I 
114TH CONGRESS 
1ST SESSION H. R. 2895 
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 
JUNE 25, 2015 
Mr. POMPEO (for himself and Mr. BEYER) introduced 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 provi-
sions as fall within the jurisdiction of the committee 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 2015’’. 
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SEC. 2. FINDINGS; SENSE OF CONGRESS. 
(a) FINDINGS.—Congress finds the following: 
(1) The National Cancer Institute estimates 
that approximately 14.5 million Americans with a 
history of cancer were alive on January 1, 2014. 
(2) About 8 million of the 14.5 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) The National Cancer Institute projects that 
the cost of cancer care in the United States 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 eight 
years, 46 community practices have started referring 
all of their patients elsewhere for treatment, 313 on-
cology office locations have closed, 149 practices 
have merged or were acquired by a corporate entity 
other than a hospital, and 544 oncology groups have 
entered 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 (hereinafter referred to as the ‘‘Moran 
study’’) found that, between 2005 and 2011, there 
was a 150-percent increase in administered chemo-
therapy in the hospital outpatient setting for Medi-
care fee-for-service beneficiaries (increasing from 
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13.5 percent in 2005 to 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 2015 for CPT Code 96413 (Chemo, iv infusion, 
1 hr), the most common drug administration code 
billed by oncology practices, is $136 but the pay-
ment rate for the same service under the Medicare 
hospital outpatient prospective payment system 
(HOPPS) fee schedule in 2012 is 100 percent high-
er at $285. 
(16) Utilization-weighted Medicare payment for 
infusion services is approximately 96 percent higher 
at the hospital outpatient department than in a phy-
sician’s office. 
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