely information 13
964	964	from radiation therapy providers and radi-14
965	965	ation therapy suppliers for each linear ac-15
966	966	celerator owned or used on or after the ef-16
967	967	fective date of the regulations issued pur-17
968	968	suant to subsection (a)(1); and 18
969	969	‘‘(vi) giving sufficient weight to com-19
970	970	pliance with quality standards among other 20
971	971	accreditation standards in determining ac-21
972	972	creditation status for radiation therapy 22
973	973	providers or radiation therapy suppliers. 23
974	974	‘‘(i) R
975	975	EPORTINGREQUIREMENTS.— 24
976	976	VerDate Sep 11 2014 21:00 Mar 28, 2025 Jkt 059200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031
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978	978	•S 1031 IS
979	979	‘‘(1) REPORT ON THE ROCR PROGRAM .—Not 1
980	980	earlier than 7 years after the date of the enactment 2
981	981	of this section, the Comptroller General of the 3
982	982	United States (referred to in this subsection as the 4
983	983	‘Comptroller General’) shall, after seeking out the 5
984	984	perspectives of radiation oncology stakeholders, sub-6
985	985	mit to the appropriate committees of jurisdiction of 7
986	986	the Senate and the House of Representatives a re-8
987	987	port that— 9
988	988	‘‘(A) evaluates— 10
989	989	‘‘(i) the implementation of the ROCR 11
990	990	Program, and the impact such Program 12
991	991	has had on Federal healthcare spending; 13
992	992	‘‘(ii) the impact the ROCR Program 14
993	993	has had on the ability of covered individ-15
994	994	uals to access covered treatment; 16
995	995	‘‘(iii) whether any cancer types or ra-17
996	996	diation therapy services, such as 18
997	997	brachytherapy, proton therapy, or thera-19
998	998	peutic radiopharmaceuticals, should be 20
999	999	added or removed from the ROCR Pro-21
1000	1000	gram; and 22
1001	1001	‘‘(iv) the potential application of the 23
1002	1002	ROCR Program to benefits provided under 24
1003	1003	part C of this title; and 25
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1006	1006	•S 1031 IS
1007	1007	‘‘(B) includes any recommendations for ad-1
1008	1008	ministrative and legislative changes. 2
1009	1009	‘‘(2) R
1010	1010	EPORT ON ACCESS TO RADIATION THER -3
1011	1011	APY IN RURAL AND UNDERSERVED AREAS .—Not 4
1012	1012	later than 3 years after the date of the enactment 5
1013	1013	of this section, the Comptroller General shall submit 6
1014	1014	a report to the appropriate committees of jurisdic-7
1015	1015	tion of the Senate and the House of Representatives 8
1016	1016	that identifies the following: 9
1017	1017	‘‘(A) Radiation therapy deserts. 10
1018	1018	‘‘(B) Methods to increase access to new ra-11
1019	1019	diation therapy technologies in rural and under-12
1020	1020	served areas, including technologies required for 13
1021	1021	clinical treatment planning, simulation, dosim-14
1022	1022	etry, medical radiation physics, radiation treat-15
1023	1023	ment devices, radiation treatment delivery, radi-16
1024	1024	ation treatment management, and such other 17
1025	1025	items as the Comptroller General may deter-18
1026	1026	mine are medically necessary. 19
1027	1027	‘‘(C) A program to provide assistance in 20
1028	1028	the form of grants or loans to radiation therapy 21
1029	1029	providers or radiation therapy suppliers for the 22
1030	1030	purpose of ensuring access to the most current 23
1031	1031	radiation therapy technology. 24
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1034	1034	•S 1031 IS
1035	1035	‘‘(3) DETERMINATION AND DEFINITION OF RA -1
1036	1036	DIATION THERAPY DESERTS .— 2
1037	1037	‘‘(A) D
1038	1038	EFINITION.—For purposes of this 3
1039	1039	subsection, the term ‘radiation therapy desert’ 4
1040	1040	means a region determined by the Comptroller 5
1041	1041	General under subparagraph (B) with a mis-6
1042	1042	match between radiation therapy resources and 7
1043	1043	oncologic need. 8
1044	1044	‘‘(B) D
1045	1045	ETERMINATION.—In determining 9
1046	1046	whether a region qualifies as a radiation ther-10
1047	1047	apy desert, the Comptroller General shall take 11
1048	1048	into account the ratio or density of radiation 12
1049	1049	therapy providers and radiation therapy sup-13
1050	1050	pliers practicing in a geographic area as com-14
1051	1051	pared to the population size in that geographic 15
1052	1052	area. 16
1053	1053	‘‘(j) D
1054	1054	EFINITIONS.—In this section: 17
1055	1055	‘‘(1) A
1056	1056	DAPTIVE RADIATION THERAPY PLAN -18
1057	1057	NING.—The term ‘adaptive radiation therapy plan-19
1058	1058	ning’ means any new technology or services identi-20
1059	1059	fied, as of the date that the regulations issued pur-21
1060	1060	suant to subsection (a)(1) become effective, by the 22
1061	1061	following HCPCS codes (and as subsequently modi-23
1062	1062	fied by the Secretary) performed after the initial 24
1063	1063	treatment plan for a covered individual: 25
1064	1064	VerDate Sep 11 2014 21:00 Mar 28, 2025 Jkt 059200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031
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1066	1066	•S 1031 IS
1067	1067	‘‘(A) 77295, 3-dimensional radiotherapy 1
1068	1068	plan, including dose-volume histograms. 2
1069	1069	‘‘(B) 77300, basic radiation dosimetry cal-3
1070	1070	culation, central axis depth dose calculation, 4
1071	1071	TDF, NSD, gap calculation, off axis factor, tis-5
1072	1072	sue inhomogeneity factors, calculation of non- 6
1073	1073	ionizing radiation surface and depth dose, as re-7
1074	1074	quired during course of treatment, only when 8
1075	1075	prescribed by the treating physician. 9
1076	1076	‘‘(C) 77301, intensity modulated radio-10
1077	1077	therapy plan, including dose-volume histograms 11
1078	1078	for target and critical structure partial toler-12
1079	1079	ance specifications. 13
1080	1080	‘‘(D) 77338, multi-leaf collimator (MLC) 14
1081	1081	devices for intensity modulated radiation ther-15
1082	1082	apy (IMRT), design and construction per IMRT 16
1083	1083	plan. 17
1084	1084	‘‘(E) 77334, Treatment devices, design 18
1085	1085	and construction; complex (irregular blocks, 19
1086	1086	special shields, compensators, wedges, molds or 20
1087	1087	casts). 21
1088	1088	‘‘(F) 77293, Respiratory motion manage-22
1089	1089	ment simulation (List separately in addition to 23
1090	1090	code for primary procedure). 24
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1092	1092	ssavage on LAPJG3WLY3PROD with BILLS 37
1093	1093	•S 1031 IS
1094	1094	‘‘(2) APPLICABLE RADIATION THERAPY PLAN -1
1095	1095	NING TRIGGER CODE .—The term ‘applicable radi-2
1096	1096	ation therapy planning trigger code’ means services 3
1097	1097	identified, as of the date that the regulations issued 4
1098	1098	pursuant to subsection (a)(1) become effective, by 5
1099	1099	the following HCPCS codes (and as subsequently 6
1100	1100	modified by the Secretary): 7
1101	1101	‘‘(A) 77261, therapeutic radiology treat-8
1102	1102	ment planning, simple. 9
1103	1103	‘‘(B) 77262, therapeutic radiology treat-10
1104	1104	ment planning, intermediate. 11
1105	1105	‘‘(C) 77263, therapeutic radiology treat-12
1106	1106	ment planning, complex. 13
1107	1107	‘‘(3) C
1108	1108	OVERED INDIVIDUAL .—The term ‘cov-14
1109	1109	ered individual’ means an individual who— 15
1110	1110	‘‘(A) is enrolled for benefits under part B; 16
1111	1111	‘‘(B) is not enrolled in a Medicare Advan-17
1112	1112	tage plan under part C or a PACE program 18
1113	1113	under section 1894; and 19
1114	1114	‘‘(C) is diagnosed with an included cancer 20
1115	1115	type. 21
1116	1116	‘‘(4) C
1117	1117	OVERED TREATMENT .— 22
1118	1118	‘‘(A) I
1119	1119	N GENERAL.—The term ‘covered 23
1120	1120	treatment’ means, subject to subparagraph (B), 24
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1123	1123	•S 1031 IS
1124	1124	radiation therapy services furnished to a cov-1
1125	1125	ered individual. 2
1126	1126	‘‘(B) E
1127	1127	XCLUSIONS.— 3
1128	1128	‘‘(i) I
1129	1129	N GENERAL.—Such term does 4
1130	1130	not include— 5
1131	1131	‘‘(I) subject to clause (ii), during 6
1132	1132	the period beginning on the date on 7
1133	1133	which the regulation issued pursuant 8
1134	1134	to subsection (a)(1) become effective 9
1135	1135	and ending on the date that is 12 10
1136	1136	years after such date, brachytherapy, 11
1137	1137	proton beam radiation therapy serv-12
1138	1138	ices, intraoperative radiotherapy, su-13
1139	1139	perficial radiation therapy, 14
1140	1140	hyperthermia, and therapeutic radio-15
1141	1141	pharmaceuticals; 16
1142	1142	‘‘(II) inpatient radiation therapy 17
1143	1143	services furnished in a subsection (d) 18
1144	1144	hospital or ambulatory surgical center; 19
1145	1145	‘‘(III) radiation therapy services 20
1146	1146	furnished in cancer hospitals that are 21
1147	1147	exempt from the hospital outpatient 22
1148	1148	prospective payment system under 23
1149	1149	section 1833(t); 24
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1152	1152	•S 1031 IS
1153	1153	‘‘(IV) physician services that are 1
1154	1154	furnished or supervised by the physi-2
1155	1155	cian or the physician practice fur-3
1156	1156	nishing radiation therapy or by an-4
1157	1157	other physician, including any surgical 5
1158	1158	procedures, chemotherapy, and other 6
1159	1159	services; 7
1160	1160	‘‘(V) physician and technical 8
1161	1161	services that are furnished using tech-9
1162	1162	nology represented by Healthcare 10
1163	1163	Common Procedure Coding System 11
1164	1164	codes that are not included in the M- 12
1165	1165	code national base rates identified in 13
1166	1166	table 75 (including in HCPCS Codes 14
1167	1167	for radiation therapy services and 15
1168	1168	supplies) of the Federal Register on 16
1169	1169	November 16, 2021, 86 Fed. Reg. 17
1170	1170	63485, 63925; or 18
1171	1171	‘‘(VI) durable medical equipment 19
1172	1172	(as defined in section 1861(n)). 20
1173	1173	‘‘(ii) I
1174	1174	NCLUSION OF CERTAIN TREAT -21
1175	1175	MENT.—After the date that is 12 years 22
1176	1176	after the date on which the regulation 23
1177	1177	issued pursuant to subsection (a)(1) be-24
1178	1178	come effective, the Secretary may deter-25
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1181	1181	•S 1031 IS
1182	1182	mine by regulation to include any of the 1
1183	1183	treatment modalities described in clause 2
1184	1184	(i)(I) as covered treatment. Before making 3
1185	1185	such determination, the Secretary shall— 4
1186	1186	‘‘(I) consider— 5
1187	1187	‘‘(aa) market penetration; 6
1188	1188	‘‘(bb) the cost of such items 7
1189	1189	or services relative to base rates; 8
1190	1190	‘‘(cc) the clinical benefits of 9
1191	1191	such items or services; and 10
1192	1192	‘‘(dd) the clear consensus of 11
1193	1193	the stakeholder community; and 12
1194	1194	‘‘(II) publish a notice of a pro-13
1195	1195	posed determination under subsection 14
1196	1196	(b)(3)(B) regarding the payment 15
1197	1197	amount proposed to be established 16
1198	1198	with respect to such item or service. 17
1199	1199	‘‘(5) E
1200	1200	PISODE OF CARE.—The term ‘episode of 18
1201	1201	care’ means, with respect to a covered individual, the 19
1202	1202	period— 20
1203	1203	‘‘(A) beginning on the day radiation ther-21
1204	1204	apy planning for an included cancer type, billed 22
1205	1205	under an applicable radiation therapy planning 23
1206	1206	trigger code, is furnished to a covered indi-24
1207	1207	vidual if radiation therapy treatment is initiated 25
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1210	1210	•S 1031 IS
1211	1211	not later than 30 days after the day such radi-1
1212	1212	ation therapy planning service is furnished; and 2
1213	1213	‘‘(B) ends— 3
1214	1214	‘‘(i) for treatment of all included can-4
1215	1215	cer types except bone and brain metastases 5
1216	1216	treatment, the day that is 90 days after 6
1217	1217	the day the episode of care begins under 7
1218	1218	clause (i); and 8
1219	1219	‘‘(ii) for bone and brain metastases 9
1220	1220	treatment, the day that is 30 days after 10
1221	1221	the day the episode of care begins under 11
1222	1222	clause (i). 12
1223	1223	‘‘(6) I
1224	1224	NCLUDED CANCER TYPES .—The term ‘in-13
1225	1225	cluded cancer type’ means any of the following types 14
1226	1226	of cancer: 15
1227	1227	‘‘(A) Anal. 16
1228	1228	‘‘(B) Bladder. 17
1229	1229	‘‘(C) Bone Metastases. 18
1230	1230	‘‘(D) Brain Metastases. 19
1231	1231	‘‘(E) Breast. 20
1232	1232	‘‘(F) Cervical. 21
1233	1233	‘‘(G) Central Nervous System Tumors. 22
1234	1234	‘‘(H) Colorectal. 23
1235	1235	‘‘(I) Head and Neck. 24
1236	1236	‘‘(J) Lung. 25
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1239	1239	•S 1031 IS
1240	1240	‘‘(K) Lymphoma. 1
1241	1241	‘‘(L) Pancreatic. 2
1242	1242	‘‘(M) Prostate. 3
1243	1243	‘‘(N) Upper Gastrointestinal. 4
1244	1244	‘‘(O) Uterine. 5
1245	1245	‘‘(7) H
1246	1246	EALTHCARE COMMON PROCEDURE COD -6
1247	1247	ING SYSTEM.—The term ‘Healthcare Common Pro-7
1248	1248	cedure Coding System’ means the standardized cod-8
1249	1249	ing system used by Medicare and other health insur-9
1250	1250	ance programs to ensure that claims are processed 10
1251	1251	in an orderly and consistent manner. 11
1252	1252	‘‘(8) I
1253	1253	NCOMPLETE EPISODE OF CARE .—The 12
1254	1254	term ‘incomplete episode of care’ means, with re-13
1255	1255	spect to a covered individual, an episode of care that 14
1256	1256	is not completed because— 15
1257	1257	‘‘(A) the individual being treated ceases to 16
1258	1258	be a covered individual, including in the case 17
1259	1259	where the individual loses benefits under this 18
1260	1260	title, at any time after the initial treatment 19
1261	1261	planning service is furnished and before the epi-20
1262	1262	sode of care for the covered treatment is com-21
1263	1263	plete; or 22
1264	1264	‘‘(B) a covered individual switches radi-23
1265	1265	ation therapy provider or radiation therapy sup-24
1266	1266	plier before all included radiation therapy serv-25
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1269	1269	•S 1031 IS
1270	1270	ices in the episode of care for the covered treat-1
1271	1271	ment have been furnished. 2
1272	1272	‘‘(9) N
1273	1273	EW TECHNOLOGY OR SERVICES .—The 3
1274	1274	term ‘new technology or services’ means any tech-4
1275	1275	nology or services that, after the date of enactment 5
1276	1276	of this section, receives a Category 1 Current Proce-6
1277	1277	dural Terminology code or is established in the year-7
1278	1278	ly update to the Medicare physician fee schedule di-8
1279	1279	rect practice expense inputs or any successor reposi-9
1280	1280	tory of the direct practice expense input for the de-10
1281	1281	livery of radiation therapy services. 11
1282	1282	‘‘(10) P
1283	1283	ROFESSIONAL COMPONENT .—The term 12
1284	1284	‘professional component’ means the included radi-13
1285	1285	ation therapy services that may only be furnished by 14
1286	1286	a physician. 15
1287	1287	‘‘(11) R
1288	1288	ADIATION THERAPY.—The term ‘radi-16
1289	1289	ation therapy’ means the careful use of various 17
1290	1290	forms of radiation, such as external beam radiation 18
1291	1291	therapy, to treat cancer and other diseases safely 19
1292	1292	and effectively. 20
1293	1293	‘‘(12) R
1294	1294	ADIATION THERAPY PROVIDER .—The 21
1295	1295	term ‘radiation therapy provider’ means a hospital 22
1296	1296	outpatient department enrolled under this title that 23
1297	1297	furnishes radiation therapy services. 24
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1301	1301	‘‘(13) RADIATION THERAPY SERVICES .—The 1
1302	1302	term ‘radiation therapy services’ means the treat-2
1303	1303	ment planning, technical preparation, special serv-3
1304	1304	ices (such as simulation), treatment delivery, and 4
1305	1305	treatment management services associated with can-5
1306	1306	cer treatment that uses high doses of radiation to 6
1307	1307	kill cancer cells and shrink tumors. 7
1308	1308	‘‘(14) R
1309	1309	ADIATION THERAPY SUPPLIER .—The 8
1310	1310	term ‘radiation therapy supplier’ means a physician 9
1311	1311	group practice or freestanding radiation therapy cen-10
1312	1312	ter enrolled under this title that furnishes radiation 11
1313	1313	therapy services. 12
1314	1314	‘‘(15) T
1315	1315	ECHNICAL COMPONENT .—The term 13
1316	1316	‘technical component’ means the included radiation 14
1317	1317	therapy services that are not furnished by a physi-15
1318	1318	cian, including the provision of equipment, supplies, 16
1319	1319	personnel, and administrative costs related to radi-17
1320	1320	ation therapy services. 18
1321	1321	‘‘(16) T
1322	1322	RANSPORTATION SERVICES .—The term 19
1323	1323	‘transportation services’ means the provision of free 20
1324	1324	or discounted transportation made available to cov-21
1325	1325	ered individuals furnished covered treatment which 22
1326	1326	are not air, luxury, or ambulance-level transpor-23
1327	1327	tation, but may include car services, ride shares, au-24
1328	1328	tonomous vehicles, or public transportation.’’. 25
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1332	1332	(b) EXCLUSION OF PARTICIPATINGRADIATION 1
1333	1333	T
1334	1334	HERAPYPROVIDERS, RADIATIONTHERAPYSUPPLIERS, 2
1335	1335	ANDPHYSICIANSFROM THEMERIT-BASEDINCENTIVE 3
1336	1336	P
1337	1337	AYMENTSYSTEM.—Section 1848(q)(1)(C)(ii) of the So-4
1338	1338	cial Security Act (42 U.S.C. 1395w–4(q)(1)(c)(II)) is 5
1339	1339	amended— 6
1340	1340	(1) in subclause (II), by striking ‘‘or’’ at the 7
1341	1341	end; 8
1342	1342	(2) in subclause (III), by striking the period at 9
1343	1343	the end and inserting ‘‘; or’’; and 10
1344	1344	(3) by adding at the end the following new sub-11
1345	1345	clause: 12
1346	1346	‘‘(IV) is a radiation therapy pro-13
1347	1347	vider or radiation therapy supplier (as 14
1348	1348	those terms are defined in subsection 15
1349	1349	(j) of section1899C) that is partici-16
1350	1350	pating in the Radiation Oncology Case 17
1351	1351	Rate Value Based Payment Program 18
1352	1352	established under that section.’’. 19
1353	1353	SEC. 4. REVISION TO CIVIL MONETARY PENALTIES RE-20
1354	1354	GARDING RADIATION ONCOLOGY CASE RATE 21
1355	1355	PATIENT TRANSPORTATION SERVICES. 22
1356	1356	Section 1128A of the Social Security Act (42 U.S.C. 23
1357	1357	1320a–7a) is amended— 24
1358	1358	(1) in subsection (i)(6)— 25
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1362	1362	(A) in subparagraph (I), by striking ‘‘or’’ 1
1363	1363	at the end; 2
1364	1364	(B) in subparagraph (J)(iii), by striking 3
1365	1365	the period at the end and inserting ‘‘; or’’; and 4
1366	1366	(C) by adding at the end the following new 5
1367	1367	subparagraph: 6
1368	1368	‘‘(K) the provision of transportation serv-7
1369	1369	ices by an eligible entity, as defined in sub-8
1370	1370	section (t), if— 9
1371	1371	‘‘(i) the availability of the transpor-10
1372	1372	tation services— 11
1373	1373	‘‘(I) is set forth in a policy that 12
1374	1374	the eligible entity, as defined in sub-13
1375	1375	section (t), applies uniformly and con-14
1376	1376	sistently; and 15
1377	1377	‘‘(II) is not determined in a man-16
1378	1378	ner related to the past or anticipated 17
1379	1379	volume or value of Federal health care 18
1380	1380	program business; 19
1381	1381	‘‘(ii) the eligible entity does not pub-20
1382	1382	licly market or advertise the transportation 21
1383	1383	services; 22
1384	1384	‘‘(iii) the driver who provides the 23
1385	1385	transportation services does not market 24
1386	1386	health care items or services during the 25
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1390	1390	course of the transportation or at any 1
1391	1391	time; 2
1392	1392	‘‘(iv) the driver or individual arrang-3
1393	1393	ing for the transportation services is not 4
1394	1394	paid on a per-beneficiary-transported basis; 5
1395	1395	‘‘(v) the eligible entity makes the 6
1396	1396	transportation services available only to an 7
1397	1397	individual who— 8
1398	1398	‘‘(I) is an established patient, as 9
1399	1399	defined in subsection (t), of the eligi-10
1400	1400	ble entity that is providing or facili-11
1401	1401	tating free or discounted transpor-12
1402	1402	tation; 13
1403	1403	‘‘(II) resides— 14
1404	1404	‘‘(aa) within a 75-mile-ra-15
1405	1405	dius of the radiation therapy pro-16
1406	1406	vider or radiation therapy sup-17
1407	1407	plier to or from which the patient 18
1408	1408	would be transported; or 19
1409	1409	‘‘(bb) in a rural area, as de-20
1410	1410	fined in subsection (t); and 21
1411	1411	‘‘(III) is receiving radiation ther-22
1412	1412	apy services for the purpose of obtain-23
1413	1413	ing medically necessary items and 24
1414	1414	services; and 25
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1418	1418	‘‘(vi) the eligible entity that makes the 1
1419	1419	transportation services available bears the 2
1420	1420	costs of the transportation services and 3
1421	1421	does not shift the burden of those costs 4
1422	1422	onto any Federal health care program, 5
1423	1423	other payers, or individuals.’’; and 6
1424	1424	(2) by adding at the end the following new sub-7
1425	1425	section: 8
1426	1426	‘‘(t) For purposes of subsection (i)(6)(K), the fol-9
1427	1427	lowing definitions apply: 10
1428	1428	‘‘(1) The term ‘eligible entity’ means any indi-11
1429	1429	vidual or entity, or any individual or entity acting on 12
1430	1430	behalf of such individual or entity that does not sup-13
1431	1431	ply health care items as the primary occupation of 14
1432	1432	the individual or entity. 15
1433	1433	‘‘(2) The term ‘established patient’ means an 16
1434	1434	individual who— 17
1435	1435	‘‘(A) has selected and scheduled an ap-18
1436	1436	pointment with a radiation therapy provider or 19
1437	1437	radiation therapy supplier; or 20
1438	1438	‘‘(B) has attended an appointment with 21
1439	1439	such provider or supplier. 22
1440	1440	‘‘(3) The terms ‘radiation therapy provider’, 23
1441	1441	‘radiation therapy services’, and ‘radiation therapy 24
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1444	1444	•S 1031 IS
1445	1445	supplier’ have the meaning given such terms in sec-1
1446	1446	tion 1866G(j). 2
1447	1447	‘‘(4) The term ‘rural area’ means an area that 3
1448	1448	is not an urban area. 4
1449	1449	‘‘(5) The term ‘transportation services’— 5
1450	1450	‘‘(A) means the provision of free or dis-6
1451	1451	counted transportation made available to Fed-7
1452	1452	eral health care program beneficiaries receiving 8
1453	1453	radiation therapy services; 9
1454	1454	‘‘(B) includes car services, ride shares, and 10
1455	1455	public transportation; and 11
1456	1456	‘‘(C) does not include air, luxury, or ambu-12
1457	1457	lance-level transportation. 13
1458	1458	‘‘(6) The term ‘urban area’ means— 14
1459	1459	‘‘(A) a Metropolitan Statistical Area or 15
1460	1460	New England County Metropolitan Area, as de-16
1461	1461	fined by the Office of Management and Budget; 17
1462	1462	‘‘(B) Litchfield County, Connecticut; 18
1463	1463	‘‘(C) York County, Maine; 19
1464	1464	‘‘(D) Sagadahoc County, Maine; 20
1465	1465	‘‘(E) Merrimack County, New Hampshire; 21
1466	1466	and 22
1467	1467	‘‘(F) Newport County, Rhode Island.’’. 23
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1470	1470	•S 1031 IS
1471	1471	SEC. 5. EXEMPTION OF RADIATION ONCOLOGY CASE RATE 1
1472	1472	VALUE BASED PAYMENT PROGRAM FROM 2
1473	1473	BUDGET NEUTRALITY ADJUSTMENT RE-3
1474	1474	QUIREMENTS. 4
1475	1475	(a) P
1476	1476	AYMENT OFBENEFITS.—Section 1833(t) of the 5
1477	1477	Social Security Act (42 U.S.C. 1395l(t)) is amended by 6
1478	1478	adding at the end the following new paragraph: 7
1479	1479	‘‘(23) N
1480	1480	ON BUDGET NEUTRAL APPLICATION OF 8
1481	1481	REDUCED EXPENDITURES RESULTING FROM THE 9
1482	1482	RADIATION ONCOLOGY CASE RATE VALUE BASED 10
1483	1483	PAYMENT PROGRAM .—The Secretary shall not take 11
1484	1484	into account the reduced expenditures that result 12
1485	1485	from the implementation of section 1899C in making 13
1486	1486	any budget neutrality adjustments under this sub-14
1487	1487	section.’’. 15
1488	1488	(b) P
1489	1489	AYMENT FORPHYSICIANS’ SERVICES.—Section 16
1490	1490	1848(c)(2)(B) of the Social Security Act (42 U.S.C. 17
1491	1491	1395w–4(c)(2)(B)) is amended— 18
1492	1492	(1) in clause (iv)— 19
1493	1493	(A) in subclause (V), by striking ‘‘and’’ at 20
1494	1494	the end; 21
1495	1495	(B) in subclause (VI), by striking the pe-22
1496	1496	riod at the end and inserting ‘‘; and’’; and 23
1497	1497	(C) by adding at the end the following new 24
1498	1498	subclause: 25
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1501	1501	•S 1031 IS
1502	1502	‘‘(VII) section 1899C shall not be 1
1503	1503	taken into account in applying clause 2
1504	1504	(ii)(II) for a year following the enact-3
1505	1505	ment of section 1899C.’’; and 4
1506	1506	(2) in clause (v), by adding at the end the fol-5
1507	1507	lowing new subclause: 6
1508	1508	‘‘(XII) R
1509	1509	EDUCED EXPENDITURES 7
1510	1510	ATTRIBUTABLE TO THE RADIATION 8
1511	1511	ONCOLOGY CASE RATE VALUE BASED 9
1512	1512	PAYMENT PROGRAM .—Effective for 10
1513	1513	fee schedules established following the 11
1514	1514	enactment of section 1899C, reduced 12
1515	1515	expenditures attributable to the Radi-13
1516	1516	ation Oncology Case Rate Value 14
1517	1517	Based Payment Program under sec-15
1518	1518	tion 1899C.’’. 16
1519	1519	Æ
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