[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2279 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2279

     To amend title XVIII of the Social Security Act to eliminate 
contributing factors to disparities in breast cancer treatment through 
   the development of a uniform set of consensus-based breast cancer 
 treatment performance measures for a 6-year quality reporting system 
     and value-based purchasing system under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 6, 2009

  Ms. Castor of Florida (for herself, Mr. Grijalva, Mr. Hinchey, Mr. 
 Rush, Ms. Bordallo, Ms. Norton, Mr. Kucinich, Ms. Baldwin, Ms. Lee of 
 California, and Ms. Sutton) 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 amend title XVIII of the Social Security Act to eliminate 
contributing factors to disparities in breast cancer treatment through 
   the development of a uniform set of consensus-based breast cancer 
 treatment performance measures for a 6-year quality reporting system 
     and value-based purchasing system under the Medicare Program.

    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 ``Eliminating Disparities in Breast 
Cancer Treatment Act of 2009''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Delays in receiving care after breast cancer diagnosis 
        are reported to be greater for African-American women than 
        White women.
            (2) Recent studies indicate that African-American women 
        with breast cancer are less likely to receive standard therapy 
        than White women.
            (3) African-American and Hispanic patients are 
        significantly more likely than White patients to be diagnosed 
        at a more advanced stage of breast cancer.
            (4) Investigators found that regardless of insurance 
        status, African-American women are 1.9 times more likely to be 
        diagnosed with an advanced stage of breast cancer than White 
        women and Hispanic women are 1.4 times more likely to be 
        diagnosed with an advanced stage of breast cancer than White 
        women.
            (5) African-American women are ten percent more likely not 
        to receive tests to determine if breast cancer has spread to 
        axillary (underarm) lymph nodes. Studies show that health 
        insurance status, race, income, and educational background are 
        directly linked to irregularity in administering this vital 
        screening.
            (6) According to American Cancer Society researchers, 
        substantial disparities remain or persist regarding cancer 
        diagnosis and treatment.

SEC. 3. PURPOSE.

    The purpose of this Act is to promote the implementation of 
standardized health care practices for breast cancer treatment under 
the Medicare program to eliminate disparities in the provision of care 
to such patients based on race, level of education, income, and health 
insurance status of such patients.

SEC. 4. CONSENSUS-BASED BREAST CANCER TREATMENT PERFORMANCE MEASURES 
              SYSTEM UNDER MEDICARE.

    Title XVIII of the Social Security Act is amended by adding at the 
end the following new section:

``SEC. 1899. BREAST CANCER TREATMENT PERFORMANCE MEASURES SYSTEM.

    ``(a) In General.--Not later than October 1, 2010, the Secretary 
shall establish, in accordance with the provisions of this section, a 
6-year breast cancer treatment quality performance system (in this 
section referred to as the `system') to--
            ``(1) assess and publicly disclose, through the use of 
        quality measures, the quality of care provided for the 
        treatment of breast cancer by specified health care providers; 
        and
            ``(2) beginning October 1, 2013, base payment under this 
        title to such providers for such treatment on the performance 
        of such providers based on such measures.
    ``(b) Specified Health Care Providers.--
            ``(1) In general.--The Secretary shall specify classes of 
        providers of services and suppliers, including hospitals, 
        cancer centers, physicians, primary care providers, and 
        specialty providers, to which the provisions of this section 
        shall apply.
            ``(2) Definition.--For purposes of this section, the term 
        `specified health care provider' means a provider of services 
        or supplier specified under paragraph (1).
    ``(c) Identification and Endorsement of Breast Cancer Treatment 
Performance Measures.--
            ``(1) In general.--Under the system, the Secretary, shall 
        enter into agreements with the National Quality Forum, an 
        organization that operates as a voluntary consensus standards 
        body as defined for purposes of section 12(d) of the National 
        Technology Transfer and Advancement Act of 1995 (Public Law 
        104-113) and Office of Management and Budget Revised Circular 
        A-119 (published in the Federal Register on February 10, 1998), 
        under which the National Quality Forum shall identify a uniform 
        set of consensus-based performance measures to evaluate the 
        quality of care provided by specified health care providers for 
        the treatment of breast cancer, endorse such set of measures 
        through its multistakeholder consensus development process, and 
        annually update such set of measures.
            ``(2) Measures described.--The set of measures described in 
        paragraph (1) shall include, with respect to the treatment of 
        breast cancer, measures of patient outcomes, the process for 
        delivering medical care related to such treatment, patient 
        counseling and engagement in decisionmaking, patient experience 
        of care, resource use, and practice capabilities, such as care 
        coordination.
    ``(d) Reporting Process.--
            ``(1) In general.--Under the system, for periods (as 
        specified by the Secretary) beginning on or after October 1, 
        2010, the Secretary shall establish a reporting process, with 
        respect to treatment furnished for breast cancer, that provides 
        for a method for specified health care providers to submit to 
        the Secretary data on the performance of such providers during 
        each period through use of the performance measures developed 
        pursuant to subsection (c)(1). Such data shall be submitted in 
        a form and manner and at a time specified by the Secretary.
            ``(2) Voluntary submission during initial 3 years.--The 
        reporting process under paragraph (1) shall provide for the 
        voluntary submission of data (and incentives for such 
        submission) under the process for periods ending before October 
        1, 2013.
            ``(3) Characteristics of data submitted under reporting 
        process.--Data submitted by a specified health care provider 
        under the reporting process under paragraph (1) shall--
                    ``(A) take into account the quality of breast 
                cancer treatment furnished to all patients of the 
                provider, regardless of the type of health insurance 
                coverage of the patient or whether or not the patient 
                has such coverage; and
                    ``(B) be structured in a manner that allows for 
                comparison according to race, educational level, 
                income, insurance status, and any other category 
                specified by the Secretary.
    ``(e) Public Disclosure.--Under the system, the Secretary shall 
establish procedures to require that information with respect to the 
quality demonstrated by a specified health care provider of treatment 
furnished for breast cancer during a period (based on the performance 
measures data submitted pursuant to subsection (c)(1) by the provider 
for such period) is made available on the official public Internet site 
of the Department of Health and Human Services in a clear and 
understandable form. Such procedures shall ensure that a specified 
health care provider has the opportunity to review the information that 
is to be made public with respect to the provider at least 30 days 
prior to such data being made public and shall provide for an appeals 
process in the case a provider claims such information to be incorrect 
or incomplete.
    ``(f) Value-Based Purchasing for Periods Beginning October 1, 
2013.--
            ``(1) In general.--Under the system, for periods beginning 
        on or after October 1, 2013, and ending before October 1, 2016, 
        the Secretary shall establish and implement, a value-based 
        purchasing program, with respect to specified health care 
        providers that furnish treatment for breast cancer during such 
        a period, under which--
                    ``(A) in the case of such a provider that does not 
                submit data in accordance with the reporting process 
                under subsection (d)(1) for such treatment furnished 
                during such period, the Secretary shall reduce payment 
                under this title for such treatment by an amount 
                specified by the Secretary; and
                    ``(B) in the case of such a provider that submits 
                data in accordance with the reporting process under 
                subsection (d)(1) for such treatment furnished during 
                such period--
                            ``(i) subject to clause (ii), if the 
                        Secretary determines such provider furnished 
                        low quality care (in accordance with a method 
                        specified by the Secretary) for such treatment, 
                        the Secretary shall reduce the amount that 
                        would otherwise be paid to such provider under 
                        this title for such treatment by an amount 
                        specified by the Secretary;
                            ``(ii) if the Secretary determines such 
                        provider furnished low quality care (in 
                        accordance with the method specified under 
                        clause (i)) for such treatment, but the quality 
                        of care has improved as compared to the quality 
                        of care the provider furnished during the 
                        previous period, the Secretary shall reduce the 
                        amount that would otherwise be paid to such 
                        provider under this title for such treatment in 
                        accordance with an incremental method 
                        established by the Secretary that ensures that 
                        the amount of such reduction--
                                    ``(I) is less than the amount 
                                specified by the Secretary under clause 
                                (i); and
                                    ``(II) is based on the extent of 
                                improvement in the quality of care; and
                            ``(iii) if the Secretary determines such 
                        provider did not furnish low quality care (in 
                        accordance with the method specified under 
                        clause (i)) for such treatment, the Secretary 
                        shall provide to such provider the amount to be 
                        paid to such provider under this title for such 
                        treatment.
            ``(2) Results-based payments.--The amount of a reduction 
        under subparagraph (A) or (B)(i) of paragraph (1) shall be 
        determined in accordance with a method established by the 
        Secretary.
    ``(g) Reports.--Not later than October 1, 2011, and for each 6-
month period thereafter (before fiscal year 2017), the Secretary shall 
submit to Congress a report that evaluates the development and 
implementation of the system, including--
            ``(1) an evaluation of the number of specified health care 
        providers that submit data pursuant to subsection (c)(1);
            ``(2) an analysis of the effect of such system on reducing 
        disparities in the provision of breast cancer treatment to 
        patients based on race, level of education, income, and health 
        insurance status of such patients; and
            ``(3) recommendations on whether (and to what extent) to 
        extend the system under this section.
    ``(h) Application to Part C.--The Secretary shall provide for a 
method to apply the provisions of this section to treatment furnished 
under a plan under part C.''.
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