I 
111TH CONGRESS 
1ST SESSION H. R. 2279 
To amend title XVIII of the Social Security Act to eliminate contributing 
factors to disparities in breast cancer treatment through the development 
of a uniform set of consensus-based breast cancer treatment performance 
measures for a 6-year quality reporting system and value-based pur-
chasing system under the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 6, 2009 
Ms. CASTOR of Florida (for herself, Mr. GRIJALVA, Mr. HINCHEY, Mr. RUSH, 
Ms. BORDALLO, Ms. NORTON, Mr. KUCINICH, Ms. BALDWIN, Ms. LEE 
of California, and Ms. SUTTON) 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 amend title XVIII of the Social Security Act to eliminate 
contributing factors to disparities in breast cancer treat-
ment through the development of a uniform set of con-
sensus-based breast cancer treatment performance meas-
ures for a 6-year quality reporting system and value- 
based purchasing system under the Medicare Program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Nov 24 2008 
02:39 May 08, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H2279.IH
H2279
jbell on PROD1PC69 with BILLS
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Eliminating Dispari-
ties in Breast Cancer Treatment Act of 2009’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Delays in receiving care after breast cancer 
diagnosis are reported to be greater for African- 
American women than White women. 
(2) Recent studies indicate that African-Amer-
ican women with breast cancer are less likely to re-
ceive standard therapy than White women. 
(3) African-American and Hispanic patients are 
significantly more likely than White patients to be 
diagnosed at a more advanced stage of breast can-
cer. 
(4) Investigators found that regardless of insur-
ance status, African-American women are 1.9 times 
more likely to be diagnosed with an advanced stage 
of breast cancer than White women and Hispanic 
women are 1.4 times more likely to be diagnosed 
with an advanced stage of breast cancer than White 
women. 
(5) African-American women are ten percent 
more likely not to receive tests to determine if breast 
cancer has spread to axillary (underarm) lymph 
nodes. Studies show that health insurance status, 
VerDate Nov 24 2008 
02:39 May 08, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H2279.IH
H2279
jbell on PROD1PC69 with BILLS
race, income, and educational background are di-
rectly linked to irregularity in administering this 
vital screening. 
(6) According to American Cancer Society re-
searchers, substantial disparities remain or persist 
regarding cancer diagnosis and treatment. 
SEC. 3. PURPOSE. 
The purpose of this Act is to promote the implemen-
tation of standardized health care practices for breast can-
cer treatment under the Medicare program to eliminate 
disparities in the provision of care to such patients based 
on race, level of education, income, and health insurance 
status of such patients. 
SEC. 4. CONSENSUS-BASED BREAST CANCER TREATMENT 
PERFORMANCE MEASURES SYSTEM UNDER 
MEDICARE. 
Title XVIII of the Social Security Act is amended by 
adding at the end the following new section: 
‘‘SEC. 1899. BREAST CANCER TREATMENT PERFORMANCE 
MEASURES SYSTEM. 
‘‘(a) IN GENERAL.—Not later than October 1, 2010, 
the Secretary shall establish, in accordance with the provi-
sions of this section, a 6-year breast cancer treatment 
quality performance system (in this section referred to as 
the ‘system’) to— 
VerDate Nov 24 2008 
02:39 May 08, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2279.IH
H2279
jbell on PROD1PC69 with BILLS
‘‘(1) assess and publicly disclose, through the 
use of quality measures, the quality of care provided 
for the treatment of breast cancer by specified 
health care providers; and 
‘‘(2) beginning October 1, 2013, base payment 
under this title to such providers for such treatment 
on the performance of such providers based on such 
measures. 
‘‘(b) SPECIFIED HEALTH CARE PROVIDERS.— 
‘‘(1) IN GENERAL.—The Secretary shall specify 
classes of providers of services and suppliers, includ-
ing hospitals, cancer centers, physicians, primary 
care providers, and specialty providers, to which the 
provisions of this section shall apply. 
‘‘(2) DEFINITION.—For purposes of this sec-
tion, the term ‘specified health care provider’ means 
a provider of services or supplier specified under 
paragraph (1). 
‘‘(c) 
IDENTIFICATION
AND
ENDORSEMENT
OF 
BREAST CANCER TREATMENT PERFORMANCE MEAS-
URES.— 
‘‘(1) IN GENERAL.—Under the system, the Sec-
retary, shall enter into agreements with the National 
Quality Forum, an organization that operates as a 
voluntary consensus standards body as defined for 
VerDate Nov 24 2008 
02:39 May 08, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2279.IH
H2279
jbell on PROD1PC69 with BILLS
purposes of section 12(d) of the National Tech-
nology Transfer and Advancement Act of 1995 
(Public Law 104–113) and Office of Management 
and Budget Revised Circular A–119 (published in 
the Federal Register on February 10, 1998), under 
which the National Quality Forum shall identify a 
uniform set of consensus-based performance meas-
ures to evaluate the quality of care provided by spec-
ified health care providers for the treatment of 
breast cancer, endorse such set of measures through 
its multistakeholder consensus development process, 
and annually update such set of measures. 
‘‘(2) MEASURES DESCRIBED.—The set of meas-
ures described in paragraph (1) shall include, with 
respect to the treatment of breast cancer, measures 
of patient outcomes, the process for delivering med-
ical care related to such treatment, patient coun-
seling and engagement in decisionmaking, patient 
experience of care, resource use, and practice capa-
bilities, such as care coordination. 
‘‘(d) REPORTING PROCESS.— 
‘‘(1) IN GENERAL.—Under the system, for peri-
ods (as specified by the Secretary) beginning on or 
after October 1, 2010, the Secretary shall establish 
a reporting process, with respect to treatment fur-
VerDate Nov 24 2008 
02:39 May 08, 2009
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2279.IH
H2279
jbell on PROD1PC69 with BILLS
nished for breast cancer, that provides for a method 
for specified health care providers to submit to the 
Secretary data on the performance of such providers 
during each period through use of the performance 
measures developed pursuant to subsection (c)(1). 
Such data shall be submitted in a form and manner 
and at a time specified by the Secretary. 
‘‘(2) VOLUNTARY SUBMISSION DURING INITIAL 
3 YEARS.—The reporting process under paragraph 
(1) shall provide for the voluntary submission of 
data (and incentives for such submission) under the 
process for periods ending before October 1, 2013. 
‘‘(3) CHARACTERISTICS
OF
DATA
SUBMITTED 
UNDER REPORTING PROCESS.—Data submitted by a 
specified health care provider under the reporting 
process under paragraph (1) shall— 
‘‘(A) take into account the quality of 
breast cancer treatment furnished to all pa-
tients of the provider, regardless of the type of 
health insurance coverage of the patient or 
whether or not the patient has such coverage; 
and 
‘‘(B) be structured in a manner that allows 
for comparison according to race, educational 
VerDate Nov 24 2008 
02:39 May 08, 2009
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2279.IH
H2279
jbell on PROD1PC69 with BILLS
level, income, insurance status, and any other 
category specified by the Secretary. 
‘‘(e) PUBLIC DISCLOSURE.—Under the system, the 
Secretary shall establish procedures to require that infor-
mation with respect to the quality demonstrated by a spec-
ified health care provider of treatment furnished for breast 
cancer during a period (based on the performance meas-
ures data submitted pursuant to subsection (c)(1) by the 
provider for such period) is made available on the official 
public Internet site of the Department of Health and 
Human Services in a clear and understandable form. Such 
procedures shall ensure that a specified health care pro-
vider has the opportunity to review the information that 
is to be made public with respect to the provider at least 
30 days prior to such data being made public and shall 
provide for an appeals process in the case a provider 
claims such information to be incorrect or incomplete. 
‘‘(f) VALUE-BASED PURCHASING FOR PERIODS BE-
GINNING OCTOBER 1, 2013.— 
‘‘(1) IN GENERAL.—Under the system, for peri-
ods beginning on or after October 1, 2013, and end-
ing before October 1, 2016, the Secretary shall es-
tablish and implement, a value-based purchasing 
program, with respect to specified health care pro-
VerDate Nov 24 2008 
02:39 May 08, 2009
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H2279.IH
H2279
jbell on PROD1PC69 with BILLS
viders that furnish treatment for breast cancer dur-
ing such a period, under which— 
‘‘(A) in the case of such a provider that 
does not submit data in accordance with the re-
porting process under subsection (d)(1) for 
such treatment furnished during such period, 
the Secretary shall reduce payment under this 
title for such treatment by an amount specified 
by the Secretary; and 
‘‘(B) in the case of such a provider that 
submits data in accordance with the reporting 
process under subsection (d)(1) for such treat-
ment furnished during such period— 
‘‘(i) subject to clause (ii), if the Sec-
retary determines such provider furnished 
low quality care (in accordance with a 
method specified by the Secretary) for 
such treatment, the Secretary shall reduce 
the amount that would otherwise be paid 
to such provider under this title for such 
treatment by an amount specified by the 
Secretary; 
‘‘(ii) if the Secretary determines such 
provider furnished low quality care (in ac-
cordance with the method specified under 
VerDate Nov 24 2008 
02:39 May 08, 2009
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H2279.IH
H2279
jbell on PROD1PC69 with BILLS
clause (i)) for such treatment, but the 
quality of care has improved as compared 
to the quality of care the provider fur-
nished during the previous period, the Sec-
retary shall reduce the amount that would 
otherwise be paid to such provider under 
this title for such treatment in accordance 
with an incremental method established by 
the Secretary that ensures that the amount 
of such reduction— 
‘‘(I) is less than the amount 
specified by the Secretary under 
clause (i); and 
‘‘(II) is based on the extent of 
improvement in the quality of care; 
and 
‘‘(iii) if the Secretary determines such 
provider did not furnish low quality care 
(in accordance with the method specified 
under clause (i)) for such treatment, the 
Secretary shall provide to such provider 
the amount to be paid to such provider 
under this title for such treatment. 
‘‘(2) RESULTS-BASED PAYMENTS.—The amount 
of a reduction under subparagraph (A) or (B)(i) of 
VerDate Nov 24 2008 
02:39 May 08, 2009
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H2279.IH
H2279
jbell on PROD1PC69 with BILLS
paragraph (1) shall be determined in accordance 
with a method established by the Secretary. 
‘‘(g) REPORTS.—Not later than October 1, 2011, and 
for each 6-month period thereafter (before fiscal year 
2017), the Secretary shall submit to Congress a report 
that evaluates the development and implementation of the 
system, including— 
‘‘(1) an evaluation of the number of specified 
health care providers that submit data pursuant to 
subsection (c)(1); 
‘‘(2) an analysis of the effect of such system on 
reducing disparities in the provision of breast cancer 
treatment to patients based on race, level of edu-
cation, income, and health insurance status of such 
patients; and 
‘‘(3) recommendations on whether (and to what 
extent) to extend the system under this section. 
‘‘(h) APPLICATION TO PART C.—The Secretary shall 
provide for a method to apply the provisions of this section 
to treatment furnished under a plan under part C.’’. 
Æ 
VerDate Nov 24 2008 
02:39 May 08, 2009
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6301
E:\BILLS\H2279.IH
H2279
jbell on PROD1PC69 with BILLS