New Medicare Law Bundles Cancer Radiation Payments: Includes $500 for Patient Transportation and Accreditation Penalties

The Radiation Oncology Case Rate Value Based Program Act of 2025 (ROCR Program) is set to completely overhaul how Medicare pays for radiation therapy—a treatment nearly 60% of cancer patients receive. Instead of paying providers for every single service, scan, and dose (the old fee-for-service model), this bill creates a single, bundled payment for an entire “episode of care” for 15 specific cancer types, like breast, lung, and prostate cancer. The goal is to move incentives from doing more services to delivering high-quality, efficient care that focuses on the patient’s outcome. While the rules are being written over the next year, the Secretary is explicitly forbidden from cutting current payment rates, which offers providers some initial stability.

The New Payment Playbook: 80/20 and Quality Checks

Under the new ROCR Program, when a provider treats a Medicare patient, they get a single, bundled “per episode payment.” This payment is complex: providers receive 80% of the total amount upfront, with the remaining 20% covering the patient’s coinsurance. For patients, this is a win, as providers are required to offer payment plans to spread out that 20% coinsurance cost, making a massive medical bill much easier to manage. However, the bill also implements a “savings adjustment” that reduces the base rate slightly to ensure Medicare sees overall cost savings—a detail that could squeeze provider margins, especially those with high operational costs.

Making Sure Patients Can Actually Get to Treatment

One of the most interesting provisions is the Health Equity Add-On Payment. Recognizing that missed appointments due to transportation issues can derail cancer treatment, the bill mandates a special payment of $500 per patient, per episode in the first year. This money is specifically earmarked for transportation services like rideshares or public transit. To get this cash, the provider must ask the patient if they’ve struggled with transportation in the last two months and, if the answer is yes, report the specific ICD10 diagnosis code Z59.82 (transportation insecurity). This is a direct, data-driven effort to tackle a real-world barrier to care that often affects lower-income patients and those in rural areas.

The Quality Hurdle: Accreditation or Bust

If you’re running a radiation therapy center, this bill significantly raises the stakes on quality. After the first two years of the program, providers who fail to meet specific accreditation requirements—say, from the American College of Radiology—will see their bundled payment reduced by 2.5%. On the flip side, providers who meet the standards get a 1% bonus. This is a clear signal: Medicare is tying a substantial portion of the payment to verifiable quality standards. There is a safety valve for “limited resource providers”—those in rural or underserved areas—who get more flexible options, such as external audits instead of full accreditation, but the Secretary will define who qualifies, and that group is capped at 10% of all providers nationwide.

Why This Bill Matters Beyond Cancer Care

Section 5 of this bill contains a technical detail that has huge implications for the entire Medicare system. When Medicare saves money in one area, those savings are usually factored into the overall budget neutrality calculations to prevent payment cuts in other areas (like general physician services). This bill explicitly states that any savings generated by the ROCR Program will not be counted in those calculations. In plain English: the savings from this cancer payment reform are locked away and can’t be used to offset budget shortfalls elsewhere. While this protects other physicians from mandatory cuts triggered by ROCR’s success, it means the overall Medicare budget won’t benefit from those savings when balancing the books.

Finally, the bill also loosens up the rules around civil monetary penalties, making it safer for entities to offer free rides to established radiation therapy patients. This is huge for access, but it comes with strict rules: no public advertising, the driver can’t sell services, and the patient must live within 75 miles (or in a rural area). This provision directly supports the $500 add-on and further removes financial hurdles for patients needing daily treatments.