I 

114TH CONGRESS 

1ST SESSION H. R. 1934 

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 

APRIL 22, 2015 

Mrs. MCMORRIS RODGERS (for herself and Mr. ISRAEL) 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, 


SSpencer on DSK4SPTVN1PROD with BILLS
2 

•HR 1934 IH

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Cancer Care Payment 

3 Reform Act of 2015’’. 

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 six 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— 


SSpencer on DSK4SPTVN1PROD with BILLS
3 

•HR 1934 IH

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

2 participate in the demonstration program 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 program; and 

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

8 affiliated with a hospital, that submitted a claim for 

9 reimbursement in the prior year for an item or serv10 ice for 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 program 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 medical professionals 

21 (including oncology nurses) inside or outside the 

22 practice in order to ensure that each such individual 

23 receives coordinated care; 

24 ‘‘(3) meaningfully uses electronic health 

25 records; 


SSpencer on DSK4SPTVN1PROD with BILLS
4 

•HR 1934 IH

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 submits an application to the Secretary 

13 under subsection (b)(1), submit an application to an 

14 entity described in paragraph (4) for accreditation 

15 as an Oncology Medical Home in accordance with 

16 such paragraph; 

17 ‘‘(6) will, for each year in which demonstration 

18 project is conducted, report to the Secretary, in such 

19 form and manner as is specified by the Secretary, 

20 on— 

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

22 respect to not less than ten of the measures de23 scribed in subsection (e), as selected by the 

24 practice; and 


SSpencer on DSK4SPTVN1PROD with BILLS
5 

•HR 1934 IH

1 ‘‘(B) the level of satisfaction of individuals 

2 who are provided with oncology services by the 

3 practice for which payment may be made under 

4 part B, as measured by a patient satisfaction 

5 survey based on the Consumer Assessment of 

6 Healthcare Providers and Systems survey or by 

7 such similar survey as the Secretary determines 

8 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 submits the application 

16 described in this subsection to the Secretary; 

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

18 project, meet the minimum performance require19 ments developed under subsection (e)(4)(B) with re20 spect to each of the measures on which the practice 

21 has agreed to report under paragraph (6)(A); and 

22 ‘‘(9) has the capacity to utilize shared decision23 making tools that facilitate the incorporation of the 

24 patient needs, preferences, and circumstances of an 

25 individual into the medical plan of the individual and 


SSpencer on DSK4SPTVN1PROD with BILLS
6 

•HR 1934 IH

1 that maintain provider flexibility to tailor care of the 

2 individual based on the full range of test and treat3 ment options available to the individual. 

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

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

6 later than six months after the date of the enact7 ment of this section, select oncology practices that 

8 submit applications to the Secretary in accordance 

9 with subsection (c) to participate in the demonstra10 tion program. 

11 ‘‘(2) MAXIMUM NUMBER OF PRACTICES.—In se12 lecting an oncology practice to participate in the 

13 demonstration program under paragraph (1), the 

14 Secretary shall ensure that the participation of such 

15 practice in the demonstration project does not, on 

16 the date on which the practice commences its par17 ticipation in the demonstration project, increase the 

18 total number of oncologists who participate in the 

19 demonstration program to a number that is greater 

20 than 1,500 oncologists. 

21 ‘‘(3) DIVERSITY OF PRACTICES.—In selecting 

22 oncology practices to participate in the demonstra23 tion project under paragraph (1), the Secretary 

24 shall, to the extent practicable, include in such selec25 tion— 


SSpencer on DSK4SPTVN1PROD with BILLS
7 

•HR 1934 IH

1 ‘‘(A) small-, medium-, and large-sized 

2 practices; and 

3 ‘‘(B) practices located in different geo4 graphic areas. 

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

6 PRACTICES.—In the case that the Secretary selects 

7 an oncology practice to participate in the demonstra8 tion project under paragraph (1) that has agreed to 

9 participate in another model, under section 1115A 

10 or otherwise, for payment under this title for oncol11 ogy services, such practice may not be assessed a 

12 penalty for electing not to participate in such other 

13 payment model if such practice makes such elec14 tion— 

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

16 any payment under such model; and 

17 ‘‘(B) in order to participate in such dem18 onstration project. 

19 ‘‘(e) MEASURES.— 

20 ‘‘(1) DEVELOPMENT.—The Secretary shall use 

21 measures described in paragraph (2), and may use 

22 measures developed under paragraph (3), to assess 

23 the performance of each participating oncology prac24 tice, as compared to other participating oncology 

25 practices. 


SSpencer on DSK4SPTVN1PROD with BILLS
8 

•HR 1934 IH

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

2 described in this paragraph, with respect to individ3 uals who receive treatment for cancer from a partici4 pating oncology practice, are the following: 

5 ‘‘(A) PATIENT CARE MEASURES.— 

6 ‘‘(i) The percentage of such individ7 uals that receives documented clinical or 

8 pathologic staging prior to initiation of a 

9 first course of cancer treatment. 

10 ‘‘(ii) The percentage of such individ11 uals that is undergoing advanced imaging 

12 and has been diagnosed with stage I or II 

13 breast cancer. 

14 ‘‘(iii) The percentage of such individ15 uals that is undergoing advanced imaging 

16 and has been diagnosed with stage I or II 

17 prostate cancer. 

18 ‘‘(iv) The percentage of such individ19 uals that, prior to receiving cancer treat20 ment, had its performance status assessed 

21 by the practice. 

22 ‘‘(v) The percentage of such individ23 uals that— 


SSpencer on DSK4SPTVN1PROD with BILLS
9 

•HR 1934 IH

1 ‘‘(I) is undergoing treatment with 

2 a chemotherapy regimen provided by 

3 the practice; 

4 ‘‘(II) has at least a 20-percent 

5 risk of developing febrile neutropenia 

6 due to a combination of regimen risk 

7 and patient risk factors; and 

8 ‘‘(III) has received from the 

9 practice either GCSF or white cell 

10 growth factor. 

11 ‘‘(vi) With respect to such individuals 

12 who receive chemotherapy treatment from 

13 the practice, the percentage of such indi14 viduals so treated that receives a treatment 

15 plan prior to the administration of such 

16 chemotherapy. 

17 ‘‘(vii) With respect to chemotherapy 

18 treatments administered to such individ19 uals by the practice, the percentage of such 

20 treatments that adhere to guidelines pub21 lished by the National Comprehensive Can22 cer Network or such other entity as the 

23 Secretary determines appropriate. 

24 ‘‘(viii) With respect to antiemetic 

25 drugs dispensed by the practice to individVerDate Sep 11 2014 07:41 Apr 29, 2015 Jkt 049200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1934.IH H1934

SSpencer on DSK4SPTVN1PROD with BILLS
10 

•HR 1934 IH

1 uals as part of moderately or highly 

2 emetogenic chemotherapy regimens for 

3 such individuals, the extent to which such 

4 drugs are administered in accordance with 

5 evidence-based guidelines or pathways that 

6 are compliant with guidelines published by 

7 the National Comprehensive Cancer Net8 work or such other entity as the Secretary 

9 determines appropriate. 

10 ‘‘(B) RESOURCE UTILIZATION MEAS11 URES.— 

12 ‘‘(i) With respect to emergency room 

13 visits in a year by such individuals who are 

14 receiving active chemotherapy treatment 

15 administered by the practice as of the date 

16 of such visits, the percentage of such visits 

17 that is associated with qualified cancer di18 agnoses of the individuals. 

19 ‘‘(ii) With respect to hospital admis20 sions in a year by such individuals who are 

21 receiving active chemotherapy treatment 

22 administered by the practice as of the date 

23 of such visits, the percentage of such ad24 missions that is associated with qualified 

25 cancer diagnoses of the individuals. 


SSpencer on DSK4SPTVN1PROD with BILLS
11 

•HR 1934 IH

1 ‘‘(C) SURVIVORSHIP MEASURES.— 

2 ‘‘(i) Survival rates for such individuals 

3 who have been diagnosed with stage I 

4 through IV breast cancer. 

5 ‘‘(ii) Survival rates for such individ6 uals who have been diagnosed with stage I 

7 through IV colorectal cancer. 

8 ‘‘(iii) Survival rates for such individ9 uals who have been diagnosed with stage I 

10 through IV lung cancer. 

11 ‘‘(iv) With respect to such individuals 

12 who receive chemotherapy treatment from 

13 the practice, the percentage of such indi14 viduals so treated that receives a survivor15 ship plan not later than 45 days after the 

16 completion of the administration of such 

17 chemotherapy to such individuals. 

18 ‘‘(v) With respect to such individuals 

19 who receive chemotherapy treatment from 

20 the practice, the percentage of such indi21 viduals that receives psychological screen22 ing. 

23 ‘‘(D) END-OF-LIFE CARE MEASURES.— 

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

25 an individual receives chemotherapy treatVerDate Sep 11 2014 07:41 Apr 29, 2015 Jkt 049200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1934.IH H1934

SSpencer on DSK4SPTVN1PROD with BILLS
12 

•HR 1934 IH

1 ment from the practice not later than 30 

2 days prior to the death of the individual. 

3 ‘‘(ii) With respect to such individuals 

4 who have a stage IV disease and have re5 ceived treatment for such disease from the 

6 practice, the percentage of such individuals 

7 so treated who have had a documented 

8 end-of-life care conversation with a physi9 cian in the practice or another health care 

10 provider who is a member of the cancer 

11 care team of the practice. 

12 ‘‘(iii) With respect to such an indi13 vidual who is referred to hospice care by a 

14 physician in the practice or a health care 

15 provider who is a member of the cancer 

16 care team of the practice, regardless of the 

17 setting in which such care is provided, the 

18 average number of days that the individual 

19 receives hospice care prior to the death of 

20 the individual. 

21 ‘‘(iv) With respect to such individuals 

22 who die while receiving care from the prac23 tice, the percentage of such deceased indi24 viduals whose death occurred in an acute 

25 care setting. 


SSpencer on DSK4SPTVN1PROD with BILLS
13 

•HR 1934 IH

1 ‘‘(3) MODIFICATION OR ADDITION OF MEAS2 URES.— 

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

4 conjunction with appropriate stakeholders, mod5 ify or add to the measures described in para6 graph (2). 

7 ‘‘(B) APPROPRIATE STAKEHOLDERS DE8 SCRIBED.—For purposes of subparagraph (A), 

9 the term ‘appropriate stakeholders’ includes on10 cology societies, oncologists who provide oncol11 ogy services to one or more individuals for 

12 which payment may be made under part B, al13 lied health professionals, health insurance 

14 issuers that have implemented alternative pay15 ment models for oncologists, patients and orga16 nizations that represent patients, and bio17 pharmaceutical and other medical technology 

18 manufacturers. 

19 ‘‘(4) ASSESSMENT.— 

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

21 for each year in which the demonstration 

22 project is conducted, assess— 

23 ‘‘(i) the performance of each partici24 pating oncology practice for such year with 

25 respect to the measures on which the pracVerDate Sep 11 2014 07:41 Apr 29, 2015 Jkt 049200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1934.IH H1934

SSpencer on DSK4SPTVN1PROD with BILLS
14 

•HR 1934 IH

1 tice has agreed to report to the Secretary 

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

3 the performance of other participating on4 cology practices with respect to such meas5 ures; and 

6 ‘‘(ii) the extent to which the practice 

7 has, during such year, used breakthrough 

8 or other best-in-class therapies. 

9 ‘‘(B) MINIMUM PERFORMANCE REQUIRE10 MENTS.—The Secretary shall, in conjunction 

11 with the appropriate stakeholders described in 

12 paragraph (3)(B), develop minimum perform13 ance requirements with respect to— 

14 ‘‘(i) each of the measures developed 

15 under this subsection; and 

16 ‘‘(ii) the level of satisfaction on which 

17 practices agree to report to the Secretary 

18 under subsection (c)(6)(B). 

19 ‘‘(f) PAYMENTS FOR PARTICIPATING

20 ONCOLOGISTS.— 

21 ‘‘(1) CARE COORDINATION MANAGEMENT

22 FEE.— 

23 ‘‘(A) IN GENERAL.—Subject to subpara24 graphs (D) and (E), the Secretary shall, in ad25 dition to any other payments made by the SecVerDate Sep 11 2014 07:41 Apr 29, 2015 Jkt 049200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H1934.IH H1934

SSpencer on DSK4SPTVN1PROD with BILLS
15 

•HR 1934 IH

1 retary under this title to a participating oncol2 ogy practice, make payment of a care coordina3 tion management fee to each such practice. 

4 ‘‘(B) TIMING OF PAYMENTS.—The care co5 ordination management fee described in sub6 paragraph (A) shall be paid to a participating 

7 oncology practice at the end of each of the fol8 lowing periods: 

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

10 after the date on which the practice sub11 mits the application described in sub12 section (c) to the Secretary under sub13 section (b)(1). 

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

15 after the date on which the practice sub16 mits such application to the Secretary. 

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

18 ‘‘(I) the period that ends 18 

19 months after the date on which the 

20 practice submits such application to 

21 the Secretary; and 

22 ‘‘(II) the period that ends 24 

23 months after the date on which the 

24 practice submits such application to 

25 the Secretary. 


SSpencer on DSK4SPTVN1PROD with BILLS
16 

•HR 1934 IH

1 ‘‘(C) AMOUNT OF PAYMENT.—The amount 

2 of the care coordination management fee de3 scribed in subparagraph (A) shall be deter4 mined by the Secretary in conjunction with 

5 oncologists who provide oncology services for 

6 which payment may be made under part B. 

7 ‘‘(2) PAYMENT IN SUBSEQUENT YEARS.— 

8 ‘‘(A) IN GENERAL.—Subject to subpara9 graphs (C) and (D), the Secretary shall make 

10 payments of an ongoing management fee to 

11 each participating oncology practice. 

12 ‘‘(B) TIMING OF PAYMENTS.—The ongoing 

13 management fee described in subparagraph (A) 

14 shall be paid to a participating oncology prac15 tice at the end of the third, fourth, and fifth 

16 years of the demonstration project. 

17 ‘‘(C) AGGREGATE AMOUNT OF PAY18 MENTS.—With respect to each of the dates of 

19 payment described in subparagraph (B), the ag20 gregate amount of payments to participating 

21 oncology practices on such date shall be deter22 mined by— 

23 ‘‘(i) determining the amount by which 

24 the aggregate expenditures that would 

25 have been expended for the previous year 


SSpencer on DSK4SPTVN1PROD with BILLS
17 

•HR 1934 IH

1 under this title if the demonstration 

2 project had not been implemented exceeds 

3 the aggregate expenditures under this title 

4 for such previous year; 

5 ‘‘(ii) calculating the amount that is 

6 half of the amount determined under 

7 clause (i); and 

8 ‘‘(iii) subtracting from the amount 

9 calculated under clause (ii) the total 

10 amount of payments made under para11 graph (1) that have not, in a prior applica12 tion of this clause, previously been so sub13 tracted from a payment determination 

14 made under this subparagraph. 

15 ‘‘(D) AMOUNT OF PAYMENTS TO INDI16 VIDUAL PRACTICES.— 

17 ‘‘(i) MINIMUM PERFORMANCE RE18 QUIREMENTS.—The Secretary may not 

19 make payments to a practice under sub20 paragraph (A) at the end of a year of the 

21 demonstration project described in sub22 paragraph (B) unless the practice meets or 

23 exceeds the minimum performance require24 ments developed under subsection 

25 (e)(4)(B) for such year with respect to— 


SSpencer on DSK4SPTVN1PROD with BILLS
18 

•HR 1934 IH

1 ‘‘(I) the measures on which the 

2 practice has agreed to report to the 

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

4 and 

5 ‘‘(II) the level of satisfaction on 

6 which the practice has agreed to re7 port to the Secretary under subsection 

8 (c)(6)(B). 

9 ‘‘(ii) CONSIDERATION OF PERFORM10 ANCE ASSESSMENT.—The Secretary shall, 

11 in conjunction with the appropriate stake12 holders described in subsection (e)(3)(B), 

13 determine the amount of a payment to an 

14 individual oncology practice under subpara15 graph (A) for a year. In making a deter16 mination under the preceding sentence, the 

17 Secretary shall take into account the per18 formance assessment of the practice under 

19 subsection (e)(4)(A) for the previous year, 

20 as compared to the performance assess21 ment of other participating oncology prac22 tices under such subsection for such pre23 vious year. 

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

25 the date that is six months after the date of the enVerDate Sep 11 2014 07:41 Apr 29, 2015 Jkt 049200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H1934.IH H1934

SSpencer on DSK4SPTVN1PROD with BILLS
19 

•HR 1934 IH

1 actment of this section, the Secretary shall issue 

2 guidance detailing the methodology that the Sec3 retary will use to implement subparagraphs (C) and 

4 (D) of paragraph (2). 

5 ‘‘(g) SECRETARY REPORTS TO PARTICIPATING ON6 COLOGY PRACTICES.—The Secretary shall inform each 

7 participating oncology practice, on a quarterly basis, of— 

8 ‘‘(1) the performance of the practice during the 

9 prior quarter with respect to the measures on which 

10 the practice has agreed to report to the Secretary 

11 under subsection (c)(6)(A); and 

12 ‘‘(2) the amount by which the expenditures that 

13 would have been expended for the prior quarter 

14 under this title by a typical oncology practice if the 

15 demonstration project had not been implemented ex16 ceeds the actual expenditures by the participating 

17 oncology practice under this title for such quarter. 

18 ‘‘(h) APPLICATIONS FROM ENTITIES TO PROVIDE

19 ACCREDITATIONS.—Not later than the date that is six 

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

21 the Secretary shall establish a process for the acceptance 

22 and consideration of applications from entities for pur23 poses of determining which entities may provide accredita24 tion to practices under subsection (c)(4) in addition to the 

25 entities described in such subsection. 


SSpencer on DSK4SPTVN1PROD with BILLS
20 

•HR 1934 IH

1 ‘‘(i) GAO REPORT.—Not later than June 1, 2019, 

2 the Comptroller General of the United States shall submit 

3 a report to Congress evaluating the success of the dem4 onstration project that includes an assessment of the im5 pact of the project upon the quality and cost-efficiency of 

6 oncology services furnished to individuals under this title, 

7 including an assessment of the satisfaction of such individ8 uals with respect to such services that were furnished 

9 under such project. Such report shall include rec10 ommendations regarding the possible expansion of the 

11 demonstration project, as well as any possible reforms that 

12 are based on the demonstration project that can be made 

13 to the program under this title with respect to payment 

14 for cancer care.’’. 

Æ 


SSpencer on DSK4SPTVN1PROD with BILLS