ROCR Value Based Program Act
Sponsored By: Representative Fitzpatrick
Introduced
Summary
Per-episode payments for radiation therapy is the bill’s core change. It would create the Radiation Oncology Case Rate Value Based Payment Program (ROCR) to pay Medicare Part B radiation therapy as bundled, site-neutral episodes and link pay to accreditation, quality, and transportation access.
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 2 benefits, 0 costs, 3 mixed.
Radiation payment program rollout guardrails
Until the new radiation payment program (ROCR) rules take effect, Medicare could not cut current radiation therapy rates under the physician fee schedule or hospital outpatient system. For one year after enactment, ROCR would not be counted in a specific physician fee schedule budget formula; after that, ROCR savings could be recognized. ROCR savings would not trigger hospital outpatient budget‑neutrality cuts. Providers in ROCR would also be excluded from MIPS reporting.
New Medicare episode payments for radiation therapy
This bill would create a new, episode-based Medicare payment for radiation therapy. The Health Secretary would write rules within 1 year and allow at least 60 days for public comments. Medicare would pay 80% of the episode amount; you would owe the Part B deductible and 20% coinsurance before any sequestration. Providers would get paid in two parts: half within 30 days after first treatment, and the rest by day 90 (day 30 for bone or brain metastases). The payment would be the same whether care is in a hospital outpatient department or a doctor’s office. Providers could offer a payment plan to spread your coinsurance.
Provider participation, accreditation, bonuses and penalties
Most Medicare radiation therapy providers would need to join the program, unless they are in a state CMMI model or get a hardship exemption. Providers would need accreditation (ACR, ACRO, or ASTRO), follow EHR rules, and submit proof; limited‑resource sites could use an external audit or other options, and new sites would have 1 year to start accreditation or an audit. For the first two years after the rules take effect, meeting these requirements would earn a 1% technical‑payment boost (0.25% for limited‑resource sites). Starting two years after the rules take effect, providers that do not meet the requirements would lose 2.5% of the technical payment (limited‑resource sites are exempt from this cut). Accreditors would have to update safety standards every 5–7 years and collect data on each linear accelerator.
Rides to treatment under strict rules
Providers could offer free or discounted rides for established patients getting needed radiation therapy. Rides would be limited to within 75 miles or for rural patients, and cannot include air, luxury, or ambulance travel. Providers could not market the rides, pay drivers per patient, or shift the ride costs to Medicare, other payers, or individuals.
How Medicare sets ROCR rates
If enacted, base rates would start from a 2021 national table for each cancer and for doctor and technical parts. Rates would update each year for local wages and inflation, and could not be cut below last year in those annual updates. Rebasing could happen every 5 years, but any cut would be capped at 1% across that period. Payments would also include a savings adjustment and may add health equity or accreditation add-ons, applied only to the technical part.
Sponsors & CoSponsors
Sponsor
Fitzpatrick
PA • R
Cosponsors
Panetta
CA • D
Sponsored 3/14/2025
Joyce (PA)
PA • R
Sponsored 3/14/2025
Tonko
NY • D
Sponsored 3/14/2025
Stevens
MI • D
Sponsored 4/7/2025
Peters
CA • D
Sponsored 5/13/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 6/2/2025
Cohen
TN • D
Sponsored 7/14/2025
Vindman
VA • D
Sponsored 8/8/2025
Scholten
MI • D
Sponsored 8/22/2025
Kim
CA • R
Sponsored 9/2/2025
Mullin
CA • D
Sponsored 10/3/2025
Carbajal
CA • D
Sponsored 10/31/2025
Dingell
MI • D
Sponsored 12/4/2025
Balderson
OH • R
Sponsored 12/9/2025
Crenshaw
TX • R
Sponsored 1/8/2026
Bilirakis
FL • R
Sponsored 1/8/2026
Salazar
FL • R
Sponsored 2/2/2026
Lieu
CA • D
Sponsored 2/3/2026
Bentz
OR • R
Sponsored 2/9/2026
Pfluger
TX • R
Sponsored 3/20/2026
Davis (NC)
NC • D
Sponsored 3/24/2026
Roll Call Votes
No roll call votes available for this bill.
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