,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #babj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #ad1 #bjbe,mr4   
,fitzpatrick 7= himself1 ,mr4 ,panetta1 
,mr4 ,joyce ( ,p5nsylvania1 & ,mr4      
,tonko7 introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d ,title     
,,xviii ( ! ,social ,security ,act to   
create a ,radiation ,oncology ,case     
,rate ,value ,bas$ ,paym5t ,program     
exempt f budget neutrality adju/m5t     
requirem5ts1 & to am5d section #aabh;,a 
( title ,,xi ( ! ,social ,security ,act 
to create a new /atutory exception = !  
provision ( free or disc\nt$            
transportation = radiation oncology     
pati5ts to receive radiation !rapy      
s]vices4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,radiation ,oncology ,case  

,rate ,value ,bas$ ,program ,act ( #bjbe
 or ! ,,rocr ,value ,bas$ ,program ,act4
  #b4 ,f9d+s  7a7 ,f9d+s ,congress f9ds 
! foll[+3 7#a7 ,radiation !rapy is !    
c>eful use ( v>i\s =ms ( radiation1 su* 
z ext]nal beam radiation !rapy1 to treat
 canc] & o!r diseases safely &          
effectively4 ,radiation oncologi/s      
develop radiation treatm5t plans &      
coord9ate ) highly specializ$ c>e teams 
to deliv] radiation !rapy4 ,ne>ly #fj   
p]c5t ( canc] pati5ts w receive         
radiation !rapy dur+ _! treatm5t4  7#b7 
,9 #bjba1 ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices report$ approximately          
#d1bjj1jjj1jjj 9 total sp5d+ = radiation
 oncology s]vices betwe5 ! ,m$ic>e      
physician fee s*$ule & hospital         
outpati5t dep>tm5ts4  7#c7 ,! ,c5t]s =  
,m$ic>e  ,m$icaid ,s]vices has          
hi/orically fac$ *all5ges 9 det]m9+     
accurate pric+ = s]vices t involve co/ly
 capital equipm5t1 result+ 9 fluctuat+  
paym5t rates "u ! ,m$ic>e physician fee 
s*$ules = s]vices involv+ ext]nal beam  

radiation !rapy4 ,additionally1 !       
,m$ic>e physician fee s*$ule has        
inadequately recogniz$ ! pr(essional    
exp]tise physicians & nonphysician      
pr(essionals ne$ to deliv] radiation    
!rapy4  7#d7 ,! curr5t paym5t sy/ems    
inc5tivize great] volumes ( c>e :ile    
bundl$ paym5ts inc5tivize pati5t c5t]$1 
effici5t1 & high value c>e4  7#e7 ,9    
#bjag1 ! ,c5t]s = ,m$ic>e  ,m$icaid     
,s]vices recogniz$ t ! ,m$ic>e paym5t   
sy/ems 7 n adequately address+ radiation
 oncology s]vices1 & ! ,c5t] = ,m$ic>e  
,m$icaid ,innovation releas$ a          
congressionally reque/$ report on !     
pursuit ( an alt]native paym5t model =  
radiation oncology 7ref]r$ to 9 ?is     
section z ! ,radiation ,oncology ,model7
 t addresses ! issues 9 ! ,m$ic>e       
physician fee s*$ule & ! ,m$ic>e        
hospital outpati5t prospective paym5t   
sy/em paym5t me?ods4  7#f7 ,conc]ns     
reg>d+ ! propos$ ,radiation ,oncology   
,model includ$ ! significant paym5t     
r$uctions propos$ 9 ! model t w\ld      

jeop>dize access to high-quality        
radiation !rapy s]vices & ! on]\s       
report+ requirem5ts = p>ticipat+        
provid]s4 ,! ,radiation ,oncology ,model
 saw indef9ite implem5tation delays4    
7#g7 ,x is necess>y1 !re=e1 to create a 
paym5t program = radiation oncology     
s]vices t appropriately recognizes !    
value ( quality radiation oncology      
s]vices ?r\gh its f9ancial inc5tives    
:ile conta9+ co/s & provid+ pati5t-c5t]$
 c>e4  #c4 ,radiation oncology case rate
 value bas$ paym5t program  7a7 ,9 g5]al
 ,title ,,xviii ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acie et seq47 is   
am5d$ by add+ at ! end ! foll[+3        
#ahii;,c4 ,radiation oncology case rate 
value bas$ paym5t program  7a7          
,e/abli%m5t  7#a7 ,9 g5]al ,n lat] ?an  
#a ye> aft] ! date ( enactm5t ( ! ,,rocr
 ,value ,bas$ ,program ,act1 ! ,secret>y
 %all promulgate regulations1 us+ !     
proc$ures describ$ 9 p>agraph 7#e71     
e/abli%+ a ,radiation ,oncology ,case   
,rate ,value ,bas$ ,paym5t ,program     

7ref]r$ to 9 ?is section z ! ,,rocr     
,program7 "u :i* p] episode paym5ts are 
provid$ to radiation !rapy provid]s or  
radiation !rapy suppli]s = cov]$        
treatm5t furni%$ to a cov]$ individual  
dur+ an episode ( c>e 7z su* t]ms are   
def9$ 9 subsection 7j77 9 accordance )  
?is section4  7#b7 ,ma9ta9+ paym5t rates
 dur+ p]iod prior to effective date (   
regulations ,! ,secret>y %all n r$uce ! 
e/abli%$ paym5t rates = radiation !rapy 
s]vices "u ! physician fee s*$ule "u    
section #ahdh or ! hospital outpati5t   
prospective paym5t sy/em "u section     
#ahcc7t7 dur+ ! "t p]iod beg9n+ on !    
date ( enactm5t ( ! ,,rocr ,value ,bas$ 
,program ,act & end+ on ! date t !      
regulations issu$ by ! ,secret>y        
pursuant to p>agraph 7#a7 become        
effective4  7#c7 ,,rocr ,program goals  
,! ,,rocr ,program %all seek to-- 7,a7  
create /able1 unifi$ paym5ts = radiation
 !rapy s]vices "u ?is title2  7,b7 r$uce
 disp>ities 9 radiation !rapy c>e =     
,m$ic>e b5efici>ies by increas+ access  

to radiation !rapy s]vices close to !   
homes ( b5efici>ies2  7,c7 enhance      
quality ( radiation !rapy c>e ?r\gh     
practice accr$itation & %ort] c\rses (  
treatm5t1 :5 appropriate2  7,d7 lev]age 
& enc\rage ! utilization ( /ate-(-!-art 
te*nology to improve c>e & outcomes2 &  
7,e7 protect ,m$ic>e res\rces by a*iev+ 
reasonable sp5d+ r$uctions 9 ,m$ic>e =  
radiation !rapy s]vices4  7#d7 ,paym5ts 
,"u ?is section1 ) respect to cov]$     
treatm5t furni%$ to cov]$ individuals1  
paym5ts %all include-- 7,a7 p] episode  
paym5ts1 z describ$ 9 subsection 7b71 to
 radiation !rapy provid]s or radiation  
!rapy suppli]s ( radiation !rapy s]vices
 :i* meet su* requirem5ts z ! ,secret>y 
%all e/abli% by regulation2 &  7,b7 !   
heal? equity a*ievem5t 9 radiation !rapy
 add-on paym5t describ$ 9 subsection    
7g74  7#e7 ,notice & comm5t rulemak+ ,! 
,secret>y %all promulgate ! regulations 
describ$ 9 p>agraph 7#a7 9 accordance ) 
section #eec ( title #e1 ,unit$ ,/ates  
,code1 & issue an advanc$ notice (      

propos$ rulemak+ & notice ( propos$     
rulemak+ ) a comm5t p]iod ( n less ?an  
#fj days = ea*4  7b7 ,p] episode paym5ts
  7#a7 ,9 g5]al  7,a7 ,paym5ts ,!       
,secret>y %all pay to a radiation !rapy 
provid] or radiation !rapy suppli] an   
am\nt equal to #hj p]c5t ( ! p] episode 
paym5t am\nt det]m9$ "u p>agraph #c     
7ref]r$ to 9 ?is section z ! p] episode 
paym5t am\nt7 = ea* cov]$ individual    
furni%$ cov]$ treatm5t = an includ$     
canc] type to cov] all pr(essional &    
te*nical s]vices furni%$ dur+ su*       
treatm5t by ! radiation !rapy provid] or
 radiation !rapy suppli] dur+ an episode
 ( c>e 7z def9$ 9 subsection 7j774  7,b7
 ,d$uctibles & co9surance ,subject to   
subsection 7e71 ! ,secret>y %all pay !  
p] episode paym5t am\nt 7subject to any 
d$uctible & co9surance o!rwise          
applicable "u "p ,b7 to ! radiation     
!rapy provid] or radiation !rapy suppli]
 = an episode ( c>e1 z describ$ 9       
subsection 7c74  7#b7 ,p] episode paym5t
 requirem5ts & tim+  7,a7 ,9 g5]al      

,subject to subp>agraph 7,b71 = ea*     
episode ( c>e furni%$ to a cov]$        
individual3 7i7 ,fir/-half ( paym5t ,!  
,secret>y %all issue #a_/b ( ! paym5t   
am\nt "u p>agraph 7#a7 prospectively n  
lat] ?an #cj days aft] ! day ( ! fir/   
deliv]y ( cov]$ treatm5t4  7ii7         
,second-half ( paym5t ,! ,secret>y %all 
issue1 ) ! exception ( an episode ( c>e 
= treatm5t ( bone or bra9 meta/ases &   
subject to clause 7iii71 ! rema9+ half (
 ! paym5t am\nt "u p>agraph 7#a7 on !   
date t is ! e>li] (-- 7,i7 ! day ! c\rse
 ( cov]$ treatm5t is s*$ul$ to end2 or  
7,,ii7 ! #ij? day ( ! episode ( c>e4    
7iii7 ,second-half ( paym5t = bone &    
bra9 meta/ases ,! ,secret>y %all issue !
 rema9+ half ( ! paym5t am\nt "u        
p>agraph 7#a7 = an episode ( c>e =      
treatm5t ( bone or bra9 meta/ases on !  
date t is ! e>li] (-- 7,i7 ! day ! c\rse
 ( cov]$ treatm5t is s*$ul$ to end2 or  
7,,ii7 ! #cj? day ( ! episode ( c>e4    
7,b7 ,pati5t dea? ,if a cov]$ individual
 dies dur+ treatm5t1 bo? episode ( c>e  

paym5ts "u subp>agraphs 7,a7 & 7,b7 %all
 be paid to ! radiation !rapy provid] or
 radiation !rapy suppli] n lat] ?an #cj 
days aft] ! day ( ! f9al deliv]y (      
radiation !rapy treatm5t to ! cov]$     
individual4  7,c7 ,consi/5cy ( paym5t   
7i7 ,9 g5]al ,! p] episode paym5t am\nt 
%all n *ange dep5d+ on ! site ( s]vice4 
7ii7 ,site ( s]vice def9$ ,= ! purposes 
( ?is subp>agraph1 ! t]m site ( s]vice  
means ! hospital outpati5t dep>tm5t or  
physician (fice 9 :i* radiation !rapy   
treatm5t is furni%$ by ! radiation !rapy
 provid] or radiation !rapy suppli]4    
7#c7 ,det]m9ation ( p] episode paym5t   
am\nt  7,a7 ,9 g5]al ,! ,secret>y %all  
det]m9e a p] episode paym5t am\nt = !   
pr(essional compon5t & te*nical compon5t
 ( treatm5t = ea* includ$ canc] type4   
7,b7 ,am\nt ,! ,secret>y %all det]m9e ! 
p] episode paym5t am\nt bas$ on national
 base rates1 z describ$ 9 subsection    
7d77#a7 & z updat$ 9 subsection 7d77#b74
  7,c7 ,adju/m5ts ,! p] episode paym5t  
am\nt %all be subject to-- 7i7 !        

adju/m5ts z describ$ 9 subsection       
7d77#b7 & 7d77#c72  7ii7 a geographic   
adju/m5t1 z describ$ 9 subsection       
7d77#c77;,a72  7iii7 an inflation       
adju/m5t1 pursuant to :i* ! ,secret>y   
%all adju/ ! p] episode paym5t am\nt by 
! p]c5tage increase 9 ! ,m$ic>e         
,economic ,index 7z describ$ 9 section  
#ahdb7 = ! pr(essional compon5t paym5ts 
& ! applicable p]c5tage increase 9 !    
,hospital ,inpati5t ,m>ket ,basket      
,update 7z describ$ 9 section           
#ahhf7;b77#c77;,b77i77 = ! te*nical     
compon5t paym5ts dur+ ea* #ab-mon?      
p]iod1 & :i* v>ies = ! pr(essional &    
te*nical compon5ts ( ! s]vice2  7iv7 a  
sav+s adju/m5t1 z describ$ 9 subsection 
7d77#c77;,b72  7v7 a heal? equity       
a*ievem5t 9 radiation !rapy adju/m5t    
applicable only to ! te*nical compon5t  
paym5ts1 z describ$ 9 subsection 7g72 & 
7vi7 a practice accr$itation adju/m5t1 z
 describ$ 9 subsection 7h71 t is only   
applicable to te*nical compon5t paym5ts4
  7c7 ,treatm5t ( incomplete episodes ( 

c>e2 concurr5t treatm5t  7#a7           
,incomplete episode ( c>e ,9 ! case ( an
 incomplete episode ( c>e1 paym5t %all  
be made to ! radiation !rapy provid] or 
radiation !rapy suppli] = s]vices       
furni%$ "u ! physician fee s*$ule "u    
section #ahdh or ! hospital outpati5t   
prospective paym5t sy/em "u section     
#ahcc7t71 z applicable4  7#b7 ,multiple 
episodes ( c>e = ! same cov]$ individual
 ,a radiation !rapy provid] or radiation
 !rapy suppli] may initiate a new       
episode ( c>e = ! same b5efici>y = !    
same c\rse ( !rapy by provid+ ano!r     
radiation !rapy treatm5t plann+ s]vice &
 bill+ "u an applicable radiation !rapy 
plann+ trigg] code 7z def9$ 9 subsection
 7j774  7#c7 ,concurr5t treatm5ts ,9 !  
case :]e a treatm5t modality describ$ 9 
subsection 7j77#d77;,b77i77,i7 is       
furni%$ to a cov]$ individual dur+ an   
episode ( c>e = an includ$ canc] type1  
paym5t may be made concurr5tly = !      
treatm5t modality "u ! applicable paym5t
 sy/em "u ?is title ) p] episode paym5t 

"u ?is section = cov]$ treatm5t dur+ !  
episode ( c>e4  7d7 ,national base rate 
7#a7 ,det]m9ation ( national base rates 
,= purposes ( ! ,secret>y det]m9+ ! p]  
episode paym5t am\nt "u subsection      
7b77#c71 ! national base rates = !      
pr(essional compon5t & te*nical compon5t
 ( radiation !rapy s]vices = ea* includ$
 canc] type are bas$ on ! ,m-,code      
national base rates id5tifi$ 9 table #ge
 7includ+ ,,hcpcs ,codes = radiation    
!rapy s]vices & supplies7 ( ! ,f$]al    
,regi/] on ,novemb] #af1 #bjba1 #hf ,f$4
 ,reg4 #fcdeh1 #fcibe4  7#b7 ,updates to
 ! national base rates  7,a7 ,annual    
updates  7i7 ,9 g5]al ,subject to clause
 7ii71 ! ,secret>y %all annually update 
! initial national base rates by-- 7,i7 
9 ! case ( ! pr(essional compon5t ( !   
cov]$ treatm5t1 ! p]c5tage increase 9 ! 
,m$ic>e ,economic ,index2 &  7,,ii7 9 ! 
case ( ! te*nical compon5t ( ! cov]$    
treatm5t1 ! applicable p]c5tage increase
 describ$ 9 section                     
#ahhf7;b77#c77;,b77i74  7ii7 ,paym5t    

floor ,= ea* annual update1 ! ,secret>y 
%all n r$uce ! national base rates bel[ 
! e/abli%$ rates f ! prior ye>4  7,b7   
,p]iodic updates  7i7 ,9 g5]al ,!       
,secret>y %all1 ?r\gh notice & comm5t   
rulemak+1 rebase or revise ! national   
base rates 9 #e-ye> int]vals1 beg9n+ on 
! day t is #e ye>s aft] ! date !        
regulations issu$ pursuant to subsection
 7a77#a7 become effective4  7ii7 ,rebas+
 limit ,! ,secret>y %all n r$uce !      
national base rates ?r\gh ! process (   
rebas+ by m ?an #a p]c5t e #e ye>s4     
7iii7 ,input f provid]s & suppli]s ,9   
rebas+ or revis+ ! national base rates  
pursuant to clause 7i71 ! ,secret>y %all
 seek significant input f radiation     
!rapy provid]s1 radiation !rapy         
suppli]s1 & o!r /akehold]s to ensure t  
su* rates are suffici5t1 p>ticul>ly =   
any new te*nology or s]vice & any       
treatm5t modality describ$ 9 clause     
7i77,i7 ( subsection 7j77#d77;,b7 t is  
det]m9$ to be a cov]$ treatm5t by !     
,secret>y "u clause 7ii7 ( su*          

subsection4  7,c7 ,rebase & revise def9$
 ,9 ?is subsection3 7i7 ,rebase ,! t]m  
rebase means to move ! base ye> = !     
/ructure ( co/s ( ! national base rates4
  7ii7 ,revise ,! t]m revise means types
 ( *anges to national base rates o!r ?an
 rebas+1 su* z us+ diff]5t data s\rces1 
co/ categories1 or price proxies 9 !    
national base rates input4  7,d7 ,new   
te*nology or s]vices  7i7 ,treatm5t "u !
 national base rates  7,i7 ,exclusion   
dur+ initial p]iod ,! ,secret>y %all n  
incorporate a radiation !rapy s]vice t  
is a new te*nology or s]vice 7z def9$ 9 
subsection 7j77 into ! national base    
rates = an includ$ canc] type prior to !
 date t is #ab ye>s aft] su* s]vice is  
fir/ id5tifi$ z a new te*nology or      
s]vice4  7,,ii7 ,incorporation aft]     
initial p]iod ,aft] ! date specifi$ 9   
subclause 7,i7 ) respect to a radiation 
!rapy s]vice t is a new te*nology or    
s]vice1 ! ,secret>y %all1 ?r\gh         
/akehold] meet+s1 reque/s = in=mation1 &
 notice & comm5t rulemak+1 engage       

provid]s1 suppli]s1 radiation !rapy     
v5dors1 pati5t gr\ps1 & ! public on     
possible incorporation ( ! new te*nology
 or s]vice into ! national base rates = 
includ$ canc] types "u p>agraph 7#a74   
7ii7 ,be=e incorporation into ! national
 base rate ,until incorporat$ into !    
national base rates "u clause 7i77,,ii71
 any new te*nology or s]vice %all be    
paid "u ! applicable paym5t sy/em "u ?is
 title4  7iii7 ,developm5t &            
transitional paym5t p]iod = adaptive    
radiation !rapy plann+  7,i7 ,developm5t
 & valuation = adaptive radiation !rapy 
plann+ ,n lat] ?an ! date ! regulations 
issu$ pursuant to subsection 7a77#a7    
become effective & 9 consultation ) !   
,am]ican ,m$ical ,association's ,curr5t 
,proc$ural ,t]m9ology ,editorial ,panel 
& ,specialty ,society ,relative ,value  
,scale ,update ,committee1 radiation    
oncology specialty societies1 &         
radiation oncology /akehold]s1 !        
,secret>y %all develop & value codes =  
adaptive radiation !rapy plann+ 7z def9$

 9 subsection 7j774  7,,ii7             
,transitional paym5t  7aa7 ,9 g5]al     
,dur+ ! p]iod beg9n+ on ! date !        
regulations issu$ pursuant to subsection
 7a77#a7 become effective & end+ on !   
date any adaptive radiation !rapy plann+
 code is develop$ & valu$1 ! ,secret>y  
%all provide a sep>ate paym5t "u !      
applicable paym5t sy/em1 9 addition to !
 p] episode paym5t am\nt1 = any m$ically
 necess>y onl9e & (fl9e adaptive        
radiation !rapy plann+ furni%$ to a     
cov]$ individual aft] ! initial treatm5t
 plan = a cov]$ individual4  7bb7       
,modifi] ,! ,secret>y %all e/abli% a    
modifi] to id5tify claims = !           
transitional paym5t = adaptive radiation
 !rapy plann+ = a cov]$ individual4     
7iv7 ,assessm5t ( c]ta9 crit]ia ,prior  
to incorporat+ a new te*nology or s]vice
 into ! national base rates pursuant to 
clause 7i77,,ii71 ! ,secret>y %all      
consid] m>ket p5etration & adoption1    
co/s relative to base rates1 cl9ical    
b5efits ( ! new te*nology or s]vice1 & !

 cle> cons5sus ( ! /akehold] community4 
7#c7 ,adju/m5ts to national base rates  
7,a7 ,geographic adju/m5t ,prior to     
apply+ ! sav+s adju/m5t describ$ 9      
subp>agraph 7,b71 ! ,secret>y %all adju/
 ! national base rates = local co/ &    
wage indices bas$ on :]e ! radiation    
!rapy s]vices are furni%$-- 7i7 9 ! case
 ( ! pr(essional compon5t paym5t rates1 
! geographic adju/m5t processes describ$
 9 ! ,m$ic>e ,physician ,fee ,s*$ule    
,geographic ,practice ,co/ ,index2 &    
7ii7 9 ! case ( ! te*nical compon5t     
paym5t rates1 ! geographic adju/m5t     
processes 9 ! hospital outpati5t        
prospective paym5t sy/em "u section     
#ahcc7t74  7,b7 ,sav+s adju/m5t  7i7 ,9 
g5]al ,! ,secret>y %all apply a sav+s   
adju/m5t "u ?is subp>agraph aft] !      
geographic adju/m5ts h be5 appli$ "u    
subp>agraph 7,a74  7ii7 ,sav+s adju/m5t 
def9$ ,! t]m sav+s adju/m5t means !     
p]c5tage by :i* ! pr(essional compon5t &
 te*nical compon5t paym5t rates are ea* 
r$uc$ to a*ieve ,m$ic>e sav+s4  7e7     

,availability ( paym5t plans = paym5t ( 
co9surance ,foll[+ ! application ( !    
adju/m5ts describ$ 9 subsection 7d71 b  
be=e ! application ( any seque/ration   
ord] issu$ "u ! ,balanc$ ,budget &      
,em]g5cy ,deficit ,control ,act ( #aihe 
7#b ,u4,s4,c4 #ijj et seq471 radiation  
!rapy provid]s & radiation !rapy        
suppli]s %all collect co9surance =      
s]vices furni%$ "u ! ,,rocr ,program    
subject to ! foll[+ rules3 7#a7 ,9 g5]al
 ,radiation !rapy provid]s & radiation  
!rapy suppli]s may collect co9surance   
applicable "u subsection 7b77#a7 = cov]$
 treatm5t furni%$ to a cov]$ individual 
"u ! ,,rocr ,program 9 multiple         
in/allm5ts "u a paym5t plan4  7#b7      
,limitation on use z a m>ket+ tool      
,radiation !rapy provid]s & radiation   
!rapy suppli]s may n use ! availability 
( paym5t plans = su* co9surance z a     
m>ket+ tool to influ5ce ! *oice ( heal? 
c>e provid] by cov]$ individuals4  7#c7 
,tim+ ( provisions ( in=mation          
,radiation !rapy provid]s & radiation   

!rapy suppli]s (f]+ a paym5t plan = su* 
co9surance may in=m ! cov]$ individual (
 ! availability ( ! paym5t plan prior to
 or dur+ ! initial treatm5t plann+      
session & z necess>y !reaft]4  7#d7     
,b5efici>y co9surance paym5t ,!         
b5efici>y co9surance paym5t %all equal  
#bj p]c5t ( ! paym5t am\nt to be paid to
 ! radiation !rapy provid] or radiation 
!rapy suppli] prior to ! application (  
any seque/ration ord] issu$ "u !        
,balanc$ ,budget & ,em]g5cy ,deficit    
,control ,act ( #aihe 7#b ,u4,s4,c4 #ijj
 et seq47 = ! bill$ ,,rocr ,program     
episode ( c>e1 except z provid$ 9       
p>agraph 7#e74  7#e7 ,incomplete episode
 ( c>e ,9 ! case ( an incomplete episode
 ( c>e1 ! b5efici>y co9surance paym5t   
%all equal #bj p]c5t ( ! am\nt t w\ld h 
be5 paid 9 ! abs5ce ( ! ,,rocr ,program 
= ! radiation !rapy s]vices furni%$ by !
 radiation !rapy provid] or radiation   
!rapy suppli] t initiat$ ! pr(essional  
compon5t &1 if applicable1 ! radiation  
!rapy provid] or radiation !rapy suppli]

 t initiat$ ! te*nical compon5t4  7f7   
,m&atory p>ticipation  7#a7 ,9 g5]al    
,except z provid$ "u p>agraph 7#b7 or   
7#c71 a radiation !rapy provid] or      
radiation !rapy suppli] t is p>ticipat+ 
9 ! program "u ?is title & furni%es a   
cov]$ treatm5t to a cov]$ individual    
%all be requir$ to p>ticipate 9 ! ,,rocr
 ,program4  7#b7 ,concurr5t p>ticipation
 9 ! ,,rocr ,program & o!r models ,a    
radiation !rapy provid] or radiation    
!rapy suppli] t is p>ticipat+ 9 a       
,/ate-bas$ ,c5t] = ,m$ic>e  ,m$icaid    
,innovation model-- 7,a7 %all n be      
prohibit$ f also p>ticipat+ 9 ! ,,rocr  
,program2 &  7,b7 is n requir$ to       
p>ticipate 9 ! ,,rocr ,program4  7#c7   
,significant h>d%ip exemption  7,a7 ,9  
g5]al ,! ,secret>y may1 on a            
case-by-case basis1 exempt a radiation  
!rapy provid] or radiation !rapy suppli]
 f ! ,,rocr ,program if ! ,secret>y     
det]m9es t application ( ! program w\ld 
result 9 a significant h>d%ip1 su* z 9 !
 case ( a natural disa/]1 = su*         

radiation !rapy provid] or radiation    
!rapy suppli] or = b5efici>ies 9 !      
geographic area ( ! radiation !rapy     
provid] or radiation !rapy suppli]4     
7,b7 ,proc$ure ,! ,secret>y %all        
promulgate regulations1 us+ ! proc$ures 
describ$ 9 subsection 7a77#e71 reg>d+   
eligibility & ! proc$ure = apply+ = a   
significant h>d%ip exemption4  7g7      
,heal? equity a*ievem5t 9 radiation     
!rapy add-,on paym5t  7#a7 ,9 g5]al     
,pursuant to p>agraph 7#b7 & subject to 
p>agraph 7#g71 ! ,secret>y %all adju/ ! 
p] episode paym5t am\nt 9 ! am\nt ( a   
heal? equity a*ievem5t 9 radiation !rapy
 add-on paym5t to advance heal? equity &
 support cov]$ individuals 9 access+ &  
complet+ _! radiation !rapy treatm5ts = 
cov]$ treatm5ts ( includ$ canc] types   
?r\gh ! provision ( transportation      
s]vices1 subject to ! succe$+ provisions
 ( ?is subsection4  7#b7 ,eligibility   
7,a7 ,9 g5]al ,! heal? equity a*ievem5t 
9 radiation !rapy add-on paym5t %all be 
made :5 ! ,,icd-#aj diagnosis code      

,z#ei4hb1 transportation insecurity is  
report$ pursuant to subp>agraph 7,b74   
7,b7 ,det]m9ation ( report+ code ,!     
radiation !rapy provid] or radiation    
!rapy suppli] %all foll[ ! foll[+       
proc$ures to det]m9e if ! ,,icd-#aj     
diagnosis code ,z#ei4hb1 transportation 
insecurity ne$s to be report$3 7i7 ,!   
radiation !rapy provid] or radiation    
!rapy suppli] %all ask ! pati5t at ! "t 
( pati5t intake dur+ ! initial pati5t   
consultation if1 )9 ! previ\s #b mon?s1 
a lack ( reliable transportation has    
kept ! pati5t f att5d+ m$ical           
appo9tm5ts1 meet+s1 or "w1 or f complet+
 activities ( daily liv+4  7ii7 ,if !   
pati5t answ]s yes to ! "q 9 clause 7i71 
,,icd-#aj diagnosis code ,z#ei4hb %all  
be report$4  7#c7 ,am\nt ,! heal? equity
 a*ievem5t 9 radiation !rapy add-on     
paym5t %all be 9 ! am\nt (-- 7,a7 =     
s]vices furni%$ dur+ ! ye> foll[+ ! date
 ! regulations issu$ pursuant to        
subsection 7a77#a7 become effective1    
#ejj p] pati5t p] episode ( c>e2 &  7,b7

 = s]vices furni%$ 9 subsequ5t ye>s1 !  
am\nt det]m9$ "u ?is p>agraph = ! prec$+
 ye>1 increas$ by #aj4  7#d7 ,paym5t    
recipi5t ,! heal? equity a*ievem5t 9    
radiation !rapy add-on paym5t %all be   
paid to ! radiation !rapy provid] or    
radiation !rapy suppli] t provides !    
te*nical compon5t ( ! radiation !rapy   
s]vices4  7#e7 ,n to be us$ 9 addition  
to or 9 lieu ( o!r s]vices ,! heal?     
equity a*ievem5t 9 radiation !rapy      
add-on paym5t %all n be made 9 addition 
to or 9 lieu ( any o!r ,/ate or ,f$]al  
program b5efits t may be us$ =          
transportation s]vices4  7#f7           
,docum5tation  7,a7 ,9 g5]al ,radiation 
!rapy provid]s & radiation !rapy        
suppli]s :o receive ! heal? equity      
a*ievem5t 9 radiation !rapy add-on      
paym5t %all ma9ta9 all docum5tation     
relat$ to ! sp5d+ ( su* paym5t on       
transportation s]vices p] cov]$         
individual = a p]iod ( #e ye>s aft] !   
end ( ! episode ( c>e ( ! applicable    
cov]$ individual4  7,b7 ,availability to

 ! ,secret>y ,! docum5tation describ$ 9 
subp>agraph 7,a7 %all be made available 
to ! ,secret>y ^u reque/4  7#g7 ,no     
modification ( co9surance ,! ,secret>y  
may n modify any co9surance obligation  
:5 implem5t+ ! heal? equity a*ievem5t 9 
radiation !rapy add-on paym5t4  7h7     
,quality inc5tives 9 ! ,,rocr ,value    
,bas$ ,paym5t ,program  7#a7 ,9 g5]al   
7,a7 ,initial increase 9 paym5t ,)      
respect to cov]$ treatm5t = an includ$  
canc] type furni%$ to a cov]$ individual
 on or aft] ! date ! regulations issu$  
pursuant to subsection 7a77#a7 become   
effective & be=e ! date t is #b ye>s    
aft] su* date1 9 ! case ( a radiation   
!rapy provid] or radiation !rapy suppli]
 t meets ! requirem5ts describ$ 9       
p>agraph 7#b71 paym5ts o!rwise made to  
su* radiation !rapy provid] or radiation
 !rapy suppli] "u ! ,,rocr ,program = ! 
te*nical compon5t ( su* s]vices %all be 
increas$ by #a p]c5t 7or #j4be p]c5t 9 !
 case ( su* a provid] or suppli] t is a 
limit$ res\rce radiation !rapy suppli]  

or limit$ res\rce radiation !rapy       
provid]74  7,b7 ,r$uction 9 paym5t  7i7 
,9 g5]al ,subject to clause 7ii71 )     
respect to cov]$ treatm5t = an includ$  
canc] type furni%$ to a cov]$ individual
 on or aft] ! date t is #b ye>s aft] !  
regulations issu$ pursuant to subsection
 7a77#a7 become effective1 9 ! case ( a 
radiation !rapy provid] or radiation    
!rapy suppli] t does n meet !           
requirem5ts describ$ 9 p>agraph 7#b71 ! 
p] episode paym5t to su* provid] or     
suppli] "u ! ,,rocr ,program %all be    
r$uc$ by #b4e p]c5t4  7ii7 ,exclusion ( 
limit$ res\rce radiation !rapy provid]s 
& limit$ res\rce radiation !rapy        
suppli]s ,?is subp>agraph %all n apply )
 respect to a limit$ res\rce radiation  
!rapy provid] or a limit$ res\rce       
radiation !rapy suppli]4  7,c7          
,def9ition ( limit$ res\rce radiation   
!rapy provid] & limit$ res\rce radiation
 !rapy suppli]  7i7 ,9 g5]al ,9 ?is     
subsection1 ! t]ms limit$ res\rce       
radiation !rapy provid] & limit$ res\rce

 radiation !rapy suppli] mean1 ) respect
 to a radiation !rapy provid] or        
radiation !rapy suppli]1 a provid] or   
suppli] t meets ! crit]ia specifi$ by ! 
,secret>y t may include crit]ia relat+  
to ! volume & socioeconomic /atus (     
pati5ts treat$ by ! radiation !rapy     
provid] or radiation !rapy suppli]1 !   
geographic area or m$ically-und]s]v$    
area s]v$ by ! radiation !rapy provid]  
or radiation !rapy suppli]1 includ+     
rural areas1 or su* o!r crit]ia z !     
,secret>y det]m9es is appropriate1 ?r\gh
 notice & comm5t rulemak+ & 9           
consultation ) radiation !rapy /akehold]
 organizations4  7ii7 ,cap on numb] (   
limit$ res\rce radiation !rapy provid]s 
& limit$ res\rce radiation !rapy        
suppli]s ,9 specify+ ! crit]ia = limit$ 
res\rce radiation !rapy provid]s &      
limit$ res\rce radiation !rapy suppli]s 
"u clause 7i71 ! ,secret>y %all ensure t
 ! total numb] ( su* provid]s & suppli]s
 does n exce$ #aj p]c5t ( ! total numb] 
( all radiation !rapy provid]s &        

radiation !rapy suppli]s4  7#b7         
,accr$itation ,requirem5ts  7,a7 ,9     
g5]al ,! requirem5ts describ$ 9 ?is     
subp>agraph ) respect to a radiation    
!rapy provid] or radiation !rapy suppli]
 7o!r ?an su* a provid] or suppli] t is 
a limit$ res\rce radiation !rapy provid]
 or limit$ res\rce radiation !rapy      
suppli]7 are t ! suppli] or provid]     
mu/-- 7i7 ma9ta9 or be 9 ! process (    
obta9+ accr$itation by ! ,am]ican       
,college ( ,radiology1 ,am]ican ,college
 ( ,radiation ,oncology1 or ,am]ican    
,society = ,radiation ,oncology 7ref]r$ 
to 9 ?is section z cov]$ radiation      
oncology accr$itation organizations72   
7ii7 comply ) c]tifi$ electronic heal?  
record te*nology requirem5ts z det]m9$  
by ! ,secret>y ) exceptions t are       
consi/5t ) ^? ( ! ,m]it-,bas$ ,inc5tive 
,paym5t ,sy/em e/abli%$ "u section      
#ahdh7q72 &  7iii7 submit to ! ,secret>y
 pro( ( ! accr$itation describ$ 9 clause
 7i7 9 su* =m & mann] z specifi$ by !   
,secret>y4  7,b7 ,requirem5ts = limit$  

res\rce radiation !rapy provid]s &      
limit$ res\rce radiation !rapy suppli]s 
,a radiation !rapy provid] or radiation 
!rapy suppli] t is a limit$ res\rce     
radiation !rapy provid] or limit$       
res\rce radiation !rapy suppli] may     
elect to satisfy ! accr$itation         
requirem5t "u ?is p>agraph by-- 7i7     
meet+ ! requirem5ts ( subp>agraph 7,a72 
7ii7 us+ an ext]nal audit t encompasses 
simil> crit]ia z a nationally recogniz$ 
radiation oncology accr$itation         
organization & submit ! outcome ( su*   
ext]nal audit to ! ,secret>y2 or  7iii7 
comply+ ) c]tifi$ electronic heal?      
record te*nology requirem5ts z det]m9$  
by ! ,secret>y ) exceptions t are       
consi/5t ) ^? ( ! ,m]it-,bas$ ,inc5tive 
,paym5t ,sy/em e/abli%$ "u section      
#ahdh7q74  7,c7 ,new provid]s ,a new    
radiation !rapy provid] or new radiation
 suppli] %all complete an initiation (  
accr$itation or ext]nal audit n lat] ?an
 ! date t is #a ye> aft] su* provid] or 
suppli] beg9s furni%+ cov]$ treatm5t to 

cov]$ individuals4  7,d7 ,radiation     
oncology accr$itation organization      
quality /&>ds ,ea* cov]$ radiation      
oncology accr$itation organization 7&   
any successor organization7 %all develop
 quality /&>ds = radiation !rapy        
provid]s & radiation !rapy suppli]s to  
ensure cov]$ treatm5ts are deliv]$ us+  
adequate & mod]n l9e> accel]ator        
te*nology1 /aff+1 & o!r compon5ts t     
protect pati5t safety & quality by-- 7i7
 consult+ ) radiation !rapy manufactur]s
 & key /akehold]s2  7ii7 solicit+ public
 comm5t on propos$ quality /&>ds1       
includ+ f physicians1 m$ical physici/s1 
& o!r heal? pr(essionals & exp]ts2      
7iii7 updat+ quality /&>ds n lat] ?an e 
#e to #g ye>s 9 p>tn]%ip ) /akehold]s2  
7iv7 ensur+ quality /&>ds = l9e>        
accel]ator te*nology are adequate & on  
p> ) curr5t te*nological advances &     
mod]n requirem5ts = /aff+ & o!r         
proc$ures associat$ ) ! deliv]y ( safe &
 effective radiation !rapy2  7v7        
collect+ timely in=mation f radiation   

!rapy provid]s & radiation !rapy        
suppli]s = ea* l9e> accel]ator own$ or  
us$ on or aft] ! effective date ( !     
regulations issu$ pursuant to subsection
 7a77#a72 &  7vi7 giv+ suffici5t weight 
to compliance ) quality /&>ds among o!r 
accr$itation /&>ds 9 det]m9+            
accr$itation /atus = radiation !rapy    
provid]s or radiation !rapy suppli]s4   
7i7 ,report+ requirem5ts  7#a7 ,report  
on ! ,,rocr ,program ,n e>li] ?an #g    
ye>s aft] ! date ( ! enactm5t ( ?is     
section1 ! ,comptroll] ,g5]al ( ! ,unit$
 ,/ates 7ref]r$ to 9 ?is subsection z ! 
,comptroll] ,g5]al7 %all1 aft] seek+ out
 ! p]spectives ( radiation oncology     
/akehold]s1 submit to ! appropriate     
committees ( jurisdiction ( ! ,s5ate & !
 ,h\se ( ,repres5tatives a report t--   
7,a7 evaluates-- 7i7 ! implem5tation ( !
 ,,rocr ,program1 & ! impact su*        
,program has _h on ,f$]al heal?c>e      
sp5d+2  7ii7 ! impact ! ,,rocr ,program 
has _h on ! ability ( cov]$ individuals 
to access cov]$ treatm5t2  7iii7 :e!r   

any canc] types or radiation !rapy      
s]vices1 su* z bra*y!rapy1 proton !rapy1
 or !rapeutic radioph>maceuticals1 %\ld 
be add$ or remov$ f ! ,,rocr ,program2 &
  7iv7 ! pot5tial application ( ! ,,rocr
 ,program to b5efits provid$ "u "p ,c ( 
?is title2 &  7,b7 includes any         
recomm5dations = adm9i/rative &         
legislative *anges4  7#b7 ,report on    
access to radiation !rapy 9 rural &     
und]s]v$ areas ,n lat] ?an #c ye>s aft] 
! date ( ! enactm5t ( ?is section1 !    
,comptroll] ,g5]al %all submit a report 
to ! appropriate committees (           
jurisdiction ( ! ,s5ate & ! ,h\se (     
,repres5tatives t id5tifies ! foll[+3   
7,a7 ,radiation !rapy des]ts4  7,b7     
,me?ods to increase access to new       
radiation !rapy te*nologies 9 rural &   
und]s]v$ areas1 includ+ te*nologies     
requir$ = cl9ical treatm5t plann+1      
simulation1 dosimetry1 m$ical radiation 
physics1 radiation treatm5t devices1    
radiation treatm5t deliv]y1 radiation   
treatm5t managem5t1 & su* o!r items z ! 

,comptroll] ,g5]al may det]m9e are      
m$ically necess>y4  7,c7 ,a program to  
provide assi/ance 9 ! =m ( grants or    
loans to radiation !rapy provid]s or    
radiation !rapy suppli]s = ! purpose (  
ensur+ access to ! mo/ curr5t radiation 
!rapy te*nology4  7#c7 ,det]m9ation &   
def9ition ( radiation !rapy des]ts  7,a7
 ,def9ition ,= purposes ( ?is           
subsection1 ! t]m radiation !rapy des]t 
means a region det]m9$ by ! ,comptroll] 
,g5]al "u subp>agraph 7,b7 ) a mismat*  
betwe5 radiation !rapy res\rces &       
oncologic ne$4  7,b7 ,det]m9ation ,9    
det]m9+ :e!r a region qualifies z a     
radiation !rapy des]t1 ! ,comptroll]    
,g5]al %all take into acc\nt ! ratio or 
d5sity ( radiation !rapy provid]s &     
radiation !rapy suppli]s practic+ 9 a   
geographic area z comp>$ to ! population
 size 9 t geographic area4  7j7         
,def9itions ,9 ?is section3 7#a7        
,adaptive radiation !rapy plann+ ,! t]m 
adaptive radiation !rapy plann+ means   
any new te*nology or s]vices id5tifi$1 z

 ( ! date t ! regulations issu$ pursuant
 to subsection 7a77#a7 become effective1
 by ! foll[+ ,,hcpcs codes 7& z         
subsequ5tly modifi$ by ! ,secret>y7     
p]=m$ aft] ! initial treatm5t plan = a  
cov]$ individual3 7,a7 #ggbie1          
#c-;dim5sional radio!rapy plan1 includ+ 
dose-volume hi/ograms4  7,b7 #ggcjj1    
basic radiation dosimetry calculation1  
c5tral axis dep? dose calculation1      
,,tdf1 ,,nsd1 gap calculation1 (f axis  
factor1 tissue inhomog5eity factors1    
calculation ( non-ioniz+ radiation      
surface & dep? dose1 z requir$ dur+     
c\rse ( treatm5t1 only :5 prescrib$ by !
 treat+ physician4  7,c7 #ggcja1        
int5sity modulat$ radio!rapy plan1      
includ+ dose-volume hi/ograms = t>get & 
critical /ructure p>tial tol]ance       
specifications4  7,d7 #ggcch1 multi-leaf
 collimator 7,,mlc7 devices = int5sity  
modulat$ radiation !rapy 7,,imrt71      
design & con/ruction p] ,,imrt plan4    
7,e7 #ggccd1 ,treatm5t devices1 design &
 con/ruction2 complex 7irregul> blocks1 

special %ields1 comp5sators1 w$ges1     
molds or ca/s74  7,f7 #ggbic1           
,respiratory motion managem5t simulation
 7,li/ sep>ately 9 addition to code =   
prim>y proc$ure74  7#b7 ,applicable     
radiation !rapy plann+ trigg] code ,!   
t]m applicable radiation !rapy plann+   
trigg] code means s]vices id5tifi$1 z ( 
! date t ! regulations issu$ pursuant to
 subsection 7a77#a7 become effective1 by
 ! foll[+ ,,hcpcs codes 7& z subsequ5tly
 modifi$ by ! ,secret>y73 7,a7 #ggbfa1  
!rapeutic radiology treatm5t plann+1    
simple4  7,b7 #ggbfb1 !rapeutic         
radiology treatm5t plann+1 int]m$iate4  
7,c7 #ggbfc1 !rapeutic radiology        
treatm5t plann+1 complex4  7#c7 ,cov]$  
individual ,! t]m cov]$ individual means
 an individual :o-- 7,a7 is enroll$ =   
b5efits "u "p ,b2  7,b7 is n enroll$ 9 a
 ,m$ic>e ,advantage plan "u "p ,c or a  
,,pace program "u section #ahid2 &  7,c7
 is diagnos$ ) an includ$ canc] type4   
7#d7 ,cov]$ treatm5t  7,a7 ,9 g5]al ,!  
t]m cov]$ treatm5t means1 subject to    

subp>agraph 7,b71 radiation !rapy       
s]vices furni%$ to a cov]$ individual4  
7,b7 ,exclusions  7i7 ,9 g5]al ,su* t]m 
does n include-- 7,i7 subject to clause 
7ii71 dur+ ! p]iod beg9n+ on ! date on  
:i* ! regulation issu$ pursuant to      
subsection 7a77#a7 become effective &   
end+ on ! date t is #ab ye>s aft] su*   
date1 bra*y!rapy1 proton beam radiation 
!rapy s]vices1 intraop]ative radio!rapy1
 sup]ficial radiation !rapy1 hyp]!rmia1 
& !rapeutic radioph>maceuticals2  7,,ii7
 inpati5t radiation !rapy s]vices       
furni%$ 9 a subsection 7d7 hospital or  
ambulatory surgical c5t]2  7,,iii7      
radiation !rapy s]vices furni%$ 9 canc] 
hospitals t are exempt f ! hospital     
outpati5t prospective paym5t sy/em "u   
section #ahcc7t72  7,,iv7 physician     
s]vices t are furni%$ or sup]vis$ by !  
physician or ! physician practice       
furni%+ radiation !rapy or by ano!r     
physician1 includ+ any surgical         
proc$ures1 *emo!rapy1 & o!r s]vices2    
7,v7 physician & te*nical s]vices t are 

furni%$ us+ te*nology repres5t$ by      
,heal?c>e ,common ,proc$ure ,cod+ ,sy/em
 codes t are n includ$ 9 ! ,m-code      
national base rates id5tifi$ 9 table #ge
 7includ+ 9 ,,hcpcs ,codes = radiation  
!rapy s]vices & supplies7 ( ! ,f$]al    
,regi/] on ,novemb] #af1 #bjba1 #hf ,f$4
 ,reg4 #fcdhe1 #fcibe2 or  7,,vi7       
durable m$ical equipm5t 7z def9$ 9      
section #ahfa7n774  7ii7 ,inclusion (   
c]ta9 treatm5t ,aft] ! date t is #ab    
ye>s aft] ! date on :i* ! regulation    
issu$ pursuant to subsection 7a77#a7    
become effective1 ! ,secret>y may       
det]m9e by regulation to include any ( !
 treatm5t modalities describ$ 9 clause  
7i77,i7 z cov]$ treatm5t4 ,be=e mak+ su*
 det]m9ation1 ! ,secret>y %all-- 7,i7   
consid]-- 7aa7 m>ket p5etration2  7bb7 !
 co/ ( su* items or s]vices relative to 
base rates2  7cc7 ! cl9ical b5efits (   
su* items or s]vices2 &  7dd7 ! cle>    
cons5sus ( ! /akehold] community2 &     
7,,ii7 publi% a notice ( a propos$      
det]m9ation "u subsection 7b77#c77;,b7  

reg>d+ ! paym5t am\nt propos$ to be     
e/abli%$ ) respect to su* item or       
s]vice4  7#e7 ,episode ( c>e ,! t]m     
episode ( c>e means1 ) respect to a     
cov]$ individual1 ! p]iod-- 7,a7 beg9n+ 
on ! day radiation !rapy plann+ = an    
includ$ canc] type1 bill$ "u an         
applicable radiation !rapy plann+ trigg]
 code1 is furni%$ to a cov]$ individual 
if radiation !rapy treatm5t is initiat$ 
n lat] ?an #cj days aft] ! day su*      
radiation !rapy plann+ s]vice is        
furni%$2 &  7,b7 ends-- 7i7 = treatm5t (
 all includ$ canc] types except bone &  
bra9 meta/ases treatm5t1 ! day t is #ij 
days aft] ! day ! episode ( c>e beg9s "u
 clause 7i72 &  7ii7 = bone & bra9      
meta/ases treatm5t1 ! day t is #cj days 
aft] ! day ! episode ( c>e beg9s "u     
clause 7i74  7#f7 ,includ$ canc] types  
,! t]m includ$ canc] type means any ( ! 
foll[+ types ( canc]3 7,a7 ,anal4  7,b7 
,bladd]4  7,c7 ,bone ,meta/ases4  7,d7  
,bra9 ,meta/ases4  7,e7 ,brea/4  7,f7   
,c]vical4  7,g7 ,c5tral ,n]v\s ,sy/em   

,tumors4  7,h7 ,colorectal4  7,i7 ,head 
& ,neck4  7,j7 ,lung4  7,k7 ,lymphoma4  
7,l7 ,pancreatic4  7,m7 ,pro/ate4  7,n7 
,upp] ,ga/ro9te/9al4  7,o7 ,ut]9e4  7#g7
 ,heal?c>e ,common ,proc$ure ,cod+      
,sy/em ,! t]m ,heal?c>e ,common         
,proc$ure ,cod+ ,sy/em means ! /&>diz$  
cod+ sy/em us$ by ,m$ic>e & o!r heal?   
insurance programs to ensure t claims   
are process$ 9 an ord]ly & consi/5t     
mann]4  7#h7 ,incomplete episode ( c>e  
,! t]m incomplete episode ( c>e means1 )
 respect to a cov]$ individual1 an      
episode ( c>e t is n complet$ because-- 
7,a7 ! individual be+ treat$ ceases to  
be a cov]$ individual1 includ+ 9 ! case 
:]e ! individual loses b5efits "u ?is   
title1 at any "t aft] ! initial treatm5t
 plann+ s]vice is furni%$ & be=e !      
episode ( c>e = ! cov]$ treatm5t is     
complete2 or  7,b7 a cov]$ individual   
swit*es radiation !rapy provid] or      
radiation !rapy suppli] be=e all includ$
 radiation !rapy s]vices 9 ! episode (  
c>e = ! cov]$ treatm5t h be5 furni%$4   

7#i7 ,new te*nology or s]vices ,! t]m   
new te*nology or s]vices means any      
te*nology or s]vices t1 aft] ! date (   
enactm5t ( ?is section1 receives a      
,category #a ,curr5t ,proc$ural         
,t]m9ology code or is e/abli%$ 9 ! ye>ly
 update to ! ,m$ic>e physician fee      
s*$ule direct practice exp5se inputs or 
any successor repository ( ! direct     
practice exp5se input = ! deliv]y (     
radiation !rapy s]vices4  7#aj7         
,pr(essional compon5t ,! t]m pr(essional
 compon5t means ! includ$ radiation     
!rapy s]vices t may only be furni%$ by a
 physician4  7#aa7 ,radiation !rapy ,!  
t]m radiation !rapy means ! c>eful use (
 v>i\s =ms ( radiation1 su* z ext]nal   
beam radiation !rapy1 to treat canc] &  
o!r diseases safely & effectively4      
7#ab7 ,radiation !rapy provid] ,! t]m   
radiation !rapy provid] means a hospital
 outpati5t dep>tm5t enroll$ "u ?is title
 t furni%es radiation !rapy s]vices4    
7#ac7 ,radiation !rapy s]vices ,! t]m   
radiation !rapy s]vices means ! treatm5t

 plann+1 te*nical prep>ation1 special   
s]vices 7su* z simulation71 treatm5t    
deliv]y1 & treatm5t managem5t s]vices   
associat$ ) canc] treatm5t t uses high  
doses ( radiation to kill canc] cells & 
%r9k tumors4  7#ad7 ,radiation !rapy    
suppli] ,! t]m radiation !rapy suppli]  
means a physician gr\p practice or      
free/&+ radiation !rapy c5t] enroll$ "u 
?is title t furni%es radiation !rapy    
s]vices4  7#ae7 ,te*nical compon5t ,!   
t]m te*nical compon5t means ! includ$   
radiation !rapy s]vices t are n furni%$ 
by a physician1 includ+ ! provision (   
equipm5t1 supplies1 p]sonnel1 &         
adm9i/rative co/s relat$ to radiation   
!rapy s]vices4  7#af7 ,transportation   
s]vices ,! t]m transportation s]vices   
means ! provision ( free or disc\nt$    
transportation made available to cov]$  
individuals furni%$ cov]$ treatm5t :i*  
are n air1 luxury1 or ambulance-level   
transportation1 b may include c>        
s]vices1 ride %>es1 autonom\s vehicles1 
or public transportation4  4  7b7       

,exclusion ( p>ticipat+ radiation !rapy 
provid]s1 radiation !rapy suppli]s1 &   
physicians f ! m]it-,bas$ inc5tive      
paym5t sy/em ,section                   
#ahdh7q77#a77;,c77ii7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7q77#a77;c77,,ii77 is am5d$--  
7#a7 9 subclause 7,,ii71 by /rik+ or at 
! end2  7#b7 9 subclause 7,,iii71 by    
/rik+ ! p]iod at ! end & ins]t+ 2 or2 & 
7#c7 by add+ at ! end ! foll[+ new      
subclause3  7,,iv7 is a radiation !rapy 
provid] or radiation !rapy suppli] 7z ^?
 t]ms are def9$ 9 subsection 7j7 (      
section#ahii;,c7 t is p>ticipat+ 9 !    
,radiation ,oncology ,case ,rate ,value 
,bas$ ,paym5t ,program e/abli%$ "u t    
section4  4  #d4 ,revision to civil     
monet>y p5alties reg>d+ radiation       
oncology case rate pati5t transportation
 s]vices ,section #aabh;,a ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#g;a7 is am5d$-- 7#a7 9         
subsection 7i77#f7-- 7,a7 9 subp>agraph 
7,i71 by /rik+ or at ! end2  7,b7 9     

subp>agraph 7,j77iii71 by /rik+ ! p]iod 
at ! end & ins]t+ 2 or2 &  7,c7 by add+ 
at ! end ! foll[+ new subp>agraph3  7,k7
 ! provision ( transportation s]vices by
 an eligible entity1 z def9$ 9          
subsection 7t71 if-- 7i7 ! availability 
( ! transportation s]vices-- 7,i7 is set
 =? 9 a policy t ! eligible entity1 z   
def9$ 9 subsection 7t71 applies uni=mly 
& consi/5tly2 &  7,,ii7 is n det]m9$ 9 a
 mann] relat$ to ! pa/ or anticipat$    
volume or value ( ,f$]al heal? c>e      
program bus9ess2  7ii7 ! eligible entity
 does n publicly m>ket or adv]tise !    
transportation s]vices2  7iii7 ! driv]  
:o provides ! transportation s]vices    
does n m>ket heal? c>e items or s]vices 
dur+ ! c\rse ( ! transportation or at   
any "t2  7iv7 ! driv] or individual     
arrang+ = ! transportation s]vices is n 
paid on a p]-b5efici>y-transport$ basis2
  7v7 ! eligible entity makes !         
transportation s]vices available only to
 an individual :o-- 7,i7 is an e/abli%$ 
pati5t1 z def9$ 9 subsection 7t71 ( !   

eligible entity t is provid+ or         
facilitat+ free or disc\nt$             
transportation2  7,,ii7 resides-- 7aa7  
)9 a #ge-mile radius ( ! radiation !rapy
 provid] or radiation !rapy suppli] to  
or f :i* ! pati5t w\ld be transport$2 or
  7bb7 9 a rural area1 z def9$ 9        
subsection 7t72 &  7,,iii7 is receiv+   
radiation !rapy s]vices = ! purpose (   
obta9+ m$ically necess>y items &        
s]vices2 &  7vi7 ! eligible entity t    
makes ! transportation s]vices available
 be>s ! co/s ( ! transportation s]vices 
& does n %ift ! burd5 ( ^? co/s onto any
 ,f$]al heal? c>e program1 o!r pay]s1 or
 individuals4  2 &  7#b7 by add+ at !   
end ! foll[+ new subsection3  7t7 ,=    
purposes ( subsection 7i77#f77,k71 !    
foll[+ def9itions apply3 7#a7 ,! t]m    
eligible entity means any individual or 
entity1 or any individual or entity act+
 on behalf ( su* individual or entity t 
does n supply heal? c>e items z ! prim>y
 occupation ( ! individual or entity4   
7#b7 ,! t]m e/abli%$ pati5t means an    

individual :o-- 7,a7 has select$ &      
s*$ul$ an appo9tm5t ) a radiation !rapy 
provid] or radiation !rapy suppli]2 or  
7,b7 has att5d$ an appo9tm5t ) su*      
provid] or suppli]4  7#c7 ,! t]ms       
radiation !rapy provid]1 radiation !rapy
 s]vices1 & radiation !rapy suppli] h ! 
mean+ giv5 su* t]ms 9 section           
#ahff;,g7j74  7#d7 ,! t]m rural area    
means an area t is n an urban area4     
7#e7 ,! t]m transportation s]vices--    
7,a7 means ! provision ( free or        
disc\nt$ transportation made available  
to ,f$]al heal? c>e program b5efici>ies 
receiv+ radiation !rapy s]vices2  7,b7  
includes c> s]vices1 ride %>es1 & public
 transportation2 &  7,c7 does n include 
air1 luxury1 or ambulance-level         
transportation4  7#f7 ,! t]m urban area 
means-- 7,a7 a ,metropolitan ,/ati/ical 
,area or ,new ,engl& ,c\nty             
,metropolitan ,area1 z def9$ by ! ,(fice
 ( ,managem5t & ,budget2  7,b7          
,lit*field ,c\nty1 ,connecticut2  7,c7  
,york ,c\nty1 ,ma9e2  7,d7 ,sagadahoc   

,c\nty1 ,ma9e2  7,e7 ,m]rimack ,c\nty1  
,new ,hamp%ire2 &  7,f7 ,newport ,c\nty1
 ,rhode ,isl&4  4  #e4 ,exemption (     
,radiation ,oncology ,case ,rate ,value 
,bas$ ,paym5t ,program f budget         
neutrality adju/m5t requirem5ts  7a7    
,paym5t ( b5efits ,section #ahcc7t7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7t77 is am5d$ by add+ at ! end !  
foll[+ new p>agraph3  7#bc7 ,non budget 
neutral application ( r$uc$ exp5ditures 
result+ f ! ,radiation ,oncology ,case  
,rate ,value ,bas$ ,paym5t ,program ,!  
,secret>y %all n take into acc\nt !     
r$uc$ exp5ditures t result f !          
implem5tation ( section #ahii;,c 9 mak+ 
any budget neutrality adju/m5ts "u ?is  
subsection4  4  7b7 ,paym5t =           
physicians' s]vices ,section            
#ahdh7;c77#b77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#d7;c77#b77;,b77 is am5d$-- 7#a7 
9 clause 7iv7-- 7,a7 9 subclause 7,v71  
by /rik+ & at ! end2  7,b7 9 subclause  
7,,vi71 by /rik+ ! p]iod at ! end &     

ins]t+ 2 &2 &  7,c7 by add+ at ! end !  
foll[+ new subclause3  7,,vii7 section  
#ahii;,c %all n be tak5 into acc\nt 9   
apply+ clause 7ii77,,ii7 = a ye> foll[+ 
! enactm5t ( section #ahii;,c4  2 &     
7#b7 9 clause 7v71 by add+ at ! end !   
foll[+ new subclause3  7,,xii7 ,r$uc$   
exp5ditures attributable to ! ,radiation
 ,oncology ,case ,rate ,value ,bas$     
,paym5t ,program ,effective = fee       
s*$ules e/abli%$ foll[+ ! enactm5t (    
section #ahii;,c1 r$uc$ exp5ditures     
attributable to ! ,radiation ,oncology  
,case ,rate ,value ,bas$ ,paym5t        
,program "u section #ahii;,c4  4