HR 2120
ROCR Value Based Program Act
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Bill overview
This bill establishes a new Medicare payment program, the Radiation Oncology Case Rate Value Based Program (ROCR Program), for radiation therapy providers and suppliers. The program aims to provide per-episode payments based on national rates, with adjustments for geographic location, inflation, and a health equity achievement add-on for transportation services. It includes provisions for mandatory participation, quality incentives, and reporting requirements to assess the program's impact and address underserved areas. The bill also modifies civil monetary penalties to account for free or discounted transportation services provided to patients.
Key provisions
- Establishes the ROCR Program to provide per-episode payments for radiation therapy services.
- Sets payment rates based on national base rates with adjustments for geographic location, inflation, and a health equity achievement add-on.
- Requires providers to be accredited and maintain quality standards.
- Mandates participation for Medicare providers, with exemptions for innovation models and hardship cases.
- Includes a provision for transportation services, offering an add-on payment for providers who offer free or discounted transportation.
- Requires the Government Accountability Office to report on program implementation and underserved areas.
- Modifies civil monetary penalties to account for free or discounted transportation services.
- Exempts the ROCR Program from budget neutrality adjustment requirements for a specified period.
Who is affected
- Radiation therapy providers (hospitals, outpatient departments)
Sponsors
Official sponsors from legislative records.
Primary sponsor
Cosponsors
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119th CONGRESS — 1st Session
H. R. 2120
IN THE HOUSE OF REPRESENTATIVES
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.
This Act may be cited as the Radiation Oncology Case Rate Value Based Program Act of 2025 ROCR Value Based Program Act
or the
.
Congress finds the following:
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.
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.
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.
The current payment systems incentivize greater volumes of care while bundled payments incentivize patient centered, efficient, and high value care.
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.
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.
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.
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.
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.
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.
Subject to subparagraph (B), for each episode of care furnished to a covered individual:
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—
the 30th day of the episode of care.
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.
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.
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;
a practice accreditation adjustment, as described in subsection (h), that is only applicable to technical component payments.
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)).
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.
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.
The Secretary shall not reduce the national base rates through the process of rebasing by more than 1 percent every 5 years.
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.
In this subsection:
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)).
The Secretary shall establish a modifier to identify claims for the transitional payment for adaptive radiation therapy planning for a covered individual.
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.
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—
in the case of the technical component payment rates, the geographic adjustment processes in the hospital outpatient prospective payment system under section 1833(t).
The term savings adjustment means the percentage by which the professional component and technical component payment rates are each reduced to achieve Medicare savings.
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:
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.
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.
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.
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).
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.
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.
is not required to participate in the ROCR Program.
The health equity achievement in radiation therapy add-on payment shall be in the amount of—
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.
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.
The Secretary may not modify any coinsurance obligation when implementing the health equity achievement in radiation therapy add-on 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).
This subparagraph shall not apply with respect to a limited resource radiation therapy provider or a limited resource radiation therapy supplier.
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.
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);
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
submit to the Secretary proof of the accreditation described in clause (i) in such form and manner as specified by the Secretary.
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—
complying 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).
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—
soliciting public comment on proposed quality standards, including from physicians, medical physicists, and other health professionals and experts;
updating quality standards not later than every 5 to 7 years in partnership with stakeholders;
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;
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
giving sufficient weight to compliance with quality standards among other accreditation standards in determining accreditation status for radiation therapy providers or radiation therapy suppliers.
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—
evaluates—
the implementation of the ROCR Program, and the impact such Program has had on Federal healthcare spending;
the impact the ROCR Program has had on the ability of covered individuals to access covered treatment;
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
the potential application of the ROCR Program to benefits provided under part C of this title; and
includes any recommendations for administrative and legislative changes.
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:
Radiation therapy deserts.
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.
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.
In this section:
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:
77295, 3-dimensional radiotherapy plan, including dose-volume histograms.
77301, intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications.
77293, Respiratory motion management simulation (List separately in addition to code for primary procedure).
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):
77261, therapeutic radiology treatment planning, simple.
is not enrolled in a Medicare Advantage plan under part C or a PACE program under section 1894; and
is diagnosed with an included cancer type.
The term covered treatment means, subject to subparagraph (B), radiation therapy services furnished to a covered individual.
inpatient radiation therapy services furnished in a subsection (d) hospital or ambulatory surgical center;
radiation therapy services furnished in cancer hospitals that are exempt from the hospital outpatient prospective payment system under section 1833(t);
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;
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
durable medical equipment (as defined in section 1861(n)).
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—
the clinical benefits of such items or services; and
the clear consensus of the stakeholder community; and
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.
ends—
Anal.
Bladder.
Bone Metastases.
Brain Metastases.
Breast.
Cervical.
Central Nervous System Tumors.
Colorectal.
Head and Neck.
Lung.
Lymphoma.
Pancreatic.
Prostate.
Upper Gastrointestinal.
Uterine.
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.
The term incomplete episode of care means, with respect to a covered individual, an episode of care that is not completed because—
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
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.
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.
The term professional component means the included radiation therapy services that may only be furnished by a physician.
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.
The term radiation therapy provider means a hospital outpatient department enrolled under this title that furnishes 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.
The term radiation therapy supplier means a physician group practice or freestanding radiation therapy center enrolled under this title that furnishes radiation therapy services.
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.
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.
Section 1848(q)(1)(C)(ii) of the Social Security Act (42 U.S.C. 1395w–4(q)(1)(c)(II)) is amended—
orat the end;
in subclause (III), by striking the period at the end and inserting ; or
; and
by adding at the end the following new subclause:
is a radiation therapy provider or radiation therapy supplier (as those terms are defined in subsection (j) of section1899C) that is participating in the Radiation Oncology Case Rate Value Based Payment Program established under that section.
Section 1128A of the Social Security Act (42 U.S.C. 1320a–7a) is amended—
orat the end;
in subparagraph (J)(iii), by striking the period at the end and inserting ; or
; and
the provision of transportation services by an eligible entity, as defined in subsection (t), if—
the availability of the transportation services—
is set forth in a policy that the eligible entity, as defined in subsection (t), applies uniformly and consistently; and
is not determined in a manner related to the past or anticipated volume or value of Federal health care program business;
the eligible entity does not publicly market or advertise the transportation services;
the eligible entity makes the transportation services available only to an individual who—
is an established patient, as defined in subsection (t), of the eligible entity that is providing or facilitating free or discounted transportation;
resides—
is receiving radiation therapy services for the purpose of obtaining medically necessary items and services; and
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.
by adding at the end the following new subsection:
For purposes of subsection (i)(6)(K), the following definitions apply:
The terms radiation therapy provider, radiation therapy services, and radiation therapy supplier have the meaning given such terms in section 1866G(j).
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:
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.
Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)(B)) is amended—
in clause (iv)—
in subclause (V), by striking and
at the end;
in subclause (VI), by striking the period at the end and inserting ; and
; and
by adding at the end the following new subclause:
section 1899C shall not be taken into account in applying clause (ii)(II) for a year following the enactment of section 1899C.
in clause (v), by adding at the end the following new subclause:
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.