I 
115TH CONGRESS 
1ST SESSION H. R. 1834 
To amend title XVIII of the Social Security Act to establish a national 
Oncology Medical Home Demonstration Project under the Medicare pro-
gram for the purpose of changing the Medicare payment for cancer 
care in order to enhance the quality of care and to improve cost effi-
ciency, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 30, 2017 
Mrs. MCMORRIS RODGERS (for herself and Ms. SEWELL of Alabama) intro-
duced the following bill; which was referred to the Committee on Energy 
and Commerce, and in addition to the Committee on Ways and Means, 
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 establish 
a national Oncology Medical Home Demonstration 
Project under the Medicare program for the purpose 
of changing the Medicare payment for cancer care in 
order to enhance the quality of care and to improve 
cost efficiency, and for other purposes. 
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 ‘‘Cancer Care Payment 
Reform Act of 2017’’. 
SEC. 2. ESTABLISHING AN ONCOLOGY MEDICAL HOME 
DEMONSTRATION 
PROJECT 
UNDER 
THE 
MEDICARE PROGRAM TO IMPROVE QUALITY 
OF CARE AND COST EFFICIENCY. 
Title XVIII of the Social Security Act is amended by 
inserting after section 1866E (42 U.S.C. 1395cc–5) the 
following new section: 
‘‘SEC. 1866F. ONCOLOGY MEDICAL HOME DEMONSTRATION 
PROJECT. 
‘‘(a) 
ESTABLISHMENT
OF
DEMONSTRATION 
PROJECT.—Not later than 12 months after the date of 
the enactment of this section, the Secretary shall establish 
an Oncology Medical Home Demonstration Project (in 
this section referred to as the ‘demonstration project’) to 
make payments in the amounts specified in subsection (f) 
to each participating oncology practice (as defined in sub-
section (b)). 
‘‘(b) DEFINITION
OF
PARTICIPATING
ONCOLOGY 
PRACTICE.—For purposes of this section, the term ‘par-
ticipating oncology practice’ means an oncology practice 
that— 
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‘‘(1) submits to the Secretary an application to 
participate in the demonstration project in accord-
ance with subsection (c); 
‘‘(2) is selected by the Secretary, in accordance 
with subsection (d), to participate in the demonstra-
tion project; and 
‘‘(3) is owned by a physician, or is owned by or 
affiliated with a hospital, that submitted a claim for 
payment in the prior year for an item or service for 
which payment may be made under part B. 
‘‘(c) APPLICATION TO PARTICIPATE.—An application 
by an oncology practice to participate in the demonstra-
tion project shall include an attestation to the Secretary 
that the practice— 
‘‘(1) furnishes physicians’ services for which 
payment may be made under part B; 
‘‘(2) coordinates oncology services furnished to 
an individual by the practice with services that are 
related to such oncology services and that are fur-
nished to such individual by practitioners (including 
oncology nurses) inside or outside the practice in 
order to ensure that each such individual receives co-
ordinated care; 
‘‘(3) 
meaningfully 
uses 
electronic 
health 
records; 
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‘‘(B) the experience of care of individuals 
who are furnished oncology services by the 
practice for which payment may be made under 
part B, as measured by a patient experience of 
care survey based on the Consumer Assessment 
of Healthcare Providers and Systems survey or 
by such similar survey as the Secretary deter-
mines appropriate; 
‘‘(7) agrees not to receive the payments de-
scribed in subclauses (I) and (II) of subsection 
(f)(1)(B)(iii) in the case that the practice does not 
report to the Secretary in accordance with para-
graph (6) with respect to performance of the prac-
tice during the 12-month period beginning on the 
date on which the practice’s agreement period for 
the demonstration project begins, as determined by 
the Secretary; 
‘‘(8) will, for each year of the demonstration 
project, meet the performance standards developed 
under subsection (e)(4)(B) with respect to each of 
the measures on which the practice has agreed to re-
port under paragraph (6)(A) and the patient experi-
ence of care on which the practice has agreed to re-
port under paragraph (6)(B); and 
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‘‘(9) has the capacity to utilize shared decision- 
making tools that facilitate the incorporation of the 
patient needs, preferences, and circumstances of an 
individual into the medical plan of the individual and 
that maintain provider flexibility to tailor care of the 
individual based on the full range of test and treat-
ment options available to the individual. 
‘‘(d) SELECTION OF PARTICIPATING PRACTICES.— 
‘‘(1) IN
GENERAL.—The Secretary shall, not 
later than 15 months after the date of the enact-
ment of this section, select oncology practices that 
submit an application to the Secretary in accordance 
with subsection (c) to participate in the demonstra-
tion project. 
‘‘(2) MAXIMUM NUMBER OF PRACTICES.—In se-
lecting an oncology practice to participate in the 
demonstration project under this section, the Sec-
retary shall ensure that the participation of such 
practice in the demonstration project does not, on 
the date on which the practice commences its par-
ticipation in the demonstration project— 
‘‘(A) increase the total number of practices 
participating in the demonstration project to a 
number that is greater than 200 practices (or 
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such number as the Secretary determines ap-
propriate); or 
‘‘(B) 
increase 
the 
total 
number 
of 
oncologists who participate in the demonstra-
tion project to a number that is greater than 
1,500 oncologists (or such number as the Sec-
retary determines appropriate). 
‘‘(3) DIVERSITY OF PRACTICES.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), in selecting oncology practices to 
participate in the demonstration project under 
this section, the Secretary shall, to the extent 
practicable, include in such selection— 
‘‘(i) small-, medium-, and large-sized 
practices; and 
‘‘(ii) practices located in different geo-
graphic areas. 
‘‘(B) INCLUSION
OF
SMALL
ONCOLOGY 
PRACTICES.—In selecting oncology practices to 
participate in the demonstration project under 
this section, the Secretary shall, to the extent 
practicable, ensure that at least 20 percent of 
the participating practices are small oncology 
practices (as determined by the Secretary). 
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‘‘(4) NO PENALTY FOR CERTAIN OPT-OUTS BY 
PRACTICES.—In the case that the Secretary selects 
an oncology practice to participate in the demonstra-
tion project under this section that has agreed to 
participate in a model established under section 
1115A for oncology services, such practice may not 
be assessed a penalty for electing not to participate 
in such model if the practice makes such election— 
‘‘(A) prior to the receipt by the practice of 
any payment for such model that would not 
otherwise be paid in the absence of such model; 
and 
‘‘(B) in order to participate in the dem-
onstration project under this section. 
‘‘(e) MEASURES.— 
‘‘(1) DEVELOPMENT.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
use measures described in paragraph (2), and 
may use measures developed under paragraph 
(3), to assess the performance of each partici-
pating oncology practice, as compared to other 
participating oncology practices as described in 
paragraph (4)(A)(i). 
‘‘(B) DETERMINATION OF MEASURES RE-
PORTED.—In determining measures to be re-
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ported under subsection (c)(6)(A), the Sec-
retary, in consultation with stakeholders, shall 
ensure that reporting under such subsection is 
not overly burdensome and that those measures 
required to be reported are aligned with appli-
cable requirements from other payors. 
‘‘(2) MEASURES
DESCRIBED.—The measures 
described in this paragraph, with respect to individ-
uals who are attributed to a participating oncology 
practice, as determined by the Secretary, are the fol-
lowing: 
‘‘(A) PATIENT CARE MEASURES.— 
‘‘(i) The percentage of such individ-
uals who receive documented clinical or 
pathologic staging prior to initiation of a 
first course of cancer treatment. 
‘‘(ii) The percentage of such individ-
uals who undergo advanced imaging and 
have been diagnosed with stage I or II 
breast cancer. 
‘‘(iii) The percentage of such individ-
uals who undergo advanced imaging and 
have been diagnosed with stage I or II 
prostate cancer. 
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‘‘(iv) The percentage of such individ-
uals who, prior to receiving cancer treat-
ment, had their performance status as-
sessed by the practice. 
‘‘(v) The percentage of such individ-
uals who— 
‘‘(I) undergo treatment with a 
chemotherapy regimen provided by the 
practice; 
‘‘(II) have at least a 20-percent 
risk of developing febrile neutropenia 
due to a combination of regimen risk 
and patient risk factors; and 
‘‘(III) have received from the 
practice either GCSF or white cell 
growth factor. 
‘‘(vi) With respect to such individuals 
who receive an oncology drug therapy from 
the practice, the percentage of such indi-
viduals who underwent a diagnostic test to 
identify 
specific 
biomarkers, 
genetic 
mutations, or characteristics prior to re-
ceiving an oncology drug therapy, where 
such a diagnostic test exists for a given 
cancer type. 
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‘‘(vii) With respect to such individuals 
who receive chemotherapy treatment from 
the practice, the percentage of such indi-
viduals so treated who receive a treatment 
plan prior to the administration of such 
chemotherapy. 
‘‘(viii) With respect to chemotherapy 
treatments administered to such individ-
uals by the practice, the percentage of such 
treatments that adhere to guidelines pub-
lished by the National Comprehensive Can-
cer Network or such other entity as the 
Secretary determines appropriate. 
‘‘(ix) With respect to antiemetic drugs 
dispensed by the practice to individuals as 
part of moderately or highly emetogenic 
chemotherapy regimens for such individ-
uals, the extent to which such drugs are 
administered in accordance with evidence- 
based guidelines or pathways that are com-
pliant with guidelines published by the Na-
tional Comprehensive Cancer Network or 
such other entity as the Secretary deter-
mines appropriate. 
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‘‘(B) 
RESOURCE
UTILIZATION
MEAS-
URES.— 
‘‘(i) With respect to emergency room 
visits in a year by such individuals who are 
receiving active chemotherapy treatment 
administered by the practice as of the date 
of such visits, the percentage of such visits 
that are associated with qualified cancer 
diagnoses of the individuals. 
‘‘(ii) With respect to hospital admis-
sions in a year by such individuals who are 
receiving active chemotherapy treatment 
administered by the practice as of the date 
of such visits, the percentage of such ad-
missions that are associated with qualified 
cancer diagnoses of the individuals. 
‘‘(C) SURVIVORSHIP MEASURES.— 
‘‘(i) Survival rates for such individuals 
who have been diagnosed with stage I 
through IV breast cancer. 
‘‘(ii) Survival rates for such individ-
uals who have been diagnosed with stage I 
through IV colorectal cancer. 
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‘‘(iii) Survival rates for such individ-
uals who have been diagnosed with stage I 
through IV lung cancer. 
‘‘(iv) With respect to such individuals 
who receive chemotherapy treatment from 
the practice, the percentage of such indi-
viduals so treated who receive a survivor-
ship plan not later than 45 days after the 
completion of the administration of such 
chemotherapy. 
‘‘(v) With respect to such individuals 
who receive chemotherapy treatment from 
the practice, the percentage of such indi-
viduals who receive psychological screening. 
‘‘(D) END-OF-LIFE CARE MEASURES.— 
‘‘(i) The number of times that such 
an individual receives chemotherapy treat-
ment from the practice within an amount 
of time specified by the Secretary, in con-
sultation with stakeholders, prior to the 
death of the individual. 
‘‘(ii) With respect to such individuals 
who have a stage IV disease and have re-
ceived treatment for such disease from the 
practice, the percentage of such individuals 
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so treated who have had a documented 
end-of-life care conversation with a physi-
cian in the practice or another health care 
provider who is a member of the cancer 
care team of the practice. 
‘‘(iii) With respect to such an indi-
vidual who is referred to hospice care by a 
physician in the practice or a health care 
provider who is a member of the cancer 
care team of the practice, regardless of the 
setting in which such care is furnished, the 
average number of days that the individual 
receives hospice care prior to the death of 
the individual. 
‘‘(iv) With respect to such individuals 
who die while receiving care from the prac-
tice, the percentage of such deceased indi-
viduals whose death occurred in an acute 
care setting. 
‘‘(3) MODIFICATION
OR
ADDITION
OF
MEAS-
URES.— 
‘‘(A) IN GENERAL.—The Secretary may, in 
consultation with appropriate stakeholders in a 
manner determined by the Secretary, modify, 
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replace, remove, or add to the measures de-
scribed in paragraph (2). 
‘‘(B) APPROPRIATE
STAKEHOLDERS
DE-
SCRIBED.—For purposes of subparagraph (A), 
the term ‘appropriate stakeholders’ includes on-
cology societies, oncologists who furnish oncol-
ogy services to one or more individuals for 
which payment may be made under part B, al-
lied health professionals, health insurance 
issuers that have implemented alternative pay-
ment models for oncologists, patients and orga-
nizations that represent patients, and bio-
pharmaceutical and other medical technology 
manufacturers. 
‘‘(4) ASSESSMENT.— 
‘‘(A) IN GENERAL.—The Secretary shall, 
for each year in which the demonstration 
project is conducted, assess— 
‘‘(i) the performance of each partici-
pating oncology practice for such year with 
respect to the measures on which the prac-
tice has agreed to report to the Secretary 
under subsection (c)(6)(A), as compared to 
the performance of other participating on-
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cology practices with respect to such meas-
ures; and 
‘‘(ii) the extent to which each partici-
pating oncology practice has, during such 
year, used breakthrough or other best-in- 
class therapies. 
‘‘(B) PERFORMANCE
STANDARDS.—The 
Secretary shall, in consultation with the appro-
priate stakeholders described in paragraph 
(3)(B) in a manner determined by the Sec-
retary, develop performance standards with re-
spect to— 
‘‘(i) each of the measures described in 
paragraph (2), including those measures as 
modified or added under paragraph (3); 
and 
‘‘(ii) the patient experience of care on 
which 
participating 
oncology 
practices 
agree to report to the Secretary under sub-
section (c)(6)(B). 
‘‘(f) PAYMENTS
FOR
PARTICIPATING
ONCOLOGY 
PRACTICES AND ONCOLOGISTS.— 
‘‘(1) CARE COORDINATION MANAGEMENT FEE 
DURING
FIRST
TWO
YEARS
OF
DEMONSTRATION 
PROJECT.— 
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‘‘(A) IN GENERAL.—The Secretary shall, 
in addition to any other payments made by the 
Secretary under this title to a participating on-
cology practice, pay a care coordination man-
agement fee to each such practice at each of the 
times specified in subparagraph (B). 
‘‘(B) TIMING OF PAYMENTS.—The care co-
ordination management fee described in sub-
paragraph (A) shall be paid to a participating 
oncology practice at the end of each of the fol-
lowing periods: 
‘‘(i) The period that ends 6 months 
after the date on which the practice’s 
agreement period for the demonstration 
project begins, as determined by the Sec-
retary. 
‘‘(ii) The period that ends 12 months 
after the date on which the practice’s 
agreement period for the demonstration 
project begins, as determined by the Sec-
retary. 
‘‘(iii) Subject to subsection (c)(7)— 
‘‘(I) the period that ends 18 
months after the date on which the 
practice’s agreement period for the 
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pating oncology practices if the demonstra-
tion project had not been implemented ex-
ceeds such aggregate expenditures for such 
individuals for such year of the demonstra-
tion project; 
‘‘(ii) calculating the amount that is 
half of the amount estimated under clause 
(i); and 
‘‘(iii) subtracting from the amount 
calculated under clause (ii) the total 
amount of payments made under para-
graph (1) that have not, in a prior applica-
tion of this clause, previously been so sub-
tracted from a calculation made under 
clause (ii). 
‘‘(E) AMOUNT
OF
PAYMENTS
TO
INDI-
VIDUAL PRACTICES THAT MEET PERFORMANCE 
STANDARDS AND ACHIEVE SAVINGS.— 
‘‘(i) PAYMENTS ONLY TO PRACTICES 
THAT MEET PERFORMANCE STANDARDS.— 
The Secretary may not make performance 
incentive payments to a participating on-
cology practice under subparagraph (A) 
with respect to a year of the demonstration 
project described in subparagraph (B) un-
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less the practice meets or exceeds the per-
formance standards developed under sub-
section (e)(4)(B) for the year with respect 
to— 
‘‘(I) the measures on which the 
practice has agreed to report to the 
Secretary under subsection (c)(6)(A); 
and 
‘‘(II) the patient experience of 
care on which the practice has agreed 
to report to the Secretary under sub-
section (c)(6)(B). 
‘‘(ii) CONSIDERATION
OF
PERFORM-
ANCE ASSESSMENT.—The Secretary shall, 
in consultation with the appropriate stake-
holders described in subsection (e)(3)(B) in 
a manner determined by the Secretary, de-
termine the amount of a performance in-
centive payment to a participating oncol-
ogy practice under subparagraph (A) for a 
year of the demonstration project described 
in subparagraph (B). In making a deter-
mination under the preceding sentence, the 
Secretary shall take into account the per-
formance assessment of the practice under 
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subsection (e)(4)(A) with respect to the 
year and the aggregate pool available for 
making payments for such year determined 
under subparagraph (D), as available for 
such year. 
‘‘(3) ISSUANCE OF GUIDANCE.—Not later than 
the date that is 12 months after the date of the en-
actment of this section, the Secretary shall issue 
guidance detailing the methodology that the Sec-
retary will use to implement subparagraphs (D) and 
(E) of paragraph (2). 
‘‘(g) SECRETARY REPORTS TO PARTICIPATING ON-
COLOGY PRACTICES.—The Secretary shall inform each 
participating oncology practice, on a periodic (such as 
quarterly) basis, of— 
‘‘(1) the performance of the practice with re-
spect to the measures on which the practice has 
agreed to report to the Secretary under subsection 
(c)(6)(A); and 
‘‘(2) the estimated amount by which the ex-
penditures that would have been expended under 
parts A and B for items and services furnished to 
individuals attributed to the practice if the dem-
onstration project had not been implemented exceeds 
the actual expenditures for such individuals. 
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‘‘(h) APPLICATIONS FROM ENTITIES TO PROVIDE 
ACCREDITATIONS.—Not later than the date that is 18 
months after the date of the enactment of this section, 
the Secretary shall establish a process for the acceptance 
and consideration of applications from entities for pur-
poses of determining which entities may provide accredita-
tion to practices under subsection (c)(4) in addition to the 
entities described in such subsection. 
‘‘(i) REVISIONS TO DEMONSTRATION PROJECT.—The 
Secretary may make appropriate revisions to the dem-
onstration project under this section in order for partici-
pating oncology practices under such demonstration 
project to meet the definition of an eligible alternative pay-
ment entity for purposes of section 1833(z). 
‘‘(j) WAIVER AUTHORITY.—The Secretary may waive 
such provisions of this title and title XI as the Secretary 
determines necessary in order to implement the dem-
onstration project under this section. 
‘‘(k) ADMINISTRATION.—Chapter 35 of title 44, 
United States Code, shall not apply to this section.’’. 
Æ 
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