II 

109TH CONGRESS 

2D SESSION S. 2340 

To amend title XVIII of the Social Security Act to preserve access to 

community cancer care by Medicare beneficiaries. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 28, 2006 

Mr. SPECTER (for himself, Mr. COLEMAN, and Mr. ISAKSON) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to preserve 

access to community cancer care by Medicare beneficiaries. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Community Cancer Care Preservation Act of 2006’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Use of average sales price methodology. 

Sec. 3. Improved payment for oncologist services. 

Sec. 4. Quality measures for cancer care. 

Sec. 5. Improved patient participation in clinical trials. 

Sec. 6. CBO report. 


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1 SEC. 2. USE OF AVERAGE SALES PRICE METHODOLOGY. 

2 (a) FINDINGS.—Congress finds that— 

3 (1) in 2005, Medicare reimbursement for cer4 tain outpatient cancer drugs was changed to reflect 

5 average sales price rather than average wholesale 

6 price; and 

7 (2) the average sales price methodology does 

8 not timely reflect changes in manufacturer’s prices 

9 for drugs. 

10 (b) ADJUSTMENT TO AVERAGE SALES PRICE CAL11 CULATION.—Section 1847A of the Social Security Act (42 

12 U.S.C. 1395w–3a) is amended— 

13 (1) in subsection (b), by adding at the end the 

14 following new paragraph: 

15 ‘‘(6) RECONCILIATION.—Payments made pursu16 ant to this subsection are subject to reconciliation to 

17 assure that such payments do not exceed or fall 

18 short of the actual average sales price during any 

19 preceding period. Such reconciliation shall be con20 ducted on a quarterly basis and the Secretary shall 

21 review all payments made to physicians under this 

22 subsection in the preceding quarter and compare 

23 such payment to the verified average sales price re24 ported by the manufacturer under subsection (c) for 

25 such quarter.’’; and 

26 (2) in subsection (c)(3)— 


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1 (A) in the first sentence, by striking 

2 ‘‘prompt pay discounts,’’; and 

3 (B) in the second sentence, by inserting 

4 ‘‘other than prompt pay discounts,’’ after 

5 ‘‘other price concessions,’’. 

6 SEC. 3. IMPROVED PAYMENT FOR ONCOLOGIST SERVICES. 

7 (a) FINDINGS.—Congress finds that— 

8 (1) in 2005, the Centers for Medicare & Med9 icaid Services implemented a $300 million dem10 onstration project to identify and assess certain on11 cology services in an office-based oncology practice 

12 that positively affect cancer outcomes in the Medi13 care population; and 

14 (2) oncologists and cancer patients benefited 

15 from the demonstration project. 

16 (b) CONTINUATION OF CURRENT DEMONSTRATION

17 PROJECT TO IDENTIFY AND ASSESS ONCOLOGY SERVICES

18 THAT POSITIVELY AFFECT CANCER OUTCOMES.— 

19 (1) IN GENERAL.—The existing demonstration 

20 project, developed by the Secretary of Health and 

21 Human Services pursuant to the Secretary’s author22 ity under sections 402(a)(1)(B) and 402(a)(2) of the 

23 Social Security Amendments of 1967 and imple24 mented in the Federal Register, ‘‘Revisions to Pay25 ment Policies Under the Physician Fee Schedule for 


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1 Calendar Year 2005,’’ 69 Fed. Reg. 66,236 (Novem2 ber 15, 2004), for purposes of identifying and as3 sessing certain oncology services that positively af4 fect outcomes in the Medicare population, shall be 

5 extended until December 31, 2006. 

6 (2) IMPLEMENTATION.—The Secretary shall 

7 continue to operate such project in the same manner 

8 as originally implemented. 

9 (3) FUNDING.—Under the demonstration 

10 project over the duration of the project, the Sec11 retary shall apply the methodology and funding con12 sistent with that established for the existing project. 

13 (4) REPORT.—Not later than July 1, 2007, the 

14 Secretary shall submit to Congress a report on the 

15 project, together with recommendations for such leg16 islation and administrative action as the Secretary 

17 determines to be appropriate. 

18 (c) ADJUSTMENT TO PHYSICIAN FEE SCHEDULE.— 

19 Section 1848(c)(2) of the Social Security Act (42 U.S.C. 

20 1395w–4(c)(2)) is amended— 

21 (1) in subparagraph (B)(iv)— 

22 (A) in subclause (II), by striking ‘‘and’’; 

23 (B) in subclause (III), by striking the pe24 riod and inserting ‘‘; and’’; and 


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1 (C) by adding at the end the following new 

2 subclause: 

3 ‘‘(IV) subparagraph (K) insofar 

4 as it relates to a physician fee sched5 ule for 2006 shall not be taken into 

6 account in applying clause (ii)(II) for 

7 drug administration services under 

8 the fee schedule for such year.’’; and 

9 (2) by adding at the end the following new sub10 paragraph: 

11 ‘‘(K) ADJUSTMENT IN PAYMENT RATES

12 FOR OVERHEAD COSTS.—In establishing the 

13 physician fee schedule under subsection (b) with 

14 respect to payments for drug administration 

15 services furnished on or after January 1, 2006, 

16 and in order to take into account overhead and 

17 related expenses, the Secretary shall provide for 

18 an additional payment in an amount equal to 2 

19 percent of the amount determined under section 

20 1847A for the drug administered.’’. 

21 SEC. 4. QUALITY MEASURES FOR CANCER CARE. 

22 (a) FINDINGS.—Congress finds that— 

23 (1) existing quality indicators relating to the 

24 quality of care furnished to cancer patients in physi25 cian offices are inconsistent across practice settings 


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1 and are not based on uniform, evidence-based and 

2 consistently applied standards; and 

3 (2) physician reimbursement should reflect im4 provements in the quality of care provided. 

5 (b) DEVELOPMENT OF QUALITY INDICATORS.—In 

6 collaboration with practicing physicians, the Secretary of 

7 Health and Human Services shall develop indicators for 

8 the evaluation of the quality of oncology services provided 

9 in the physician office setting. Such indicators shall not 

10 be implemented for any purpose unless the Secretary has 

11 provided for an assessment of the proposed indicators by 

12 the physician community. 

13 (c) PILOT AND DEMONSTRATION PROJECTS.—The 

14 Secretary may conduct pilot projects and demonstration 

15 projects to test such indicators as appropriate. 

16 SEC. 5. IMPROVED PATIENT PARTICIPATION IN CLINICAL 

17 TRIALS. 

18 (a) FINDINGS.—Congress finds that— 

19 (1) the current report of the President’s Cancer 

20 Panel has documented the increasing incidence and 

21 costs of cancer to the United States; and 

22 (2) the current report of the President’s Cancer 

23 Panel has identified problems in translating research 

24 into effective cancer care. 


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1 (b) STRATEGIC PLAN FOR IMPROVED PATIENT PAR2 TICIPATION.— 

3 (1) IN GENERAL.—In collaboration with prac4 ticing physicians, the Director of the National Can5 cer Institute shall develop a strategic plan to in6 crease the number of cancer patients who enroll in 

7 clinical trials. 

8 (2) COMPONENTS OF PLAN.—Such plan shall 

9 include components designed to— 

10 (A) improve patient education regarding 

11 clinical trials; 

12 (B) facilitate the clinical trial process; and 

13 (C) ensure the viability of conducting clin14 ical research in all settings where treatment is 

15 provided. 

16 (c) REPORT.—Not later than January 1, 2007, the 

17 Secretary of Health and Human Services shall submit to 

18 Congress a report on the strategic plan under subsection 

19 (b) together with recommendations for such legislation 

20 and administrative action as the Secretary determines to 

21 be appropriate. 

22 SEC. 6. CBO REPORT. 

23 Not later than one year after the date of the enact24 ment of this Act, the Director of the Congressional Budget 

25 Office shall submit to Congress a report that describes the 


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1 impact of the provisions of the Medicare Prescription 

2 Drug, Improvement, and Modernization Act of 2003 (Pub3 lic Law 108–173) as implemented on oncologists and 

4 other physicians who provide cancer care and a compari5 son of such impact with the impact of such law estimated 

6 by such Office before its enactment. 

Æ 


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