II 

110TH CONGRESS 

1ST SESSION S. 1750 

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 

JULY 9, 2007 

Mr. SPECTER (for himself and Mr. CASEY) 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 2007’’. 

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. Application of average sales price payment methodology. 

Sec. 3. Increase in Medicare part B reimbursement for certain chemotherapy 

administration. 

Sec. 4. Provisions for the appropriate reporting and billing of physicians’ services associated with pharmacy facilities management and medical oncology treatment planning. 


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1 SEC. 2. APPLICATION OF AVERAGE SALES PRICE PAYMENT 

2 METHODOLOGY. 

3 (a) REQUIRING MONTHLY AND NOT QUARTERLY DE4 TERMINATIONS.— 

5 (1) IN GENERAL.—Section 1847A(c) of the So6 cial Security Act (42 U.S.C. 1395w–3a(c)) is 

7 amended— 

8 (A) in paragraph (1)— 

9 (i) in the matter preceding subpara10 graph (A) and in subparagraph (A), by 

11 striking ‘‘calendar quarter’’ and inserting 

12 ‘‘month’’ each place it appears; and 

13 (ii) in subparagraph (B), by striking 

14 ‘‘quarter’’ and inserting ‘‘month’’; 

15 (B) in paragraph (4)— 

16 (i) in the heading, by striking ‘‘QUAR17 TER’’ and inserting ‘‘MONTH’’; and 

18 (ii) by striking ‘‘calendar quarter’’ 

19 and inserting ‘‘month’’; and 

20 (C) in paragraph (5)— 

21 (i) in subparagraph (A), by striking 

22 ‘‘quarterly’’ and inserting ‘‘monthly’’ each 

23 place it appears; and 

24 (ii) by amending subparagraph (B) to 

25 read as follows: 


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1 ‘‘(B) UPDATES IN PAYMENT AMOUNTS.— 

2 The payment amounts under subsection (b) 

3 shall be updated and applied by the Secretary 

4 based upon the manufacturer’s average sales 

5 price for a drug or biological calculated for the 

6 most recent month for which data are available. 

7 This update shall be made no later than two 

8 months following publication of such data by 

9 the manufacturer.’’. 

10 (2) EFFECTIVE DATE.—The amendments made 

11 by paragraph (1) shall apply to payment amounts 

12 for months beginning on or after January 1, 2008. 

13 (b) ADJUSTMENT TO AVERAGE SALES PRICE CAL14 CULATION.— 

15 (1) IN GENERAL.—Section 1847A(c) of such 

16 Act (42 U.S.C. 1395w–3(a)(c)) is further amended 

17 in paragraph (3)— 

18 (A) in the first sentence, by striking 

19 ‘‘prompt pay discounts,’’; and 

20 (B) in the second sentence, by inserting 

21 ‘‘(other than prompt pay discounts),’’ after 

22 ‘‘other price concessions,’’. 

23 (2) EFFECTIVE DATE.—The amendments made 

24 by paragraph (1) shall apply to payment amounts 

25 for months beginning on or after January 1, 2008. 


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1 SEC. 3. INCREASE IN MEDICARE PART B REIMBURSEMENT 

2 FOR CERTAIN CHEMOTHERAPY ADMINISTRA3 TION. 

4 (a) IN GENERAL.—Section 1848(a) of the Social Se5 curity Act (42 U.S.C. 1395w–4(a)) is amended by adding 

6 at the end the following new paragraph: 

7 ‘‘(5) SPECIAL RULE FOR CERTAIN CHEMO8 THERAPY ADMINISTRATION.— 

9 ‘‘(A) IN GENERAL.—In the case of Medi10 care chemotherapy administration services fur11 nished on or after January 1, 2008, the fee 

12 schedule amount to be applied shall be equal to 

13 the following: 

14 ‘‘(i) FIRST HOUR OF CHEMOTHERAPY

15 INFUSIONS.—For such services described 

16 in clause (i), (ii), or (iii) of subparagraph 

17 (B), an amount equal to 132 percent of 

18 the fee schedule amount otherwise applica19 ble under this section (without regard to 

20 this paragraph) for such respective serv21 ices. 

22 ‘‘(ii) SUBSEQUENT HOURS OF CHEMO23 THERAPY INFUSIONS.—For such services 

24 described in clause (iv) or (v) of subpara25 graph (B), an amount equal to 70 percent 

26 of the amount determined under clause (i) 


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1 for services described in clause (i) or (iii), 

2 respectively, of such subparagraph. 

3 ‘‘(B) MEDICARE CHEMOTHERAPY ADMINIS4 TRATION SERVICES DEFINED.—For purposes of 

5 this paragraph, the term ‘Medicare chemo6 therapy administration services’ means physi7 cians’ services identified, as of January 1, 

8 2007, by any of the following codes (or any suc9 cessor to such a code as identified by the Sec10 retary) for which payments are made under 

11 subsection (b): 

12 ‘‘(i) CPT code 96413 (relating to in13 travenous infusions of initial drug up to 

14 one hour). 

15 ‘‘(ii) CPT code 96417 (relating to ad16 ditional, sequential intravenous infusions of 

17 different drugs up to one hour). 

18 ‘‘(iii) CPT code 96422 (relating to 

19 inter-arterial infusions for up to one hour). 

20 ‘‘(iv) CPT code 96415 (relating to in21 travenous infusions for subsequent hours). 

22 ‘‘(v) CPT code 96423 (relating to 

23 inter-arterial infusions for subsequent 

24 hours).’’. 


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1 SEC. 4. PROVISIONS FOR THE APPROPRIATE REPORTING 

2 AND BILLING OF PHYSICIANS’ SERVICES AS3 SOCIATED WITH PHARMACY FACILITIES MAN4 AGEMENT AND MEDICAL ONCOLOGY TREAT5 MENT PLANNING. 

6 (a) IN GENERAL.—Section 1848(c)(2) of the Social 

7 Security Act (42 U.S.C. 1395w–4(c)(2)) is amended— 

8 (1) in subparagraph (B)(iv)— 

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

10 (B) in subclause (III), by striking the pe11 riod; and 

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

13 subclauses: 

14 ‘‘(IV) subparagraph (K) insofar 

15 as it relates to a physician fee sched16 ule for 2008 and each subsequent 

17 year shall not be taken into account in 

18 applying clause (ii)(II) for drug ad19 ministration services under the fee 

20 schedule for such year; and 

21 ‘‘(V) subparagraph (L) insofar as 

22 it relates to a physician fee schedule 

23 for 2008 and each subsequent year 

24 shall not be taken into account in ap25 plying clause (ii)(II) for medical on26 cology treatment planning services 


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1 under the fee schedule for such 

2 year.’’; and 

3 (2) by adding at the end the following new sub4 paragraphs: 

5 ‘‘(K) ADJUSTMENT IN PAYMENT RATES

6 FOR PHARMACY FACILITIES MANAGEMENT

7 COSTS.—In establishing the physician fee 

8 schedule under subsection (b) with respect to 

9 payments for drug administration services fur10 nished on or after January 1, 2008, and in 

11 order to take into account pharmacy facilities 

12 management costs, the Secretary shall provide 

13 for an additional payment for such services in 

14 an amount equal to 2 percent of the amount de15 termined under section 1847A for the drug ad16 ministered. 

17 ‘‘(L) PROVISIONS FOR THE APPROPRIATE

18 REPORTING AND BILLING OF PHYSICIANS’ 

19 SERVICES ASSOCIATED WITH PHARMACY FACILI20 TIES MANAGEMENT AND MEDICAL ONCOLOGY

21 TREATMENT PLANNING.— 

22 ‘‘(i) CREATION OF NEW CPT CODES.— 

23 ‘‘(I) PHARMACY FACILITIES MAN24 AGEMENT.—Not later than one year 

25 after the date of the enactment of this 


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1 subparagraph, in carrying out sub2 paragraph (K), the Secretary shall 

3 issue appropriate CPT codes for the 

4 reporting and billing of pharmacy fa5 cilities management services that 

6 would correspond to the additional 

7 payment provided under subparagraph 

8 (K). 

9 ‘‘(II) MEDICAL ONCOLOGY

10 TREATMENT PLANNING.—Not later 

11 than one year after the date of the en12 actment of this subparagraph, the 

13 Secretary shall issue two new CPT 

14 codes, one moderate and one complex, 

15 for the reporting and billing of med16 ical oncology treatment planning serv17 ices furnished by physicians and other 

18 professional staff in the specialties of 

19 hematology, hematology-oncology, and 

20 medical oncology. 

21 ‘‘(ii) USE OF EXISTING PROCESSES.— 

22 In carrying out clause (i), the Secretary 

23 shall use existing processes for the imple24 mentation of such coding changes, as ap25 propriate. 


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1 ‘‘(iii) CONSULTATION.—In carrying 

2 out clause (i), the Secretary shall consult 

3 with representatives of physicians in the 

4 specialties of hematology, hematology-on5 cology, and medical oncology affected by 

6 the adoption of such coding changes.’’. 

Æ 


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