Congress shields new radiation therapy payments from Medicare cost controls

What it does

This bill creates a new Medicare payment system for radiation oncology services that bundles payments per treatment episode rather than per individual service. It exempts this new program from budget neutrality requirements (meaning savings don't trigger automatic payment cuts elsewhere), and it creates a carve-out in anti-kickback law to allow radiation therapy providers to offer free or discounted transportation to patients without penalty.

Why we flagged it

The bill's core mechanism is a bundled payment model for radiation oncology, but its most consequential feature is the exemption from budget neutrality—a fiscal carve-out that shields the program from the cost-control mechanisms that normally apply to Medicare payment changes.

• Section 4 amends civil monetary penalty law to create a new safe harbor for free/discounted transportation by radiation therapy providers—substantively unrelated to the bundled payment program itself.

What the text implies

• The budget neutrality exemption (Section 5) means the program's costs are not offset by automatic payment reductions elsewhere in Medicare, effectively creating an unfunded mandate or requiring offsetting cuts in other programs.
• Mandatory participation for most radiation therapy providers eliminates opt-out, potentially forcing smaller or rural providers into a new payment model without choice.
• The transportation add-on ($500–$510 per patient per episode) is paid to providers, not directly to patients, creating a subsidy to providers conditioned on self-reported patient transportation insecurity—no enforcement mechanism for actual use.
• The 12-year exclusion of advanced modalities (proton therapy, brachytherapy, therapeutic radiopharmaceuticals) from the bundled payment may disadvantage patients who need these services and create a two-tier system.
• Quality incentives (1% bonus for accredited providers, 2.5% penalty for non-accredited after year 2) may disadvantage rural and limited-resource providers, despite carve-outs for the smallest 10%.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

The bill offers concrete benefits to Medicare beneficiaries with cancer—stable bundled payments may improve access and reduce fragmentation, and the transportation add-on directly helps patients overcome barriers to care. However, the budget neutrality exemption means the program's costs are not offset by savings elsewhere in Medicare, potentially shifting costs to other beneficiaries or taxpayers; the transportation provision is narrowly defined and conditioned on provider discretion; and manda

Who stands to gain

• radiation therapy providers and suppliers (bundled payment stability, transportation add-on, quality
• hospital outpatient departments furnishing radiation therapy
• freestanding radiation therapy centers
• physician group practices furnishing radiation therapy

Named in the bill

Centers for Medicare & Medicaid Services (CMS), American College of Radiology, American College of Radiation Oncology, American Society for Radiation Oncology, Comptroller General of the US, Medicare Part B, Medicare Advantage (Part C), PACE programs, Merit-Based Incentive Payment System (MIPS)

Where it stands

48 cosponsors: 29 Democrats, 19 Republicans.

• Mar 14, 2025 — Introduced · Congress.gov: “Introduced in House”
• Mar 14, 2025 — Referred to House Committee on Ways and Means and House Committee on Energy and Commerce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

12 lobbying clients named this bill on 20 disclosure filings across 3 quarters, Sep 2025 to Jun 2026. Those filings disclosed $10,639,582 in lobbying spend. A filing names 10 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 93% of bills with at least one filing.

Brian Fitzpatrick, the sponsor, reported $2,362,211 in PAC receipts in the 2026 cycle. $1,000 of that came from 1 PAC tied to these lobbying clients.

• American Medical Association — $5,643,000 on 2 filings
• Mckesson Corporation & Affiliates U.S. Oncology and Rx Savings Solutions — $1,710,000 on 2 filings
• Boston Scientific Corporation — $1,212,000 on 2 filings
• Siemens Medical Solutions Usa, Inc — $860,000 on 1 filing
• Association for Clinical Oncology — $480,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.