[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4330 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  2d Session
                                S. 4330

 To amend title XVIII of the Social Security Act to create a Radiation 
   Oncology Case Rate Value Based Payment Program exempt from budget 
neutrality adjustment requirements, and to amend section 1128A of title 
 XI of the Social Security Act to create a new statutory exception for 
   the provision of free or discounted transportation for radiation 
        oncology patients to receive radiation therapy services.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 14, 2024

  Mr. Tillis introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to create a Radiation 
   Oncology Case Rate Value Based Payment Program exempt from budget 
neutrality adjustment requirements, and to amend section 1128A of title 
 XI of the Social Security Act to create a new statutory exception for 
   the provision of free or discounted transportation for radiation 
        oncology patients to receive radiation therapy services.

    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 2024'' or the ``ROCR Value Based Program Act of 
2024''.

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 schedule 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)(3)(B)(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.
                    ``(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) In general.--For purposes of this 
                        subparagraph, 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.
                            ``(ii) 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 
                                into the national base rates for an 
                                included 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 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).
                            ``(iii) Before incorporation into the 
                        national base rate.--Until incorporated into 
                        the national base rates under clause (ii)(II), 
                        any new technology or service shall be paid 
                        under the applicable payment system under this 
                        title.
                            ``(iv) Assessment of certain criteria.--
                        Prior to incorporating a new technology or 
                        service into the national base rates pursuant 
                        to clause (ii)(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 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 3 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 0.5 percent (or 0.25 percent in the case 
                of such a provider or supplier that is a small 
                radiation therapy supplier or small 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 3 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 1.0 percent.
                            ``(ii) Exclusion of small radiation therapy 
                        providers and small radiation therapy 
                        suppliers.--This 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 
                radiation therapy supplier, a provider or supplier that 
                meets the criteria specified by the Secretary, that may 
                include criteria relating to the number of linear 
                accelerators owned or used by the radiation therapy 
                provider or radiation therapy supplier, the volume of 
                patients treated by the radiation therapy provider or 
                radiation therapy supplier, or such other criteria as 
                the Secretary determines is appropriate, in 
                consultation with radiation therapy stakeholder 
                organizations.
            ``(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 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 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 small radiation therapy 
                providers and small radiation therapy suppliers.--A 
                radiation therapy provider or radiation therapy 
                supplier that is a small radiation therapy provider or 
                small 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.
    ``(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) 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.
            ``(2) 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.
            ``(3) Covered treatment.--
                    ``(A) In general.--The term `covered treatment' 
                means, subject to subparagraph (B), radiation therapy 
                services furnished to a covered 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 effective and ending 
                        on the date that is 10 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 
                        furnishing radiation therapy or by another 
                        physician, such as cancer surgeries, 
                        chemotherapy, and other services; or
                            ``(v) physician 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.
            ``(4) 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).
            ``(5) 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.
            ``(6) 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.
            ``(7) 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.
            ``(8) Professional component.--The term `professional 
        component' means the included radiation therapy services that 
        may only be furnished by a physician.
            ``(9) 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.
            ``(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 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.
            ``(12) 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.
            ``(13) 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.
            ``(14) 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, 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 section1899C) 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 miles 
                                        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(k).
            ``(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.''.
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