The "Radiation Oncology Case Rate Value Based Program Act of 2025" proposes to establish a new Medicare payment model for radiation therapy services. This Radiation Oncology Case Rate Value Based Payment Program (ROCR Program) aims to create stable, unified payments for radiation therapy, reduce disparities in access, and enhance the quality of care. It also seeks to leverage state-of-the-art technology and protect Medicare resources through reasonable spending reductions. The Secretary of Health and Human Services is mandated to promulgate regulations for this program within one year of enactment.

Under the ROCR Program, radiation therapy providers and suppliers will receive per-episode payments for covered treatments furnished to Medicare beneficiaries with specific cancer types. These payments will cover both professional and technical services, with 80 percent of the payment issued prospectively. The per-episode payment amounts will be based on national base rates, subject to annual and periodic updates, and adjusted for geographic location, inflation, and a savings factor. Importantly, payment rates for radiation therapy services will not be reduced under existing fee schedules until the ROCR Program regulations become effective.

The bill incorporates quality incentives by offering a payment increase for providers who meet accreditation requirements and imposing a reduction for those who do not after two years. Limited resource providers have alternative compliance options for accreditation. Furthermore, the program outlines a process for incorporating new technologies or services into the national base rates, with a 12-year exclusion period followed by stakeholder engagement for integration. Adaptive radiation therapy planning will receive a separate transitional payment until its codes are developed and valued.

A significant component of the ROCR Program is the Health Equity Achievement in Radiation Therapy (HEART) add-on payment, designed to support patient access by funding transportation services. This add-on, starting at $500 per patient per episode and increasing annually, is triggered when a patient reports transportation insecurity. Concurrently, the bill amends existing law to create a statutory exception to civil monetary penalties, allowing eligible entities to provide free or discounted transportation to radiation oncology patients under specific conditions, such as uniform policy application and no marketing.

Participation in the ROCR Program will generally be mandatory for radiation therapy providers and suppliers, with limited exceptions for those in State-based innovation models or facing significant hardship. Providers participating in ROCR will also be excluded from the Merit-Based Incentive Payment System (MIPS). Crucially, the bill explicitly exempts the ROCR Program from budget neutrality adjustment requirements, ensuring that any reduced expenditures resulting from the program do not lead to cuts in other Medicare payments. The Comptroller General will also report on the program's impact and identify "radiation therapy deserts" to improve access.