What does Preamble of S 1031 do?

This bill, formally titled '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.' The bill proposes to amend Title XVIII of the Social Security Act to establish a Radiation Oncology Case Rate Value Based Payment Program. The proposed program would be exempt from budget neutrality adjustment requirements. The bill also seeks to amend section 1128A of title XI of the Social Security Act to create an exception for providing free or discounted transportation to radiation oncology patients.

What does SHORT TITLE. of S 1031 do?

This bill is formally titled the Radiation Oncology Case Rate Value Based Program Act of 2025.

What does FINDINGS. of S 1031 do?

This section outlines findings related to radiation oncology services and Medicare payment systems. Radiation therapy is described as a safe and effective treatment for cancer and other diseases, utilized by nearly 60% of cancer patients. Medicare spending on radiation oncology services was approximately $4.2 billion in 2021. The Centers for Medicare & Medicaid Services (CMS) has faced challenges in accurately pricing radiation oncology services due to costly equipment. Current payment systems incentivize care volume, while bundled payments encourage patient-centered, efficient care. CMS recognized in 2017 that payment systems were not adequately addressing radiation oncology services, leading to a congressionally requested report on an alternative payment model. Concerns arose regarding the proposed Radiation Oncology Model due to potential payment reductions and burdensome reporting requirements, resulting in implementation delays. The section concludes that a new payment program is necessary to recognize the value of quality radiation oncology services while controlling costs and prioritizing patient-centered care.

What does RADIATION ONCOLOGY CASE RATE VALUE BASED PAYMENT PROGRAM. of S 1031 do?

This section establishes the Radiation Oncology Case Rate Value Based Payment Program (ROCR Program) under Title XVIII of the Social Security Act. The Secretary is required to promulgate regulations for the ROCR Program within one year of the Act's enactment. The ROCR Program aims to create stable payments, reduce disparities in care, enhance quality, leverage technology, and protect Medicare resources. Payments under the program will include per-episode payments and a health equity achievement add-on payment. The Secretary will pay 80 percent of the per-episode payment amount for covered individuals receiving treatment for included cancer types. Payments will be made prospectively and, in most cases, within 30 days of the first delivery of treatment. The per-episode payment amount will be determined based on national base rates and adjusted for various factors, including geographic location, inflation, and practice accreditation.

What does REVISION TO CIVIL MONETARY PENALTIES REGARDING RADIATION of S 1031 do?

This section amends Section 1128A of the Social Security Act (42 U.S.C. 1320a-7a) regarding civil monetary penalties. It adds a new subparagraph (K) to subsection (i)(6) outlining conditions for transportation services provided by an 'eligible entity' to be exempt from penalties. These conditions include a uniform policy for service availability, no marketing of services, restrictions on driver marketing, and payment not based on a per-beneficiary basis. The eligible entity must make services available only to 'established patients' receiving radiation therapy within a 75-mile radius or in a 'rural area'. The entity must bear the costs of transportation and not shift them to federal health care programs, other payers, or individuals. A new subsection (t) is added, defining key terms like 'eligible entity' (an individual or entity not primarily supplying health care items), 'established patient', 'radiation therapy provider', 'rural area', and 'transportation services'. Transportation services are defined as free or discounted transportation for radiation therapy recipients, including car services, ride shares, and public transportation, but excluding air, luxury, or ambulance-level transportation. The definition of 'urban area' includes Metropolitan Statistical Areas and specific counties in Connecticut, Maine, New Hampshire, and Rhode Island.

What does EXEMPTION OF RADIATION ONCOLOGY CASE RATE VALUE BASED PAYMENT of S 1031 do?

This section amends Section 1833(t) of the Social Security Act to prevent reduced expenditures from the radiation oncology case rate value-based payment program from being considered in budget neutrality adjustments. It also amends Section 1848(c)(2)(B) of the Social Security Act. Specifically, it modifies clauses (iv) and (v) to exclude section 1899C from certain application calculations. The amendments specify that section 1899C shall not be taken into account in applying clause (ii)(II) for a year following enactment. 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 are addressed.

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ROCR Value Based Program Act — S. 1031

Last updated: 3/13/2025 · Introduced: 3/13/2025

Author: Thomas Tillis (R-NC)

TL;DR (AI)

This bill establishes a new Radiation Oncology Case Rate Value Based Payment Program (ROCR Program) within Medicare, aiming to stabilize payments, reduce care disparities, and enhance quality.
The ROCR Program will provide per-episode payments for radiation oncology treatment, including an add-on payment to address health equity, and payments will be made prospectively.
The bill creates an exception allowing eligible entities to provide free or discounted transportation to radiation oncology patients without incurring civil monetary penalties, provided certain conditions are met.
Eligible entities providing transportation must have a uniform policy, not market their services, and bear the costs without shifting them to federal health care programs or patients.
The bill exempts the ROCR Program from budget neutrality adjustment requirements, ensuring its financial viability and preventing it from impacting other Medicare programs.

119th Congressin committeeHR. 2120(In Committee)Official page

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Includes provisions on preamble, short title., and 4 more.

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