[Congressional Record Volume 146, Number 101 (Tuesday, September 5, 2000)]
[Senate]
[Pages S8022-S8023]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ASHCROFT (for himself, Mr. Hagel, and Mr. Abraham):
  S. 3003. A bill to preserve access to outpatient cancer therapy 
services under the medicare program by requiring the Health Care 
Financing Administration to follow appropriate procedures and utilize a 
formal nationwide analysis by the Comptroller General of the United 
States in making any changes to the rates of reimbursement for such 
services; to the Committee on Finance.


                      cancer care preservation act

  Mr. ASHCROFT. Mr. President, in recent years, our nation has achieved 
tremendous advances in its War on Cancer--including developing 
breakthrough therapies and expanding the cancer care delivery system of 
convenient and low-cost community settings. This progress has enabled 
us to achieve an unprecedented reduction in American cancer deaths, 
which began in 1998.
  Today, 90% of all chemotherapy treatments are delivered in community 
settings like doctors' offices and outpatient hospital settings. Two 
important components of Medicare reimbursement for outpatient cancer 
treatments support these community care sites: payment for drugs 
themselves; and payment for the services of the physicians, nurses, and 
other caregivers who treat patients with cancer.
  Unfortunately, the Health Care Financing Administration has targeted 
outpatient cancer therapy services for deep budget cuts. HCFA has 
proposed to reduce drastically Medicare reimbursement rates for cancer 
drugs by unilaterally changing the definition of ``average wholesale 
price,'' which is at the heart of the current reimbursement formula. 
While there are indications that drug reimbursements have often 
exceeded doctors' and hospitals' costs, these margins have been used to 
help cover costs for professional services, which are inadequately 
reimbursed according to the cancer community, the General Accounting 
Office, and HCFA itself. Yet HCFA has not made any adjustments in these 
professional services payments.
  The planned cuts in Medicare reimbursement rates threaten to force 
doctors to send seniors with cancer out of the community settings where 
they now receive care and into more expensive in-patient settings. As a 
result, seniors may lose the option of receiving cancer treatments from 
the caregivers of their choice in settings that are close to the 
support structure of family, friends, and community. In addition, since 
the cost of cancer treatments are generally higher in hospital in-
patient settings than they are in outpatient settings, this ill-
conceived proposal to force seniors into hospitals will actually cause 
Medicare spending to rise.
  Mr. President, I have heard from many Missourians--doctors, patients, 
and hospital officials--about how the Administration's planned cuts in 
Medicare outpatient cancer care reimbursement rates will negatively 
impact patient care. I would like to share with my colleagues what some 
of them have told me.
  Dr. Burton Needles of St. Louis wrote to me to say that his patients 
prefer receiving chemotherapy in his office rather than in the 
hospital, but that the planned cuts would make it impossible for him to 
continue treating Medicare cancer patients in his office. On the other 
side of the state in Kansas City, Dr. Christopher Sirridge said that 
the result would be less accessible care for seniors with cancer, and 
even higher costs for the Medicare program.
  In Columbia, officials at the Ellis Fischel Cancer Center have told 
me that HCFA's change in reimbursement rates would make it extremely 
difficult for them to continue to be a source of chemotherapy and 
supportive care for cancer patients.
  And, finally, Mr. President, let me share the words of a cancer 
patient, Darlene Bahr, from St. Louis. Ms. Bahr wrote to me: ``I have 
been fighting cancer for 18 years. This is the fourth time I have 
cancer. I have been on a total of four years of chemo, which had been 
successful. I am now on chemo and hope it will be successful again.'' 
Ms. Bahr continues: ``If the physician's office and the hospital cannot 
afford to give me these drugs, where will I get them? Does Medicare 
want to eliminate cancer care?''
  Mr. President, Medicare beneficiaries like Ms. Bahr--who are facing 
battles against cancer--must not be saddled with the added burden of 
worrying about whether they will receive the care they need, in the 
setting they choose. Many doctors have communicated to HCFA and 
Congress that the Administration's plan to cut payments for cancer-
fighting drug treatments will likely prevent doctors from delivering 
outpatient cancer care--leaving thousands of seniors without this 
preferred, and lower cost, option.
  Congress must act to ensure that our progress in cancer treatment is 
not undermined by bureaucratic, inappropriate changes to Medicare 
reimbursement rates for cancer care.
  Therefore, Mr. President, today, I am introducing the Cancer Care 
Preservation Act, which will guarantee that HCFA cannot implement any 
reductions to Medicare reimbursement for outpatient cancer treatment 
unless those changes: are developed in concert

[[Page S8023]]

with the General Accounting Office, the Medicare Payment Advisory 
Commission, and representatives of the cancer care community, including 
patients, survivors, nurses, physicians, and researchers; provide for 
appropriate payment rates for outpatient cancer therapy services, based 
upon the determinations made by the General Accounting Office; and are 
authorized by an act of Congress.
  My legislation also will require GAO to complete a formal nationwide 
analysis to determine the physician and non-physician clinical 
resources necessary to provide safe outpatient cancer therapy services. 
In addition, GAO must determine the appropriate payment rates for such 
services under the Medicare program.
  Medicare beneficiaries with cancer must be confident that they will 
continue to receive the care they need, in the setting they choose, 
without risk of arbitrary and unexpected reductions in reimbursement 
that may force their doctors to cease offering treatment or refer them 
to a different facility for treatment.
  So today, I urge my colleagues to join with me in ensuring that our 
seniors receive full access to the life-saving therapies they need in 
the settings they choose, by cosponsoring the Cancer Care Preservation 
Act.
  Mr. President, I ask unanimous consent that the Cancer Care 
Preservation Act be printed in the Record immediately following my 
remarks.
  I yield the floor.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 3003

       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 ``Cancer Care Preservation Act 
     of 2000''.

     SEC. 2. FINDING.

       Congress finds that in light of the tremendous advances 
     achieved by this Nation in its war on cancer, including the 
     development of breakthrough therapies, the expansion of the 
     cancer care delivery system to convenient and low-cost 
     community settings, and the unprecedented annual reduction in 
     American cancer deaths beginning in 1998, legislation is 
     needed to ensure that these advances are not undermined by 
     inappropriate changes to rates of reimbursement for 
     outpatient cancer therapy services under the medicare program 
     under title XVIII of the Social Security Act (42 U.S.C. 1395 
     et seq.).

     SEC. 3. PRESERVATION OF REIMBURSEMENT RATES FOR OUTPATIENT 
                   CANCER THERAPY SERVICES.

       Notwithstanding any other provision of law, the 
     Administrator of the Health Care Financing Administration may 
     not implement any reduction to the rates of reimbursement for 
     outpatient cancer therapy services under the medicare program 
     under title XVIII of the Social Security Act (42 U.S.C. 1395 
     et seq.), unless such reductions--
       (1) are developed in consultation with the Comptroller 
     General of the United States, the Medicare Payment Advisory 
     Commission established under section 1805 of such Act (42 
     U.S.C. 1395b-6) (in this Act referred to as ``MedPAC''), and 
     representatives of the cancer care community, including 
     patients, survivors, nurses, physicians, and researchers;
       (2) provide for appropriate payment rates for outpatient 
     cancer therapy services, based upon the determinations made 
     by the Comptroller General of the United States in the 
     nationwide analysis required under section 4 of this Act; and
       (3) are authorized by an Act of Congress.

     SEC. 4. FORMAL NATIONWIDE ANALYSIS OF CLINICAL RESOURCES 
                   NECESSARY TO PROVIDE SAFE OUTPATIENT CANCER 
                   THERAPY SERVICES.

       (a) Analysis.--
       (1) In general.--The Comptroller General of the United 
     States shall conduct a nationwide analysis to determine the 
     physician and non-physician clinical resources necessary to 
     provide safe outpatient cancer therapy services and the 
     appropriate payment rates for such services under the 
     medicare program under title XVIII of the Social Security Act 
     (42 U.S.C. 1395 et seq.).
       (2) Issues analyzed.--In conducting the analysis under 
     paragraph (1), the Comptroller General of the United States 
     shall determine--
       (A) the adequacy of practice expense relative value units 
     associated with the utilization of those clinical resources;
       (B) the adequacy of work units in the practice expense 
     formula; and
       (C) the necessity for an additional reimbursement 
     methodology for outpatient cancer therapy services that falls 
     outside the practice expense formula.
       (3) Consultation.--In conducting the analysis under 
     paragraph (1), the Comptroller General of the United States 
     shall consult with Administrator of the Health Care Financing 
     Administration, MedPAC, and representatives of the cancer 
     care community, including patients, survivors, nurses, 
     physicians, and researchers.
       (b) Report.--Not later than 1 year after the date of 
     enactment of this Act, the Comptroller General of the United 
     States shall submit a report to Congress on the analysis 
     conducted under subsection (a) together with recommendations 
     for such legislative and administrative action as the 
     Comptroller General of the United States determines 
     appropriate.
                                 ______