ROCR Value Based Program Act
Sponsored By: Senator Thomas Tillis
Introduced
Summary
Creates a Medicare value‑based, per‑episode payment system for radiation oncology. It would shift payments from fee‑for‑service to unified case rates that aim to reward quality, stabilize payments, and improve near‑home access for patients.
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 1 benefits, 1 costs, 3 mixed.
New Medicare episode pay for radiation therapy
This bill would create a per‑episode payment program for Medicare radiation therapy, with rules issued within one year. Most Medicare radiation providers would have to join, with case‑by‑case hardship exceptions and an option out for some state models. Rates would start from 2021 base tables, then get local cost adjustments and a savings cut, and be updated each year without going below the prior year; every five years, rebasing could cut at most 1%. Payments would come in two parts: half within 30 days after the first treatment and the rest by the end of treatment or day 90 (day 30 for bone or brain metastases); if a patient dies, both parts would be paid within 30 days of the last treatment. Incomplete episodes would be paid under current systems, and a new episode for the same course would require new planning and a trigger billing code.
Help with rides to radiation treatment
If enacted, providers could get a $500 add‑on per episode (rising $10 each year) to help patients who report transportation insecurity and have ICD‑10 Z59.82 recorded. The payment would go to the technical component provider, could not replace other transport benefits, and would not change your coinsurance. The bill would also allow certain providers to give free or discounted local rides under strict rules: a uniform policy, no marketing, within 75 miles or in rural areas, and the provider must pay the cost.
Some treatments excluded for 12 years
If enacted, the new payment program would not cover brachytherapy, proton beam therapy, intraoperative radiotherapy, superficial radiation therapy, hyperthermia, or therapeutic radiopharmaceuticals for 12 years after the rules take effect. After 12 years, the Secretary could add any of these back only after study, clear stakeholder input, and proposed rulemaking.
Provider bonuses, penalties, and special payments
This bill would give accredited providers that meet EHR rules a 1% payment boost for two years; limited‑resource sites would get 0.25%. After two years, providers that fail accreditation would face a 2.5% cut; limited‑resource sites would not be cut, and the rules would cap these sites at no more than 10% of all providers. It would also create a temporary extra payment for medically necessary adaptive radiation planning until new billing codes are ready.
Your radiation coinsurance and payment plans
If enacted, Medicare would pay providers 80% of the episode amount and you would owe 20% coinsurance. Your coinsurance would be based on the payment amount before any sequestration cuts. Providers could let you pay that 20% in installments under a payment plan, but they could not market their services using payment plans. For incomplete episodes, your coinsurance would equal 20% of what would have been paid under current systems.
Sponsors & CoSponsors
Sponsor
Thomas Tillis
NC • R
Cosponsors
Gary Peters
MI • D
Sponsored 3/13/2025
Roger Marshall
KS • R
Sponsored 7/15/2025
Christopher Coons
DE • D
Sponsored 7/15/2025
Roll Call Votes
No roll call votes available for this bill.
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