[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3675 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3675

    To improve the quality and cost effectiveness of cancer care to 
    Medicare beneficiaries by establishing a national demonstration 
                                project.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 30, 2009

    Mr. Davis of Alabama (for himself, Ms. Kilroy, Mr. Israel, Mr. 
  Courtney, and Mr. Schiff) 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 improve the quality and cost effectiveness of cancer care to 
    Medicare beneficiaries by establishing a national demonstration 
                                project.

    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 ``National Quality Cancer Care 
Demonstration Project Act of 2009''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) In order to ensure the delivery of quality, cost-
        efficient medical care to patients with cancer, Medicare should 
        reinforce and expand the use of evidence-based guidelines and 
        the provision of demonstrated quality delivery of care through 
        adjustments in the payment system.
            (2) An Institute of Medicine report entitled ``Ensuring 
        Quality Cancer Care'' recommends that the following items are 
        essential components in quality cancer care delivery:
                    (A) An agreed-upon treatment plan that outlines the 
                goals of care.
                    (B) Access to clinical trials.
                    (C) Policies to ensure full disclosure of 
                information about appropriate treatment options to 
                patients.
                    (D) A mechanism to coordinate services.
            (3) According to the Institute of Medicine, the quality of 
        cancer care must be measured by using a core set of quality 
        measures. Cancer care quality measures should be used to hold 
        providers, including health care systems, health plans, and 
        physicians, accountable for demonstrating that they provide and 
        improve quality of care.
            (4) In its report, ``From Cancer Patient to Cancer 
        Survivor: Lost in Transition'', the Institute of Medicine 
        recommended that individuals with cancer completing primary 
        treatment be provided a comprehensive summary of their care 
        along with a follow-up survivorship plan of treatment.
            (5) The medical literature suggests that adherence to 
        quality metrics and evidence-based guidelines help lower costs 
        by reducing use of physician services, hospitalizations, and 
        supplemental and expensive drugs.
            (6) Although treatment planning and follow-up cancer care 
        planning are recognized critical components of cancer care, 
        none of the 153 quality measures in the Centers for Medicare & 
        Medicaid Services (CMS) 2009 Physician Quality Reporting 
        Initiative (PQRI) addresses overall treatment planning or 
        follow-up care planning for cancer patients.

SEC. 3. MEDICARE QUALITY CANCER CARE DEMONSTRATION PROJECT.

    (a) Establishment.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish a 
quality cancer care demonstration project under this section (in this 
section referred to as the ``QCCD project'') for the purpose of 
establishing quality metrics and aligning Medicare payment incentives 
in the areas of treatment planning and follow-up cancer care planning 
for Medicare beneficiaries with cancer.
    (b) Test Metrics and Reporting Systems Through a Pay-For-Reporting 
Incentive Program.--Under the QCCD project, the Secretary shall do the 
following:
            (1) Identify and address gaps in current quality measures 
        related to the areas of active treatment planning and follow-up 
        cancer care planning by refining the performance measures 
        described in paragraphs (1) and (2) of subsection (d) relating 
        to active treatment planning and follow-up cancer planning for 
        clinician-level reporting.
            (2) Use quality assessment programs of oncology 
        professional societies to report quality data to the extent 
        feasible and explore the potential to report quality data 
        through other registries and other electronic means for 
        treatment planning and follow-up cancer care planning, 
        including identifying data elements necessary to measure 
        quality of treatment planning and follow-up cancer care 
        planning and determine how those elements could be collected 
        through claims data or registries or other electronic means.
            (3) Test and validate identified treatment planning and 
        follow-up cancer care planning quality measures through a pay-
        for-reporting program with oncologists, which program--
                    (A) ensures that oncologists are able to accurately 
                report on measures through simple HCPCS coding 
                mechanisms; and
                    (B) tests processes of submitting treatment 
                planning and follow-up cancer care planning measures 
                through registries or other electronic means.
    (c) Incentive Payment.--
            (1) In general.--Under the QCCD project, the Secretary 
        shall provide for a separate payment under section 1848 of the 
        Social Security Act (42 U.S.C. 1395w-4), to be divided into a 
        baseline payment amount and an additional payment amount, as 
        specified by the Secretary, for a treatment planning code and 
        follow-up cancer care planning code. The amount of such 
        payments under the project shall be designed to total 
        $300,000,000 each year. Payments under the project shall be 
        designed to be paid on an ongoing basis as claims are 
        submitted.
            (2) Requirement to satisfy baseline mandatory measures to 
        receive baseline payment.--In order for a physician to receive 
        any payment under the QCCD project for treatment planning or 
        follow-up cancer care planning, a physician must report in a 
        manner specified under the project that all of the baseline 
        mandatory measures described in paragraph (1)(A) or (2)(A), 
        respectively, of subsection (d) were satisfied.
            (3) Requirement to satisfy all measures to receive 
        additional payment.--In order for a physician to receive the 
        additional payment amount described in paragraph (1) under this 
        subsection for treatment planning or follow-up cancer care 
        planning, a physician must report in a manner specified under 
        the project that all of measures described in paragraph (1) or 
        (2), respectively, of subsection (d) were satisfied.
    (d) Measures.--
            (1) Treatment planning measures.--The specific measures 
        related to treatment planning and any subsequent modifications 
        described in this paragraph are as follows:
                    (A) Baseline mandatory measures.--
                            (i) Documented pathology report.
                            (ii) Documented clinical staging prior to 
                        initiation of first course of treatment.
                            (iii) Performed treatment education by 
                        oncology nursing staff.
                            (iv) Provided the patient with a written 
                        care plan for patients in active treatment, 
                        which advises patient of relevant options.
                    (B) Augmented.--
                            (i) Implemented practice-endorsed treatment 
                        plan consistent with nationally recognized 
                        evidence based guidelines.
                            (ii) Documented clinical trial discussed 
                        with the patient, or that no clinical trial 
                        available.
                            (iii) Documented discussion or coordination 
                        with other physicians involved in the patient's 
                        care.
            (2) Follow-up cancer planning.--The specific measures 
        related to follow-up cancer planning described in this 
        paragraph are as follows:
                    (A) Baseline mandatory.--
                            (i) Documented conclusion of primary cancer 
                        care treatment.
                            (ii) Documented session with the patient to 
                        provide recommendations for the subsequent care 
                        of the patient with respect to the cancer 
                        involved.
                    (B) Augmented.--Provision of a written document to 
                the patient that--
                            (i) describes the elements of the completed 
                        primary treatment, including past symptom 
                        management, furnished to such patient;
                            (ii) provides recommendations for the 
                        subsequent care of the patient with respect to 
                        the cancer involved;
                            (iii) is furnished to the individual in 
                        person within a period specified by the 
                        Secretary that is as soon as practicable after 
                        the completion of such primary treatment; and
                            (iv) is furnished, to the greatest extent 
                        practicable, in a form that appropriately takes 
                        into account cultural and linguistic needs of 
                        the individual in order to make the plan 
                        accessible to the individual.
    (e) Duration of Project.--
            (1) In general.--The Secretary shall conduct the 
        demonstration project over a sufficient period (of not less 
        than 2 years) to allow for refinement of metrics and reporting 
        methodologies and for analyses. The project shall continue, 
        subject to paragraph (2), to operate until the Secretary has 
        developed and implemented under part B of the Medicare program 
        a payment system that relates payment under such part for 
        professional oncology services to performance on measures 
        developed and refined under the demonstration project.
            (2) Transition.--The Secretary shall provide for a 
        transition period over the course of 2 years during which 
        oncologists are permitted to transition from the payment system 
        under the demonstration project to the payment system described 
        in paragraph (1).
    (f) Project Evaluation.--
            (1) In general.--The Secretary shall conduct an evaluation 
        of the QCCD project--
                    (A) to determine oncologist participation in the 
                project;
                    (B) to assess the cost effectiveness of the 
                project, including an analyses of the cost savings (if 
                any) to the Medicare part A and B programs resulting 
                from a general reduction in physician services, 
                hospitalizations, and supplemental care drug costs;
                    (C) to compare outcomes of patients participating 
                in the project to outcomes for those not participating 
                in the project;
                    (D) to determine the satisfaction of patients 
                participating in the project; and
                    (E) to evaluate other such matters as the Secretary 
                determines is appropriate.
            (2) Reporting.--Not later than 90 days after the completion 
        of the second year following the commencement of the QCCD 
        project, the Secretary shall submit to Congress a report on the 
        evaluation conducted under paragraph (1) together which such 
        recommendations for legislation or administrative action as the 
        Secretary determines is appropriate.
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