[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6725 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 6725

To establish budget neutral demonstration projects to study and improve 
the quality and cost effectiveness of cancer care services provided to 
                        Medicare beneficiaries.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 31, 2008

   Mr. Crowley (for himself, Mr. Rogers of Michigan, Mr. English of 
Pennsylvania, Mrs. Capps, Mr. Kennedy, Mr. Thompson of California, Ms. 
  Schwartz, and Ms. Berkley) introduced the following bill; which was 
  referred to the Committee on Ways and Means, and in addition to the 
   Committee on Energy and Commerce, 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 establish budget neutral demonstration projects to study and improve 
the quality and cost effectiveness of cancer care services provided to 
                        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.

    This Act may be cited as the ``Oncology Quality Care Improvement 
Act of 2008''.

SEC. 2. BUDGET NEUTRAL MEDICARE ONCOLOGY CARE QUALITY IMPROVEMENT 
              DEMONSTRATION PROJECTS.

    (a) Definitions.--In this section:
            (1) Demonstration project.--The term ``demonstration 
        project'' means a demonstration project established by the 
        Secretary under subsection (b).
            (2) Eligible beneficiary.--The term ``eligible 
        beneficiary'' means an individual who--
                    (A) is entitled to benefits under part A and 
                enrolled under part B, but not enrolled in a Medicare 
                Advantage plan under part C, of title XVIII of the 
                Social Security Act; and
                    (B) is diagnosed with one or more of at least six 
                prevalent cancer conditions, including breast, colon, 
                lung, and ovarian cancer and additional cancers, 
                designated by the Secretary as appropriate for 
                demonstration projects.
            (3) Oncology care group.--The term ``oncology care group'' 
        means a group of physicians, or physicians and oncology nurse 
        practitioners, that is organized for the purpose of providing 
        community-based cancer care services under a demonstration 
        project.
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (b) Establishment.--
            (1) In general.--Subject to the succeeding provisions of 
        this section, the Secretary shall establish demonstration 
        projects under which the Secretary shall test and evaluate 
        methods that improve the quality of care provided to eligible 
        beneficiaries with certain cancer diagnoses and that reduce 
        expenditures that would otherwise be made under the Medicare 
        program on behalf of such individuals for such cancer 
        diagnoses. Such methods shall include--
                    (A) the adoption of and adherence to clinical, 
                evidence-based practice guidelines and treatment 
                protocols; and
                    (B) the use of electronic health record (EHR) 
                technology or other method that allows for timely data 
                collection and reporting.
            (2) Expectations of group participants.--Under a 
        demonstration project oncology care groups participating in the 
        project--
                    (A) are expected to reduce spending under parts A 
                and B of title XVIII of the Social Security Act to a 
                level equal to or below 95 percent of the per-patient 
                amount projected by the Secretary under such parts in 
                the absence of such project; and
                    (B) shall be eligible for payment of two separate 
                fees, allotted from the 5 percent expected savings 
                described in subparagraph (A)--
                            (i) one of which is a reporting fee, that 
                        is fully refundable to the Secretary for groups 
                        that fail to meet the established spending 
                        targets; and
                            (ii) the other of which is a performance 
                        fee that is paid only to groups that meet the 
                        established spending targets as determined by 
                        the Secretary after annual cost reconciliation.
    (c) Design of Projects.--
            (1) Establishment of baselines.--In establishing 
        demonstration projects under this section--
                    (A) The Secretary shall develop, in conjunction 
                with the Office of Management and Budget, a per-
                beneficiary spending baseline for each of these 
                diagnoses against which the financial performance of 
                demonstration project participants would be measured. 
                This baseline will include expenditures for 
                beneficiaries with any of the targeted diagnoses, 
                inclusive of all inpatient costs and outpatient costs, 
                including costs of prescription drugs under part D of 
                title XVIII of the Social Security Act.
                    (B) The Secretary shall establish, in conjunction 
                with demonstration project participants, which 
                performance standards and savings targets will be used 
                to measure improvements to clinical quality, 
                improvements to provider and beneficiary satisfaction, 
                and achievement of savings.
                    (C) The Secretary shall encourage participation 
                from varied geographic regions.
            (2) Requirement for estimate of budget neutral costs for 
        each project.--As part of the establishment of baselines under 
        paragraph (1)(A), the Secretary shall evaluate the costs of 
        furnishing care under demonstration projects. The Secretary may 
        not implement a demonstration project under this section unless 
        the Secretary determines that the costs of providing care to 
        individuals with cancer diagnoses under the project will not 
        exceed the costs, in the aggregate, of furnishing care to such 
        individuals under title XVIII of the Social Security Act, that 
        would otherwise be paid without regard to the demonstration 
        project for the period of the project.
            (3) Cost comparisons during project.--The Secretary shall 
        monitor the performance of participating oncology care groups 
        against the baselines developed under paragraph (1)(A) with 
        respect to demonstration project participants relative to the 
        performance of non-participating oncology care groups that 
        furnish oncology care services in a community-based setting to 
        similarly situated individuals but that do not employ or adhere 
        to electronic health record (EHR) technology or clinical, 
        evidence-based practice guidelines and treatment protocols.
    (d) Participation.--
            (1) In general.--An oncology care group that provides care 
        for a minimum number of eligible beneficiaries (as specified by 
        the Secretary) may participate in a demonstration project if 
        the oncology care group agrees--
                    (A) to report electronically clinical quality and 
                outcomes measures in accordance with requirements 
                established by the Secretary under the project; and
                    (B)(i) to use electronic health record (EHR) 
                technology to manage the clinical care of eligible 
                beneficiaries consistent with paragraph (2); or
                    (ii) to demonstrate to the satisfaction of the 
                Secretary the ability to measure and report pathway 
                adherence consistent with paragraph (2) through 
                alternative means approved by the Secretary.
                The Secretary shall strive to be as inclusive of 
                alternative means of reporting as possible.
            (2) Practice standards.--Each oncology care group 
        participating in a demonstration project shall demonstrate the 
        ability--
                    (A) to provide cancer care services that are 
                comprehensive, predictable, provider-led, and 
                transparent;
                    (B) to deliver a variety of treatment options 
                safely and efficiently;
                    (C) to identify and eliminate execution barriers, 
                enhance capacity availability, and utilization, and to 
                use the latest research and technology available;
                    (D) to employ a patient education infrastructure 
                and patient surveys;
                    (E) to adopt and adhere to clinical, evidence-based 
                practice guidelines and treatment protocols that are 
                evidence based and peer reviewed with a mechanism for 
                monitoring compliance on a routine basis;
                    (F) to meet such clinical quality and outcome 
                measures as the Secretary shall require;
                    (G) to measure and report data regarding variations 
                in the utilization and allocation of services, where 
                such data can be used to reduce scientific uncertainty 
                in the delivery of care;
                    (H) to establish and maintain a method of data 
                collection that can track compliance to pathways and 
                report compliance electronically for such beneficiaries 
                or an alternative method approved by the Secretary; and
                    (I) to meet such other service provision 
                requirements as the Secretary may specify.
            (3) Voluntariness.--Participation of providers of services 
        and suppliers, and of individuals with cancer diagnoses, in a 
        demonstration project shall be voluntary.
    (e) Payment Methodology.----
            (1) In general.--Under a demonstration project the 
        Secretary shall pay, from the projected 5 percent savings 
        described in subsection (b)(2)(A), a per beneficiary amount to 
        each participating oncology care group that meets or exceeds 
        specific performance standards established by the Secretary 
        with respect to the clinical quality and outcome measures 
        reported under subsection (d)(1)(A). Such per beneficiary 
        amount shall be composed of--
                    (A) a reporting fee described in paragraph (2), 
                equal to half of such 5 percent savings; and
                    (B) a performance fee described in paragraph (3), 
                equal to half of such 5 percent savings.
            (2) Reporting fee.--The reporting fee described in this 
        paragraph shall be paid to participating oncology care groups 
        intermittently, for costs associated with electronic health 
        record maintenance, protocol adherence, and reporting of 
        quality metrics. Such fee shall be fully refunded after annual 
        cost reconciliation by participating oncology care groups that 
        fail to meet the 5 percent savings target.
            (3) Performance fee.--A performance fee described in this 
        paragraph shall be paid after annual cost reconciliation to 
        participating oncology care groups that meet the spending 
        targets established by the Secretary.
    (f) Demonstration Project Sites.--The demonstration projects shall 
be open to participation by self-identified oncology care groups 
employing--
            (1) formal, evidence-based treatment protocols applicable 
        to patients with the selected diagnoses; and
            (2)(A) full electronic health record (EHR) technology; or
            (B) other data collection processes or databases approved 
        by the Secretary.
    (g) Duration.--The Secretary shall conduct demonstration projects 
for the 3-year period beginning on the date that is 90 days after the 
date of the enactment of this Act.
    (h) Evaluation and Report.--
            (1) Evaluations.--The Secretary shall conduct an evaluation 
        of the demonstration projects--
                    (A) to assess patient outcomes for the individuals 
                with cancer diagnoses participating in the projects as 
                compared to such outcomes to other individuals for the 
                same health conditions;
                    (B) to analyze the cost effectiveness of the 
                projects, including an evaluation of the cost savings 
                (if any) to the Medicare program attributable to 
                reductions in physicians' services, hospital stays, 
                supplemental care drug costs, and part D drug costs;
                    (C) to determine the satisfaction of patients 
                participating in the demonstration projects; and
                    (D) to evaluate other such matters as the Secretary 
                determines is appropriate.
            (2) Reports.--Not later than 90 days after the completion 
        of 1 year following the commencement of the demonstration 
        projects, and biannually thereafter, the Secretary shall submit 
        to Congress a report on the evaluation conducted under 
        paragraph (1) together which such recommendations for 
        legislation or administrative action, regarding the extension, 
        expansion, or termination of the demonstration projects, as the 
        Secretary determines is appropriate.
    (i) Waiver Authority.--The Secretary shall waive compliance with 
the requirements of title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) to such extent and for such period as the Secretary 
determines is necessary to conduct demonstration projects.
    (j) Funding.--
            (1) Demonstration projects.--
                    (A) In general.--Subject to subparagraph (B) and 
                paragraph (2), the Secretary shall provide for the 
                transfer, from the Federal Hospital Insurance Trust 
                Fund under section 1817 of the Social Security Act (42 
                U.S.C. 1395i) and from the Federal Supplementary 
                Insurance Trust Fund under section 1841 of such Act (42 
                U.S.C. 1395t), in such proportion as the Secretary 
                determines appropriate, of such funds as are necessary 
                for the costs of carrying out demonstration projects.
                    (B) Budget neutrality.--In conducting demonstration 
                projects under this section, the Secretary shall ensure 
                that the aggregate payments made by the Secretary under 
                the Medicare program do not exceed the amount which the 
                Secretary would have paid under the Medicare program 
                for the provision of cancer treatment services if the 
                demonstration projects were not implemented.
            (2) Evaluation and report.--There are authorized to be 
        appropriated such sums as are necessary for the purpose of 
        conducting the evaluation and submitting reports to Congress 
        under subsection (h).
                                 <all>