I 

111TH CONGRESS 

1ST SESSION H. R. 2279 

To amend title XVIII of the Social Security Act to eliminate contributing 

factors to disparities in breast cancer treatment through the development 

of a uniform set of consensus-based breast cancer treatment performance 

measures for a 6-year quality reporting system and value-based purchasing system under the Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 6, 2009 

Ms. CASTOR of Florida (for herself, Mr. GRIJALVA, Mr. HINCHEY, Mr. RUSH, 

Ms. BORDALLO, Ms. NORTON, Mr. KUCINICH, Ms. BALDWIN, Ms. LEE

of California, and Ms. SUTTON) introduced the following bill; which was 

referred to the Committee on Ways and Means, and in addition to the 

Committee on Energy and Commerce, 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 eliminate 

contributing factors to disparities in breast cancer treatment through the development of a uniform set of consensus-based breast cancer treatment performance measures for a 6-year quality reporting system and valuebased purchasing system under the Medicare Program. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Eliminating Dispari3 ties in Breast Cancer Treatment Act of 2009’’. 

4 SEC. 2. FINDINGS. 

5 Congress finds the following: 

6 (1) Delays in receiving care after breast cancer 

7 diagnosis are reported to be greater for African8 American women than White women. 

9 (2) Recent studies indicate that African-Amer10 ican women with breast cancer are less likely to re11 ceive standard therapy than White women. 

12 (3) African-American and Hispanic patients are 

13 significantly more likely than White patients to be 

14 diagnosed at a more advanced stage of breast can15 cer. 

16 (4) Investigators found that regardless of insur17 ance status, African-American women are 1.9 times 

18 more likely to be diagnosed with an advanced stage 

19 of breast cancer than White women and Hispanic 

20 women are 1.4 times more likely to be diagnosed 

21 with an advanced stage of breast cancer than White 

22 women. 

23 (5) African-American women are ten percent 

24 more likely not to receive tests to determine if breast 

25 cancer has spread to axillary (underarm) lymph 

26 nodes. Studies show that health insurance status, 


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1 race, income, and educational background are di2 rectly linked to irregularity in administering this 

3 vital screening. 

4 (6) According to American Cancer Society re5 searchers, substantial disparities remain or persist 

6 regarding cancer diagnosis and treatment. 

7 SEC. 3. PURPOSE. 

8 The purpose of this Act is to promote the implemen9 tation of standardized health care practices for breast can10 cer treatment under the Medicare program to eliminate 

11 disparities in the provision of care to such patients based 

12 on race, level of education, income, and health insurance 

13 status of such patients. 

14 SEC. 4. CONSENSUS-BASED BREAST CANCER TREATMENT 

15 PERFORMANCE MEASURES SYSTEM UNDER 

16 MEDICARE. 

17 Title XVIII of the Social Security Act is amended by 

18 adding at the end the following new section: 

19 ‘‘SEC. 1899. BREAST CANCER TREATMENT PERFORMANCE 

20 MEASURES SYSTEM. 

21 ‘‘(a) IN GENERAL.—Not later than October 1, 2010, 

22 the Secretary shall establish, in accordance with the provi23 sions of this section, a 6-year breast cancer treatment 

24 quality performance system (in this section referred to as 

25 the ‘system’) to— 


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1 ‘‘(1) assess and publicly disclose, through the 

2 use of quality measures, the quality of care provided 

3 for the treatment of breast cancer by specified 

4 health care providers; and 

5 ‘‘(2) beginning October 1, 2013, base payment 

6 under this title to such providers for such treatment 

7 on the performance of such providers based on such 

8 measures. 

9 ‘‘(b) SPECIFIED HEALTH CARE PROVIDERS.— 

10 ‘‘(1) IN GENERAL.—The Secretary shall specify 

11 classes of providers of services and suppliers, includ12 ing hospitals, cancer centers, physicians, primary 

13 care providers, and specialty providers, to which the 

14 provisions of this section shall apply. 

15 ‘‘(2) DEFINITION.—For purposes of this sec16 tion, the term ‘specified health care provider’ means 

17 a provider of services or supplier specified under 

18 paragraph (1). 

19 ‘‘(c) IDENTIFICATION AND ENDORSEMENT OF

20 BREAST CANCER TREATMENT PERFORMANCE MEAS21 URES.— 

22 ‘‘(1) IN GENERAL.—Under the system, the Sec23 retary, shall enter into agreements with the National 

24 Quality Forum, an organization that operates as a 

25 voluntary consensus standards body as defined for 


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1 purposes of section 12(d) of the National Tech2 nology Transfer and Advancement Act of 1995 

3 (Public Law 104–113) and Office of Management 

4 and Budget Revised Circular A–119 (published in 

5 the Federal Register on February 10, 1998), under 

6 which the National Quality Forum shall identify a 

7 uniform set of consensus-based performance meas8 ures to evaluate the quality of care provided by spec9 ified health care providers for the treatment of 

10 breast cancer, endorse such set of measures through 

11 its multistakeholder consensus development process, 

12 and annually update such set of measures. 

13 ‘‘(2) MEASURES DESCRIBED.—The set of meas14 ures described in paragraph (1) shall include, with 

15 respect to the treatment of breast cancer, measures 

16 of patient outcomes, the process for delivering med17 ical care related to such treatment, patient coun18 seling and engagement in decisionmaking, patient 

19 experience of care, resource use, and practice capa20 bilities, such as care coordination. 

21 ‘‘(d) REPORTING PROCESS.— 

22 ‘‘(1) IN GENERAL.—Under the system, for peri23 ods (as specified by the Secretary) beginning on or 

24 after October 1, 2010, the Secretary shall establish 

25 a reporting process, with respect to treatment furVerDate Nov 24 2008 02:39 May 08, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2279.IH H2279

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1 nished for breast cancer, that provides for a method 

2 for specified health care providers to submit to the 

3 Secretary data on the performance of such providers 

4 during each period through use of the performance 

5 measures developed pursuant to subsection (c)(1). 

6 Such data shall be submitted in a form and manner 

7 and at a time specified by the Secretary. 

8 ‘‘(2) VOLUNTARY SUBMISSION DURING INITIAL

9 3 YEARS.—The reporting process under paragraph 

10 (1) shall provide for the voluntary submission of 

11 data (and incentives for such submission) under the 

12 process for periods ending before October 1, 2013. 

13 ‘‘(3) CHARACTERISTICS OF DATA SUBMITTED

14 UNDER REPORTING PROCESS.—Data submitted by a 

15 specified health care provider under the reporting 

16 process under paragraph (1) shall— 

17 ‘‘(A) take into account the quality of 

18 breast cancer treatment furnished to all pa19 tients of the provider, regardless of the type of 

20 health insurance coverage of the patient or 

21 whether or not the patient has such coverage; 

22 and 

23 ‘‘(B) be structured in a manner that allows 

24 for comparison according to race, educational 


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1 level, income, insurance status, and any other 

2 category specified by the Secretary. 

3 ‘‘(e) PUBLIC DISCLOSURE.—Under the system, the 

4 Secretary shall establish procedures to require that infor5 mation with respect to the quality demonstrated by a spec6 ified health care provider of treatment furnished for breast 

7 cancer during a period (based on the performance meas8 ures data submitted pursuant to subsection (c)(1) by the 

9 provider for such period) is made available on the official 

10 public Internet site of the Department of Health and 

11 Human Services in a clear and understandable form. Such 

12 procedures shall ensure that a specified health care pro13 vider has the opportunity to review the information that 

14 is to be made public with respect to the provider at least 

15 30 days prior to such data being made public and shall 

16 provide for an appeals process in the case a provider 

17 claims such information to be incorrect or incomplete. 

18 ‘‘(f) VALUE-BASED PURCHASING FOR PERIODS BE19 GINNING OCTOBER 1, 2013.— 

20 ‘‘(1) IN GENERAL.—Under the system, for peri21 ods beginning on or after October 1, 2013, and end22 ing before October 1, 2016, the Secretary shall es23 tablish and implement, a value-based purchasing 

24 program, with respect to specified health care proVerDate Nov 24 2008 02:39 May 08, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2279.IH H2279

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1 viders that furnish treatment for breast cancer dur2 ing such a period, under which— 

3 ‘‘(A) in the case of such a provider that 

4 does not submit data in accordance with the re5 porting process under subsection (d)(1) for 

6 such treatment furnished during such period, 

7 the Secretary shall reduce payment under this 

8 title for such treatment by an amount specified 

9 by the Secretary; and 

10 ‘‘(B) in the case of such a provider that 

11 submits data in accordance with the reporting 

12 process under subsection (d)(1) for such treat13 ment furnished during such period— 

14 ‘‘(i) subject to clause (ii), if the Sec15 retary determines such provider furnished 

16 low quality care (in accordance with a 

17 method specified by the Secretary) for 

18 such treatment, the Secretary shall reduce 

19 the amount that would otherwise be paid 

20 to such provider under this title for such 

21 treatment by an amount specified by the 

22 Secretary; 

23 ‘‘(ii) if the Secretary determines such 

24 provider furnished low quality care (in ac25 cordance with the method specified under 


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1 clause (i)) for such treatment, but the 

2 quality of care has improved as compared 

3 to the quality of care the provider fur4 nished during the previous period, the Sec5 retary shall reduce the amount that would 

6 otherwise be paid to such provider under 

7 this title for such treatment in accordance 

8 with an incremental method established by 

9 the Secretary that ensures that the amount 

10 of such reduction— 

11 ‘‘(I) is less than the amount 

12 specified by the Secretary under 

13 clause (i); and 

14 ‘‘(II) is based on the extent of 

15 improvement in the quality of care; 

16 and 

17 ‘‘(iii) if the Secretary determines such 

18 provider did not furnish low quality care 

19 (in accordance with the method specified 

20 under clause (i)) for such treatment, the 

21 Secretary shall provide to such provider 

22 the amount to be paid to such provider 

23 under this title for such treatment. 

24 ‘‘(2) RESULTS-BASED PAYMENTS.—The amount 

25 of a reduction under subparagraph (A) or (B)(i) of 


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1 paragraph (1) shall be determined in accordance 

2 with a method established by the Secretary. 

3 ‘‘(g) REPORTS.—Not later than October 1, 2011, and 

4 for each 6-month period thereafter (before fiscal year 

5 2017), the Secretary shall submit to Congress a report 

6 that evaluates the development and implementation of the 

7 system, including— 

8 ‘‘(1) an evaluation of the number of specified 

9 health care providers that submit data pursuant to 

10 subsection (c)(1); 

11 ‘‘(2) an analysis of the effect of such system on 

12 reducing disparities in the provision of breast cancer 

13 treatment to patients based on race, level of edu14 cation, income, and health insurance status of such 

15 patients; and 

16 ‘‘(3) recommendations on whether (and to what 

17 extent) to extend the system under this section. 

18 ‘‘(h) APPLICATION TO PART C.—The Secretary shall 

19 provide for a method to apply the provisions of this section 

20 to treatment furnished under a plan under part C.’’. 

Æ 


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