[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1190 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 1190

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 27, 2007

   Mr. Davis of Alabama (for himself and 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 2007''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Application of average sales price payment methodology.
Sec. 3. Increase in Medicare part B reimbursement for chemotherapy 
                            administration.
Sec. 4. Provisions for the appropriate reporting and billing of 
                            physicians' services associated with 
                            pharmacy facilities management and medical 
                            oncology treatment planning.

SEC. 2. APPLICATION OF AVERAGE SALES PRICE PAYMENT METHODOLOGY.

    (a) Requiring Monthly and Not Quarterly Determinations.--
            (1) In general.--Section 1847A(c) of the Social Security 
        Act (42 U.S.C. 1395w-3a(c)) is amended--
                    (A) in paragraph (1)--
                            (i) in the matter preceding subparagraph 
                        (A) and in subparagraph (A), by striking 
                        ``calendar quarter'' and inserting ``month'' 
                        each place it appears; and
                            (ii) in subparagraph (B), by striking 
                        ``quarter'' and inserting ``month'';
                    (B) in paragraph (4)--
                            (i) in the heading, by striking ``quarter'' 
                        and inserting ``month''; and
                            (ii) by striking ``calendar quarter'' and 
                        inserting ``month''; and
                    (C) in paragraph (5)--
                            (i) in subparagraph (A), by striking 
                        ``quarterly'' and inserting ``monthly'' each 
                        place it appears; and
                            (ii) by amending subparagraph (B) to read 
                        as follows:
                    ``(B) Updates in payment amounts.--The payment 
                amounts under subsection (b) shall be updated and 
                applied by the Secretary based upon the manufacturer's 
                average sales price for a drug or biological calculated 
                for the most recent month for which data are available. 
                This update shall be made no later than two months 
                following publication of such data by the 
                manufacturer.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to payment amounts for months beginning on or after 
        January 1, 2008.
    (b) Adjustment to Average Sales Price Calculation.--
            (1) In general.--Section 1847A(c) of such Act (42 U.S.C. 
        1395w-3(a)(c)) is further amended in paragraph (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,''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to payment amounts for months beginning on or after 
        January 1, 2008.

SEC. 3. INCREASE IN MEDICARE PART B REIMBURSEMENT FOR CERTAIN 
              CHEMOTHERAPY ADMINISTRATION.

    (a) In General.--Section 1848(a) of the Social Security Act (42 
U.S.C. 1395w-4(a)) is amended by adding at the end the following new 
paragraph:
            ``(5) Special rule for ceratin chemotherapy 
        administration.--
                    ``(A) In general.--In the case of Medicare 
                chemotherapy administration services furnished on or 
                after January 1, 2008, the fee schedule amount to be 
                applied shall be equal to the following:
                            ``(i) First hour of chemotherapy 
                        infusions.--For such services described in 
                        clause (i), (ii), or (iii) of subparagraph (B), 
                        an amount equal to 132 percent of the fee 
                        schedule amount otherwise applicable under this 
                        section (without regard to this paragraph) for 
                        such respective services.
                            ``(ii) Subsequent hours of chemotherapy 
                        infusions.--For such services described in 
                        clause (iv) or (v) of subparagraph (B), an 
                        amount equal to 70 percent of the amount 
                        determined under clause (i) for services 
                        described in clause (i) or (iii), respectively, 
                        of such subparagraph.
                    ``(B) Medicare chemotherapy administration services 
                defined.--For purposes of this paragraph, the term 
                `Medicare chemotherapy administration services' means 
                physicians' services identified, as of January 1, 2007, 
                by any of the following codes (or any successor to such 
                a code as identified by the Secretary) for which 
                payments are made under subsection (b):
                            ``(i) CPT code 96413 (relating to 
                        intravenous infusions of initial drug up to one 
                        hour).
                            ``(ii) CPT code 96417 (relating to 
                        additional, sequential intravenous infusions of 
                        different drugs up to one hour).
                            ``(iii) CPT code 96422 (relating to inter-
                        arterial infusions for up to one hour).
                            ``(iv) CPT code 96415 (relating to 
                        intravenous infusions for subsequent hours).
                            ``(v) CPT code 96423 (relating to inter-
                        arterial infusions for subsequent hours).''.

SEC. 4. PROVISIONS FOR THE APPROPRIATE REPORTING AND BILLING OF 
              PHYSICIANS' SERVICES ASSOCIATED WITH PHARMACY FACILITIES 
              MANAGEMENT AND MEDICAL ONCOLOGY TREATMENT PLANNING.

    (a) In General.--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
                    (C) by adding at the end the following new 
                subclauses:
                                    ``(IV) subparagraph (K) insofar as 
                                it relates to a physician fee schedule 
                                for 2008 and each subsequent year shall 
                                not be taken into account in applying 
                                clause (ii)(II) for drug administration 
                                services under the fee schedule for 
                                such year; and
                                    ``(V) subparagraph (L) insofar as 
                                it relates to a physician fee schedule 
                                for 2008 and each subsequent year shall 
                                not be taken into account in applying 
                                clause (ii)(II) for medical oncology 
                                treatment planning services under the 
                                fee schedule for such year.''; and
            (2) by adding at the end the following new subparagraphs:
                    ``(K) Adjustment in payment rates for pharmacy 
                facilities management costs.--In establishing the 
                physician fee schedule under subsection (b) with 
                respect to payments for drug administration services 
                furnished on or after January 1, 2008, and in order to 
                take into account pharmacy facilities management costs, 
                the Secretary shall provide for an additional payment 
                for such services in an amount equal to 2 percent of 
                the amount determined under section 1847A for the drug 
                administered.
                    ``(L) Provisions for the appropriate reporting and 
                billing of physicians' services associated with 
                pharmacy facilities management and medical oncology 
                treatment planning.--
                            ``(i) Creation of new cpt codes.--
                                    ``(I) Pharmacy facilities 
                                management.--Not later than one year 
                                after the date of the enactment of this 
                                subparagraph, in carrying out 
                                subparagraph (K), the Secretary shall 
                                issue appropriate CPT codes for the 
                                reporting and billing of pharmacy 
                                facilities management services that 
                                would correspond to the additional 
                                payment provided under subparagraph 
                                (K).
                                    ``(II) Medical oncology treatment 
                                planning.--Not later than one year 
                                after the date of the enactment of this 
                                subparagraph, the Secretary shall issue 
                                two new CPT codes, one moderate and one 
                                complex, for the reporting and billing 
                                of medical oncology treatment planning 
                                services furnished by physicians and 
                                other professional staff in the 
                                specialties of hematology, hematology-
                                oncology, and medical oncology.
                            ``(ii) Use of existing processes.--In 
                        carrying out clause (i), the Secretary shall 
                        use existing processes for the implementation 
                        of such coding changes, as appropriate.
                            ``(iii) Consultation.--In carrying out 
                        clause (i), the Secretary shall consult with 
                        representatives of physicians in the 
                        specialties of hematology, hematology-oncology, 
                        and medical oncology affected by the adoption 
                        of such coding changes.''.
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