119-s1031

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1031 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 1031

 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

 March 13, 2025

Mr. Tillis (for himself and Mr. Peters) 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.

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

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Radiation Oncology Case Rate Value 
Based Program Act of 2025'' or the ``ROCR Value Based Program Act''.

SEC. 2. FINDINGS.

    (a) 

=== Findings ===
-Congress finds the following:

    (1) Radiation therapy is the careful use of various forms 
 of radiation, such as external beam radiation 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 
 radiation therapy during their treatment.

    (2) In 2021, the Centers for Medicare & Medicaid Services 
 reported approximately $4,200,000,000 in total spending for 
 radiation oncology services between the Medicare physician fee 
 schedule and hospital outpatient departments.

    (3) The Centers for Medicare & Medicaid Services has 
 historically faced challenges in determining accurate pricing 
 for services that involve costly capital 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 has 
 inadequately recognized the professional expertise 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 & Medicaid Services 
 recognized that the Medicare payment systems were not 
 adequately addressing radiation oncology services, and the 
 Center for Medicare & Medicaid Innovation released a 
 congressionally requested report on the pursuit of an 
 alternative payment 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 reductions proposed in 
 the model that would jeopardize access to high-quality 
 radiation therapy services and the onerous reporting 
 requirements for participating providers. The Radiation 
 Oncology Model saw indefinite implementation delays.

    (7) It is necessary, therefore, to create a payment program 
 for radiation oncology services that appropriately recognizes 
 the value of quality radiation oncology services through its 
 financial incentives 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 regulations, 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 
 an episode of care (as such terms are defined in subsection

    (j) ) in accordance with this section.
 ``

    (2) Maintaining payment rates during period prior to 
 effective date of regulations.--The Secretary shall not reduce 
 the established payment rates for radiation therapy services 
 under the physician fee schedule under 

section 1848 or the 
 hospital outpatient prospective payment system 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 pursuant 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 therapy care 
 for Medicare beneficiaries by increasing 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;
 ``
            (D) leverage and encourage the utilization of 
 state-of-the-art technology to improve care and 
 outcomes; and
 ``
        (E) protect Medicare resources by achieving 
 reasonable spending reductions in Medicare for 
 radiation therapy services.
 ``

    (4) Payments.--Under this section, with respect to 
 covered treatment furnished to covered individuals, 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 radiation 
 therapy add-on payment described in subsection

    (g) .
 ``

    (5) Notice and comment rulemaking.--The Secretary shall 
 promulgate the regulations described in paragraph

    (1) in 
 accordance with 

section 553 of title 5, United States Code, and 
 issue an advanced 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.--
 ``

    (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 professional and technical services furnished 
 during such treatment by the radiation therapy provider 
 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 applicable 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 subparagraph
        (B) , for 
 each episode of care furnished to a covered individual:
 ``
            (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 exception of an 
 episode of care for treatment of bone or brain 
 metastases and subject to clause
            (iii) , the 
 remaining half of the payment amount under 
 paragraph

    (1) on the date that is the earlier 
 of--
 ``
            (I) the day the course of covered 
 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 Secretary 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 covered 
 treatment is scheduled to end; or
 ``
            (II) the 30th day of the episode 
 of care.
 ``
        (B) Patient death.--If a covered individual dies 
 during treatment, both episode of care payments under 
 subparagraphs
        (A) and
        (B) shall be paid to the 
 radiation therapy provider 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 depending 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 payment amount.--
 ``
        (A) In general.--The Secretary shall determine a 
 per episode payment amount for the professional 
 component and technical component of treatment for each 
 included cancer type.
 ``
        (B) Amount.--The Secretary shall determine the 
 per episode payment amount based on national base 
 rates, as described in subsection
            (d) (1) and as updated 
 in subsection
            (d) (2) .
 ``
            (C) Adjustments.--The per episode payment amount 
 shall be subject to--
 ``
            (i) the adjustments as described in 
 subsection
            (d) (2) and
            (d) (3) ;
 ``
            (ii) a geographic adjustment, as 
 described in subsection
            (d) (3)
        (A) ;
 ``
            (iii) an inflation adjustment, pursuant 
 to which the Secretary shall adjust the per 
 episode payment amount by the percentage 
 increase in the Medicare Economic Index (as 
 described in 

section 1842 for the professional 
 component payments and the applicable 
 percentage increase in the Hospital Inpatient 
 Market Basket Update (as described in 

section 1886

    (b)

    (3)
        (B)
            (i) ) for the technical component 
 payments during each 12-month period, and which 
 varies for the professional and technical 
 components of the service;
 ``
            (iv) a savings adjustment, as described 
 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 adjustment, 
 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 radiation 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 same course of therapy by providing another 
 radiation therapy treatment planning service and billing under 
 an applicable radiation therapy planning trigger code (as 
 defined in subsection

    (j) ).
 ``

    (3) Concurrent treatments.--In the case where a treatment 
 modality described in subsection

    (j)

    (4)
        (B)
            (i) 
            (I) is furnished 
 to a covered individual during an episode of care for an 
 included cancer type, payment may be made concurrently for the 
 treatment 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 Register on November 16, 2021, 86 Fed. Reg. 63458, 
 63925.
 ``

    (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 
 professional component of the covered 
 treatment, 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 
 described in 

section 1886

    (b)

    (3)
        (B)
            (i) .
 ``
            (ii) Payment floor.--For each annual 
 update, the Secretary shall not reduce the 
 national base rates below the established rates 
 from the prior year.
 ``
        (B) Periodic updates.--
 ``
            (i) In general.--The Secretary shall, 
 through notice and comment rulemaking, rebase 
 or revise the national base rates in 5-year 
 intervals, beginning on the day that is 5 years 
 after the date the regulations issued pursuant 
 to subsection

    (a)

    (1) become effective.
 ``
            (ii) Rebasing limit.--The Secretary 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 to ensure 
 that such rates are sufficient, particularly 
 for any new technology or service and any 
 treatment modality described in clause
            (i) 
            (I) of subsection

    (j)

    (4)
        (B) that is determined to 
 be a covered treatment by the Secretary under 
 clause
            (ii) of such subsection.
 ``
            (C) Rebase and revise defined.--In this 
 subsection:
 ``
            (i) Rebase.--The term `rebase' means to 
 move the base year for the structure 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.--
 ``
            (i) Treatment under the national base 
 rates.--
 ``
            (I) Exclusion during initial 
 period.--The Secretary shall not 
 incorporate a radiation therapy service 
 that is a new technology or service (as 
 defined in subsection

    (j) ) into the 
 national base rates for an included 
 cancer type prior to the date that is 
 12 years after such service is first 
 identified as a new technology or 
 service.
 ``
            (II) Incorporation after initial 
 period.--After the date specified 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 
 providers, suppliers, radiation therapy 
 vendors, patient groups, and the public 
 on possible incorporation of the new 
 technology or service into the national 
 base rates for included cancer types 
 under paragraph

    (1) .
 ``
            (ii) Before incorporation into the 
 national base rate.--Until incorporated into 
 the national base rates under clause
            (i) 
            (II) , 
 any new technology or service shall be paid 
 under the applicable payment system under this 
 title.
 ``
            (iii) Development and transitional 
 payment period for adaptive radiation therapy 
 planning.--
 ``
            (I) Development and valuation for 
 adaptive radiation therapy planning.--
 Not later than the date the regulations 
 issued pursuant to subsection

    (a)

    (1) become effective and in consultation 
 with the American Medical Association's 
 Current Procedural Terminology 
 Editorial Panel and Specialty Society 
 Relative Value Scale Update Committee, 
 radiation oncology specialty societies, 
 and radiation oncology stakeholders, 
 the Secretary shall develop and value 
 codes for adaptive radiation therapy 
 planning (as defined in subsection

    (j) ).
 ``
            (II) Transitional payment.--
 ``

    (aa) In general.--During 
 the period beginning on the 
 date the regulations issued 
 pursuant to subsection

    (a)

    (1) become effective and ending on 
 the date any adaptive radiation 
 therapy planning code is 
 developed and valued, the 
 Secretary shall provide a 
 separate payment under the 
 applicable payment system, in 
 addition to the per episode 
 payment amount, for any 
 medically necessary online and 
 offline adaptive radiation 
 therapy planning furnished to a 
 covered individual after the 
 initial treatment plan for a 
 covered individual.
 ``

    (bb) Modifier.--The 
 Secretary shall establish a 
 modifier to identify claims for 
 the transitional payment for 
 adaptive radiation therapy 
 planning for a covered 
 individual.
 ``
            (iv) Assessment of certain criteria.--
 Prior to incorporating a new technology or 
 service into the national base rates pursuant 
 to clause
            (i) 
            (II) , the Secretary shall consider 
 market penetration and adoption, costs relative 
 to base rates, clinical benefits of the new 
 technology or 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 Geographic Practice Cost 
 Index; and
 ``
            (ii) in the case of the technical 
 component payment rates, the geographic 
 adjustment processes in the hospital outpatient 
 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 adjustments 
 have been applied under subparagraph
        (A) .
 ``
            (ii) Savings adjustment defined.--The 
 term `savings adjustment' means the percentage 
 by which the professional component and 
 technical component payment rates are each 
 reduced to achieve Medicare savings.
 ``

    (e) Availability of Payment Plans for Payment 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 providers 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 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 information.--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 necessary 
 thereafter.
 ``

    (4) Beneficiary coinsurance payment.--The beneficiary 
 coinsurance payment shall equal 20 percent of the payment 
 amount to be paid to the radiation therapy provider or 
 radiation therapy supplier prior to 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.) 
 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 
 services furnished by the radiation therapy provider or 
 radiation therapy supplier that initiated the professional 
 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 
 participating 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 from the ROCR Program if the 
 Secretary determines that application of the program 
 would result in a significant hardship, such as in the 
 case of a natural disaster, for such radiation therapy 
 provider or radiation therapy supplier 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 eligibility and the 
 procedure for applying for a significant 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 adjust the per episode 
 payment amount in the amount of a health equity achievement in 
 radiation therapy add-on payment to advance health equity and 
 support covered individuals in accessing and completing their 
 radiation therapy treatments for covered treatments of included 
 cancer types through the provision of transportation services, 
 subject to the succeeding provisions of this subsection.
 ``

    (2) Eligibility.--
 ``
        (A) In general.--The health equity achievement in 
 radiation therapy add-on payment shall be made when the 
 ICD-10 diagnosis code Z59.82, transportation insecurity 
 is reported pursuant to subparagraph
        (B) .
 ``
        (B) Determination of reporting code.--The 
 radiation therapy provider or radiation therapy 
 supplier shall follow the following procedures to 
 determine if the ICD-10 diagnosis code Z59.82, 
 transportation insecurity needs to be reported:
 ``
            (i) The radiation therapy provider or 
 radiation therapy supplier shall ask the 
 patient 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.
 ``

    (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 pursuant 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 paragraph 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 radiation 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 radiation 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 obligation when implementing the 
 health equity achievement 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 included cancer type furnished 
 to a covered individual on or after the date the 
 regulations issued pursuant to subsection

    (a)

    (1) become 
 effective and before the date that is 2 years after 
 such date, in the case of a radiation therapy provider 
 or radiation therapy supplier that 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 1 percent (or 0.25 percent in the case of 
 such a provider or supplier that is a limited resource 
 radiation therapy supplier or limited resource 
 radiation therapy 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 covered 
 individual on or after the date that is 2 years 
 after the regulations issued pursuant 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 paragraph

    (2) , the 
 per episode payment to such provider or 
 supplier under the ROCR Program shall be 
 reduced by 2.5 percent.
 ``
            (ii) Exclusion of limited resource 
 radiation therapy providers and limited 
 resource radiation therapy suppliers.--This 
 subparagraph shall not apply with respect to a 
 limited resource radiation therapy provider or 
 a limited resource radiation therapy supplier.
 ``
            (C) Definition of limited resource radiation 
 therapy provider and limited resource radiation therapy 
 supplier.--
 ``
            (i) In general.--In this subsection, the 
 terms `limited resource radiation therapy 
 provider' and `limited resource radiation 
 therapy supplier' mean, with respect to a 
 radiation therapy provider or radiation therapy 
 supplier, a provider or supplier that meets the 
 criteria specified by the Secretary that may 
 include criteria relating to the volume and 
 socioeconomic status of patients treated by the 
 radiation therapy provider or radiation therapy 
 supplier, the geographic area or medically-
 underserved area served by the radiation 
 therapy provider or radiation therapy supplier, 
 including rural areas, or such other criteria 
 as the Secretary determines is appropriate, 
 through notice and comment rulemaking and in 
 consultation with radiation therapy stakeholder 
 organizations.
 ``
            (ii) Cap on number of limited resource 
 radiation therapy providers and limited 
 resource radiation therapy suppliers.--In 
 specifying the criteria for limited resource 
 radiation therapy providers and limited 
 resource radiation therapy suppliers under 
 clause
            (i) , the Secretary shall ensure that the 
 total number of such providers and suppliers 
 does not exceed 10 percent of the total number 
 of all radiation therapy providers and 
 radiation therapy suppliers.
 ``

    (2) Accreditation requirements.--
 ``
        (A) In general.--The requirements described in 
 this subparagraph with respect to a radiation therapy 
 provider or radiation therapy supplier (other than such 
 a provider or supplier that is a limited resource 
 radiation therapy provider or limited resource 
 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 (referred to in this section as 
 `covered radiation oncology accreditation 
 organizations');
 ``
            (ii) comply with certified electronic 
 health record technology requirements as 
 determined by the Secretary with exceptions 
 that are consistent with those of the Merit-
 Based Incentive Payment System established 
 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 limited resource radiation 
 therapy providers and limited resource radiation 
 therapy suppliers.--A radiation therapy provider or 
 radiation therapy supplier that is a limited resource 
 radiation therapy provider or limited resource 
 radiation therapy supplier may elect to satisfy the 
 accreditation requirement under this paragraph by--
 ``
            (i) meeting the requirements of 
 subparagraph
        (A) ;
 ``
            (ii) using an external audit that 
 encompasses 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 electronic 
 health record technology requirements as 
 determined by the Secretary with exceptions 
 that are consistent with those of the Merit-
 Based Incentives Payment System established 
 under 

section 1848

    (q) .
 ``
            (C) New providers.--A new radiation therapy 
 provider or new radiation supplier shall complete an 
 initiation of accreditation or external audit not later 
 than the date that is 1 year after such provider or 
 supplier begins furnishing covered treatment to covered 
 individuals.
 ``
            (D) Radiation oncology accreditation organization 
 quality standards.--Each covered radiation oncology 
 accreditation organization (and any successor 
 organization) shall develop quality standards for 
 radiation therapy providers and radiation therapy 
 suppliers to ensure covered treatments are delivered 
 using adequate and modern linear accelerator 
 technology, staffing, and other components that protect 
 patient safety and quality by--
 ``
            (i) consulting with radiation therapy 
 manufacturers and key stakeholders;
 ``
            (ii) soliciting public comment on 
 proposed quality standards, including from 
 physicians, medical physicists, and other 
 health professionals and experts;
 ``
            (iii) updating quality standards not 
 later than every 5 to 7 years in partnership 
 with stakeholders;
 ``
            (iv) ensuring quality standards for 
 linear accelerator technology are adequate and 
 on par with current technological advances and 
 modern requirements for staffing and other 
 procedures associated with the delivery of safe 
 and effective radiation therapy;
 ``
            (v) collecting timely information from 
 radiation therapy providers and radiation 
 therapy suppliers for each linear accelerator 
 owned or used on or after the effective date of 
 the regulations issued pursuant to subsection

    (a)

    (1) ; and
 ``
            (vi) giving sufficient weight to 
 compliance with quality standards among other 
 accreditation standards in determining 
 accreditation status for radiation therapy 
 providers or radiation therapy suppliers.
 ``
            (i) Reporting Requirements.--
 ``

    (1) Report on the rocr program.--Not earlier than 7 years 
 after the date of the enactment 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, submit 
 to the appropriate committees of jurisdiction of the Senate and 
 the House of Representatives a report 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 individuals to access 
 covered treatment;
 ``
            (iii) whether any cancer types or 
 radiation therapy services, such as 
 brachytherapy, proton therapy, or therapeutic 
 radiopharmaceuticals, should be added or 
 removed from the ROCR Program; and
 ``
            (iv) the potential application of the 
 ROCR Program to benefits provided under part C 
 of this title; and
 ``
        (B) includes any recommendations for 
 administrative and legislative changes.
 ``

    (2) Report on access to radiation therapy 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 jurisdiction 
 of the Senate and the House of Representatives that identifies 
 the following:
 ``
        (A) Radiation therapy deserts.
 ``
        (B) Methods to increase access to new radiation 
 therapy technologies in rural and underserved areas, 
 including technologies required for clinical treatment 
 planning, simulation, dosimetry, medical radiation 
 physics, radiation treatment devices, radiation 
 treatment delivery, radiation treatment management, and 
 such other items as the Comptroller General may 
 determine 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 radiation therapy 
 deserts.--
 ``
        (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 mismatch between radiation 
 therapy resources and oncologic need.
 ``
        (B) Determination.--In determining whether a 
 region qualifies as a radiation therapy desert, the 
 Comptroller General shall take into account the ratio 
 or density of radiation therapy providers and radiation 
 therapy suppliers practicing in a geographic area as 
 compared to the population size in that geographic 
 area.
 ``

    (j) 

=== Definitions. ===
-In this section:
 ``

    (1) Adaptive radiation therapy planning.--The term 
 `adaptive radiation therapy planning' means any new technology 
 or 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) performed after the initial treatment plan for a 
 covered individual:
 ``
        (A) 77295, 3-dimensional radiotherapy plan, 
 including dose-volume histograms.
 ``
        (B) 77300, basic radiation dosimetry calculation, 
 central axis depth dose calculation, TDF, NSD, gap 
 calculation, off axis factor, tissue inhomogeneity 
 factors, calculation of non-ionizing radiation surface 
 and depth dose, as required during course of treatment, 
 only when prescribed by the treating physician.
 ``
            (C) 77301, intensity modulated radiotherapy plan, 
 including dose-volume histograms for target and 
 critical structure partial tolerance specifications.
 ``
            (D) 77338, multi-leaf collimator
            (MLC) devices 
 for intensity modulated radiation therapy

    (IMRT) , 
 design and construction per IMRT plan.
 ``
        (E) 77334, Treatment devices, design and 
 construction; complex (irregular blocks, special 
 shields, compensators, wedges, molds or casts).
 ``
        (F) 77293, Respiratory motion management 
 simulation (List separately in addition to code for 
 primary procedure).
 ``

    (2) Applicable radiation therapy planning trigger code.--
 The term `applicable radiation 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 treatment 
 planning, simple.
 ``
        (B) 77262, therapeutic radiology treatment 
 planning, intermediate.
 ``
            (C) 77263, therapeutic radiology treatment 
 planning, complex.
 ``

    (3) Covered individual.--The term `covered individual' 
 means an individual who--
 ``
        (A) is enrolled for benefits under part B;
 ``
        (B) is not enrolled in a Medicare Advantage plan 
 under part C or a PACE program under 

section 1894; and
 ``
            (C) is diagnosed with an included cancer type.
 ``

    (4) Covered treatment.--
 ``
        (A) In general.--The term `covered treatment' 
 means, subject to subparagraph
        (B) , radiation therapy 
 services furnished to a covered individual.
 ``
        (B) Exclusions.--
 ``
            (i) In general.--Such term does not 
 include--
 ``
            (I) subject to clause
            (ii) , 
 during the period beginning on the date 
 on which the regulation issued pursuant 
 to subsection

    (a)

    (1) become effective 
 and ending on the date that is 12 years 
 after such date, brachytherapy, proton 
 beam radiation therapy services, 
 intraoperative radiotherapy, 
 superficial radiation therapy, 
 hyperthermia, and therapeutic 
 radiopharmaceuticals;
 ``
            (II) inpatient radiation therapy 
 services furnished in a subsection
            (d) hospital or ambulatory surgical center;
 ``
            (III) radiation therapy services 
 furnished in cancer hospitals that are 
 exempt from the hospital outpatient 
 prospective payment system under 
 

section 1833

    (t) ;
 ``
            (IV) physician services that are 
 furnished or supervised by the 
 physician or the physician practice 
 furnishing radiation therapy or by 
 another physician, including any 
 surgical procedures, chemotherapy, and 
 other services;
 ``
            (V) physician and technical 
 services that are furnished 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; or
 ``
            (VI) durable medical equipment 
 (as defined in 

section 1861

    (n) ).
 ``
            (ii) Inclusion of certain treatment.--
 After the date that is 12 years after the date 
 on which the regulation issued pursuant to 
 subsection

    (a)

    (1) become effective, the 
 Secretary may determine by regulation to 
 include any of the treatment modalities 
 described in clause
            (i) 
            (I) as covered 
 treatment. Before making such determination, 
 the Secretary shall--
 ``
            (I) consider--
 ``

    (aa) market penetration;
 ``

    (bb) the cost of such 
 items or services relative to 
 base rates;
 ``
            (cc) the clinical 
 benefits of such items or 
 services; and
 ``
            (dd) the clear consensus 
 of the stakeholder community; 
 and
 ``
            (II) publish a notice of a 
 proposed determination under subsection

    (b)

    (3)
        (B) regarding the payment amount 
 proposed to be established with respect 
 to such item or service.
 ``

    (5) Episode of care.--The term `episode of care' means, 
 with respect to a covered individual, the period--
 ``
        (A) beginning on the day radiation therapy 
 planning for an included cancer type, billed under an 
 applicable radiation therapy planning trigger code, is 
 furnished to a covered individual if radiation therapy 
 treatment is initiated not later than 30 days after the 
 day such radiation therapy planning service is 
 furnished; and
 ``
        (B) ends--
 ``
            (i) for treatment of all included cancer 
 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) .
 ``

    (6) Included cancer types.--The term `included cancer 
 type' means any of the following types of cancer:
 ``
        (A) Anal.
 ``
        (B) Bladder.
 ``
            (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.
 ``

    (7) Healthcare common procedure coding system.--The term 
 `Healthcare Common Procedure Coding System' means the 
 standardized coding system used by Medicare and other health 
 insurance programs to ensure that claims are processed in an 
 orderly and consistent manner.
 ``

    (8) Incomplete episode of care.--The term `incomplete 
 episode of care' means, with respect 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 where the 
 individual loses benefits under this title, at any time 
 after the initial treatment planning service is 
 furnished and before the episode of care for the 
 covered treatment is complete; or
 ``
        (B) a covered individual switches radiation 
 therapy provider or radiation therapy supplier before 
 all included radiation therapy services in the episode 
 of care for the covered treatment have been furnished.
 ``

    (9) New technology or services.--The term `new technology 
 or services' means any technology or services that, after the 
 date of enactment 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.
 ``

    (10) Professional component.--The term `professional 
 component' means the included radiation therapy services that 
 may only be furnished by a physician.
 ``

    (11) Radiation therapy.--The term `radiation 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.
 ``

    (12) Radiation therapy provider.--The term `radiation 
 therapy provider' means a hospital outpatient department 
 enrolled under this title that furnishes radiation therapy 
 services.
 ``

    (13) Radiation therapy services.--The term `radiation 
 therapy services' means the treatment planning, technical 
 preparation, special services (such as simulation), treatment 
 delivery, and treatment management services associated with 
 cancer treatment that uses high doses of radiation to kill 
 cancer cells and shrink tumors.
 ``

    (14) Radiation therapy supplier.--The term `radiation 
 therapy supplier' means a physician group practice or 
 freestanding radiation therapy center enrolled under this title 
 that furnishes radiation therapy services.
 ``

    (15) Technical component.--The term `technical component' 
 means the included radiation therapy services that are not 
 furnished by a physician, including the provision of equipment, 
 supplies, personnel, and administrative costs related to 
 radiation therapy services.
 ``

    (16) Transportation services.--The term `transportation 
 services' means the provision of free or discounted 
 transportation made available to covered individuals furnished 
 covered treatment which are not air, luxury, or ambulance-level 
 transportation, but may include car services, ride shares, 
 autonomous vehicles, or public transportation.''.

    (b) Exclusion of Participating Radiation Therapy Providers, 
Radiation Therapy Suppliers, and Physicians From the Merit-Based 
Incentive Payment System.--

Section 1848

    (q)

    (1)
            (C) 
            (ii) of the Social 
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 subclause:
 ``
            (IV) is a radiation therapy 
 provider or radiation therapy supplier 
 (as those terms are defined in 
 subsection

    (j) of 

section 1899C) that is 
 participating in the Radiation Oncology 
 Case Rate Value Based Payment Program 
 established under that section.''.

SEC. 4. REVISION TO CIVIL MONETARY PENALTIES REGARDING 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;
        (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 services by 
 an eligible entity, as defined in subsection

    (t) , if--
 ``
            (i) the availability of the 
 transportation services--
 ``
            (I) is set forth in a policy that 
 the eligible entity, as defined in 
 subsection

    (t) , applies uniformly and 
 consistently; and
 ``
            (II) is not determined in a 
 manner related to the past or 
 anticipated volume or value of Federal 
 health care program business;
 ``
            (ii) the eligible entity does not 
 publicly 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;
 ``
            (iv) the driver or individual arranging 
 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 
 eligible entity that is providing or 
 facilitating free or discounted 
 transportation;
 ``
            (II) resides--
 ``

    (aa) within a 75-mile-
 radius of the radiation therapy 
 provider or radiation therapy 
 supplier to or from which the 
 patient would be transported; 
 or
 ``

    (bb) in a rural area, as 
 defined in subsection

    (t) ; and
 ``
            (III) is receiving radiation 
 therapy services for the purpose of 
 obtaining medically necessary items and 
 services; and
 ``
            (vi) the eligible entity that makes the 
 transportation services available bears the 
 costs of the transportation services and does 
 not shift the burden of those costs onto any 
 Federal health care program, other payers, or 
 individuals.''; and

    (2) by adding at the end the following new subsection:
 ``

    (t) For purposes of subsection
            (i) (6)
        (K) , the following 
definitions apply:
 ``

    (1) The term `eligible entity' means any individual or 
 entity, or any individual or entity acting on behalf of such 
 individual or entity that does not supply health care items as 
 the primary occupation of the individual or entity.
 ``

    (2) The term `established patient' means an individual 
 who--
 ``
        (A) has selected and scheduled an appointment 
 with a radiation therapy provider or radiation therapy 
 supplier; or
 ``
        (B) has attended an appointment with such 
 provider or supplier.
 ``

    (3) The terms `radiation therapy provider', `radiation 
 therapy services', and `radiation therapy supplier' have the 
 meaning given such terms in 

section 1866G

    (j) .
 ``

    (4) The term `rural area' means an area that is not an 
 urban area.
 ``

    (5) The term `transportation services'--
 ``
        (A) means the provision of free or discounted 
 transportation made available to Federal health care 
 program beneficiaries receiving radiation therapy 
 services;
 ``
        (B) includes car services, ride shares, and 
 public transportation; and
 ``
            (C) does not include air, luxury, or ambulance-
 level transportation.
 ``

    (6) The term `urban area' means--
 ``
        (A) a Metropolitan Statistical Area or New 
 England County Metropolitan Area, as defined by the 
 Office of Management and Budget;
 ``
        (B) Litchfield County, Connecticut;
 ``
            (C) York County, Maine;
 ``
            (D) Sagadahoc County, Maine;
 ``
        (E) Merrimack County, New Hampshire; and
 ``
        (F) Newport County, Rhode Island.''.

SEC. 5. EXEMPTION OF RADIATION ONCOLOGY CASE RATE VALUE BASED PAYMENT 
 PROGRAM FROM BUDGET NEUTRALITY ADJUSTMENT REQUIREMENTS.

    (a) Payment of Benefits.--

Section 1833

    (t) of the Social Security 
Act (42 U.S.C. 1395l

    (t) ) is amended by adding at the end the following 
new paragraph:
 ``

    (23) Non budget neutral application of reduced 
 expenditures resulting from the radiation oncology case rate 
 value based payment program.--The Secretary shall not take into 
 account the reduced expenditures that result from the 
 implementation of 

section 1899C in making any budget neutrality 
 adjustments under this subsection.''.

    (b) Payment for Physicians' Services.--

Section 1848
            (c) (2)
        (B) of the 
Social Security Act (42 U.S.C. 1395w-4
            (c) (2)
        (B) ) is amended--

    (1) in clause
            (iv) --
        (A) in subclause
            (V) , by striking ``and'' at the 
 end;
        (B) in subclause
            (VI) , by striking the period at 
 the end and inserting ``; and''; and
            (C) by adding at the end the following new 
 subclause:
 ``
            (VII) section 1899C shall not be 
 taken into account in applying clause
            (ii) 
            (II) for a year following the 
 enactment of 

section 1899C.''; and

    (2) in clause
            (v) , by adding at the end the following new 
 subclause:
 ``
            (XII) Reduced expenditures 
 attributable to the radiation oncology 
 case rate value based payment 
 program.--Effective for fee schedules 
 established following the enactment of 
 

section 1899C, reduced expenditures 
 attributable to the Radiation Oncology 
 Case Rate Value Based Payment Program 
 under 

section 1899C.''.
 <all>