[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4098 Introduced in House (IH)]







109th CONGRESS
  1st Session
                                H. R. 4098

 To amend title XVIII of the Social Security Act to preserve access to 
            community cancer care by Medicare beneficiaries.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 20, 2005

 Mr. Ramstad introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to preserve access to 
            community cancer care by Medicare beneficiaries.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Community Cancer 
Care Preservation Act of 2005''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Use of average sales price methodology.
Sec. 3. Improved payment for oncologist services.
Sec. 4. Quality measures for cancer care.
Sec. 5. Improved patient participation in clinical trials.
Sec. 6. CBO report.

SEC. 2. USE OF AVERAGE SALES PRICE METHODOLOGY.

    (a) Findings.--Congress finds that--
            (1) in 2005, Medicare reimbursement for certain outpatient 
        cancer drugs was changed to reflect average sales price rather 
        than average wholesale price; and
            (2) the average sales price methodology does not timely 
        reflect changes in manufacturer's prices for drugs.
    (b) Adjustment to Average Sales Price Calculation.--Section 1847A 
of the Social Security Act (42 U.S.C. 1395w-3a) is amended--
            (1) in subsection (b), by adding at the end the following 
        new paragraph:
            ``(6) Reconciliation.--Payments made pursuant to this 
        subsection are subject to reconciliation to assure that such 
        payments do not exceed or fall short of the actual average 
        sales price during any preceding period. Such reconciliation 
        shall be conducted on a quarterly basis and the Secretary shall 
        review all payments made to physicians under this subsection in 
        the preceding quarter and compare such payment to the verified 
        average sales price reported by the manufacturer under 
        subsection (c) for such quarter.''; and
            (2) in subsection (c)(3)--
                    (A) in the first sentence, by striking ``prompt pay 
                discounts,''; and
                    (B) in the second sentence, by inserting ``other 
                than prompt pay discounts,'' after ``other price 
                concessions,''.

SEC. 3. IMPROVED PAYMENT FOR ONCOLOGIST SERVICES.

    (a) Findings.--Congress finds that--
            (1) in 2005, the Centers for Medicare & Medicaid Services 
        implemented a $300 million demonstration project to identify 
        and assess certain oncology services in an office-based 
        oncology practice that positively affect cancer outcomes in the 
        Medicare population; and
            (2) oncologists and cancer patients benefited from the 
        demonstration project.
    (b) Continuation of Current Demonstration Project to Identify and 
Assess Oncology Services That Positively Affect Cancer Outcomes.--
            (1) In general.--The existing demonstration project, 
        developed by the Secretary of Health and Human Services 
        pursuant to the Secretary's authority under sections 
        402(a)(1)(B) and 402(a)(2) of the Social Security Amendments of 
        1967 and implemented in the Federal Register, ``Revisions to 
        Payment Policies Under the Physician Fee Schedule for Calendar 
        Year 2005,'' 69 Fed. Reg. 66,236 (November 15, 2004), for 
        purposes of identifying and assessing certain oncology services 
        that positively affect outcomes in the Medicare population, 
        shall be extended until December 31, 2006.
            (2) Implementation.--The Secretary shall continue to 
        operate such project in the same manner as originally 
        implemented.
            (3) Funding.--Under the demonstration project over the 
        duration of the project, the Secretary shall apply the 
        methodology and funding consistent with that established for 
        the existing project.
            (4) Report.--Not later than July 1, 2007, the Secretary 
        shall submit to Congress a report on the project, together with 
        recommendations for such legislation and administrative action 
        as the Secretary determines to be appropriate.
    (c) Adjustment to Physician Fee Schedule.--Section 1848(c)(2) of 
the Social Security Act (42 U.S.C. 1395w-4(c)(2)) is amended--
            (1) in subparagraph (B)(iv)--
                    (A) in subclause (II), by striking ``and'';
                    (B) in subclause (III), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following new 
                subclause:
                                    ``(IV) subparagraph (K) insofar as 
                                it relates to a physician fee schedule 
                                for 2006 shall not be taken into 
                                account in applying clause (ii)(II) for 
                                drug administration services under the 
                                fee schedule for such year.''; and
            (2) by adding at the end the following new subparagraph:
                    ``(K) Adjustment in payment rates for overhead 
                costs.--In establishing the physician fee schedule 
                under subsection (b) with respect to payments for drug 
                administration services furnished on or after January 
                1, 2006, and in order to take into account overhead and 
                related expenses, the Secretary shall provide for an 
                additional payment in an amount equal to 2 percent of 
                the amount determined under section 1847A for the drug 
                administered.''.

SEC. 4. QUALITY MEASURES FOR CANCER CARE.

    (a) Findings.--Congress finds that--
            (1) existing quality indicators relating to the quality of 
        care furnished to cancer patients in physician offices are 
        inconsistent across practice settings and are not based on 
        uniform, evidence-based and consistently applied standards; and
            (2) physician reimbursement should reflect improvements in 
        the quality of care provided.
    (b) Development of Quality Indicators.--In collaboration with 
practicing physicians, the Secretary of Health and Human Services shall 
develop indicators for the evaluation of the quality of oncology 
services provided in the physician office setting. Such indicators 
shall not be implemented for any purpose unless the Secretary has 
provided for an assessment of the proposed indicators by the physician 
community.
    (c) Pilot and Demonstration Projects.--The Secretary may conduct 
pilot projects and demonstration projects to test such indicators as 
appropriate.

SEC. 5. IMPROVED PATIENT PARTICIPATION IN CLINICAL TRIALS.

    (a) Findings.--Congress finds that--
            (1) the current report of the President's Cancer Panel has 
        documented the increasing incidence and costs of cancer to the 
        United States; and
            (2) the current report of the President's Cancer Panel has 
        identified problems in translating research into effective 
        cancer care.
    (b) Strategic Plan for Improved Patient Participation.--
            (1) In general.--In collaboration with practicing 
        physicians, the Director of the National Cancer Institute shall 
        develop a strategic plan to increase the number of cancer 
        patients who enroll in clinical trials.
            (2) Components of plan.--Such plan shall include components 
        designed to--
                    (A) improve patient education regarding clinical 
                trials;
                    (B) facilitate the clinical trial process; and
                    (C) ensure the viability of conducting clinical 
                research in all settings where treatment is provided.
    (c) Report.--Not later than January 1, 2007, the Secretary of 
Health and Human Services shall submit to Congress a report on the 
strategic plan under subsection (b) together with recommendations for 
such legislation and administrative action as the Secretary determines 
to be appropriate.

SEC. 6. CBO REPORT.

    Not later than one year after the date of the enactment of this 
Act, the Director of the Congressional Budget Office shall submit to 
Congress a report that describes the impact of the provisions of the 
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 
(Public Law 108-173) as implemented on oncologists and other physicians 
who provide cancer care and a comparison of such impact with the impact 
of such law estimated by such Office before its enactment.
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