I 

115TH CONGRESS 

1ST SESSION H. R. 1834 

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. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 30, 2017 

Mrs. MCMORRIS RODGERS (for herself and Ms. SEWELL of Alabama) 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 

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. 

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 ‘‘Cancer Care Payment 

3 Reform Act of 2017’’. 

4 SEC. 2. ESTABLISHING AN ONCOLOGY MEDICAL HOME 

5 DEMONSTRATION PROJECT UNDER THE 

6 MEDICARE PROGRAM TO IMPROVE QUALITY 

7 OF CARE AND COST EFFICIENCY. 

8 Title XVIII of the Social Security Act is amended by 

9 inserting after section 1866E (42 U.S.C. 1395cc–5) the 

10 following new section: 

11 ‘‘SEC. 1866F. ONCOLOGY MEDICAL HOME DEMONSTRATION 

12 PROJECT. 

13 ‘‘(a) ESTABLISHMENT OF DEMONSTRATION

14 PROJECT.—Not later than 12 months after the date of 

15 the enactment of this section, the Secretary shall establish 

16 an Oncology Medical Home Demonstration Project (in 

17 this section referred to as the ‘demonstration project’) to 

18 make payments in the amounts specified in subsection (f) 

19 to each participating oncology practice (as defined in sub20 section (b)). 

21 ‘‘(b) DEFINITION OF PARTICIPATING ONCOLOGY

22 PRACTICE.—For purposes of this section, the term ‘par23 ticipating oncology practice’ means an oncology practice 

24 that— 


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1 ‘‘(1) submits to the Secretary an application to 

2 participate in the demonstration project in accord3 ance with subsection (c); 

4 ‘‘(2) is selected by the Secretary, in accordance 

5 with subsection (d), to participate in the demonstra6 tion project; and 

7 ‘‘(3) is owned by a physician, or is owned by or 

8 affiliated with a hospital, that submitted a claim for 

9 payment in the prior year for an item or service for 

10 which payment may be made under part B. 

11 ‘‘(c) APPLICATION TO PARTICIPATE.—An application 

12 by an oncology practice to participate in the demonstra13 tion project shall include an attestation to the Secretary 

14 that the practice— 

15 ‘‘(1) furnishes physicians’ services for which 

16 payment may be made under part B; 

17 ‘‘(2) coordinates oncology services furnished to 

18 an individual by the practice with services that are 

19 related to such oncology services and that are fur20 nished to such individual by practitioners (including 

21 oncology nurses) inside or outside the practice in 

22 order to ensure that each such individual receives co23 ordinated care; 

24 ‘‘(3) meaningfully uses electronic health 

25 records; 


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1 ‘‘(4) will, not later than one year after the date 

2 on which the practice commences its participation in 

3 the demonstration project, be accredited as an On4 cology Medical Home by the Commission on Cancer, 

5 the National Committee for Quality Assurance, or 

6 such other entity as the Secretary determines appro7 priate; 

8 ‘‘(5) will repay all amounts paid by the Sec9 retary to the practice under subsection (f)(1)(A) in 

10 the case that the practice does not, on a date that 

11 is not later than 60 days after the date on which the 

12 practice’s agreement period for the demonstration 

13 project begins, as determined by the Secretary, sub14 mit an application to an entity described in para15 graph (4) for accreditation as an Oncology Medical 

16 Home in accordance with such paragraph; 

17 ‘‘(6) will, for each year in which the demonstra18 tion project is conducted, report to the Secretary, in 

19 such form and manner as is specified by the Sec20 retary, on— 

21 ‘‘(A) the performance of the practice with 

22 respect to measures described in subsection (e) 

23 as determined by the Secretary, subject to sub24 section (e)(1)(B); and 


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1 ‘‘(B) the experience of care of individuals 

2 who are furnished oncology services by the 

3 practice for which payment may be made under 

4 part B, as measured by a patient experience of 

5 care survey based on the Consumer Assessment 

6 of Healthcare Providers and Systems survey or 

7 by such similar survey as the Secretary deter8 mines appropriate; 

9 ‘‘(7) agrees not to receive the payments de10 scribed in subclauses (I) and (II) of subsection 

11 (f)(1)(B)(iii) in the case that the practice does not 

12 report to the Secretary in accordance with para13 graph (6) with respect to performance of the prac14 tice during the 12-month period beginning on the 

15 date on which the practice’s agreement period for 

16 the demonstration project begins, as determined by 

17 the Secretary; 

18 ‘‘(8) will, for each year of the demonstration 

19 project, meet the performance standards developed 

20 under subsection (e)(4)(B) with respect to each of 

21 the measures on which the practice has agreed to re22 port under paragraph (6)(A) and the patient experi23 ence of care on which the practice has agreed to re24 port under paragraph (6)(B); and 


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1 ‘‘(9) has the capacity to utilize shared decision2 making tools that facilitate the incorporation of the 

3 patient needs, preferences, and circumstances of an 

4 individual into the medical plan of the individual and 

5 that maintain provider flexibility to tailor care of the 

6 individual based on the full range of test and treat7 ment options available to the individual. 

8 ‘‘(d) SELECTION OF PARTICIPATING PRACTICES.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall, not 

10 later than 15 months after the date of the enact11 ment of this section, select oncology practices that 

12 submit an application to the Secretary in accordance 

13 with subsection (c) to participate in the demonstra14 tion project. 

15 ‘‘(2) MAXIMUM NUMBER OF PRACTICES.—In se16 lecting an oncology practice to participate in the 

17 demonstration project under this section, the Sec18 retary shall ensure that the participation of such 

19 practice in the demonstration project does not, on 

20 the date on which the practice commences its par21 ticipation in the demonstration project— 

22 ‘‘(A) increase the total number of practices 

23 participating in the demonstration project to a 

24 number that is greater than 200 practices (or 


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1 such number as the Secretary determines ap2 propriate); or 

3 ‘‘(B) increase the total number of 

4 oncologists who participate in the demonstra5 tion project to a number that is greater than 

6 1,500 oncologists (or such number as the Sec7 retary determines appropriate). 

8 ‘‘(3) DIVERSITY OF PRACTICES.— 

9 ‘‘(A) IN GENERAL.—Subject to subpara10 graph (B), in selecting oncology practices to 

11 participate in the demonstration project under 

12 this section, the Secretary shall, to the extent 

13 practicable, include in such selection— 

14 ‘‘(i) small-, medium-, and large-sized 

15 practices; and 

16 ‘‘(ii) practices located in different geo17 graphic areas. 

18 ‘‘(B) INCLUSION OF SMALL ONCOLOGY

19 PRACTICES.—In selecting oncology practices to 

20 participate in the demonstration project under 

21 this section, the Secretary shall, to the extent 

22 practicable, ensure that at least 20 percent of 

23 the participating practices are small oncology 

24 practices (as determined by the Secretary). 


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1 ‘‘(4) NO PENALTY FOR CERTAIN OPT-OUTS BY

2 PRACTICES.—In the case that the Secretary selects 

3 an oncology practice to participate in the demonstra4 tion project under this section that has agreed to 

5 participate in a model established under section 

6 1115A for oncology services, such practice may not 

7 be assessed a penalty for electing not to participate 

8 in such model if the practice makes such election— 

9 ‘‘(A) prior to the receipt by the practice of 

10 any payment for such model that would not 

11 otherwise be paid in the absence of such model; 

12 and 

13 ‘‘(B) in order to participate in the dem14 onstration project under this section. 

15 ‘‘(e) MEASURES.— 

16 ‘‘(1) DEVELOPMENT.— 

17 ‘‘(A) IN GENERAL.—The Secretary shall 

18 use measures described in paragraph (2), and 

19 may use measures developed under paragraph 

20 (3), to assess the performance of each partici21 pating oncology practice, as compared to other 

22 participating oncology practices as described in 

23 paragraph (4)(A)(i). 

24 ‘‘(B) DETERMINATION OF MEASURES RE25 PORTED.—In determining measures to be reVerDate Sep 11 2014 05:52 Apr 05, 2017 Jkt 069200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1834.IH H1834

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1 ported under subsection (c)(6)(A), the Sec2 retary, in consultation with stakeholders, shall 

3 ensure that reporting under such subsection is 

4 not overly burdensome and that those measures 

5 required to be reported are aligned with appli6 cable requirements from other payors. 

7 ‘‘(2) MEASURES DESCRIBED.—The measures 

8 described in this paragraph, with respect to individ9 uals who are attributed to a participating oncology 

10 practice, as determined by the Secretary, are the fol11 lowing: 

12 ‘‘(A) PATIENT CARE MEASURES.— 

13 ‘‘(i) The percentage of such individ14 uals who receive documented clinical or 

15 pathologic staging prior to initiation of a 

16 first course of cancer treatment. 

17 ‘‘(ii) The percentage of such individ18 uals who undergo advanced imaging and 

19 have been diagnosed with stage I or II 

20 breast cancer. 

21 ‘‘(iii) The percentage of such individ22 uals who undergo advanced imaging and 

23 have been diagnosed with stage I or II 

24 prostate cancer. 


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1 ‘‘(iv) The percentage of such individ2 uals who, prior to receiving cancer treat3 ment, had their performance status as4 sessed by the practice. 

5 ‘‘(v) The percentage of such individ6 uals who— 

7 ‘‘(I) undergo treatment with a 

8 chemotherapy regimen provided by the 

9 practice; 

10 ‘‘(II) have at least a 20-percent 

11 risk of developing febrile neutropenia 

12 due to a combination of regimen risk 

13 and patient risk factors; and 

14 ‘‘(III) have received from the 

15 practice either GCSF or white cell 

16 growth factor. 

17 ‘‘(vi) With respect to such individuals 

18 who receive an oncology drug therapy from 

19 the practice, the percentage of such indi20 viduals who underwent a diagnostic test to 

21 identify specific biomarkers, genetic 

22 mutations, or characteristics prior to re23 ceiving an oncology drug therapy, where 

24 such a diagnostic test exists for a given 

25 cancer type. 


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1 ‘‘(vii) With respect to such individuals 

2 who receive chemotherapy treatment from 

3 the practice, the percentage of such indi4 viduals so treated who receive a treatment 

5 plan prior to the administration of such 

6 chemotherapy. 

7 ‘‘(viii) With respect to chemotherapy 

8 treatments administered to such individ9 uals by the practice, the percentage of such 

10 treatments that adhere to guidelines pub11 lished by the National Comprehensive Can12 cer Network or such other entity as the 

13 Secretary determines appropriate. 

14 ‘‘(ix) With respect to antiemetic drugs 

15 dispensed by the practice to individuals as 

16 part of moderately or highly emetogenic 

17 chemotherapy regimens for such individ18 uals, the extent to which such drugs are 

19 administered in accordance with evidence20 based guidelines or pathways that are com21 pliant with guidelines published by the Na22 tional Comprehensive Cancer Network or 

23 such other entity as the Secretary deter24 mines appropriate. 


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1 ‘‘(B) RESOURCE UTILIZATION MEAS2 URES.— 

3 ‘‘(i) With respect to emergency room 

4 visits in a year by such individuals who are 

5 receiving active chemotherapy treatment 

6 administered by the practice as of the date 

7 of such visits, the percentage of such visits 

8 that are associated with qualified cancer 

9 diagnoses of the individuals. 

10 ‘‘(ii) With respect to hospital admis11 sions in a year by such individuals who are 

12 receiving active chemotherapy treatment 

13 administered by the practice as of the date 

14 of such visits, the percentage of such ad15 missions that are associated with qualified 

16 cancer diagnoses of the individuals. 

17 ‘‘(C) SURVIVORSHIP MEASURES.— 

18 ‘‘(i) Survival rates for such individuals 

19 who have been diagnosed with stage I 

20 through IV breast cancer. 

21 ‘‘(ii) Survival rates for such individ22 uals who have been diagnosed with stage I 

23 through IV colorectal cancer. 


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1 ‘‘(iii) Survival rates for such individ2 uals who have been diagnosed with stage I 

3 through IV lung cancer. 

4 ‘‘(iv) With respect to such individuals 

5 who receive chemotherapy treatment from 

6 the practice, the percentage of such indi7 viduals so treated who receive a survivor8 ship plan not later than 45 days after the 

9 completion of the administration of such 

10 chemotherapy. 

11 ‘‘(v) With respect to such individuals 

12 who receive chemotherapy treatment from 

13 the practice, the percentage of such indi14 viduals who receive psychological screening. 

15 ‘‘(D) END-OF-LIFE CARE MEASURES.— 

16 ‘‘(i) The number of times that such 

17 an individual receives chemotherapy treat18 ment from the practice within an amount 

19 of time specified by the Secretary, in con20 sultation with stakeholders, prior to the 

21 death of the individual. 

22 ‘‘(ii) With respect to such individuals 

23 who have a stage IV disease and have re24 ceived treatment for such disease from the 

25 practice, the percentage of such individuals 


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1 so treated who have had a documented 

2 end-of-life care conversation with a physi3 cian in the practice or another health care 

4 provider who is a member of the cancer 

5 care team of the practice. 

6 ‘‘(iii) With respect to such an indi7 vidual who is referred to hospice care by a 

8 physician in the practice or a health care 

9 provider who is a member of the cancer 

10 care team of the practice, regardless of the 

11 setting in which such care is furnished, the 

12 average number of days that the individual 

13 receives hospice care prior to the death of 

14 the individual. 

15 ‘‘(iv) With respect to such individuals 

16 who die while receiving care from the prac17 tice, the percentage of such deceased indi18 viduals whose death occurred in an acute 

19 care setting. 

20 ‘‘(3) MODIFICATION OR ADDITION OF MEAS21 URES.— 

22 ‘‘(A) IN GENERAL.—The Secretary may, in 

23 consultation with appropriate stakeholders in a 

24 manner determined by the Secretary, modify, 


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1 replace, remove, or add to the measures de2 scribed in paragraph (2). 

3 ‘‘(B) APPROPRIATE STAKEHOLDERS DE4 SCRIBED.—For purposes of subparagraph (A), 

5 the term ‘appropriate stakeholders’ includes on6 cology societies, oncologists who furnish oncol7 ogy services to one or more individuals for 

8 which payment may be made under part B, al9 lied health professionals, health insurance 

10 issuers that have implemented alternative pay11 ment models for oncologists, patients and orga12 nizations that represent patients, and bio13 pharmaceutical and other medical technology 

14 manufacturers. 

15 ‘‘(4) ASSESSMENT.— 

16 ‘‘(A) IN GENERAL.—The Secretary shall, 

17 for each year in which the demonstration 

18 project is conducted, assess— 

19 ‘‘(i) the performance of each partici20 pating oncology practice for such year with 

21 respect to the measures on which the prac22 tice has agreed to report to the Secretary 

23 under subsection (c)(6)(A), as compared to 

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1 cology practices with respect to such meas2 ures; and 

3 ‘‘(ii) the extent to which each partici4 pating oncology practice has, during such 

5 year, used breakthrough or other best-in6 class therapies. 

7 ‘‘(B) PERFORMANCE STANDARDS.—The 

8 Secretary shall, in consultation with the appro9 priate stakeholders described in paragraph 

10 (3)(B) in a manner determined by the Sec11 retary, develop performance standards with re12 spect to— 

13 ‘‘(i) each of the measures described in 

14 paragraph (2), including those measures as 

15 modified or added under paragraph (3); 

16 and 

17 ‘‘(ii) the patient experience of care on 

18 which participating oncology practices 

19 agree to report to the Secretary under sub20 section (c)(6)(B). 

21 ‘‘(f) PAYMENTS FOR PARTICIPATING ONCOLOGY

22 PRACTICES AND ONCOLOGISTS.— 

23 ‘‘(1) CARE COORDINATION MANAGEMENT FEE

24 DURING FIRST TWO YEARS OF DEMONSTRATION

25 PROJECT.— 


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1 ‘‘(A) IN GENERAL.—The Secretary shall, 

2 in addition to any other payments made by the 

3 Secretary under this title to a participating on4 cology practice, pay a care coordination man5 agement fee to each such practice at each of the 

6 times specified in subparagraph (B). 

7 ‘‘(B) TIMING OF PAYMENTS.—The care co8 ordination management fee described in sub9 paragraph (A) shall be paid to a participating 

10 oncology practice at the end of each of the fol11 lowing periods: 

12 ‘‘(i) The period that ends 6 months 

13 after the date on which the practice’s 

14 agreement period for the demonstration 

15 project begins, as determined by the Sec16 retary. 

17 ‘‘(ii) The period that ends 12 months 

18 after the date on which the practice’s 

19 agreement period for the demonstration 

20 project begins, as determined by the Sec21 retary. 

22 ‘‘(iii) Subject to subsection (c)(7)— 

23 ‘‘(I) the period that ends 18 

24 months after the date on which the 

25 practice’s agreement period for the 


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1 demonstration project begins, as de2 termined by the Secretary; and 

3 ‘‘(II) the period that ends 24 

4 months after the date on which the 

5 practice’s agreement period for the 

6 demonstration project begins, as de7 termined by the Secretary. 

8 ‘‘(C) AMOUNT OF PAYMENT.—The Sec9 retary shall, in consultation with oncologists 

10 who furnish oncology services for which pay11 ment may be made under part B in a manner 

12 determined by the Secretary, determine the 

13 amount of the care coordination management 

14 fee described in subparagraph (A). 

15 ‘‘(2) PERFORMANCE INCENTIVE PAYMENTS.— 

16 ‘‘(A) IN GENERAL.—Subject to subpara17 graphs (C) and (E), the Secretary shall, in ad18 dition to any other payments made by the Sec19 retary under this title to a participating oncol20 ogy practice, pay a performance incentive pay21 ment to each such practice for each year of the 

22 demonstration project described in subpara23 graph (B). 

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1 paragraph (A) shall be paid to a participating 

2 oncology practice as soon as practicable fol3 lowing the end of the third, fourth, and fifth 

4 years of the demonstration project. 

5 ‘‘(C) SOURCE OF PAYMENTS.—Perform6 ance incentive payments made to participating 

7 oncology practices under subparagraph (A) for 

8 each of the years of the demonstration project 

9 described in subparagraph (B) shall be paid 

10 from the aggregate pool available for making 

11 payments for each such year determined under 

12 subparagraph (D), as available for each such 

13 year. 

14 ‘‘(D) AGGREGATE POOL AVAILABLE FOR

15 MAKING PAYMENTS.—With respect to each of 

16 the years of the demonstration project described 

17 in subparagraph (B), the aggregate pool avail18 able for making performance incentive pay19 ments for each such year shall be determined 

20 by— 

21 ‘‘(i) estimating the amount by which 

22 the aggregate expenditures that would 

23 have been expended for the year under 

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1 pating oncology practices if the demonstra2 tion project had not been implemented ex3 ceeds such aggregate expenditures for such 

4 individuals for such year of the demonstra5 tion project; 

6 ‘‘(ii) calculating the amount that is 

7 half of the amount estimated under clause 

8 (i); and 

9 ‘‘(iii) subtracting from the amount 

10 calculated under clause (ii) the total 

11 amount of payments made under para12 graph (1) that have not, in a prior applica13 tion of this clause, previously been so sub14 tracted from a calculation made under 

15 clause (ii). 

16 ‘‘(E) AMOUNT OF PAYMENTS TO INDI17 VIDUAL PRACTICES THAT MEET PERFORMANCE

18 STANDARDS AND ACHIEVE SAVINGS.— 

19 ‘‘(i) PAYMENTS ONLY TO PRACTICES

20 THAT MEET PERFORMANCE STANDARDS.— 

21 The Secretary may not make performance 

22 incentive payments to a participating on23 cology practice under subparagraph (A) 

24 with respect to a year of the demonstration 

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1 less the practice meets or exceeds the per2 formance standards developed under sub3 section (e)(4)(B) for the year with respect 

4 to— 

5 ‘‘(I) the measures on which the 

6 practice has agreed to report to the 

7 Secretary under subsection (c)(6)(A); 

8 and 

9 ‘‘(II) the patient experience of 

10 care on which the practice has agreed 

11 to report to the Secretary under sub12 section (c)(6)(B). 

13 ‘‘(ii) CONSIDERATION OF PERFORM14 ANCE ASSESSMENT.—The Secretary shall, 

15 in consultation with the appropriate stake16 holders described in subsection (e)(3)(B) in 

17 a manner determined by the Secretary, de18 termine the amount of a performance in19 centive payment to a participating oncol20 ogy practice under subparagraph (A) for a 

21 year of the demonstration project described 

22 in subparagraph (B). In making a deter23 mination under the preceding sentence, the 

24 Secretary shall take into account the per25 formance assessment of the practice under 


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1 subsection (e)(4)(A) with respect to the 

2 year and the aggregate pool available for 

3 making payments for such year determined 

4 under subparagraph (D), as available for 

5 such year. 

6 ‘‘(3) ISSUANCE OF GUIDANCE.—Not later than 

7 the date that is 12 months after the date of the en8 actment of this section, the Secretary shall issue 

9 guidance detailing the methodology that the Sec10 retary will use to implement subparagraphs (D) and 

11 (E) of paragraph (2). 

12 ‘‘(g) SECRETARY REPORTS TO PARTICIPATING ON13 COLOGY PRACTICES.—The Secretary shall inform each 

14 participating oncology practice, on a periodic (such as 

15 quarterly) basis, of— 

16 ‘‘(1) the performance of the practice with re17 spect to the measures on which the practice has 

18 agreed to report to the Secretary under subsection 

19 (c)(6)(A); and 

20 ‘‘(2) the estimated amount by which the ex21 penditures that would have been expended under 

22 parts A and B for items and services furnished to 

23 individuals attributed to the practice if the dem24 onstration project had not been implemented exceeds 

25 the actual expenditures for such individuals. 


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1 ‘‘(h) APPLICATIONS FROM ENTITIES TO PROVIDE

2 ACCREDITATIONS.—Not later than the date that is 18 

3 months after the date of the enactment of this section, 

4 the Secretary shall establish a process for the acceptance 

5 and consideration of applications from entities for pur6 poses of determining which entities may provide accredita7 tion to practices under subsection (c)(4) in addition to the 

8 entities described in such subsection. 

9 ‘‘(i) REVISIONS TO DEMONSTRATION PROJECT.—The 

10 Secretary may make appropriate revisions to the dem11 onstration project under this section in order for partici12 pating oncology practices under such demonstration 

13 project to meet the definition of an eligible alternative pay14 ment entity for purposes of section 1833(z). 

15 ‘‘(j) WAIVER AUTHORITY.—The Secretary may waive 

16 such provisions of this title and title XI as the Secretary 

17 determines necessary in order to implement the dem18 onstration project under this section. 

19 ‘‘(k) ADMINISTRATION.—Chapter 35 of title 44, 

20 United States Code, shall not apply to this section.’’. 

Æ 


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