# Plain Language Summary: ROCR Value Based Program Act

This bill creates a new payment system for radiation therapy services under Medicare. Right now, Medicare pays for radiation therapy services through two different systems depending on where treatment happens—one system for doctor's offices and another for hospital outpatient departments. This bill would replace those systems with a single, unified payment approach specifically designed for radiation oncology (cancer treatment using radiation).

Here's what would actually change for patients and providers. Instead of paying for each individual radiation therapy session, Medicare would pay a flat rate per treatment episode—essentially one bundled payment that covers all the professional and technical services a patient receives during their entire course of radiation therapy for a specific cancer. This payment would be split into two parts: half paid upfront when treatment begins, and the other half paid either when treatment ends or after 90 days, whichever comes first. For patients with bone or brain metastases (cancer that has spread), the second payment would come after 30 days instead. The bill aims to create more stable, predictable payments while encouraging providers to deliver efficient, high-quality care rather than simply doing more treatments.

The bill also includes protections to ensure radiation therapy remains accessible. It prevents Medicare from cutting payment rates for radiation therapy services during the transition period while new regulations are being written. Additionally, the bill allows providers to offer free or discounted transportation to radiation therapy patients without violating anti-kickback laws—addressing a real barrier that prevents some patients from getting the treatment they need. The legislation includes bonuses for providers who achieve health equity goals and maintain practice accreditation, incentivizing quality care and access for underserved communities.

ROCR Value Based Program Act

Fitzpatrick, Brian K.

Radiation Oncology Case Rate Value Based Program Act of 2025 or the ROCR Value Based Program ActThis bill establishes a specialized payment program under Medicare for providers and suppliers of radiation oncology services.&nbsp;Specifically, the Centers for Medicare &amp; 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&nbsp;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 &amp; 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&nbsp;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.