[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2869 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 2869

 To amend title XVIII of the Social Security Act to establish payment 
 parity under the Medicare program for ambulatory cancer care services 
   furnished in the hospital outpatient department and the physician 
                            office setting.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 31, 2013

  Mr. Rogers of Michigan (for himself and Ms. Matsui) 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 establish payment 
 parity under the Medicare program for ambulatory cancer care services 
   furnished in the hospital outpatient department and the physician 
                            office setting.

    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 ``Medicare Patient Access to Cancer 
Treatment Act of 2013''.

SEC. 2. FINDINGS; SENSE OF CONGRESS.

    (a) Findings.--Congress finds the following:
            (1) The National Cancer Institute estimates that 
        approximately 13.7 million Americans with a history of cancer 
        were alive on January 1, 2012.
            (2) About 8 million of the 13.7 million Americans living 
        with cancer are over age 65, and approximately half of cancer 
        care spending is associated with Medicare beneficiaries.
            (3) National spending on cancer care in 2010 is estimated 
        at $125 billion.
            (4) In 2011, the National Cancer Institute released 
        projections of the cost of cancer care in the United States, 
        finding the total cost of cancer care in 2020 is expected to be 
        $206 billion.
            (5) In a 2010 study, Milliman reported that in 2007 a 
        cancer patient receiving chemotherapy incurred average costs of 
        approximately $111,000, three times the cost of a coronary 
        artery disease patient, and six times the cost of a diabetes 
        patient.
            (6) Over the last several years, the United States has been 
        touted as world leader in providing high-quality cancer care.
            (7) United States cancer survival rates are higher than the 
        average in Europe and Canada for 13 of 16 types of cancer.
            (8) Until recently, over 80 percent of United States cancer 
        patients received care in the community setting.
            (9) Over the past several years, the country has 
        experienced a significant shift of outpatient cancer care 
        delivery from the physician's office to the hospital outpatient 
        department.
            (10) Reports show that over the past six years, 43 
        community practices have started referring all of their 
        patients elsewhere for treatment, 288 oncology office locations 
        have closed, 131 practices have merged or were acquired by a 
        corporate entity other than a hospital, and 469 oncology groups 
        have entered into an employment or professional services 
        agreement with a hospital.
            (11) Over 1,000 clinics or practices have been impacted 
        over the last 3 years out of a population of only 6,000 
        oncologists in community practice in the United States.
            (12) A 2013 study published by The Moran Company (``Moran 
        study'') found that, between 2005 and 2011, there was a 150 
        percent increase in administered chemotherapy in the hospital 
        outpatient setting for Medicare fee-for-service beneficiaries 
        (increasing from 13.5 percent in 2005 to 33.0 percent in 2011) 
        as compared to administration in physician community cancer 
        clinics.
            (13) The Moran study found that, in 2005, almost 87 percent 
        of Medicare patients were receiving their care in the community 
        setting, by 2011 only 67 percent were utilizing the community 
        setting.
            (14) The Moran study reports that Medicare payments for 
        chemotherapy administered in hospital outpatient settings have 
        more than tripled since 2005 (from $90 million to $300 million) 
        while payments to physician community cancer clinics have 
        actually decreased by 14.5 percent.
            (15) The Medicare physician fee schedule rate in 2012 for 
        CPT Code 96413 (Chemo, iv infusion, 1 hr), the most common drug 
        administration code billed by oncology practices, is $139 but 
        the payment rate for the same service under the Medicare 
        hospital outpatient prospective payment system (HOPPS) fee 
        schedule in 2012 is 50 percent higher at $208.
            (16) Utilization-weighted Medicare payment for infusion 
        services is approximately 55 percent higher at the hospital 
        outpatient department than in a physician's office.
            (17) Medicare proposed in 2012 to pay hospital outpatient 
        departments 25 percent more for radiation therapy services than 
        for the same services performed in physicians' offices, 
        including a 70 percent differential for intensity modulated 
        radiation treatment (IMRT) and a 188 percent differential for 
        stereotactic body radiation therapy delivery (SBRT).
            (18) One third of hospitals in the United States purchase 
        chemotherapy drugs through the section 340B program at a 
        discount of up to 50 percent, resulting in a net cost to such 
        hospitals that typically is at least 30 percent below 
        reimbursement rate (which is based on 106 percent of the 
        average sales price) for community oncologists for such drugs.
            (19) Medicare reimburses 70 percent of hospital bad debt 
        (uncollectable coinsurance).
            (20) According to an October 2011 Milliman study, the cost 
        of treating cancer patients is significantly lower for both 
        Medicare patients (10 percent lower in copayment amounts, more 
        than $650 savings a year) and the Medicare program (14.2 
        percent less, a savings of $6,500 a year per patient) when 
        provided in community-based cancer settings as compared to the 
        same treatment in hospital outpatient departments.
            (21) The April 1, 2013, sequestration cuts to Medicare 
        allowed for a 28 percent cut to the services reimbursement in 
        Medicare part B drugs to community oncologists.
            (22) A recent Community Oncology Alliance survey showed 
        that 69 percent of practices surveyed reported that patient 
        treatment or operational changes already have been made due to 
        the sequester cut to cancer drugs, with 49 percent of practices 
        forced to send Medicare patients elsewhere for treatment, and 
        62 percent of practices reported that they will be forced to 
        send Medicare patients elsewhere for treatment if the 
        sequestration cuts stay in place through July 31, 2013.
            (23) The June 2013 report of the Medicare Payment Advisory 
        Commission highlighted the large disparities in payment in 
        outpatient settings and noted that the payment variations 
        across settings should be addressed quickly due to the fact 
        that current disparities have created incentives for hospitals 
        to buy physician practices, driving up costs for the Medicare 
        program and for beneficiaries.
    (b) Sense of Congress.--It is the sense of Congress that, to ensure 
the future of community cancer care, Medicare reimbursement should be 
equal for the same service provided to a cancer patient regardless of 
whether the service is delivered in the hospital outpatient department 
or physician's office.

SEC. 3. EQUALIZING MEDICARE REIMBURSEMENT IN HOSPITAL OUTPATIENT 
              DEPARTMENTS AND PHYSICIANS' OFFICES FOR CANCER CARE 
              SERVICES.

    (a) In General.--Section 1833(t) of the Social Security Act (42 
U.S.C. 1395l(t)) is amended--
            (1) in paragraph (2)--
                    (A) in subparagraph (G), by striking ``and'' at the 
                end;
                    (B) in subparagraph (H), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by inserting after subparagraph (H) the 
                following new subparagraph:
                    ``(I) payment for covered OPD services that are 
                cancer care services (as defined in subparagraph (B) of 
                paragraph (18)) shall be made consistent with 
                subparagraph (A) of such paragraph.''; and
            (2) by adding at the end the following new paragraph:
            ``(18) Special payment rule for cancer care services.--
                    ``(A) In general.--In the case of cancer care 
                services that are furnished on or after January 1, 
                2014, the payment amount for such services under this 
                subsection and under section 1848 shall be a budget 
                neutral combination (as determined by the Secretary) 
                of--
                            ``(i) the amount otherwise payable under 
                        this subsection for such services; and
                            ``(ii) the amount otherwise payable under 
                        section 1848 for such services.
                    ``(B) Cancer care services defined.--For purposes 
                of this subsection, the term `cancer care services' 
                means covered OPD services or physicians' services for 
                which payment is made under section 1848 that are 
                furnished in conjunction with the diagnosis or 
                treatment of cancer.''.
    (b) Conforming Amendment.--Section 1848(a) of Social Security Act 
(42 U.S.C. 1395w-4(a)) is amended by adding at the end the following 
new paragraph:
            ``(9) Application of special rule for cancer care 
        services.--In the case of physicians' services that are cancer 
        care services (as defined in subparagraph (B) of section 
        1833(t)(18)) that are furnished on or after January 1, 2014, 
        the payment amount for such services under this section shall 
        be the payment amount for such services determined under 
        subparagraph (A) of such section.''.
                                 <all>