I 
113TH CONGRESS 
1ST SESSION H. R. 2869 
To amend title XVIII of the Social Security Act to establish payment parity 
under the Medicare program for ambulatory cancer care services fur-
nished in the hospital outpatient department and the physician office 
setting. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 31, 2013 
Mr. ROGERS of Michigan (for himself and Ms. MATSUI) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to establish 
payment parity under the Medicare program for ambula-
tory cancer care services furnished in the hospital out-
patient department and the physician office setting. 
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 ‘‘Medicare Patient Ac-
cess to Cancer Treatment Act of 2013’’. 
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SEC. 2. FINDINGS; SENSE OF CONGRESS. 
(a) FINDINGS.—Congress finds the following: 
(1) The National Cancer Institute estimates 
that approximately 13.7 million Americans with a 
history of cancer were alive on January 1, 2012. 
(2) About 8 million of the 13.7 million Ameri-
cans living with cancer are over age 65, and approxi-
mately half of cancer care spending is associated 
with Medicare beneficiaries. 
(3) National spending on cancer care in 2010 
is estimated at $125 billion. 
(4) In 2011, the National Cancer Institute re-
leased projections of the cost of cancer care in the 
United States, finding the total cost of cancer care 
in 2020 is expected to be $206 billion. 
(5) In a 2010 study, Milliman reported that in 
2007 a cancer patient receiving chemotherapy in-
curred average costs of approximately $111,000, 
three times the cost of a coronary artery disease pa-
tient, and six times the cost of a diabetes patient. 
(6) Over the last several years, the United 
States has been touted as world leader in providing 
high-quality cancer care. 
(7) United States cancer survival rates are 
higher than the average in Europe and Canada for 
13 of 16 types of cancer. 
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(8) Until recently, over 80 percent of United 
States cancer patients received care in the commu-
nity setting. 
(9) Over the past several years, the country has 
experienced a significant shift of outpatient cancer 
care delivery from the physician’s office to the hos-
pital outpatient department. 
(10) Reports show that over the past six years, 
43 community practices have started referring all of 
their patients elsewhere for treatment, 288 oncology 
office locations have closed, 131 practices have 
merged or were acquired by a corporate entity other 
than a hospital, and 469 oncology groups have en-
tered into an employment or professional services 
agreement with a hospital. 
(11) Over 1,000 clinics or practices have been 
impacted over the last 3 years out of a population 
of only 6,000 oncologists in community practice in 
the United States. 
(12) A 2013 study published by The Moran 
Company (‘‘Moran study’’) found that, between 
2005 and 2011, there was a 150 percent increase in 
administered chemotherapy in the hospital out-
patient setting for Medicare fee-for-service bene-
ficiaries (increasing from 13.5 percent in 2005 to 
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33.0 percent in 2011) as compared to administration 
in physician community cancer clinics. 
(13) The Moran study found that, in 2005, al-
most 87 percent of Medicare patients were receiving 
their care in the community setting, by 2011 only 67 
percent were utilizing the community setting. 
(14) The Moran study reports that Medicare 
payments for chemotherapy administered in hospital 
outpatient settings have more than tripled since 
2005 (from $90 million to $300 million) while pay-
ments to physician community cancer clinics have 
actually decreased by 14.5 percent. 
(15) The Medicare physician fee schedule rate 
in 2012 for CPT Code 96413 (Chemo, iv infusion, 
1 hr), the most common drug administration code 
billed by oncology practices, is $139 but the pay-
ment rate for the same service under the Medicare 
hospital outpatient prospective payment system 
(HOPPS) fee schedule in 2012 is 50 percent higher 
at $208. 
(16) Utilization-weighted Medicare payment for 
infusion services is approximately 55 percent higher 
at the hospital outpatient department than in a phy-
sician’s office. 
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(17) Medicare proposed in 2012 to pay hospital 
outpatient departments 25 percent more for radi-
ation therapy services than for the same services 
performed in physicians’ offices, including a 70 per-
cent differential for intensity modulated radiation 
treatment (IMRT) and a 188 percent differential for 
stereotactic body radiation therapy delivery (SBRT). 
(18) One third of hospitals in the United States 
purchase chemotherapy drugs through the section 
340B program at a discount of up to 50 percent, re-
sulting in a net cost to such hospitals that typically 
is at least 30 percent below reimbursement rate 
(which is based on 106 percent of the average sales 
price) for community oncologists for such drugs. 
(19) Medicare reimburses 70 percent of hospital 
bad debt (uncollectable coinsurance). 
(20) According to an October 2011 Milliman 
study, the cost of treating cancer patients is signifi-
cantly lower for both Medicare patients (10 percent 
lower in copayment amounts, more than $650 sav-
ings a year) and the Medicare program (14.2 per-
cent less, a savings of $6,500 a year per patient) 
when provided in community-based cancer settings 
as compared to the same treatment in hospital out-
patient departments. 
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(21) The April 1, 2013, sequestration cuts to 
Medicare allowed for a 28 percent cut to the services 
reimbursement in Medicare part B drugs to commu-
nity oncologists. 
(22) A recent Community Oncology Alliance 
survey showed that 69 percent of practices surveyed 
reported that patient treatment or operational 
changes already have been made due to the seques-
ter cut to cancer drugs, with 49 percent of practices 
forced to send Medicare patients elsewhere for treat-
ment, and 62 percent of practices reported that they 
will be forced to send Medicare patients elsewhere 
for treatment if the sequestration cuts stay in place 
through July 31, 2013. 
(23) The June 2013 report of the Medicare 
Payment Advisory Commission highlighted the large 
disparities in payment in outpatient settings and 
noted that the payment variations across settings 
should be addressed quickly due to the fact that cur-
rent disparities have created incentives for hospitals 
to buy physician practices, driving up costs for the 
Medicare program and for beneficiaries. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that, to ensure the future of community cancer care, 
Medicare reimbursement should be equal for the same 
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service provided to a cancer patient regardless of whether 
the service is delivered in the hospital outpatient depart-
ment or physician’s office. 
SEC. 3. EQUALIZING MEDICARE REIMBURSEMENT IN HOS-
PITAL OUTPATIENT DEPARTMENTS AND PHY-
SICIANS’ OFFICES FOR CANCER CARE SERV-
ICES. 
(a) IN GENERAL.—Section 1833(t) of the Social Se-
curity Act (42 U.S.C. 1395l(t)) is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (G), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (H), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by inserting after subparagraph (H) 
the following new subparagraph: 
‘‘(I) payment for covered OPD services 
that are cancer care services (as defined in sub-
paragraph (B) of paragraph (18)) shall be 
made consistent with subparagraph (A) of such 
paragraph.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(18) SPECIAL
PAYMENT
RULE
FOR
CANCER 
CARE SERVICES.— 
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‘‘(A) IN GENERAL.—In the case of cancer 
care services that are furnished on or after Jan-
uary 1, 2014, the payment amount for such 
services under this subsection and under section 
1848 shall be a budget neutral combination (as 
determined by the Secretary) of— 
‘‘(i) the amount otherwise payable 
under this subsection for such services; 
and 
‘‘(ii) the amount otherwise payable 
under section 1848 for such services. 
‘‘(B) CANCER CARE SERVICES DEFINED.— 
For purposes of this subsection, the term ‘can-
cer care services’ means covered OPD services 
or physicians’ services for which payment is 
made under section 1848 that are furnished in 
conjunction with the diagnosis or treatment of 
cancer.’’. 
(b) CONFORMING AMENDMENT.—Section 1848(a) of 
Social Security Act (42 U.S.C. 1395w–4(a)) is amended 
by adding at the end the following new paragraph: 
‘‘(9) APPLICATION OF SPECIAL RULE FOR CAN-
CER
CARE
SERVICES.—In the case of physicians’ 
services that are cancer care services (as defined in 
subparagraph (B) of section 1833(t)(18)) that are 
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furnished on or after January 1, 2014, the payment 
amount for such services under this section shall be 
the payment amount for such services determined 
under subparagraph (A) of such section.’’. 
Æ 
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