I 
113TH CONGRESS 
1ST SESSION H. R. 3295 
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 
OCTOBER 16, 2013 
Ms. CASTOR of Florida introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on En-
ergy and Commerce, 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 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, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Eliminating Dispari-
ties in Breast Cancer Treatment Act of 2013’’. 
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, 
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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. 1899B. BREAST CANCER TREATMENT PERFORMANCE 
MEASURES SYSTEM. 
‘‘(a) IN GENERAL.—Not later than October 1, 2014, 
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— 
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‘‘(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, 2017, 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 
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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, 2014, the Secretary shall establish 
a reporting process, with respect to treatment fur-
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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, 2017. 
‘‘(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 
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