[Congressional Record Volume 163, Number 35 (Tuesday, February 28, 2017)]
[Senate]
[Pages S1502-S1504]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CORNYN (for himself and Mr. Carper):
  S. 463. A bill to amend title XVIII of the Social Security Act to 
establish a national Oncology Medical Home Demonstration Project under 
the Medicare program for the purpose of changing the Medicare payment 
for cancer care in order to enhance the quality of care and to improve 
cost efficiency, and for other purposes; to the Committee on Finance.

                                 S. 463

       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 Payment Reform 
     Act of 2017''.

     SEC. 2. ESTABLISHING AN ONCOLOGY MEDICAL HOME DEMONSTRATION 
                   PROJECT UNDER THE MEDICARE PROGRAM TO IMPROVE 
                   QUALITY OF CARE AND COST EFFICIENCY.

       Title XVIII of the Social Security Act is amended by 
     inserting after section 1866E (42 U.S.C. 1395cc-5) the 
     following new section:

     ``SEC. 1866F. ONCOLOGY MEDICAL HOME DEMONSTRATION PROJECT.

       ``(a) Establishment of Demonstration Project.--Not later 
     than 12 months after the date of the enactment of this 
     section, the Secretary shall establish an Oncology Medical 
     Home Demonstration Project (in this section referred to as 
     the `demonstration project') to make payments in the amounts 
     specified in subsection (f) to each participating oncology 
     practice (as defined in subsection (b)).
       ``(b) Definition of Participating Oncology Practice.--For 
     purposes of this section, the term `participating oncology 
     practice' means an oncology practice that--
       ``(1) submits to the Secretary an application to 
     participate in the demonstration project in accordance with 
     subsection (c);
       ``(2) is selected by the Secretary, in accordance with 
     subsection (d), to participate in the demonstration project; 
     and
       ``(3) is owned by a physician, or is owned by or affiliated 
     with a hospital, that submitted a claim for payment in the 
     prior year for an item or service for which payment may be 
     made under part B.
       ``(c) Application To Participate.--An application by an 
     oncology practice to participate in the demonstration project 
     shall include an attestation to the Secretary that the 
     practice--
       ``(1) furnishes physicians' services for which payment may 
     be made under part B;
       ``(2) coordinates oncology services furnished to an 
     individual by the practice with services that are related to 
     such oncology services and that are furnished to such 
     individual by practitioners (including oncology nurses) 
     inside or outside the practice in order to ensure that each 
     such individual receives coordinated care;
       ``(3) meaningfully uses electronic health records;
       ``(4) will, not later than one year after the date on which 
     the practice commences its participation in the demonstration 
     project, be accredited as an Oncology Medical Home by the 
     Commission on Cancer, the National Committee for Quality 
     Assurance, or such other entity as the Secretary determines 
     appropriate;
       ``(5) will repay all amounts paid by the Secretary to the 
     practice under subsection (f)(1)(A) in the case that the 
     practice does not, on a date that is not later than 60 days 
     after the date on which the practice's agreement period for 
     the demonstration project begins, as determined by the 
     Secretary, submit an application to an entity described in 
     paragraph (4) for accreditation as an Oncology Medical Home 
     in accordance with such paragraph;
       ``(6) will, for each year in which the demonstration 
     project is conducted, report to the Secretary, in such form 
     and manner as is specified by the Secretary, on--
       ``(A) the performance of the practice with respect to 
     measures described in subsection (e) as determined by the 
     Secretary, subject to subsection (e)(1)(B); and
       ``(B) the experience of care of individuals who are 
     furnished oncology services by the practice for which payment 
     may be made under part B, as measured by a patient experience 
     of care survey based on the Consumer Assessment of Healthcare 
     Providers and Systems survey or by such similar survey as the 
     Secretary determines appropriate;
       ``(7) agrees not to receive the payments described in 
     subclauses (I) and (II) of subsection (f)(1)(B)(iii) in the 
     case that the practice does not report to the Secretary in 
     accordance with paragraph (6) with respect to performance of 
     the practice during the 12-month period beginning on the date 
     on which the practice's agreement period for the 
     demonstration project begins, as determined by the Secretary;
       ``(8) will, for each year of the demonstration project, 
     meet the performance standards developed under subsection 
     (e)(4)(B) with respect to each of the measures on which the 
     practice has agreed to report under paragraph (6)(A) and the 
     patient experience of care on which the practice has agreed 
     to report under paragraph (6)(B); and
       ``(9) has the capacity to utilize shared decision-making 
     tools that facilitate the incorporation of the patient needs, 
     preferences, and circumstances of an individual into the 
     medical plan of the individual and that maintain provider 
     flexibility to tailor care of the individual based on the 
     full range of test and treatment options available to the 
     individual.
       ``(d) Selection of Participating Practices.--
       ``(1) In general.--The Secretary shall, not later than 15 
     months after the date of the enactment of this section, 
     select oncology practices that submit an application to the 
     Secretary in accordance with subsection (c) to participate in 
     the demonstration project.
       ``(2) Maximum number of practices.--In selecting an 
     oncology practice to participate in the demonstration project 
     under this section, the Secretary shall ensure that the 
     participation of such practice in the demonstration project 
     does not, on the date on which the practice commences its 
     participation in the demonstration project--
       ``(A) increase the total number of practices participating 
     in the demonstration project to a number that is greater than 
     200 practices (or such number as the Secretary determines 
     appropriate); or
       ``(B) increase the total number of oncologists who 
     participate in the demonstration project to a number that is 
     greater than 1,500 oncologists (or such number as the 
     Secretary determines appropriate).
       ``(3) Diversity of practices.--
       ``(A) In general.--Subject to subparagraph (B), in 
     selecting oncology practices to participate in the 
     demonstration project under this section, the Secretary 
     shall, to the extent practicable, include in such selection--
       ``(i) small-, medium-, and large-sized practices; and
       ``(ii) practices located in different geographic areas.
       ``(B) Inclusion of small oncology practices.--In selecting 
     oncology practices to participate in the demonstration 
     project under this section, the Secretary shall, to the 
     extent practicable, ensure that at least 20 percent of the 
     participating practices are small oncology practices (as 
     determined by the Secretary).
       ``(4) No penalty for certain opt-outs by practices.--In the 
     case that the Secretary selects an oncology practice to 
     participate in the demonstration project under this section 
     that has agreed to participate in a model established under 
     section 1115A for oncology services, such practice may not be 
     assessed a penalty for electing not to participate in such 
     model if the practice makes such election--
       ``(A) prior to the receipt by the practice of any payment 
     for such model that would not otherwise be paid in the 
     absence of such model; and
       ``(B) in order to participate in the demonstration project 
     under this section.
       ``(e) Measures.--
       ``(1) Development.--

[[Page S1503]]

       ``(A) In general.--The Secretary shall use measures 
     described in paragraph (2), and may use measures developed 
     under paragraph (3), to assess the performance of each 
     participating oncology practice, as compared to other 
     participating oncology practices as described in paragraph 
     (4)(A)(i).
       ``(B) Determination of measures reported.--In determining 
     measures to be reported under subsection (c)(6)(A), the 
     Secretary, in consultation with stakeholders, shall ensure 
     that reporting under such subsection is not overly burdensome 
     and that those measures required to be reported are aligned 
     with applicable requirements from other payors.
       ``(2) Measures described.--The measures described in this 
     paragraph, with respect to individuals who are attributed to 
     a participating oncology practice, as determined by the 
     Secretary, are the following:
       ``(A) Patient care measures.--
       ``(i) The percentage of such individuals who receive 
     documented clinical or pathologic staging prior to initiation 
     of a first course of cancer treatment.
       ``(ii) The percentage of such individuals who undergo 
     advanced imaging and have been diagnosed with stage I or II 
     breast cancer.
       ``(iii) The percentage of such individuals who undergo 
     advanced imaging and have been diagnosed with stage I or II 
     prostate cancer.
       ``(iv) The percentage of such individuals who, prior to 
     receiving cancer treatment, had their performance status 
     assessed by the practice.
       ``(v) The percentage of such individuals who--

       ``(I) undergo treatment with a chemotherapy regimen 
     provided by the practice;
       ``(II) have at least a 20-percent risk of developing 
     febrile neutropenia due to a combination of regimen risk and 
     patient risk factors; and
       ``(III) have received from the practice either GCSF or 
     white cell growth factor.

       ``(vi) With respect to such individuals who receive an 
     oncology drug therapy from the practice, the percentage of 
     such individuals who underwent a diagnostic test to identify 
     specific biomarkers, genetic mutations, or characteristics 
     prior to receiving an oncology drug therapy, where such a 
     diagnostic test exists for a given cancer type.
       ``(vii) With respect to such individuals who receive 
     chemotherapy treatment from the practice, the percentage of 
     such individuals so treated who receive a treatment plan 
     prior to the administration of such chemotherapy.
       ``(viii) With respect to chemotherapy treatments 
     administered to such individuals by the practice, the 
     percentage of such treatments that adhere to guidelines 
     published by the National Comprehensive Cancer Network or 
     such other entity as the Secretary determines appropriate.
       ``(ix) With respect to antiemetic drugs dispensed by the 
     practice to individuals as part of moderately or highly 
     emetogenic chemotherapy regimens for such individuals, the 
     extent to which such drugs are administered in accordance 
     with evidence-based guidelines or pathways that are compliant 
     with guidelines published by the National Comprehensive 
     Cancer Network or such other entity as the Secretary 
     determines appropriate.
       ``(B) Resource utilization measures.--
       ``(i) With respect to emergency room visits in a year by 
     such individuals who are receiving active chemotherapy 
     treatment administered by the practice as of the date of such 
     visits, the percentage of such visits that are associated 
     with qualified cancer diagnoses of the individuals.
       ``(ii) With respect to hospital admissions in a year by 
     such individuals who are receiving active chemotherapy 
     treatment administered by the practice as of the date of such 
     visits, the percentage of such admissions that are associated 
     with qualified cancer diagnoses of the individuals.
       ``(C) Survivorship measures.--
       ``(i) Survival rates for such individuals who have been 
     diagnosed with stage I through IV breast cancer.
       ``(ii) Survival rates for such individuals who have been 
     diagnosed with stage I through IV colorectal cancer.
       ``(iii) Survival rates for such individuals who have been 
     diagnosed with stage I through IV lung cancer.
       ``(iv) With respect to such individuals who receive 
     chemotherapy treatment from the practice, the percentage of 
     such individuals so treated who receive a survivorship plan 
     not later than 45 days after the completion of the 
     administration of such chemotherapy.
       ``(v) With respect to such individuals who receive 
     chemotherapy treatment from the practice, the percentage of 
     such individuals who receive psychological screening.
       ``(D) End-of-life care measures.--
       ``(i) The number of times that such an individual receives 
     chemotherapy treatment from the practice within an amount of 
     time specified by the Secretary, in consultation with 
     stakeholders, prior to the death of the individual.
       ``(ii) With respect to such individuals who have a stage IV 
     disease and have received treatment for such disease from the 
     practice, the percentage of such individuals so treated who 
     have had a documented end-of-life care conversation with a 
     physician in the practice or another health care provider who 
     is a member of the cancer care team of the practice.
       ``(iii) With respect to such an individual who is referred 
     to hospice care by a physician in the practice or a health 
     care provider who is a member of the cancer care team of the 
     practice, regardless of the setting in which such care is 
     furnished, the average number of days that the individual 
     receives hospice care prior to the death of the individual.
       ``(iv) With respect to such individuals who die while 
     receiving care from the practice, the percentage of such 
     deceased individuals whose death occurred in an acute care 
     setting.
       ``(3) Modification or addition of measures.--
       ``(A) In general.--The Secretary may, in consultation with 
     appropriate stakeholders in a manner determined by the 
     Secretary, modify, replace, remove, or add to the measures 
     described in paragraph (2).
       ``(B) Appropriate stakeholders described.--For purposes of 
     subparagraph (A), the term `appropriate stakeholders' 
     includes oncology societies, oncologists who furnish oncology 
     services to one or more individuals for which payment may be 
     made under part B, allied health professionals, health 
     insurance issuers that have implemented alternative payment 
     models for oncologists, patients and organizations that 
     represent patients, and biopharmaceutical and other medical 
     technology manufacturers.
       ``(4) Assessment.--
       ``(A) In general.--The Secretary shall, for each year in 
     which the demonstration project is conducted, assess--
       ``(i) the performance of each participating oncology 
     practice for such year with respect to the measures on which 
     the practice has agreed to report to the Secretary under 
     subsection (c)(6)(A), as compared to the performance of other 
     participating oncology practices with respect to such 
     measures; and
       ``(ii) the extent to which each participating oncology 
     practice has, during such year, used breakthrough or other 
     best-in-class therapies.
       ``(B) Performance standards.--The Secretary shall, in 
     consultation with the appropriate stakeholders described in 
     paragraph (3)(B) in a manner determined by the Secretary, 
     develop performance standards with respect to--
       ``(i) each of the measures described in paragraph (2), 
     including those measures as modified or added under paragraph 
     (3); and
       ``(ii) the patient experience of care on which 
     participating oncology practices agree to report to the 
     Secretary under subsection (c)(6)(B).
       ``(f) Payments for Participating Oncology Practices and 
     Oncologists.--
       ``(1) Care coordination management fee during first two 
     years of demonstration project.--
       ``(A) In general.--The Secretary shall, in addition to any 
     other payments made by the Secretary under this title to a 
     participating oncology practice, pay a care coordination 
     management fee to each such practice at each of the times 
     specified in subparagraph (B).
       ``(B) Timing of payments.--The care coordination management 
     fee described in subparagraph (A) shall be paid to a 
     participating oncology practice at the end of each of the 
     following periods:
       ``(i) The period that ends 6 months after the date on which 
     the practice's agreement period for the demonstration project 
     begins, as determined by the Secretary.
       ``(ii) The period that ends 12 months after the date on 
     which the practice's agreement period for the demonstration 
     project begins, as determined by the Secretary.
       ``(iii) Subject to subsection (c)(7)--

       ``(I) the period that ends 18 months after the date on 
     which the practice's agreement period for the demonstration 
     project begins, as determined by the Secretary; and
       ``(II) the period that ends 24 months after the date on 
     which the practice's agreement period for the demonstration 
     project begins, as determined by the Secretary.

       ``(C) Amount of payment.--The Secretary shall, in 
     consultation with oncologists who furnish oncology services 
     for which payment may be made under part B in a manner 
     determined by the Secretary, determine the amount of the care 
     coordination management fee described in subparagraph (A).
       ``(2) Performance incentive payments.--
       ``(A) In general.--Subject to subparagraphs (C) and (E), 
     the Secretary shall, in addition to any other payments made 
     by the Secretary under this title to a participating oncology 
     practice, pay a performance incentive payment to each such 
     practice for each year of the demonstration project described 
     in subparagraph (B).
       ``(B) Timing of payments.--The performance incentive 
     payment described in subparagraph (A) shall be paid to a 
     participating oncology practice as soon as practicable 
     following the end of the third, fourth, and fifth years of 
     the demonstration project.
       ``(C) Source of payments.--Performance incentive payments 
     made to participating oncology practices under subparagraph 
     (A) for each of the years of the demonstration project 
     described in subparagraph (B) shall be paid from the 
     aggregate pool available for making payments for each such 
     year determined under subparagraph (D), as available for each 
     such year.
       ``(D) Aggregate pool available for making payments.--With 
     respect to each of the years of the demonstration project 
     described in subparagraph (B), the aggregate pool available 
     for making performance incentive

[[Page S1504]]

     payments for each such year shall be determined by--
       ``(i) estimating the amount by which the aggregate 
     expenditures that would have been expended for the year under 
     parts A and B for items and services furnished to individuals 
     attributed to participating oncology practices if the 
     demonstration project had not been implemented exceeds such 
     aggregate expenditures for such individuals for such year of 
     the demonstration project;
       ``(ii) calculating the amount that is half of the amount 
     estimated under clause (i); and
       ``(iii) subtracting from the amount calculated under clause 
     (ii) the total amount of payments made under paragraph (1) 
     that have not, in a prior application of this clause, 
     previously been so subtracted from a calculation made under 
     clause (ii).
       ``(E) Amount of payments to individual practices that meet 
     performance standards and achieve savings.--
       ``(i) Payments only to practices that meet performance 
     standards.--The Secretary may not make performance incentive 
     payments to a participating oncology practice under 
     subparagraph (A) with respect to a year of the demonstration 
     project described in subparagraph (B) unless the practice 
     meets or exceeds the performance standards developed under 
     subsection (e)(4)(B) for the year with respect to--

       ``(I) the measures on which the practice has agreed to 
     report to the Secretary under subsection (c)(6)(A); and
       ``(II) the patient experience of care on which the practice 
     has agreed to report to the Secretary under subsection 
     (c)(6)(B).

       ``(ii) Consideration of performance assessment.--The 
     Secretary shall, in consultation with the appropriate 
     stakeholders described in subsection (e)(3)(B) in a manner 
     determined by the Secretary, determine the amount of a 
     performance incentive payment to a participating oncology 
     practice under subparagraph (A) for a year of the 
     demonstration project described in subparagraph (B). In 
     making a determination under the preceding sentence, the 
     Secretary shall take into account the performance assessment 
     of the practice under subsection (e)(4)(A) with respect to 
     the year and the aggregate pool available for making payments 
     for such year determined under subparagraph (D), as available 
     for such year.
       ``(3) Issuance of guidance.--Not later than the date that 
     is 12 months after the date of the enactment of this section, 
     the Secretary shall issue guidance detailing the methodology 
     that the Secretary will use to implement subparagraphs (D) 
     and (E) of paragraph (2).
       ``(g) Secretary Reports to Participating Oncology 
     Practices.--The Secretary shall inform each participating 
     oncology practice, on a periodic (such as quarterly) basis, 
     of--
       ``(1) the performance of the practice with respect to the 
     measures on which the practice has agreed to report to the 
     Secretary under subsection (c)(6)(A); and
       ``(2) the estimated amount by which the expenditures that 
     would have been expended under parts A and B for items and 
     services furnished to individuals attributed to the practice 
     if the demonstration project had not been implemented exceeds 
     the actual expenditures for such individuals.
       ``(h) Applications From Entities To Provide 
     Accreditations.--Not later than the date that is 18 months 
     after the date of the enactment of this section, the 
     Secretary shall establish a process for the acceptance and 
     consideration of applications from entities for purposes of 
     determining which entities may provide accreditation to 
     practices under subsection (c)(4) in addition to the entities 
     described in such subsection.
       ``(i) Revisions to Demonstration Project.--The Secretary 
     may make appropriate revisions to the demonstration project 
     under this section in order for participating oncology 
     practices under such demonstration project to meet the 
     definition of an eligible alternative payment entity for 
     purposes of section 1833(z).
       ``(j) Waiver Authority.--The Secretary may waive such 
     provisions of this title and title XI as the Secretary 
     determines necessary in order to implement the demonstration 
     project under this section.
       ``(k) Administration.--Chapter 35 of title 44, United 
     States Code, shall not apply to this section.''.
                                 ______