I 
118TH CONGRESS 
2D SESSION 
H. R. 8404 
To amend title XVIII of the Social Security Act to create a Radiation 
Oncology Case Rate Value Based Payment Program exempt from budget 
neutrality adjustment requirements, and to amend section 1128A of 
title XI of the Social Security Act to create a new statutory exception 
for the provision of free or discounted transportation for radiation oncol-
ogy patients to receive radiation therapy services. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2024 
Mr. FITZPATRICK (for himself, Mr. PANETTA, Mr. JOYCE of Pennsylvania, 
and Mr. TONKO) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee 
on Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to create 
a Radiation Oncology Case Rate Value Based Payment 
Program exempt from budget neutrality adjustment re-
quirements, and to amend section 1128A of title XI 
of the Social Security Act to create a new statutory 
exception for the provision of free or discounted transpor-
tation for radiation oncology patients to receive radiation 
therapy services. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Radiation Oncology 
Case Rate Value Based Program Act of 2024’’ or the 
‘‘ROCR Value Based Program Act’’. 
SEC. 2. FINDINGS. 
(a) FINDINGS.—Congress finds the following: 
(1) Radiation therapy is the careful use of var-
ious forms of radiation, such as external beam radi-
ation therapy, to treat cancer and other diseases 
safely and effectively. Radiation oncologists develop 
radiation treatment plans and coordinate with highly 
specialized care teams to deliver radiation therapy. 
Nearly 60 percent of cancer patients will receive ra-
diation therapy during their treatment. 
(2) In 2021, the Centers for Medicare & Med-
icaid 
Services 
reported 
approximately 
$4,200,000,000 in total spending for radiation on-
cology services between the Medicare physician fee 
schedule and hospital outpatient departments. 
(3) The Centers for Medicare & Medicaid Serv-
ices has historically faced challenges in determining 
accurate pricing for services that involve costly cap-
ital equipment, resulting in fluctuating payment 
rates under the Medicare physician fee schedules for 
services involving external beam radiation therapy. 
Additionally, the Medicare physician fee schedule 
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has inadequately recognized the professional exper-
tise physicians and nonphysician professionals need 
to deliver radiation therapy. 
(4) The current payment systems incentivize 
greater volumes of care while bundled payments 
incentivize patient centered, efficient, and high value 
care. 
(5) In 2017, the Centers for Medicare & Med-
icaid Services recognized that the Medicare payment 
systems were not adequately addressing radiation 
oncology services, and the Center for Medicare & 
Medicaid Innovation released a congressionally re-
quested report on the pursuit of an alternative pay-
ment model for radiation oncology (referred to in 
this section as the ‘‘Radiation Oncology Model’’) 
that addresses the issues in the Medicare physician 
fee schedule and the Medicare hospital outpatient 
prospective payment system payment methods. 
(6) Concerns regarding the proposed Radiation 
Oncology Model included the significant payment re-
ductions proposed in the model that would jeop-
ardize access to high-quality radiation therapy serv-
ices and the onerous reporting requirements for par-
ticipating providers. The Radiation Oncology Model 
saw indefinite implementation delays. 
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(7) It is necessary, therefore, to create a pay-
ment program for radiation oncology services that 
appropriately recognizes the value of quality radi-
ation oncology services through its financial incen-
tives while containing costs and providing patient- 
centered care. 
SEC. 3. RADIATION ONCOLOGY CASE RATE VALUE BASED 
PAYMENT PROGRAM. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.) is amended by adding at 
the end the following: 
‘‘SEC. 1899C. RADIATION ONCOLOGY CASE RATE VALUE 
BASED PAYMENT PROGRAM. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of the ROCR Value Based 
Program Act, the Secretary shall promulgate regula-
tions, using the procedures described in paragraph 
(5), establishing a Radiation Oncology Case Rate 
Value Based Payment Program (referred to in this 
section as the ‘ROCR Program’) under which per 
episode payments are provided to radiation therapy 
providers or radiation therapy suppliers for covered 
treatment furnished to a covered individual during 
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an episode of care (as such terms are defined in sub-
section (j)) in accordance with this section. 
‘‘(2) MAINTAINING
PAYMENT
RATES
DURING 
PERIOD
PRIOR
TO
EFFECTIVE
DATE
OF
REGULA-
TIONS.—The Secretary shall not reduce the estab-
lished payment rates for radiation therapy services 
under the physician fee schedule under section 1848 
or the hospital outpatient prospective payment sys-
tem under section 1833(t) during the time period 
beginning on the date of enactment of the ROCR 
Value Based Program Act and ending on the date 
that the regulations issued by the Secretary pursu-
ant to paragraph (1) become effective. 
‘‘(3) ROCR PROGRAM
GOALS.—The ROCR 
Program shall seek to— 
‘‘(A) create stable, unified payments for 
radiation therapy services under this title; 
‘‘(B) reduce disparities in radiation ther-
apy care for Medicare beneficiaries by increas-
ing access to radiation therapy services close to 
the homes of beneficiaries; 
‘‘(C) enhance quality of radiation therapy 
care through practice accreditation and shorter 
courses of treatment, when appropriate; 
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‘‘(D) leverage and encourage the utilization 
of state-of-the-art technology to improve care 
and outcomes; and 
‘‘(E) protect Medicare resources by achiev-
ing reasonable spending reductions in Medicare 
for radiation therapy services. 
‘‘(4) PAYMENTS.—Under this section, with re-
spect to covered treatment furnished to covered indi-
viduals, payments shall include— 
‘‘(A) per episode payments, as described in 
subsection (b), to radiation therapy providers or 
radiation therapy suppliers of radiation therapy 
services which meet such requirements as the 
Secretary shall establish by regulation; and 
‘‘(B) the health equity achievement in radi-
ation therapy add-on payment described in sub-
section (g). 
‘‘(5) NOTICE
AND
COMMENT
RULEMAKING.— 
The Secretary shall promulgate the regulations de-
scribed in paragraph (1) in accordance with section 
553 of title 5, United States Code, and issue an ad-
vanced notice of proposed rulemaking and notice of 
proposed rulemaking with a comment period of not 
less than 60 days for each. 
‘‘(b) PER EPISODE PAYMENTS.— 
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‘‘(1) IN GENERAL.— 
‘‘(A) PAYMENTS.—The Secretary shall pay 
to a radiation therapy provider or radiation 
therapy supplier an amount equal to 80 percent 
of the per episode payment amount determined 
under paragraph 3 (referred to in this section 
as ‘the per episode payment amount’) for each 
covered individual furnished covered treatment 
for an included cancer type to cover all profes-
sional and technical services furnished during 
such treatment by the radiation therapy pro-
vider or radiation therapy supplier during an 
episode of care (as defined in subsection (j)). 
‘‘(B) DEDUCTIBLES AND COINSURANCE.— 
Subject to subsection (e), the Secretary shall 
pay the per episode payment amount (subject to 
any deductible and coinsurance otherwise appli-
cable under part B) to the radiation therapy 
provider or radiation therapy supplier for an 
episode of care, as described in subsection (c). 
‘‘(2) PER
EPISODE
PAYMENT
REQUIREMENTS 
AND TIMING.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), for each episode of care furnished to 
a covered individual: 
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‘‘(i) FIRST-HALF OF PAYMENT.—The 
Secretary shall issue 1⁄2 of the payment 
amount under paragraph (1) prospectively 
not later than 30 days after the day of the 
first delivery of covered treatment. 
‘‘(ii) SECOND-HALF
OF
PAYMENT.— 
The Secretary shall issue, with the excep-
tion of an episode of care for treatment of 
bone or brain metastases and subject to 
clause (iii), the remaining half of the pay-
ment amount under paragraph (1) on the 
date that is the earlier of— 
‘‘(I) the day the course of cov-
ered treatment is scheduled to end; or 
‘‘(II) the 90th day of the episode 
of care. 
‘‘(iii) SECOND-HALF OF PAYMENT FOR 
BONE AND BRAIN METASTASES.—The Sec-
retary shall issue the remaining half of the 
payment amount under paragraph (1) for 
an episode of care for treatment of bone or 
brain metastases on the date that is the 
earlier of— 
‘‘(I) the day the course of cov-
ered treatment is schedule to end; or 
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‘‘(II) the 30th day of the episode 
of care. 
‘‘(B) PATIENT DEATH.—If a covered indi-
vidual dies during treatment, both episode of 
care payments under subparagraphs (A) and 
(B) shall be paid to the radiation therapy pro-
vider or radiation therapy supplier not later 
than 30 days after the day of the final delivery 
of radiation therapy treatment to the covered 
individual. 
‘‘(C) CONSISTENCY OF PAYMENT.— 
‘‘(i) IN
GENERAL.—The per episode 
payment amount shall not change depend-
ing on the site of service. 
‘‘(ii) SITE
OF
SERVICE
DEFINED.— 
For the purposes of this subparagraph, the 
term ‘site of service’ means the hospital 
outpatient department or physician office 
in which radiation therapy treatment is 
furnished by the radiation therapy provider 
or radiation therapy supplier. 
‘‘(3) DETERMINATION OF PER EPISODE PAY-
MENT AMOUNT.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
determine a per episode payment amount for 
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the professional and technical components 
of the service; 
‘‘(iv) a savings adjustment, as de-
scribed in subsection (d)(3)(B); 
‘‘(v) a health equity achievement in 
radiation therapy adjustment applicable 
only to the technical component payments, 
as described in subsection (g); and 
‘‘(vi) a practice accreditation adjust-
ment, as described in subsection (h), that 
is only applicable to technical component 
payments. 
‘‘(c) TREATMENT
OF INCOMPLETE EPISODES
OF 
CARE; CONCURRENT TREATMENT.— 
‘‘(1) INCOMPLETE EPISODE OF CARE.—In the 
case of an incomplete episode of care, payment shall 
be made to the radiation therapy provider or radi-
ation therapy supplier for services furnished under 
the physician fee schedule under section 1848 or the 
hospital outpatient prospective payment system 
under section 1833(t), as applicable. 
‘‘(2) MULTIPLE EPISODES OF CARE FOR THE 
SAME COVERED INDIVIDUAL.—A radiation therapy 
provider or radiation therapy supplier may initiate a 
new episode of care for the same beneficiary for the 
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same course of therapy by providing another radi-
ation therapy treatment planning service and billing 
under an applicable radiation therapy planning trig-
ger code (as defined in subsection (j). 
‘‘(3) CONCURRENT TREATMENTS.—In the case 
where a treatment modality described in subsection 
(j)(3)(B)(i) is furnished to a covered individual dur-
ing an episode of care for an included cancer type, 
payment may be made concurrently for the treat-
ment modality under the applicable payment system 
under this title with per episode payment under this 
section for covered treatment during the episode of 
care. 
‘‘(d) NATIONAL BASE RATE.— 
‘‘(1) DETERMINATION
OF
NATIONAL
BASE 
RATES.—For purposes of the Secretary determining 
the per episode payment amount under subsection 
(b)(3), the national base rates for the professional 
component and technical component of radiation 
therapy services for each included cancer type are 
based on the M-Code national base rates identified 
in table 75 (including HCPCS Codes for radiation 
therapy services and supplies) of the Federal Reg-
ister on November 16, 2021, 86 Fed. Reg. 63458, 
63925. 
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‘‘(2) UPDATES
TO
THE
NATIONAL
BASE 
RATES.— 
‘‘(A) ANNUAL UPDATES.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the Secretary shall annually update 
the initial national base rates by— 
‘‘(I) in the case of the profes-
sional component of the covered treat-
ment, the percentage increase in the 
Medicare Economic Index; and 
‘‘(II) in the case of the technical 
component of the covered treatment, 
the applicable percentage increase de-
scribed in section 1886(b)(3)(B)(i). 
‘‘(ii) PAYMENT FLOOR.—For each an-
nual update, the Secretary shall not reduce 
the national base rates below the estab-
lished rates from the prior year. 
‘‘(B) PERIODIC UPDATES.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall, through notice and comment rule-
making, rebase or revise the national base 
rates in 5-year intervals, beginning on the 
day that is 5 years after the date the regu-
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lations issued pursuant to subsection 
(a)(1) become effective. 
‘‘(ii) REBASING
LIMIT.—The Sec-
retary shall not reduce the national base 
rates through the process of rebasing by 
more than 1 percent every 5 years. 
‘‘(iii) INPUT
FROM
PROVIDERS
AND 
SUPPLIERS.—In rebasing or revising the 
national base rates pursuant to clause (i), 
the Secretary shall seek significant input 
from radiation therapy providers, radiation 
therapy suppliers, and other stakeholders. 
‘‘(C) REBASE AND REVISE DEFINED.—In 
this subsection: 
‘‘(i) 
REBASE.—The 
term 
‘rebase’ 
means to move the base year for the struc-
ture of costs of the national base rates. 
‘‘(ii) 
REVISE.—The 
term 
‘revise’ 
means types of changes to national base 
rates other than rebasing, such as using 
different data sources, cost categories, or 
price proxies in the national base rates 
input. 
‘‘(D) NEW TECHNOLOGY OR SERVICES.— 
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‘‘(i) IN
GENERAL.—For purposes of 
this subparagraph, the term ‘new tech-
nology or services’ means any technology 
or services that, after the date of enact-
ment of this section, receives a Category 1 
Current Procedural Terminology code or is 
established in the yearly update to the 
Medicare physician fee schedule direct 
practice expense inputs or any successor 
repository of the direct practice expense 
input for the delivery of radiation therapy 
services. 
‘‘(ii) TREATMENT
UNDER
THE
NA-
TIONAL BASE RATES.— 
‘‘(I) EXCLUSION DURING INITIAL 
PERIOD.—The Secretary shall not in-
corporate a radiation therapy service 
that is a new technology or service 
into the national base rates for an in-
cluded cancer type prior to the date 
that is 10 years after such service is 
first identified as a new technology or 
service described in clause (i). 
‘‘(II) INCORPORATION AFTER INI-
TIAL PERIOD.—After the date speci-
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fied in subclause (I) with respect to a 
radiation therapy service that is a new 
technology or service, the Secretary 
shall, through stakeholder meetings, 
requests for information, and notice 
and comment rulemaking, engage pro-
viders, suppliers, radiation therapy 
vendors, patient groups, and the pub-
lic on possible incorporation of the 
new technology or service into the na-
tional base rates for included cancer 
types under paragraph (1). 
‘‘(iii) BEFORE INCORPORATION INTO 
THE NATIONAL BASE RATE.—Until incor-
porated into the national base rates under 
clause (ii)(II), any new technology or serv-
ice shall be paid under the applicable pay-
ment system under this title. 
‘‘(iv) ASSESSMENT OF CERTAIN CRI-
TERIA.—Prior to incorporating a new tech-
nology or service into the national base 
rates pursuant to clause (ii)(II), the Sec-
retary shall consider market penetration 
and adoption, costs relative to base rates, 
clinical benefits of the new technology or 
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service, and the clear consensus of the 
stakeholder community. 
‘‘(3) 
ADJUSTMENTS
TO
NATIONAL
BASE 
RATES.— 
‘‘(A) GEOGRAPHIC ADJUSTMENT.—Prior to 
applying the savings adjustment described in 
subparagraph (B), the Secretary shall adjust 
the national base rates for local cost and wage 
indices based on where the radiation therapy 
services are furnished— 
‘‘(i) in the case of the professional 
component payment rates, the geographic 
adjustment processes described in the 
Medicare Physician Fee Schedule Geo-
graphic Practice Cost Index; and 
‘‘(ii) in the case of the technical com-
ponent payment rates, the geographic ad-
justment processes in the hospital out-
patient prospective payment system under 
section 1833(t). 
‘‘(B) SAVINGS ADJUSTMENT.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall apply a savings adjustment under 
this subparagraph after the geographic ad-
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justments have been applied under sub-
paragraph (A). 
‘‘(ii) 
SAVINGS
ADJUSTMENT
DE-
FINED.—The term ‘savings adjustment’ 
means the percentage by which the profes-
sional component and technical component 
payment rates are each reduced to achieve 
Medicare savings. 
‘‘(e) AVAILABILITY OF PAYMENT PLANS FOR PAY-
MENT OF COINSURANCE.—Following the application of 
the adjustments described in subsection (d), but before the 
application of any sequestration order issued under the 
Balanced Budget and Emergency Deficit Control Act of 
1985 (2 U.S.C. 900 et seq.), radiation therapy providers 
and radiation therapy suppliers shall collect coinsurance 
for services furnished under the ROCR Program subject 
to the following rules: 
‘‘(1) IN
GENERAL.—Radiation therapy pro-
viders and radiation therapy suppliers may collect 
coinsurance applicable under subsection (b)(1) for 
covered treatment furnished to a covered individual 
under the ROCR Program in multiple installments 
under a payment plan. 
‘‘(2) LIMITATION
ON
USE
AS
A
MARKETING 
TOOL.—Radiation therapy providers and radiation 
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therapy suppliers may not use the availability of 
payment plans for such coinsurance as a marketing 
tool to influence the choice of health care provider 
by covered individuals. 
‘‘(3) TIMING
OF
PROVISIONS
OF
INFORMA-
TION.—Radiation therapy providers and radiation 
therapy suppliers offering a payment plan for such 
coinsurance may inform the covered individual of the 
availability of the payment plan prior to or during 
the initial treatment planning session and as nec-
essary thereafter. 
‘‘(4) BENEFICIARY COINSURANCE PAYMENT.— 
The beneficiary coinsurance payment shall equal 20 
percent of the payment amount to be paid to the ra-
diation therapy provider or radiation therapy sup-
plier prior to the application of any sequestration 
order issued under the Balanced Budget and Emer-
gency Deficit Control Act of 1985 (2 U.S.C. 900 et 
seq.) for the billed ROCR Program episode of care, 
except as provided in paragraph (5). 
‘‘(5) INCOMPLETE EPISODE OF CARE.—In the 
case of an incomplete episode of care, the beneficiary 
coinsurance payment shall equal 20 percent of the 
amount that would have been paid in the absence of 
the ROCR Program for the radiation therapy serv-
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ices furnished by the radiation therapy provider or 
radiation therapy supplier that initiated the profes-
sional component and, if applicable, the radiation 
therapy provider or radiation therapy supplier that 
initiated the technical component. 
‘‘(f) MANDATORY PARTICIPATION.— 
‘‘(1) IN GENERAL.—Except as provided under 
paragraph (2) or (3), a radiation therapy provider or 
radiation therapy supplier that is participating in 
the program under this title and furnishes a covered 
treatment to a covered individual shall be required 
to participate in the ROCR Program. 
‘‘(2) CONCURRENT
PARTICIPATION
IN
THE 
ROCR PROGRAM AND OTHER MODELS.—A radiation 
therapy provider or radiation therapy supplier that 
is participating in a State-based Center for Medicare 
& Medicaid Innovation model— 
‘‘(A) shall not be prohibited from also par-
ticipating in the ROCR Program; and 
‘‘(B) is not required to participate in the 
ROCR Program. 
‘‘(3) SIGNIFICANT HARDSHIP EXEMPTION.— 
‘‘(A) IN
GENERAL.—The Secretary may, 
on a case-by-case basis, exempt a radiation 
therapy provider or radiation therapy supplier 
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from the ROCR Program if the Secretary de-
termines that application of the program would 
result in a significant hardship for such radi-
ation therapy provider or radiation therapy sup-
plier or for beneficiaries in the geographic area 
of the radiation therapy provider or radiation 
therapy supplier. 
‘‘(B) PROCEDURE.—The Secretary shall 
promulgate regulations, using the procedures 
described in subsection (a)(5), regarding eligi-
bility and the procedure for applying for a sig-
nificant hardship exemption. 
‘‘(g) HEALTH EQUITY ACHIEVEMENT IN RADIATION 
THERAPY ADD-ON PAYMENT.— 
‘‘(1) IN GENERAL.—Pursuant to paragraph (2) 
and subject to paragraph (7), the Secretary shall ad-
just the per episode payment amount in the amount 
of a health equity achievement in radiation therapy 
add-on payment to advance health equity and sup-
port covered individuals in accessing and completing 
their radiation therapy treatments for covered treat-
ments of included cancer types through the provision 
of transportation services, subject to the succeeding 
provisions of this subsection. 
‘‘(2) ELIGIBILITY.— 
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‘‘(A) IN
GENERAL.—The health equity 
achievement in radiation therapy add-on pay-
ment shall be made when the ICD–10 diagnosis 
code Z59.82, transportation insecurity is re-
ported pursuant to subparagraph (B). 
‘‘(B) 
DETERMINATION
OF
REPORTING 
CODE.—The radiation therapy provider or radi-
ation therapy supplier shall follow the following 
procedures to determine if the ICD–10 diag-
nosis code Z59.82, transportation insecurity 
needs to be reported: 
‘‘(i) The radiation therapy provider or 
radiation therapy supplier shall ask the pa-
tient at the time of patient intake during 
the initial patient consultation if, within 
the previous 2 months, a lack of reliable 
transportation has kept the patient from 
attending medical appointments, meetings, 
or work, or from completing activities of 
daily living. 
‘‘(ii) If the patient answers yes to the 
question in clause (i), ICD–10 diagnosis 
code Z59.82 shall be reported. 
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‘‘(3) AMOUNT.—The health equity achievement 
in radiation therapy add-on payment shall be in the 
amount of— 
‘‘(A) for services furnished during the year 
following the date the regulations issued pursu-
ant to subsection (a)(1) become effective, $500 
per patient per episode of care; and 
‘‘(B) for services furnished in subsequent 
years, the amount determined under this para-
graph for the preceding year, increased by $10. 
‘‘(4) PAYMENT RECIPIENT.—The health equity 
achievement in radiation therapy add-on payment 
shall be paid to the radiation therapy provider or ra-
diation therapy supplier that provides the technical 
component of the radiation therapy services. 
‘‘(5) NOT TO BE USED IN ADDITION TO OR IN 
LIEU
OF
OTHER
SERVICES.—The health equity 
achievement in radiation therapy add-on payment 
shall not be made in addition to or in lieu of any 
other State or Federal program benefits that may be 
used for transportation services. 
‘‘(6) DOCUMENTATION.— 
‘‘(A) IN
GENERAL.—Radiation therapy 
providers and radiation therapy suppliers who 
receive the health equity achievement in radi-
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ation therapy add-on payment shall maintain all 
documentation related to the spending of such 
payment on transportation services per covered 
individual for a period of 5 years after the end 
of the episode of care of the applicable covered 
individual. 
‘‘(B) AVAILABILITY TO THE SECRETARY.— 
The documentation described in subparagraph 
(A) shall be made available to the Secretary 
upon request. 
‘‘(7) NO
MODIFICATION
OF
COINSURANCE.— 
The Secretary may not modify any coinsurance obli-
gation when implementing the health equity achieve-
ment in radiation therapy add-on payment. 
‘‘(h) QUALITY INCENTIVES IN THE ROCR VALUE 
BASED PAYMENT PROGRAM.— 
‘‘(1) IN GENERAL.— 
‘‘(A) INITIAL
INCREASE
IN
PAYMENT.— 
With respect to covered treatment for an in-
cluded cancer type furnished to a covered indi-
vidual on or after the date the regulations 
issued pursuant to subsection (a)(1) become ef-
fective and before the date that is 3 years after 
such date, in the case of a radiation therapy 
provider or radiation therapy supplier that 
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meets the requirements described in paragraph 
(2), payments otherwise made to such radiation 
therapy provider or radiation therapy supplier 
under the ROCR Program for the technical 
component of such services shall be increased 
by 0.5 percent (or 0.25 percent in the case of 
such a provider or supplier that is a small radi-
ation therapy supplier or small radiation ther-
apy provider. 
‘‘(B) REDUCTION IN PAYMENT.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), with respect to covered treatment for 
an included cancer type furnished to a cov-
ered individual on or after the date that is 
3 years after the regulations issued pursu-
ant to subsection (a)(1) become effective, 
in the case of a radiation therapy provider 
or radiation therapy supplier that does not 
meet the requirements described in para-
graph (2), the per episode payment to such 
provider or supplier under the ROCR Pro-
gram shall be reduced by 1.0 percent. 
‘‘(ii) EXCLUSION
OF
SMALL
RADI-
ATION
THERAPY
PROVIDERS
AND
SMALL 
RADIATION
THERAPY
SUPPLIERS.—This 
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subparagraph shall not apply with respect 
to a small radiation therapy provider or a 
small radiation therapy supplier. 
‘‘(C) DEFINITION
OF
SMALL
RADIATION 
THERAPY
PROVIDER
AND
SMALL
RADIATION 
THERAPY
SUPPLIER.—In this subsection, the 
terms ‘small radiation therapy provider’ and 
‘small radiation therapy supplier’ mean, with 
respect to a radiation therapy provider or radi-
ation therapy supplier, a provider or supplier 
that meets the criteria specified by the Sec-
retary, that may include criteria relating to the 
number of linear accelerators owned or used by 
the radiation therapy provider or radiation ther-
apy supplier, the volume of patients treated by 
the radiation therapy provider or radiation ther-
apy supplier, or such other criteria as the Sec-
retary determines is appropriate, in consulta-
tion with radiation therapy stakeholder organi-
zations. 
‘‘(2) ACCREDITATION REQUIREMENTS.— 
‘‘(A) IN GENERAL.—The requirements de-
scribed in this subparagraph with respect to a 
radiation therapy provider or radiation therapy 
supplier (other than such a provider or supplier 
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that is a small radiation therapy provider or 
small radiation therapy supplier) are that the 
supplier or provider must— 
‘‘(i) maintain or be in the process of 
obtaining accreditation by the American 
College of Radiology, American College of 
Radiation Oncology, or American Society 
for Radiation Oncology; 
‘‘(ii) comply with certified electronic 
health record technology requirements as 
determined by the Secretary with excep-
tions that are consistent with those of the 
Merit-based Incentive Payment System es-
tablished under section 1848(q); and 
‘‘(iii) submit to the Secretary proof of 
the accreditation described in clause (i) in 
such form and manner as specified by the 
Secretary. 
‘‘(B) REQUIREMENTS
FOR
SMALL
RADI-
ATION THERAPY PROVIDERS AND SMALL RADI-
ATION THERAPY SUPPLIERS.—A radiation ther-
apy provider or radiation therapy supplier that 
is a small radiation therapy provider or small 
radiation therapy supplier may elect to satisfy 
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the accreditation requirement under this para-
graph by— 
‘‘(i) meeting the requirements of sub-
paragraph (A); 
‘‘(ii) using an external audit that en-
compasses similar criteria as a nationally 
recognized radiation oncology accreditation 
organization and submit the outcome of 
such external audit to the Secretary; or 
‘‘(iii) complying with certified elec-
tronic health record technology require-
ments as determined by the Secretary with 
exceptions that are consistent with those of 
the Merit-Based Incentives Payment Sys-
tem established under section 1848(q). 
‘‘(C) NEW PROVIDERS.—A new radiation 
therapy provider or new radiation supplier shall 
complete an initiation of accreditation or exter-
nal audit not later than the date that is 1 year 
after such provider or supplier begins fur-
nishing covered treatment to covered individ-
uals. 
‘‘(i) REPORTING REQUIREMENTS.— 
‘‘(1) REPORT ON THE ROCR PROGRAM.—Not 
earlier than 7 years after the date of the enactment 
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of this section, the Comptroller General of the 
United States (referred to in this subsection as the 
‘Comptroller General’) shall, after seeking out the 
perspectives of radiation oncology stakeholders, sub-
mit to the appropriate committees of jurisdiction of 
the Senate and the House of Representatives a re-
port that— 
‘‘(A) evaluates— 
‘‘(i) the implementation of the ROCR 
Program, and the impact such Program 
has had on Federal healthcare spending; 
‘‘(ii) the impact the ROCR Program 
has had on the ability of covered individ-
uals to access covered treatment; 
‘‘(iii) whether any cancer types or ra-
diation 
therapy 
services, 
such 
as 
brachytherapy, proton therapy, or thera-
peutic radiopharmaceuticals, should be 
added or removed from the ROCR Pro-
gram; and 
‘‘(iv) the potential application of the 
ROCR Program to benefits provided under 
part C of this title; and 
‘‘(B) includes any recommendations for ad-
ministrative and legislative changes. 
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‘‘(2) REPORT ON ACCESS TO RADIATION THER-
APY
IN
RURAL
AND
UNDERSERVED
AREAS.—Not 
later than 3 years after the date of the enactment 
of this section, the Comptroller General shall submit 
a report to the appropriate committees of jurisdic-
tion of the Senate and the House of Representatives 
that identifies the following: 
‘‘(A) Radiation therapy deserts. 
‘‘(B) Methods to increase access to new ra-
diation therapy technologies in rural and under-
served areas, including technologies required for 
clinical treatment planning, simulation, dosim-
etry, medical radiation physics, radiation treat-
ment devices, radiation treatment delivery, radi-
ation treatment management, and such other 
items as the Comptroller General may deter-
mine are medically necessary. 
‘‘(C) A program to provide assistance in 
the form of grants or loans to radiation therapy 
providers or radiation therapy suppliers for the 
purpose of ensuring access to the most current 
radiation therapy technology. 
‘‘(3) DETERMINATION AND DEFINITION OF RA-
DIATION THERAPY DESERTS.— 
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‘‘(A) DEFINITION.—For purposes of this 
subsection, the term ‘radiation therapy desert’ 
means a region determined by the Comptroller 
General under subparagraph (B) with a mis-
match between radiation therapy resources and 
oncologic need. 
‘‘(B) DETERMINATION.—In determining 
whether a region qualifies as a radiation ther-
apy desert, the Comptroller General shall take 
into account the ratio or density of radiation 
therapy providers and radiation therapy sup-
pliers practicing in a geographic area as com-
pared to the population size in that geographic 
area. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) APPLICABLE RADIATION THERAPY PLAN-
NING TRIGGER CODE.—The term ‘applicable radi-
ation therapy planning trigger code’ means services 
identified, as of the date that the regulations issued 
pursuant to subsection (a)(1) become effective, by 
the following HCPCS codes (and as subsequently 
modified by the Secretary): 
‘‘(A) 77261, therapeutic radiology treat-
ment planning, simple. 
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‘‘(B) 77262, therapeutic radiology treat-
ment planning, intermediate. 
‘‘(C) 77263, therapeutic radiology treat-
ment planning, complex. 
‘‘(2) COVERED
INDIVIDUAL.—The term ‘cov-
ered individual’ means an individual who— 
‘‘(A) is enrolled for benefits under part B; 
‘‘(B) is not enrolled in a Medicare Advan-
tage plan under part C or a PACE program 
under section 1894; and 
‘‘(C) is diagnosed with an included cancer 
type. 
‘‘(3) COVERED TREATMENT.— 
‘‘(A) IN
GENERAL.—The term ‘covered 
treatment’ means, subject to subparagraph (B), 
radiation therapy services furnished to a cov-
ered individual. 
‘‘(B) EXCLUSIONS.—Such term does not 
include— 
‘‘(i) during the period beginning on 
the date on which the regulation issued 
pursuant to subsection (a)(1) become effec-
tive and ending on the date that is 10 
years after such date, brachytherapy, pro-
ton 
beam 
radiation 
therapy 
services, 
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intraoperative radiotherapy, superficial ra-
diation therapy, hyperthermia, and thera-
peutic radiopharmaceuticals; 
‘‘(ii) inpatient radiation therapy serv-
ices furnished in a subsection (d) hospital 
or ambulatory surgical center; 
‘‘(iii) radiation therapy services fur-
nished in cancer hospitals that are exempt 
from the hospital outpatient prospective 
payment system under section 1833(t); 
‘‘(iv) physician services that are fur-
nished or supervised by the physician fur-
nishing radiation therapy or by another 
physician, such as cancer surgeries, chemo-
therapy, and other services; or 
‘‘(v) physician services that are fur-
nished using technology represented by 
Healthcare Common Procedure Coding 
System codes that are not included in the 
M-code national base rates identified in 
table 75 (including in HCPCS Codes for 
radiation therapy services and supplies) of 
the Federal Register on November 16, 
2021, 86 Fed. Reg. 63485, 63925. 
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‘‘(4) EPISODE OF CARE.—The term ‘episode of 
care’ means, with respect to a covered individual, the 
period— 
‘‘(A) beginning on the day radiation ther-
apy planning for an included cancer type, billed 
under an applicable radiation therapy planning 
trigger code, is furnished to a covered indi-
vidual if radiation therapy treatment is initiated 
not later than 30 days after the day such radi-
ation therapy planning service is furnished; and 
‘‘(B) ends— 
‘‘(i) for treatment of all included can-
cer types except bone and brain metastases 
treatment, the day that is 90 days after 
the day the episode of care begins under 
clause (i); and 
‘‘(ii) for bone and brain metastases 
treatment, the day that is 30 days after 
the day the episode of care begins under 
clause (i). 
‘‘(5) INCLUDED CANCER TYPES.—The term ‘in-
cluded cancer type’ means any of the following types 
of cancer: 
‘‘(A) Anal. 
‘‘(B) Bladder. 
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‘‘(C) Bone Metastases. 
‘‘(D) Brain Metastases. 
‘‘(E) Breast. 
‘‘(F) Cervical. 
‘‘(G) Central Nervous System Tumors. 
‘‘(H) Colorectal. 
‘‘(I) Head and Neck. 
‘‘(J) Lung. 
‘‘(K) Lymphoma. 
‘‘(L) Pancreatic. 
‘‘(M) Prostate. 
‘‘(N) Upper Gastrointestinal. 
‘‘(O) Uterine. 
‘‘(6) HEALTHCARE COMMON PROCEDURE COD-
ING SYSTEM.—The term ‘Healthcare Common Pro-
cedure Coding System’ means the standardized cod-
ing system used by Medicare and other health insur-
ance programs to ensure that claims are processed 
in an orderly and consistent manner. 
‘‘(7) INCOMPLETE
EPISODE
OF
CARE.—The 
term ‘incomplete episode of care’ means, with re-
spect to a covered individual, an episode of care that 
is not completed because— 
‘‘(A) the individual being treated ceases to 
be a covered individual, including in the case 
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where the individual loses benefits under this 
title, at any time after the initial treatment 
planning service is furnished and before the epi-
sode of care for the covered treatment is com-
plete; or 
‘‘(B) a covered individual switches radi-
ation therapy provider or radiation therapy sup-
plier before all included radiation therapy serv-
ices in the episode of care for the covered treat-
ment have been furnished. 
‘‘(8) PROFESSIONAL
COMPONENT.—The term 
‘professional component’ means the included radi-
ation therapy services that may only be furnished by 
a physician. 
‘‘(9) RADIATION
THERAPY.—The term ‘radi-
ation therapy’ means the careful use of various 
forms of radiation, such as external beam radiation 
therapy, to treat cancer and other diseases safely 
and effectively. 
‘‘(10) RADIATION
THERAPY
PROVIDER.—The 
term ‘radiation therapy provider’ means a hospital 
outpatient department enrolled under this title that 
furnishes radiation therapy services. 
‘‘(11) RADIATION
THERAPY
SERVICES.—The 
term ‘radiation therapy services’ means the treat-
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ment planning, technical preparation, special serv-
ices (such as simulation), treatment delivery, and 
treatment management services associated with can-
cer treatment that uses high doses of radiation to 
kill cancer cells and shrink tumors. 
‘‘(12) RADIATION
THERAPY
SUPPLIER.—The 
term ‘radiation therapy supplier’ means a physician 
group practice or freestanding radiation therapy cen-
ter enrolled under this title that furnishes radiation 
therapy services. 
‘‘(13) TECHNICAL
COMPONENT.—The term 
‘technical component’ means the included radiation 
therapy services that are not furnished by a physi-
cian, including the provision of equipment, supplies, 
personnel, and administrative costs related to radi-
ation therapy services. 
‘‘(14) TRANSPORTATION SERVICES.—The term 
‘transportation services’ means the provision of free 
or discounted transportation made available to cov-
ered individuals furnished covered treatment which 
are not air, luxury, or ambulance-level transpor-
tation, but may include car services, ride shares, or 
public transportation.’’. 
(b) EXCLUSION
OF
PARTICIPATING
RADIATION 
THERAPY PROVIDERS, RADIATION THERAPY SUPPLIERS, 
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AND PHYSICIANS FROM THE MERIT-BASED INCENTIVE 
PAYMENT SYSTEM.—Section 1848(q)(1)(C)(ii) of the So-
cial Security Act (42 U.S.C. 1395w-4(q)(1)(c)(II)) is 
amended— 
(1) in subclause (II), by striking ‘‘or’’ at the 
end; 
(2) in subclause (III), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following new sub-
clause: 
‘‘(IV) is a radiation therapy pro-
vider or radiation therapy supplier (as 
those terms are defined in subsection 
(j) of section1899C) that is partici-
pating in the Radiation Oncology Case 
Rate Value Based Payment Program 
established under that section.’’. 
SEC. 4. REVISION TO CIVIL MONETARY PENALTIES RE-
GARDING RADIATION ONCOLOGY CASE RATE 
PATIENT TRANSPORTATION SERVICES. 
Section 1128A of the Social Security Act (42 U.S.C. 
1320a–7a) is amended— 
(1) in subsection (i)(6)— 
(A) in subparagraph (I), by striking ‘‘or’’ 
at the end; 
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(B) in subparagraph (J)(iii), by striking 
the period at the end and inserting ‘‘; or’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(K) the provision of transportation serv-
ices by an eligible entity, as defined in sub-
section (t), if— 
‘‘(i) the availability of the transpor-
tation services— 
‘‘(I) is set forth in a policy that 
the eligible entity, as defined in sub-
section (t), applies uniformly and con-
sistently; and 
‘‘(II) is not determined in a man-
ner related to the past or anticipated 
volume or value of Federal health care 
program business; 
‘‘(ii) the eligible entity does not pub-
licly market or advertise the transportation 
services; 
‘‘(iii) the driver who provides the 
transportation services does not market 
health care items or services during the 
course of the transportation or at any 
time; 
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‘‘(iv) the driver or individual arrang-
ing for the transportation services is not 
paid on a per-beneficiary-transported basis; 
‘‘(v) the eligible entity makes the 
transportation services available only to an 
individual who— 
‘‘(I) is an established patient, as 
defined in subsection (t), of the eligi-
ble entity that is providing or facili-
tating free or discounted transpor-
tation; 
‘‘(II) resides— 
‘‘(aa) within a 75 miles ra-
dius of the radiation therapy pro-
vider or radiation therapy sup-
plier to or from which the patient 
would be transported; or 
‘‘(bb) in a rural area, as de-
fined in subsection (t); and 
‘‘(III) is receiving radiation ther-
apy services for the purpose of obtain-
ing medically necessary items and 
services; and 
‘‘(vi) the eligible entity that makes the 
transportation services available bears the 
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