I 

110TH CONGRESS 

1ST SESSION H. R. 1190 

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

community cancer care by Medicare beneficiaries. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 27, 2007 

Mr. DAVIS of Alabama (for himself and Mr. RAMSTAD) 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 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. 


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

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

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 


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1 (ii) by amending subparagraph (B) to 

2 read as follows: 

3 ‘‘(B) UPDATES IN PAYMENT AMOUNTS.— 

4 The payment amounts under subsection (b) 

5 shall be updated and applied by the Secretary 

6 based upon the manufacturer’s average sales 

7 price for a drug or biological calculated for the 

8 most recent month for which data are available. 

9 This update shall be made no later than two 

10 months following publication of such data by 

11 the manufacturer.’’. 

12 (2) EFFECTIVE DATE.—The amendments made 

13 by paragraph (1) shall apply to payment amounts 

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

15 (b) ADJUSTMENT TO AVERAGE SALES PRICE CAL16 CULATION.— 

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

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

19 in paragraph (3)— 

20 (A) in the first sentence, by striking 

21 ‘‘prompt pay discounts,’’; and 

22 (B) in the second sentence, by inserting 

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

24 ‘‘other price concessions,’’. 


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1 (2) EFFECTIVE DATE.—The amendments made 

2 by paragraph (1) shall apply to payment amounts 

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

4 SEC. 3. INCREASE IN MEDICARE PART B REIMBURSEMENT 

5 FOR CERTAIN CHEMOTHERAPY ADMINISTRA6 TION. 

7 (a) IN GENERAL.—Section 1848(a) of the Social Se8 curity Act (42 U.S.C. 1395w–4(a)) is amended by adding 

9 at the end the following new paragraph: 

10 ‘‘(5) SPECIAL RULE FOR CERATIN CHEMO11 THERAPY ADMINISTRATION.— 

12 ‘‘(A) IN GENERAL.—In the case of Medi13 care chemotherapy administration services fur14 nished on or after January 1, 2008, the fee 

15 schedule amount to be applied shall be equal to 

16 the following: 

17 ‘‘(i) FIRST HOUR OF CHEMOTHERAPY

18 INFUSIONS.—For such services described 

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

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

21 the fee schedule amount otherwise applica22 ble under this section (without regard to 

23 this paragraph) for such respective serv24 ices. 


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1 ‘‘(ii) SUBSEQUENT HOURS OF CHEMO2 THERAPY INFUSIONS.—For such services 

3 described in clause (iv) or (v) of subpara4 graph (B), an amount equal to 70 percent 

5 of the amount determined under clause (i) 

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

7 respectively, of such subparagraph. 

8 ‘‘(B) MEDICARE CHEMOTHERAPY ADMINIS9 TRATION SERVICES DEFINED.—For purposes of 

10 this paragraph, the term ‘Medicare chemo11 therapy administration services’ means physi12 cians’ services identified, as of January 1, 

13 2007, by any of the following codes (or any suc14 cessor to such a code as identified by the Sec15 retary) for which payments are made under 

16 subsection (b): 

17 ‘‘(i) CPT code 96413 (relating to in18 travenous infusions of initial drug up to 

19 one hour). 

20 ‘‘(ii) CPT code 96417 (relating to ad21 ditional, sequential intravenous infusions of 

22 different drugs up to one hour). 

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

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


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1 ‘‘(iv) CPT code 96415 (relating to in2 travenous infusions for subsequent hours). 

3 ‘‘(v) CPT code 96423 (relating to 

4 inter-arterial infusions for subsequent 

5 hours).’’. 

6 SEC. 4. PROVISIONS FOR THE APPROPRIATE REPORTING 

7 AND BILLING OF PHYSICIANS’ SERVICES AS8 SOCIATED WITH PHARMACY FACILITIES MAN9 AGEMENT AND MEDICAL ONCOLOGY TREAT10 MENT PLANNING. 

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

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

13 (1) in subparagraph (B)(iv)— 

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

15 (B) in subclause (III), by striking the pe16 riod; and 

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

18 subclauses: 

19 ‘‘(IV) subparagraph (K) insofar 

20 as it relates to a physician fee sched21 ule for 2008 and each subsequent 

22 year shall not be taken into account in 

23 applying clause (ii)(II) for drug ad24 ministration services under the fee 

25 schedule for such year; and 


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1 ‘‘(V) subparagraph (L) insofar as 

2 it relates to a physician fee schedule 

3 for 2008 and each subsequent year 

4 shall not be taken into account in ap5 plying clause (ii)(II) for medical on6 cology treatment planning services 

7 under the fee schedule for such 

8 year.’’; and 

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

11 ‘‘(K) ADJUSTMENT IN PAYMENT RATES

12 FOR PHARMACY FACILITIES MANAGEMENT

13 COSTS.—In establishing the physician fee 

14 schedule under subsection (b) with respect to 

15 payments for drug administration services fur16 nished on or after January 1, 2008, and in 

17 order to take into account pharmacy facilities 

18 management costs, the Secretary shall provide 

19 for an additional payment for such services in 

20 an amount equal to 2 percent of the amount de21 termined under section 1847A for the drug ad22 ministered. 

23 ‘‘(L) PROVISIONS FOR THE APPROPRIATE

24 REPORTING AND BILLING OF PHYSICIANS’ 

25 SERVICES ASSOCIATED WITH PHARMACY FACILIVerDate Aug 31 2005 01:06 Mar 01, 2007 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1190.IH H1190

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1 TIES MANAGEMENT AND MEDICAL ONCOLOGY

2 TREATMENT PLANNING.— 

3 ‘‘(i) CREATION OF NEW CPT CODES.— 

4 ‘‘(I) PHARMACY FACILITIES MAN5 AGEMENT.—Not later than one year 

6 after the date of the enactment of this 

7 subparagraph, in carrying out sub8 paragraph (K), the Secretary shall 

9 issue appropriate CPT codes for the 

10 reporting and billing of pharmacy fa11 cilities management services that 

12 would correspond to the additional 

13 payment provided under subparagraph 

14 (K). 

15 ‘‘(II) MEDICAL ONCOLOGY

16 TREATMENT PLANNING.—Not later 

17 than one year after the date of the en18 actment of this subparagraph, the 

19 Secretary shall issue two new CPT 

20 codes, one moderate and one complex, 

21 for the reporting and billing of med22 ical oncology treatment planning serv23 ices furnished by physicians and other 

24 professional staff in the specialties of 


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1 hematology, hematology-oncology, and 

2 medical oncology. 

3 ‘‘(ii) USE OF EXISTING PROCESSES.— 

4 In carrying out clause (i), the Secretary 

5 shall use existing processes for the imple6 mentation of such coding changes, as ap7 propriate. 

8 ‘‘(iii) CONSULTATION.—In carrying 

9 out clause (i), the Secretary shall consult 

10 with representatives of physicians in the 

11 specialties of hematology, hematology-on12 cology, and medical oncology affected by 

13 the adoption of such coding changes.’’. 

Æ 


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