(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. 
(24) In a published Meeting Brief in 2015, 
MedPAC reaffirmed their recommendation that 
‘‘Medicare should begin to move towards site-neutral 
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payments where there is clear overlap in the services 
provided’’. 
(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 
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 
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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.— 
‘‘(A) IN GENERAL.—In the case of cancer 
care services that are furnished on or after Jan-
uary 1, 2016, 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.’’. 
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(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 
furnished on or after January 1, 2016, 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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