I 
110TH CONGRESS 
2D SESSION 
H. R. 6725 
To establish budget neutral demonstration projects to study and improve 
the quality and cost effectiveness of cancer care services provided to 
Medicare beneficiaries. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 31, 2008 
Mr. CROWLEY (for himself, Mr. ROGERS of Michigan, Mr. ENGLISH of Penn-
sylvania, Mrs. CAPPS, Mr. KENNEDY, Mr. THOMPSON of California, Ms. 
SCHWARTZ, and Ms. BERKLEY) 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 de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To establish budget neutral demonstration projects to study 
and improve the quality and cost effectiveness of cancer 
care services provided to Medicare beneficiaries. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Oncology Quality Care 
Improvement Act of 2008’’. 
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SEC. 2. BUDGET NEUTRAL MEDICARE ONCOLOGY CARE 
QUALITY 
IMPROVEMENT 
DEMONSTRATION 
PROJECTS. 
(a) DEFINITIONS.—In this section: 
(1) DEMONSTRATION
PROJECT.—The term 
‘‘demonstration project’’ means a demonstration 
project established by the Secretary under sub-
section (b). 
(2) ELIGIBLE BENEFICIARY.—The term ‘‘eligi-
ble beneficiary’’ means an individual who— 
(A) is entitled to benefits under part A and 
enrolled under part B, but not enrolled in a 
Medicare Advantage plan under part C, of title 
XVIII of the Social Security Act; and 
(B) is diagnosed with one or more of at 
least six prevalent cancer conditions, including 
breast, colon, lung, and ovarian cancer and ad-
ditional cancers, designated by the Secretary as 
appropriate for demonstration projects. 
(3) ONCOLOGY CARE GROUP.—The term ‘‘on-
cology care group’’ means a group of physicians, or 
physicians and oncology nurse practitioners, that is 
organized for the purpose of providing community- 
based cancer care services under a demonstration 
project. 
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(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(b) ESTABLISHMENT.— 
(1) IN
GENERAL.—Subject to the succeeding 
provisions of this section, the Secretary shall estab-
lish demonstration projects under which the Sec-
retary shall test and evaluate methods that improve 
the quality of care provided to eligible beneficiaries 
with certain cancer diagnoses and that reduce ex-
penditures that would otherwise be made under the 
Medicare program on behalf of such individuals for 
such cancer diagnoses. Such methods shall include— 
(A) the adoption of and adherence to clin-
ical, evidence-based practice guidelines and 
treatment protocols; and 
(B) the use of electronic health record 
(EHR) technology or other method that allows 
for timely data collection and reporting. 
(2) EXPECTATIONS OF GROUP PARTICIPANTS.— 
Under a demonstration project oncology care groups 
participating in the project— 
(A) are expected to reduce spending under 
parts A and B of title XVIII of the Social Secu-
rity Act to a level equal to or below 95 percent 
of the per-patient amount projected by the Sec-
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retary under such parts in the absence of such 
project; and 
(B) shall be eligible for payment of two 
separate fees, allotted from the 5 percent ex-
pected savings described in subparagraph (A)— 
(i) one of which is a reporting fee, 
that is fully refundable to the Secretary for 
groups that fail to meet the established 
spending targets; and 
(ii) the other of which is a perform-
ance fee that is paid only to groups that 
meet the established spending targets as 
determined by the Secretary after annual 
cost reconciliation. 
(c) DESIGN OF PROJECTS.— 
(1) ESTABLISHMENT OF BASELINES.—In estab-
lishing demonstration projects under this section— 
(A) The Secretary shall develop, in con-
junction with the Office of Management and 
Budget, a per-beneficiary spending baseline for 
each of these diagnoses against which the finan-
cial performance of demonstration project par-
ticipants would be measured. This baseline will 
include expenditures for beneficiaries with any 
of the targeted diagnoses, inclusive of all inpa-
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tient costs and outpatient costs, including costs 
of prescription drugs under part D of title 
XVIII of the Social Security Act. 
(B) The Secretary shall establish, in con-
junction with demonstration project partici-
pants, which performance standards and sav-
ings targets will be used to measure improve-
ments to clinical quality, improvements to pro-
vider and beneficiary satisfaction, and achieve-
ment of savings. 
(C) The Secretary shall encourage partici-
pation from varied geographic regions. 
(2) REQUIREMENT FOR ESTIMATE OF BUDGET 
NEUTRAL COSTS FOR EACH PROJECT.—As part of 
the establishment of baselines under paragraph 
(1)(A), the Secretary shall evaluate the costs of fur-
nishing care under demonstration projects. The Sec-
retary may not implement a demonstration project 
under this section unless the Secretary determines 
that the costs of providing care to individuals with 
cancer diagnoses under the project will not exceed 
the costs, in the aggregate, of furnishing care to 
such individuals under title XVIII of the Social Se-
curity Act, that would otherwise be paid without re-
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gard to the demonstration project for the period of 
the project. 
(3) COST
COMPARISONS
DURING
PROJECT.— 
The Secretary shall monitor the performance of par-
ticipating oncology care groups against the baselines 
developed under paragraph (1)(A) with respect to 
demonstration project participants relative to the 
performance of non-participating oncology care 
groups that furnish oncology care services in a com-
munity-based setting to similarly situated individuals 
but that do not employ or adhere to electronic health 
record (EHR) technology or clinical, evidence-based 
practice guidelines and treatment protocols. 
(d) PARTICIPATION.— 
(1) IN GENERAL.—An oncology care group that 
provides care for a minimum number of eligible 
beneficiaries (as specified by the Secretary) may par-
ticipate in a demonstration project if the oncology 
care group agrees— 
(A) to report electronically clinical quality 
and outcomes measures in accordance with re-
quirements established by the Secretary under 
the project; and 
(B)(i) to use electronic health record 
(EHR) technology to manage the clinical care 
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of eligible beneficiaries consistent with para-
graph (2); or 
(ii) to demonstrate to the satisfaction of 
the Secretary the ability to measure and report 
pathway adherence consistent with paragraph 
(2) through alternative means approved by the 
Secretary. 
The Secretary shall strive to be as inclusive of 
alternative means of reporting as possible. 
(2) PRACTICE
STANDARDS.—Each oncology 
care group participating in a demonstration project 
shall demonstrate the ability— 
(A) to provide cancer care services that are 
comprehensive, predictable, provider-led, and 
transparent; 
(B) to deliver a variety of treatment op-
tions safely and efficiently; 
(C) to identify and eliminate execution bar-
riers, enhance capacity availability, and utiliza-
tion, and to use the latest research and tech-
nology available; 
(D) to employ a patient education infra-
structure and patient surveys; 
(E) to adopt and adhere to clinical, evi-
dence-based practice guidelines and treatment 
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