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Medicare Proposing New Payment Reimbursement Model Restricting Access to Proton Therapy

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On July 16th, Medicare or CMS (Centers for Medicare and Medicaid Services) proposed a major change to their coverage for proton therapy called the Radiation Oncology Alternative Payment Model or RO APM. This proposed ruling would include proton therapy to be reimbursed at the same rate as other radiation therapies without regard to cost and resource differentials. This change could result in a negative impact by restricting patient access to proton therapy.

  • Proton centers will be challenged to serve patients under the RO APM.
  • The RO APM would restrict and jeopardize Medicare beneficiaries’ access to proton therapy.
  • The RO APM would threaten access to proton therapy for children who benefit most.
  • The RO APM would not support innovation such as proton therapy treatment and research.

We ask you to join us in a national effort to reach out and contact your congressional leaders and make them aware of this proposed ruling and to request proton therapy be excluded from this model.

We can influence a positive change for future cancer patients. Please help us ensure future cancer patients have access to proton therapy as a treatment option.


Governor Lee signs “Proton Therapy Access Act” into law, providing members of Tennessee State Insurance Plan expanded proton therapy coverage.

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Nashville, Tennessee (April 26,2019) — Governor Bill Lee signed bill SB 195/HB 184, also known as the “Proton Therapy Access Act” which requires the state health insurance plan to extend coverage for proton radiation therapy as an approved cancer treatment option.  The bill received overwhelming approval in the House of Representatives with a 94-0 vote.  The measure previously passed The Senate with a 27-1 vote.


Don Denton, President of Tennessee Cancer Patient Coalition and a prostate cancer survivor said, “This bill allows members of the Tennessee State health plan greater access to one of the world’s most advanced cancer treatment options. It’s the mission of our organization to gain insurance coverage for everyone, and today we took a step in that direction. Tennessee’s cancer patients can thank House sponsor Rep. Robin Smith (R, Hixson) and Senate sponsor Sen. Becky Massey (R, Knoxville), along with several co-sponsors. Additionally, we appreciate the leadership of our state legislature for their support of providing access to proton therapy, currently accessible in three locations in Tennessee.”

Carl Koella III, President, Provision CARES Proton Therapy Knoxville said, “We have been serving the state of Tennessee since January 2014, and today we celebrate the passage of this bill as a victory for members of the state insurance plan across the state who can now have expanded coverage for proton therapy.”  Dr.  Aashish Shah, President of Provision CARES Proton Therapy Nashville, the newest proton center in Tennessee treating cancer patients in Franklin, said, “Members of the state plan will now have access to proton therapy for cancer treatment which can reduce damage to nearby tissue and organs thus providing fewer side effects and a better quality of life both during and after treatment.”

Proton therapy is an advanced form of radiation therapy that is noninvasive and uses a single beam of high-energy protons to kill cancer cells. Both standard x-ray radiation and proton radiation damage cancer cells, but unlike standard radiation therapy, proton therapy deposits the majority of the radiation dose directly into the tumor.  This spares nearby healthy tissues and organs from receiving radiation, thus improving outcomes by reducing damaging side effects and complications, compared to conventional radiation.

About Tennessee Cancer Patient Coalition

Tennessee Cancer Patient Coalition, led by President, Don Denton, author and prostate cancer survivor, was formed in 2015, and serves as an advocate for cancer patients and their caregivers in the State of Tennessee.  Tennessee Cancer Patient Coalition collaborates with former cancer patients to educate government officials and support legislation that can positively impact treatment, research, coverage and outcomes for cancer patients.


Media Contact:

Don Denton, President

Tennessee Cancer Patient Coalition

(865) 437-9545