II 

118TH CONGRESS 

2D SESSION S. 4330 

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 oncology patients to receive radiation therapy services. 

IN THE SENATE OF THE UNITED STATES 

MAY 14, 2024 

Mr. TILLIS introduced the following bill; which was read twice and referred 

to the Committee on Finance 

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 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 oncology patients to receive radiation 

therapy services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Radiation Oncology 

3 Case Rate Value Based Program Act of 2024’’ or the 

4 ‘‘ROCR Value Based Program Act of 2024’’. 

5 SEC. 2. FINDINGS. 

6 (a) FINDINGS.—Congress finds the following: 

7 (1) Radiation therapy is the careful use of var8 ious forms of radiation, such as external beam radi9 ation therapy, to treat cancer and other diseases 

10 safely and effectively. Radiation oncologists develop 

11 radiation treatment plans and coordinate with highly 

12 specialized care teams to deliver radiation therapy. 

13 Nearly 60 percent of cancer patients will receive ra14 diation therapy during their treatment. 

15 (2) In 2021, the Centers for Medicare & Med16 icaid Services reported approximately 

17 $4,200,000,000 in total spending for radiation on18 cology services between the Medicare physician fee 

19 schedule and hospital outpatient departments. 

20 (3) The Centers for Medicare & Medicaid Serv21 ices has historically faced challenges in determining 

22 accurate pricing for services that involve costly cap23 ital equipment, resulting in fluctuating payment 

24 rates under the Medicare physician fee schedules for 

25 services involving external beam radiation therapy. 

26 Additionally, the Medicare physician fee schedule 


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1 has inadequately recognized the professional exper2 tise physicians and nonphysician professionals need 

3 to deliver radiation therapy. 

4 (4) The current payment systems incentivize 

5 greater volumes of care while bundled payments 

6 incentivize patient centered, efficient, and high value 

7 care. 

8 (5) In 2017, the Centers for Medicare & Med9 icaid Services recognized that the Medicare payment 

10 systems were not adequately addressing radiation 

11 oncology services, and the Center for Medicare & 

12 Medicaid Innovation released a congressionally re13 quested report on the pursuit of an alternative pay14 ment model for radiation oncology (referred to in 

15 this section as the ‘‘Radiation Oncology Model’’) 

16 that addresses the issues in the Medicare physician 

17 fee schedule and the Medicare hospital outpatient 

18 prospective payment system payment methods. 

19 (6) Concerns regarding the proposed Radiation 

20 Oncology Model included the significant payment re21 ductions proposed in the model that would jeop22 ardize access to high-quality radiation therapy serv23 ices and the onerous reporting requirements for par24 ticipating providers. The Radiation Oncology Model 

25 saw indefinite implementation delays. 


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1 (7) It is necessary, therefore, to create a pay2 ment program for radiation oncology services that 

3 appropriately recognizes the value of quality radi4 ation oncology services through its financial incen5 tives while containing costs and providing patient6 centered care. 

7 SEC. 3. RADIATION ONCOLOGY CASE RATE VALUE BASED 

8 PAYMENT PROGRAM. 

9 (a) IN GENERAL.—Title XVIII of the Social Security 

10 Act (42 U.S.C. 1395 et seq.) is amended by adding at 

11 the end the following: 

12 ‘‘SEC. 1899C. RADIATION ONCOLOGY CASE RATE VALUE 

13 BASED PAYMENT PROGRAM. 

14 ‘‘(a) ESTABLISHMENT.— 

15 ‘‘(1) IN GENERAL.—Not later than 1 year after 

16 the date of enactment of the ROCR Value Based 

17 Program Act, the Secretary shall promulgate regula18 tions, using the procedures described in paragraph 

19 (5), establishing a Radiation Oncology Case Rate 

20 Value Based Payment Program (referred to in this 

21 section as the ‘ROCR Program’) under which per 

22 episode payments are provided to radiation therapy 

23 providers or radiation therapy suppliers for covered 

24 treatment furnished to a covered individual during 


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1 an episode of care (as such terms are defined in sub2 section (j)) in accordance with this section. 

3 ‘‘(2) MAINTAINING PAYMENT RATES DURING

4 PERIOD PRIOR TO EFFECTIVE DATE OF REGULA5 TIONS.—The Secretary shall not reduce the estab6 lished payment rates for radiation therapy services 

7 under the physician fee schedule under section 1848 

8 or the hospital outpatient prospective payment sys9 tem under section 1833(t) during the time period 

10 beginning on the date of enactment of the ROCR 

11 Value Based Program Act and ending on the date 

12 that the regulations issued by the Secretary pursu13 ant to paragraph (1) become effective. 

14 ‘‘(3) ROCR PROGRAM GOALS.—The ROCR 

15 Program shall seek to— 

16 ‘‘(A) create stable, unified payments for 

17 radiation therapy services under this title; 

18 ‘‘(B) reduce disparities in radiation ther19 apy care for Medicare beneficiaries by increas20 ing access to radiation therapy services close to 

21 the homes of beneficiaries; 

22 ‘‘(C) enhance quality of radiation therapy 

23 care through practice accreditation and shorter 

24 courses of treatment, when appropriate; 


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1 ‘‘(D) leverage and encourage the utilization 

2 of state-of-the-art technology to improve care 

3 and outcomes; and 

4 ‘‘(E) protect Medicare resources by achiev5 ing reasonable spending reductions in Medicare 

6 for radiation therapy services. 

7 ‘‘(4) PAYMENTS.—Under this section, with re8 spect to covered treatment furnished to covered indi9 viduals, payments shall include— 

10 ‘‘(A) per episode payments, as described in 

11 subsection (b), to radiation therapy providers or 

12 radiation therapy suppliers of radiation therapy 

13 services which meet such requirements as the 

14 Secretary shall establish by regulation; and 

15 ‘‘(B) the health equity achievement in radi16 ation therapy add-on payment described in sub17 section (g). 

18 ‘‘(5) NOTICE AND COMMENT RULEMAKING.— 

19 The Secretary shall promulgate the regulations de20 scribed in paragraph (1) in accordance with section 

21 553 of title 5, United States Code, and issue an ad22 vanced notice of proposed rulemaking and notice of 

23 proposed rulemaking with a comment period of not 

24 less than 60 days for each. 

25 ‘‘(b) PER EPISODE PAYMENTS.— 


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1 ‘‘(1) IN GENERAL.— 

2 ‘‘(A) PAYMENTS.—The Secretary shall pay 

3 to a radiation therapy provider or radiation 

4 therapy supplier an amount equal to 80 percent 

5 of the per episode payment amount determined 

6 under paragraph 3 (referred to in this section 

7 as ‘the per episode payment amount’) for each 

8 covered individual furnished covered treatment 

9 for an included cancer type to cover all profes10 sional and technical services furnished during 

11 such treatment by the radiation therapy pro12 vider or radiation therapy supplier during an 

13 episode of care (as defined in subsection (j)). 

14 ‘‘(B) DEDUCTIBLES AND COINSURANCE.— 

15 Subject to subsection (e), the Secretary shall 

16 pay the per episode payment amount (subject to 

17 any deductible and coinsurance otherwise appli18 cable under part B) to the radiation therapy 

19 provider or radiation therapy supplier for an 

20 episode of care, as described in subsection (c). 

21 ‘‘(2) PER EPISODE PAYMENT REQUIREMENTS

22 AND TIMING.— 

23 ‘‘(A) IN GENERAL.—Subject to subpara24 graph (B), for each episode of care furnished to 

25 a covered individual: 


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1 ‘‘(i) FIRST-HALF OF PAYMENT.—The 

Secretary shall issue 1 2 ⁄2 of the payment 

3 amount under paragraph (1) prospectively 

4 not later than 30 days after the day of the 

5 first delivery of covered treatment. 

6 ‘‘(ii) SECOND-HALF OF PAYMENT.— 

7 The Secretary shall issue, with the excep8 tion of an episode of care for treatment of 

9 bone or brain metastases and subject to 

10 clause (iii), the remaining half of the pay11 ment amount under paragraph (1) on the 

12 date that is the earlier of— 

13 ‘‘(I) the day the course of cov14 ered treatment is scheduled to end; or 

15 ‘‘(II) the 90th day of the episode 

16 of care. 

17 ‘‘(iii) SECOND-HALF OF PAYMENT FOR

18 BONE AND BRAIN METASTASES.—The Sec19 retary shall issue the remaining half of the 

20 payment amount under paragraph (1) for 

21 an episode of care for treatment of bone or 

22 brain metastases on the date that is the 

23 earlier of— 

24 ‘‘(I) the day the course of cov25 ered treatment is schedule to end; or 


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1 ‘‘(II) the 30th day of the episode 

2 of care. 

3 ‘‘(B) PATIENT DEATH.—If a covered indi4 vidual dies during treatment, both episode of 

5 care payments under subparagraphs (A) and 

6 (B) shall be paid to the radiation therapy pro7 vider or radiation therapy supplier not later 

8 than 30 days after the day of the final delivery 

9 of radiation therapy treatment to the covered 

10 individual. 

11 ‘‘(C) CONSISTENCY OF PAYMENT.— 

12 ‘‘(i) IN GENERAL.—The per episode 

13 payment amount shall not change depend14 ing on the site of service. 

15 ‘‘(ii) SITE OF SERVICE DEFINED.— 

16 For the purposes of this subparagraph, the 

17 term ‘site of service’ means the hospital 

18 outpatient department or physician office 

19 in which radiation therapy treatment is 

20 furnished by the radiation therapy provider 

21 or radiation therapy supplier. 

22 ‘‘(3) DETERMINATION OF PER EPISODE PAY23 MENT AMOUNT.— 

24 ‘‘(A) IN GENERAL.—The Secretary shall 

25 determine a per episode payment amount for 


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1 the professional component and technical com2 ponent of treatment for each included cancer 

3 type. 

4 ‘‘(B) AMOUNT.—The Secretary shall deter5 mine the per episode payment amount based on 

6 national base rates, as described in subsection 

7 (d)(1) and as updated in subsection (d)(2). 

8 ‘‘(C) ADJUSTMENTS.—The per episode 

9 payment amount shall be subject to— 

10 ‘‘(i) the adjustments as described in 

11 subsection (d)(2) and (d)(3); 

12 ‘‘(ii) a geographic adjustment, as de13 scribed in subsection (d)(3)(A); 

14 ‘‘(iii) an inflation adjustment, pursu15 ant to which the Secretary shall adjust the 

16 per episode payment amount by the per17 centage increase in the Medicare Economic 

18 Index (as described in section 1842 for the 

19 professional component payments and the 

20 applicable percentage increase in the Hos21 pital Inpatient Market Basket Update (as 

22 described in section 1886(b)(3)(B)(i)) for 

23 the technical component payments during 

24 each 12-month period, and which varies for 


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1 the professional and technical components 

2 of the service; 

3 ‘‘(iv) a savings adjustment, as de4 scribed in subsection (d)(3)(B); 

5 ‘‘(v) a health equity achievement in 

6 radiation therapy adjustment applicable 

7 only to the technical component payments, 

8 as described in subsection (g); and 

9 ‘‘(vi) a practice accreditation adjust10 ment, as described in subsection (h), that 

11 is only applicable to technical component 

12 payments. 

13 ‘‘(c) TREATMENT OF INCOMPLETE EPISODES OF

14 CARE; CONCURRENT TREATMENT.— 

15 ‘‘(1) INCOMPLETE EPISODE OF CARE.—In the 

16 case of an incomplete episode of care, payment shall 

17 be made to the radiation therapy provider or radi18 ation therapy supplier for services furnished under 

19 the physician fee schedule under section 1848 or the 

20 hospital outpatient prospective payment system 

21 under section 1833(t), as applicable. 

22 ‘‘(2) MULTIPLE EPISODES OF CARE FOR THE

23 SAME COVERED INDIVIDUAL.—A radiation therapy 

24 provider or radiation therapy supplier may initiate a 

25 new episode of care for the same beneficiary for the 


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1 same course of therapy by providing another radi2 ation therapy treatment planning service and billing 

3 under an applicable radiation therapy planning trig4 ger code (as defined in subsection (j). 

5 ‘‘(3) CONCURRENT TREATMENTS.—In the case 

6 where a treatment modality described in subsection 

7 (j)(3)(B)(i) is furnished to a covered individual dur8 ing an episode of care for an included cancer type, 

9 payment may be made concurrently for the treat10 ment modality under the applicable payment system 

11 under this title with per episode payment under this 

12 section for covered treatment during the episode of 

13 care. 

14 ‘‘(d) NATIONAL BASE RATE.— 

15 ‘‘(1) DETERMINATION OF NATIONAL BASE

16 RATES.—For purposes of the Secretary determining 

17 the per episode payment amount under subsection 

18 (b)(3), the national base rates for the professional 

19 component and technical component of radiation 

20 therapy services for each included cancer type are 

21 based on the M-Code national base rates identified 

22 in table 75 (including HCPCS Codes for radiation 

23 therapy services and supplies) of the Federal Reg24 ister on November 16, 2021, 86 Fed. Reg. 63458, 

25 63925. 


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1 ‘‘(2) UPDATES TO THE NATIONAL BASE

2 RATES.— 

3 ‘‘(A) ANNUAL UPDATES.— 

4 ‘‘(i) IN GENERAL.—Subject to clause 

5 (ii), the Secretary shall annually update 

6 the initial national base rates by— 

7 ‘‘(I) in the case of the profes8 sional component of the covered treat9 ment, the percentage increase in the 

10 Medicare Economic Index; and 

11 ‘‘(II) in the case of the technical 

12 component of the covered treatment, 

13 the applicable percentage increase de14 scribed in section 1886(b)(3)(B)(i). 

15 ‘‘(ii) PAYMENT FLOOR.—For each an16 nual update, the Secretary shall not reduce 

17 the national base rates below the estab18 lished rates from the prior year. 

19 ‘‘(B) PERIODIC UPDATES.— 

20 ‘‘(i) IN GENERAL.—The Secretary 

21 shall, through notice and comment rule22 making, rebase or revise the national base 

23 rates in 5-year intervals, beginning on the 

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1 lations issued pursuant to subsection 

2 (a)(1) become effective. 

3 ‘‘(ii) REBASING LIMIT.—The Sec4 retary shall not reduce the national base 

5 rates through the process of rebasing by 

6 more than 1 percent every 5 years. 

7 ‘‘(iii) INPUT FROM PROVIDERS AND

8 SUPPLIERS.—In rebasing or revising the 

9 national base rates pursuant to clause (i), 

10 the Secretary shall seek significant input 

11 from radiation therapy providers, radiation 

12 therapy suppliers, and other stakeholders. 

13 ‘‘(C) REBASE AND REVISE DEFINED.—In 

14 this subsection: 

15 ‘‘(i) REBASE.—The term ‘rebase’ 

16 means to move the base year for the struc17 ture of costs of the national base rates. 

18 ‘‘(ii) REVISE.—The term ‘revise’ 

19 means types of changes to national base 

20 rates other than rebasing, such as using 

21 different data sources, cost categories, or 

22 price proxies in the national base rates 

23 input. 

24 ‘‘(D) NEW TECHNOLOGY OR SERVICES.— 


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1 ‘‘(i) IN GENERAL.—For purposes of 

2 this subparagraph, the term ‘new tech3 nology or services’ means any technology 

4 or services that, after the date of enact5 ment of this section, receives a Category 1 

6 Current Procedural Terminology code or is 

7 established in the yearly update to the 

8 Medicare physician fee schedule direct 

9 practice expense inputs or any successor 

10 repository of the direct practice expense 

11 input for the delivery of radiation therapy 

12 services. 

13 ‘‘(ii) TREATMENT UNDER THE NA14 TIONAL BASE RATES.— 

15 ‘‘(I) EXCLUSION DURING INITIAL

16 PERIOD.—The Secretary shall not in17 corporate a radiation therapy service 

18 that is a new technology or service 

19 into the national base rates for an in20 cluded cancer type prior to the date 

21 that is 10 years after such service is 

22 first identified as a new technology or 

23 service described in clause (i). 

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1 fied in subclause (I) with respect to a 

2 radiation therapy service that is a new 

3 technology or service, the Secretary 

4 shall, through stakeholder meetings, 

5 requests for information, and notice 

6 and comment rulemaking, engage pro7 viders, suppliers, radiation therapy 

8 vendors, patient groups, and the pub9 lic on possible incorporation of the 

10 new technology or service into the na11 tional base rates for included cancer 

12 types under paragraph (1). 

13 ‘‘(iii) BEFORE INCORPORATION INTO

14 THE NATIONAL BASE RATE.—Until incor15 porated into the national base rates under 

16 clause (ii)(II), any new technology or serv17 ice shall be paid under the applicable pay18 ment system under this title. 

19 ‘‘(iv) ASSESSMENT OF CERTAIN CRI20 TERIA.—Prior to incorporating a new tech21 nology or service into the national base 

22 rates pursuant to clause (ii)(II), the Sec23 retary shall consider market penetration 

24 and adoption, costs relative to base rates, 

25 clinical benefits of the new technology or 


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1 service, and the clear consensus of the 

2 stakeholder community. 

3 ‘‘(3) ADJUSTMENTS TO NATIONAL BASE

4 RATES.— 

5 ‘‘(A) GEOGRAPHIC ADJUSTMENT.—Prior to 

6 applying the savings adjustment described in 

7 subparagraph (B), the Secretary shall adjust 

8 the national base rates for local cost and wage 

9 indices based on where the radiation therapy 

10 services are furnished— 

11 ‘‘(i) in the case of the professional 

12 component payment rates, the geographic 

13 adjustment processes described in the 

14 Medicare Physician Fee Schedule Geo15 graphic Practice Cost Index; and 

16 ‘‘(ii) in the case of the technical com17 ponent payment rates, the geographic ad18 justment processes in the hospital out19 patient prospective payment system under 

20 section 1833(t). 

21 ‘‘(B) SAVINGS ADJUSTMENT.— 

22 ‘‘(i) IN GENERAL.—The Secretary 

23 shall apply a savings adjustment under 

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1 justments have been applied under sub2 paragraph (A). 

3 ‘‘(ii) SAVINGS ADJUSTMENT DE4 FINED.—The term ‘savings adjustment’ 

5 means the percentage by which the profes6 sional component and technical component 

7 payment rates are each reduced to achieve 

8 Medicare savings. 

9 ‘‘(e) AVAILABILITY OF PAYMENT PLANS FOR PAY10 MENT OF COINSURANCE.—Following the application of 

11 the adjustments described in subsection (d), but before the 

12 application of any sequestration order issued under the 

13 Balanced Budget and Emergency Deficit Control Act of 

14 1985 (2 U.S.C. 900 et seq.), radiation therapy providers 

15 and radiation therapy suppliers shall collect coinsurance 

16 for services furnished under the ROCR Program subject 

17 to the following rules: 

18 ‘‘(1) IN GENERAL.—Radiation therapy pro19 viders and radiation therapy suppliers may collect 

20 coinsurance applicable under subsection (b)(1) for 

21 covered treatment furnished to a covered individual 

22 under the ROCR Program in multiple installments 

23 under a payment plan. 

24 ‘‘(2) LIMITATION ON USE AS A MARKETING

25 TOOL.—Radiation therapy providers and radiation 


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1 therapy suppliers may not use the availability of 

2 payment plans for such coinsurance as a marketing 

3 tool to influence the choice of health care provider 

4 by covered individuals. 

5 ‘‘(3) TIMING OF PROVISIONS OF INFORMA6 TION.—Radiation therapy providers and radiation 

7 therapy suppliers offering a payment plan for such 

8 coinsurance may inform the covered individual of the 

9 availability of the payment plan prior to or during 

10 the initial treatment planning session and as nec11 essary thereafter. 

12 ‘‘(4) BENEFICIARY COINSURANCE PAYMENT.— 

13 The beneficiary coinsurance payment shall equal 20 

14 percent of the payment amount to be paid to the ra15 diation therapy provider or radiation therapy sup16 plier prior to the application of any sequestration 

17 order issued under the Balanced Budget and Emer18 gency Deficit Control Act of 1985 (2 U.S.C. 900 et 

19 seq.) for the billed ROCR Program episode of care, 

20 except as provided in paragraph (5). 

21 ‘‘(5) INCOMPLETE EPISODE OF CARE.—In the 

22 case of an incomplete episode of care, the beneficiary 

23 coinsurance payment shall equal 20 percent of the 

24 amount that would have been paid in the absence of 

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1 ices furnished by the radiation therapy provider or 

2 radiation therapy supplier that initiated the profes3 sional component and, if applicable, the radiation 

4 therapy provider or radiation therapy supplier that 

5 initiated the technical component. 

6 ‘‘(f) MANDATORY PARTICIPATION.— 

7 ‘‘(1) IN GENERAL.—Except as provided under 

8 paragraph (2) or (3), a radiation therapy provider or 

9 radiation therapy supplier that is participating in 

10 the program under this title and furnishes a covered 

11 treatment to a covered individual shall be required 

12 to participate in the ROCR Program. 

13 ‘‘(2) CONCURRENT PARTICIPATION IN THE

14 ROCR PROGRAM AND OTHER MODELS.—A radiation 

15 therapy provider or radiation therapy supplier that 

16 is participating in a State-based Center for Medicare 

17 & Medicaid Innovation model— 

18 ‘‘(A) shall not be prohibited from also par19 ticipating in the ROCR Program; and 

20 ‘‘(B) is not required to participate in the 

21 ROCR Program. 

22 ‘‘(3) SIGNIFICANT HARDSHIP EXEMPTION.— 

23 ‘‘(A) IN GENERAL.—The Secretary may, 

24 on a case-by-case basis, exempt a radiation 

25 therapy provider or radiation therapy supplier 


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1 from the ROCR Program if the Secretary de2 termines that application of the program would 

3 result in a significant hardship for such radi4 ation therapy provider or radiation therapy sup5 plier or for beneficiaries in the geographic area 

6 of the radiation therapy provider or radiation 

7 therapy supplier. 

8 ‘‘(B) PROCEDURE.—The Secretary shall 

9 promulgate regulations, using the procedures 

10 described in subsection (a)(5), regarding eligi11 bility and the procedure for applying for a sig12 nificant hardship exemption. 

13 ‘‘(g) HEALTH EQUITY ACHIEVEMENT IN RADIATION

14 THERAPY ADD-ON PAYMENT.— 

15 ‘‘(1) IN GENERAL.—Pursuant to paragraph (2) 

16 and subject to paragraph (7), the Secretary shall ad17 just the per episode payment amount in the amount 

18 of a health equity achievement in radiation therapy 

19 add-on payment to advance health equity and sup20 port covered individuals in accessing and completing 

21 their radiation therapy treatments for covered treat22 ments of included cancer types through the provision 

23 of transportation services, subject to the succeeding 

24 provisions of this subsection. 

25 ‘‘(2) ELIGIBILITY.— 


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1 ‘‘(A) IN GENERAL.—The health equity 

2 achievement in radiation therapy add-on pay3 ment shall be made when the ICD–10 diagnosis 

4 code Z59.82, transportation insecurity is re5 ported pursuant to subparagraph (B). 

6 ‘‘(B) DETERMINATION OF REPORTING

7 CODE.—The radiation therapy provider or radi8 ation therapy supplier shall follow the following 

9 procedures to determine if the ICD–10 diag10 nosis code Z59.82, transportation insecurity 

11 needs to be reported: 

12 ‘‘(i) The radiation therapy provider or 

13 radiation therapy supplier shall ask the pa14 tient at the time of patient intake during 

15 the initial patient consultation if, within 

16 the previous 2 months, a lack of reliable 

17 transportation has kept the patient from 

18 attending medical appointments, meetings, 

19 or work, or from completing activities of 

20 daily living. 

21 ‘‘(ii) If the patient answers yes to the 

22 question in clause (i), ICD–10 diagnosis 

23 code Z59.82 shall be reported. 


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1 ‘‘(3) AMOUNT.—The health equity achievement 

2 in radiation therapy add-on payment shall be in the 

3 amount of— 

4 ‘‘(A) for services furnished during the year 

5 following the date the regulations issued pursu6 ant to subsection (a)(1) become effective, $500 

7 per patient per episode of care; and 

8 ‘‘(B) for services furnished in subsequent 

9 years, the amount determined under this para10 graph for the preceding year, increased by $10. 

11 ‘‘(4) PAYMENT RECIPIENT.—The health equity 

12 achievement in radiation therapy add-on payment 

13 shall be paid to the radiation therapy provider or ra14 diation therapy supplier that provides the technical 

15 component of the radiation therapy services. 

16 ‘‘(5) NOT TO BE USED IN ADDITION TO OR IN

17 LIEU OF OTHER SERVICES.—The health equity 

18 achievement in radiation therapy add-on payment 

19 shall not be made in addition to or in lieu of any 

20 other State or Federal program benefits that may be 

21 used for transportation services. 

22 ‘‘(6) DOCUMENTATION.— 

23 ‘‘(A) IN GENERAL.—Radiation therapy 

24 providers and radiation therapy suppliers who 

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1 ation therapy add-on payment shall maintain all 

2 documentation related to the spending of such 

3 payment on transportation services per covered 

4 individual for a period of 5 years after the end 

5 of the episode of care of the applicable covered 

6 individual. 

7 ‘‘(B) AVAILABILITY TO THE SECRETARY.— 

8 The documentation described in subparagraph 

9 (A) shall be made available to the Secretary 

10 upon request. 

11 ‘‘(7) NO MODIFICATION OF COINSURANCE.— 

12 The Secretary may not modify any coinsurance obli13 gation when implementing the health equity achieve14 ment in radiation therapy add-on payment. 

15 ‘‘(h) QUALITY INCENTIVES IN THE ROCR VALUE

16 BASED PAYMENT PROGRAM.— 

17 ‘‘(1) IN GENERAL.— 

18 ‘‘(A) INITIAL INCREASE IN PAYMENT.— 

19 With respect to covered treatment for an in20 cluded cancer type furnished to a covered indi21 vidual on or after the date the regulations 

22 issued pursuant to subsection (a)(1) become ef23 fective and before the date that is 3 years after 

24 such date, in the case of a radiation therapy 

25 provider or radiation therapy supplier that 


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1 meets the requirements described in paragraph 

2 (2), payments otherwise made to such radiation 

3 therapy provider or radiation therapy supplier 

4 under the ROCR Program for the technical 

5 component of such services shall be increased 

6 by 0.5 percent (or 0.25 percent in the case of 

7 such a provider or supplier that is a small radi8 ation therapy supplier or small radiation ther9 apy provider. 

10 ‘‘(B) REDUCTION IN PAYMENT.— 

11 ‘‘(i) IN GENERAL.—Subject to clause 

12 (ii), with respect to covered treatment for 

13 an included cancer type furnished to a cov14 ered individual on or after the date that is 

15 3 years after the regulations issued pursu16 ant to subsection (a)(1) become effective, 

17 in the case of a radiation therapy provider 

18 or radiation therapy supplier that does not 

19 meet the requirements described in para20 graph (2), the per episode payment to such 

21 provider or supplier under the ROCR Pro22 gram shall be reduced by 1.0 percent. 

23 ‘‘(ii) EXCLUSION OF SMALL RADI24 ATION THERAPY PROVIDERS AND SMALL

25 RADIATION THERAPY SUPPLIERS.—This 


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1 subparagraph shall not apply with respect 

2 to a small radiation therapy provider or a 

3 small radiation therapy supplier. 

4 ‘‘(C) DEFINITION OF SMALL RADIATION

5 THERAPY PROVIDER AND SMALL RADIATION

6 THERAPY SUPPLIER.—In this subsection, the 

7 terms ‘small radiation therapy provider’ and 

8 ‘small radiation therapy supplier’ mean, with 

9 respect to a radiation therapy provider or radi10 ation therapy supplier, a provider or supplier 

11 that meets the criteria specified by the Sec12 retary, that may include criteria relating to the 

13 number of linear accelerators owned or used by 

14 the radiation therapy provider or radiation ther15 apy supplier, the volume of patients treated by 

16 the radiation therapy provider or radiation ther17 apy supplier, or such other criteria as the Sec18 retary determines is appropriate, in consulta19 tion with radiation therapy stakeholder organi20 zations. 

21 ‘‘(2) ACCREDITATION REQUIREMENTS.— 

22 ‘‘(A) IN GENERAL.—The requirements de23 scribed in this subparagraph with respect to a 

24 radiation therapy provider or radiation therapy 

25 supplier (other than such a provider or supplier 


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1 that is a small radiation therapy provider or 

2 small radiation therapy supplier) are that the 

3 supplier or provider must— 

4 ‘‘(i) maintain or be in the process of 

5 obtaining accreditation by the American 

6 College of Radiology, American College of 

7 Radiation Oncology, or American Society 

8 for Radiation Oncology; 

9 ‘‘(ii) comply with certified electronic 

10 health record technology requirements as 

11 determined by the Secretary with excep12 tions that are consistent with those of the 

13 Merit-based Incentive Payment System es14 tablished under section 1848(q); and 

15 ‘‘(iii) submit to the Secretary proof of 

16 the accreditation described in clause (i) in 

17 such form and manner as specified by the 

18 Secretary. 

19 ‘‘(B) REQUIREMENTS FOR SMALL RADI20 ATION THERAPY PROVIDERS AND SMALL RADI21 ATION THERAPY SUPPLIERS.—A radiation ther22 apy provider or radiation therapy supplier that 

23 is a small radiation therapy provider or small 

24 radiation therapy supplier may elect to satisfy 


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1 the accreditation requirement under this para2 graph by— 

3 ‘‘(i) meeting the requirements of sub4 paragraph (A); 

5 ‘‘(ii) using an external audit that en6 compasses similar criteria as a nationally 

7 recognized radiation oncology accreditation 

8 organization and submit the outcome of 

9 such external audit to the Secretary; or 

10 ‘‘(iii) complying with certified elec11 tronic health record technology require12 ments as determined by the Secretary with 

13 exceptions that are consistent with those of 

14 the Merit-Based Incentives Payment Sys15 tem established under section 1848(q). 

16 ‘‘(C) NEW PROVIDERS.—A new radiation 

17 therapy provider or new radiation supplier shall 

18 complete an initiation of accreditation or exter19 nal audit not later than the date that is 1 year 

20 after such provider or supplier begins fur21 nishing covered treatment to covered individ22 uals. 

23 ‘‘(i) REPORTING REQUIREMENTS.— 

24 ‘‘(1) REPORT ON THE ROCR PROGRAM.—Not 

25 earlier than 7 years after the date of the enactment 


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1 of this section, the Comptroller General of the 

2 United States (referred to in this subsection as the 

3 ‘Comptroller General’) shall, after seeking out the 

4 perspectives of radiation oncology stakeholders, sub5 mit to the appropriate committees of jurisdiction of 

6 the Senate and the House of Representatives a re7 port that— 

8 ‘‘(A) evaluates— 

9 ‘‘(i) the implementation of the ROCR 

10 Program, and the impact such Program 

11 has had on Federal healthcare spending; 

12 ‘‘(ii) the impact the ROCR Program 

13 has had on the ability of covered individ14 uals to access covered treatment; 

15 ‘‘(iii) whether any cancer types or ra16 diation therapy services, such as 

17 brachytherapy, proton therapy, or thera18 peutic radiopharmaceuticals, should be 

19 added or removed from the ROCR Pro20 gram; and 

21 ‘‘(iv) the potential application of the 

22 ROCR Program to benefits provided under 

23 part C of this title; and 

24 ‘‘(B) includes any recommendations for ad25 ministrative and legislative changes. 


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1 ‘‘(2) REPORT ON ACCESS TO RADIATION THER2 APY IN RURAL AND UNDERSERVED AREAS.—Not 

3 later than 3 years after the date of the enactment 

4 of this section, the Comptroller General shall submit 

5 a report to the appropriate committees of jurisdic6 tion of the Senate and the House of Representatives 

7 that identifies the following: 

8 ‘‘(A) Radiation therapy deserts. 

9 ‘‘(B) Methods to increase access to new ra10 diation therapy technologies in rural and under11 served areas, including technologies required for 

12 clinical treatment planning, simulation, dosim13 etry, medical radiation physics, radiation treat14 ment devices, radiation treatment delivery, radi15 ation treatment management, and such other 

16 items as the Comptroller General may deter17 mine are medically necessary. 

18 ‘‘(C) A program to provide assistance in 

19 the form of grants or loans to radiation therapy 

20 providers or radiation therapy suppliers for the 

21 purpose of ensuring access to the most current 

22 radiation therapy technology. 

23 ‘‘(3) DETERMINATION AND DEFINITION OF RA24 DIATION THERAPY DESERTS.— 


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1 ‘‘(A) DEFINITION.—For purposes of this 

2 subsection, the term ‘radiation therapy desert’ 

3 means a region determined by the Comptroller 

4 General under subparagraph (B) with a mis5 match between radiation therapy resources and 

6 oncologic need. 

7 ‘‘(B) DETERMINATION.—In determining 

8 whether a region qualifies as a radiation ther9 apy desert, the Comptroller General shall take 

10 into account the ratio or density of radiation 

11 therapy providers and radiation therapy sup12 pliers practicing in a geographic area as com13 pared to the population size in that geographic 

14 area. 

15 ‘‘(j) DEFINITIONS.—In this section: 

16 ‘‘(1) APPLICABLE RADIATION THERAPY PLAN17 NING TRIGGER CODE.—The term ‘applicable radi18 ation therapy planning trigger code’ means services 

19 identified, as of the date that the regulations issued 

20 pursuant to subsection (a)(1) become effective, by 

21 the following HCPCS codes (and as subsequently 

22 modified by the Secretary): 

23 ‘‘(A) 77261, therapeutic radiology treat24 ment planning, simple. 


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1 ‘‘(B) 77262, therapeutic radiology treat2 ment planning, intermediate. 

3 ‘‘(C) 77263, therapeutic radiology treat4 ment planning, complex. 

5 ‘‘(2) COVERED INDIVIDUAL.—The term ‘cov6 ered individual’ means an individual who— 

7 ‘‘(A) is enrolled for benefits under part B; 

8 ‘‘(B) is not enrolled in a Medicare Advan9 tage plan under part C or a PACE program 

10 under section 1894; and 

11 ‘‘(C) is diagnosed with an included cancer 

12 type. 

13 ‘‘(3) COVERED TREATMENT.— 

14 ‘‘(A) IN GENERAL.—The term ‘covered 

15 treatment’ means, subject to subparagraph (B), 

16 radiation therapy services furnished to a cov17 ered individual. 

18 ‘‘(B) EXCLUSIONS.—Such term does not 

19 include— 

20 ‘‘(i) during the period beginning on 

21 the date on which the regulation issued 

22 pursuant to subsection (a)(1) become effec23 tive and ending on the date that is 10 

24 years after such date, brachytherapy, pro25 ton beam radiation therapy services, 


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1 intraoperative radiotherapy, superficial ra2 diation therapy, hyperthermia, and thera3 peutic radiopharmaceuticals; 

4 ‘‘(ii) inpatient radiation therapy serv5 ices furnished in a subsection (d) hospital 

6 or ambulatory surgical center; 

7 ‘‘(iii) radiation therapy services fur8 nished in cancer hospitals that are exempt 

9 from the hospital outpatient prospective 

10 payment system under section 1833(t); 

11 ‘‘(iv) physician services that are fur12 nished or supervised by the physician fur13 nishing radiation therapy or by another 

14 physician, such as cancer surgeries, chemo15 therapy, and other services; or 

16 ‘‘(v) physician services that are fur17 nished using technology represented by 

18 Healthcare Common Procedure Coding 

19 System codes that are not included in the 

20 M-code national base rates identified in 

21 table 75 (including in HCPCS Codes for 

22 radiation therapy services and supplies) of 

23 the Federal Register on November 16, 

24 2021, 86 Fed. Reg. 63485, 63925. 


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1 ‘‘(4) EPISODE OF CARE.—The term ‘episode of 

2 care’ means, with respect to a covered individual, the 

3 period— 

4 ‘‘(A) beginning on the day radiation ther5 apy planning for an included cancer type, billed 

6 under an applicable radiation therapy planning 

7 trigger code, is furnished to a covered indi8 vidual if radiation therapy treatment is initiated 

9 not later than 30 days after the day such radi10 ation therapy planning service is furnished; and 

11 ‘‘(B) ends— 

12 ‘‘(i) for treatment of all included can13 cer types except bone and brain metastases 

14 treatment, the day that is 90 days after 

15 the day the episode of care begins under 

16 clause (i); and 

17 ‘‘(ii) for bone and brain metastases 

18 treatment, the day that is 30 days after 

19 the day the episode of care begins under 

20 clause (i). 

21 ‘‘(5) INCLUDED CANCER TYPES.—The term ‘in22 cluded cancer type’ means any of the following types 

23 of cancer: 

24 ‘‘(A) Anal. 

25 ‘‘(B) Bladder. 


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1 ‘‘(C) Bone Metastases. 

2 ‘‘(D) Brain Metastases. 

3 ‘‘(E) Breast. 

4 ‘‘(F) Cervical. 

5 ‘‘(G) Central Nervous System Tumors. 

6 ‘‘(H) Colorectal. 

7 ‘‘(I) Head and Neck. 

8 ‘‘(J) Lung. 

9 ‘‘(K) Lymphoma. 

10 ‘‘(L) Pancreatic. 

11 ‘‘(M) Prostate. 

12 ‘‘(N) Upper Gastrointestinal. 

13 ‘‘(O) Uterine. 

14 ‘‘(6) HEALTHCARE COMMON PROCEDURE COD15 ING SYSTEM.—The term ‘Healthcare Common Pro16 cedure Coding System’ means the standardized cod17 ing system used by Medicare and other health insur18 ance programs to ensure that claims are processed 

19 in an orderly and consistent manner. 

20 ‘‘(7) INCOMPLETE EPISODE OF CARE.—The 

21 term ‘incomplete episode of care’ means, with re22 spect to a covered individual, an episode of care that 

23 is not completed because— 

24 ‘‘(A) the individual being treated ceases to 

25 be a covered individual, including in the case 


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1 where the individual loses benefits under this 

2 title, at any time after the initial treatment 

3 planning service is furnished and before the epi4 sode of care for the covered treatment is com5 plete; or 

6 ‘‘(B) a covered individual switches radi7 ation therapy provider or radiation therapy sup8 plier before all included radiation therapy serv9 ices in the episode of care for the covered treat10 ment have been furnished. 

11 ‘‘(8) PROFESSIONAL COMPONENT.—The term 

12 ‘professional component’ means the included radi13 ation therapy services that may only be furnished by 

14 a physician. 

15 ‘‘(9) RADIATION THERAPY.—The term ‘radi16 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 ‘‘(10) RADIATION 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 ‘‘(11) RADIATION THERAPY SERVICES.—The 

25 term ‘radiation therapy services’ means the treatVerDate Sep 11 2014 18:45 Jun 20, 2024 Jkt 049200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\S4330.IS S4330

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1 ment planning, technical preparation, special serv2 ices (such as simulation), treatment delivery, and 

3 treatment management services associated with can4 cer treatment that uses high doses of radiation to 

5 kill cancer cells and shrink tumors. 

6 ‘‘(12) RADIATION THERAPY SUPPLIER.—The 

7 term ‘radiation therapy supplier’ means a physician 

8 group practice or freestanding radiation therapy cen9 ter enrolled under this title that furnishes radiation 

10 therapy services. 

11 ‘‘(13) TECHNICAL COMPONENT.—The term 

12 ‘technical component’ means the included radiation 

13 therapy services that are not furnished by a physi14 cian, including the provision of equipment, supplies, 

15 personnel, and administrative costs related to radi16 ation therapy services. 

17 ‘‘(14) TRANSPORTATION SERVICES.—The term 

18 ‘transportation services’ means the provision of free 

19 or discounted transportation made available to cov20 ered individuals furnished covered treatment which 

21 are not air, luxury, or ambulance-level transpor22 tation, but may include car services, ride shares, or 

23 public transportation.’’. 

24 (b) EXCLUSION OF PARTICIPATING RADIATION

25 THERAPY PROVIDERS, RADIATION THERAPY SUPPLIERS, 


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1 AND PHYSICIANS FROM THE MERIT-BASED INCENTIVE

2 PAYMENT SYSTEM.—Section 1848(q)(1)(C)(ii) of the So3 cial Security Act (42 U.S.C. 1395w-4(q)(1)(c)(II)) is 

4 amended— 

5 (1) in subclause (II), by striking ‘‘or’’ at the 

6 end; 

7 (2) in subclause (III), by striking the period at 

8 the end and inserting ‘‘; or’’; and 

9 (3) by adding at the end the following new sub10 clause: 

11 ‘‘(IV) is a radiation therapy pro12 vider or radiation therapy supplier (as 

13 those terms are defined in subsection 

14 (j) of section1899C) that is partici15 pating in the Radiation Oncology Case 

16 Rate Value Based Payment Program 

17 established under that section.’’. 

18 SEC. 4. REVISION TO CIVIL MONETARY PENALTIES RE19 GARDING RADIATION ONCOLOGY CASE RATE 

20 PATIENT TRANSPORTATION SERVICES. 

21 Section 1128A of the Social Security Act (42 U.S.C. 

22 1320a–7a) is amended— 

23 (1) in subsection (i)(6)— 

24 (A) in subparagraph (I), by striking ‘‘or’’ 

25 at the end; 


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1 (B) in subparagraph (J)(iii), by striking 

2 the period at the end and inserting ‘‘; or’’; and 

3 (C) by adding at the end the following new 

4 subparagraph: 

5 ‘‘(K) the provision of transportation serv6 ices by an eligible entity, as defined in sub7 section (t), if— 

8 ‘‘(i) the availability of the transpor9 tation services— 

10 ‘‘(I) is set forth in a policy that 

11 the eligible entity, as defined in sub12 section (t), applies uniformly and con13 sistently; and 

14 ‘‘(II) is not determined in a man15 ner related to the past or anticipated 

16 volume or value of Federal health care 

17 program business; 

18 ‘‘(ii) the eligible entity does not pub19 licly market or advertise the transportation 

20 services; 

21 ‘‘(iii) the driver who provides the 

22 transportation services does not market 

23 health care items or services during the 

24 course of the transportation or at any 

25 time; 


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1 ‘‘(iv) the driver or individual arrang2 ing for the transportation services is not 

3 paid on a per-beneficiary-transported basis; 

4 ‘‘(v) the eligible entity makes the 

5 transportation services available only to an 

6 individual who— 

7 ‘‘(I) is an established patient, as 

8 defined in subsection (t), of the eligi9 ble entity that is providing or facili10 tating free or discounted transpor11 tation; 

12 ‘‘(II) resides— 

13 ‘‘(aa) within a 75 miles ra14 dius of the radiation therapy pro15 vider or radiation therapy sup16 plier to or from which the patient 

17 would be transported; or 

18 ‘‘(bb) in a rural area, as de19 fined in subsection (t); and 

20 ‘‘(III) is receiving radiation ther21 apy services for the purpose of obtain22 ing medically necessary items and 

23 services; and 

24 ‘‘(vi) the eligible entity that makes the 

25 transportation services available bears the 


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1 costs of the transportation services and 

2 does not shift the burden of those costs 

3 onto any Federal health care program, 

4 other payers, or individuals.’’; and 

5 (2) by adding at the end the following new sub6 section: 

7 ‘‘(t) For purposes of subsection (i)(6)(K), the fol8 lowing definitions apply: 

9 ‘‘(1) The term ‘eligible entity’ means any indi10 vidual or entity, or any individual or entity acting on 

11 behalf of such individual or entity that does not sup12 ply health care items as the primary occupation of 

13 the individual or entity. 

14 ‘‘(2) The term ‘established patient’ means an 

15 individual who— 

16 ‘‘(A) has selected and scheduled an ap17 pointment with a radiation therapy provider or 

18 radiation therapy supplier; or 

19 ‘‘(B) has attended an appointment with 

20 such provider or supplier. 

21 ‘‘(3) The terms ‘radiation therapy provider’, 

22 ‘radiation therapy services’, and ‘radiation therapy 

23 supplier’ have the meaning given such terms in sec24 tion 1866G(k). 


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1 ‘‘(4) The term ‘rural area’ means an area that 

2 is not an urban area. 

3 ‘‘(5) The term ‘transportation services’— 

4 ‘‘(A) means the provision of free or dis5 counted transportation made available to Fed6 eral health care program beneficiaries receiving 

7 radiation therapy services; 

8 ‘‘(B) includes car services, ride shares, and 

9 public transportation; and 

10 ‘‘(C) does not include air, luxury, or ambu11 lance-level transportation. 

12 ‘‘(6) The term ‘urban area’ means— 

13 ‘‘(A) a Metropolitan Statistical Area or 

14 New England County Metropolitan Area, as de15 fined by the Office of Management and Budget; 

16 ‘‘(B) Litchfield County, Connecticut; 

17 ‘‘(C) York County, Maine; 

18 ‘‘(D) Sagadahoc County, Maine; 

19 ‘‘(E) Merrimack County, New Hampshire; 

20 and 

21 ‘‘(F) Newport County, Rhode Island.’’. 


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1 SEC. 5. EXEMPTION OF RADIATION ONCOLOGY CASE RATE 

2 VALUE BASED PAYMENT PROGRAM FROM 

3 BUDGET NEUTRALITY ADJUSTMENT RE4 QUIREMENTS. 

5 (a) PAYMENT OF BENEFITS.—Section 1833(t) of the 

6 Social Security Act (42 U.S.C. 1395l(t)) is amended by 

7 adding at the end the following new paragraph: 

8 ‘‘(23) NON BUDGET NEUTRAL APPLICATION OF

9 REDUCED EXPENDITURES RESULTING FROM THE

10 RADIATION ONCOLOGY CASE RATE VALUE BASED

11 PAYMENT PROGRAM.—The Secretary shall not take 

12 into account the reduced expenditures that result 

13 from the implementation of section 1899C in making 

14 any budget neutrality adjustments under this sub15 section.’’. 

16 (b) PAYMENT FOR PHYSICIANS’ SERVICES.—Section 

17 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 

18 1395w–4(c)(2)(B)) is amended— 

19 (1) in clause (iv)— 

20 (A) in subclause (V), by striking ‘‘and’’ at 

21 the end; 

22 (B) in subclause (VI), by striking the pe23 riod at the end and inserting ‘‘; and’’; and 

24 (C) by adding at the end the following new 

25 subclause: 


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1 ‘‘(VII) section 1899C shall not be 

2 taken into account in applying clause 

3 (ii)(II) for a year following the enact4 ment of section 1899C.’’; and 

5 (2) in clause (v), by adding at the end the fol6 lowing new subclause: 

7 ‘‘(XII) REDUCED EXPENDITURES

8 ATTRIBUTABLE TO THE RADIATION

9 ONCOLOGY CASE RATE VALUE BASED

10 PAYMENT PROGRAM.—Effective for 

11 fee schedules established following the 

12 enactment of section 1899C, reduced 

13 expenditures attributable to the Radi14 ation Oncology Case Rate Value 

15 Based Payment Program under sec16 tion 1899C.’’. 

Æ 


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