The Centers for Medicare and Medicaid Services (CMS) announced plans to launch the Radiation Oncology Model on January 1, 2022, with minimal reductions to discount factor payment cuts and the removal of brachytherapy services from the model. According to an initial ASTRO analysis of the proposed changes, CMS did little to address the underlying punitive nature of the model on mandated participants, as the discount factor payment cuts and participation burden remain serious concerns. ASTRO is disappointed that CMS continues to largely ignore recommendations from the radiation oncology community, cancer patients, health policy experts and Congress. The discount factors decrease from 3.75% to 3.5% for professional component services and from 4.75% to 4.5% for technical component services, due to the Agency’s proposal to remove brachytherapy and liver cancer from the model. CMS recognized ASTRO’s concerns about the model’s impact on cases involving both brachytherapy and external beam radiation therapy. CMS also is adopting an extreme and uncontrollable circumstances policy for significant events, such as the COVID-19 public health emergency. ASTRO will provide a more detailed summary of changes in coming days and conduct in depth data analysis to help assess the financial impact on practices. ASTRO also will engage in advocacy to drive additional reforms to the RO Model.