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ROCR Value Based Program Act
4/6/2025, 12:50 PM
Summary of Bill S 1031
Additionally, the bill seeks to amend section 1128A of title XI of the Social Security Act to create a new exception for the provision of free or discounted transportation for radiation oncology patients who need to receive radiation therapy services. This exception would allow providers to offer transportation assistance to patients without facing penalties or legal repercussions.
Overall, the purpose of Bill 119 s 1031 is to improve access to radiation oncology services and ensure that providers are fairly compensated for the care they provide. By exempting the payment program from budget neutrality adjustments and creating an exception for transportation assistance, this bill aims to support both patients and providers in the delivery of radiation therapy services.
Congressional Summary of S 1031
Radiation Oncology Case Rate Value Based Program Act of 2025 or the ROCR Value Based Program Act
This bill establishes a specialized payment program under Medicare for providers and suppliers of radiation oncology services.
Specifically, the Centers for Medicare & Medicaid Services (CMS) must establish a program under which radiation therapy providers (i.e., hospital outpatient departments) and suppliers (i.e., physician group practices and freestanding radiation therapy centers) receive payments for each episode of care provided to individuals with specified types of cancer. An episode of care means the period beginning on the day radiation therapy planning is furnished to the individual and ending (1) for individuals with bone or brain metastases, 30 days later; and (2) for individuals with other cancer types, 90 days later.
Participation in the program is mandatory for providers and suppliers that participate in Medicare, unless the provider or supplier is part of a state-based Center for Medicare & Medicaid Innovation model or qualifies for a significant hardship exemption. The CMS must set payment rates for the program based on national payment rates with specified adjustments (e.g., geographic adjustments). Providers and suppliers who provide certain transportation services for individuals under their care may receive an additional payment. Providers and suppliers must be accredited in accordance with certain standards, subject to payment reductions.
The Government Accountability Office must report on (1) implementation of the program, and (2) underserved areas that are in need of more or newer radiation therapy resources.
