I 
111TH CONGRESS 
1ST SESSION H. R. 3675 
To improve the quality and cost effectiveness of cancer care to Medicare 
beneficiaries by establishing a national demonstration project. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 30, 2009 
Mr. DAVIS
of Alabama (for himself, Ms. KILROY, Mr. ISRAEL, Mr. 
COURTNEY, and Mr. SCHIFF) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committee on Ways and Means, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To improve the quality and cost effectiveness of cancer care 
to Medicare beneficiaries by establishing a national dem-
onstration project. 
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 ‘‘National Quality Can-
cer Care Demonstration Project Act of 2009’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) In order to ensure the delivery of quality, 
cost-efficient medical care to patients with cancer, 
Medicare should reinforce and expand the use of evi-
dence-based guidelines and the provision of dem-
onstrated quality delivery of care through adjust-
ments in the payment system. 
(2) An Institute of Medicine report entitled 
‘‘Ensuring Quality Cancer Care’’ recommends that 
the following items are essential components in qual-
ity cancer care delivery: 
(A) An agreed-upon treatment plan that 
outlines the goals of care. 
(B) Access to clinical trials. 
(C) Policies to ensure full disclosure of in-
formation about appropriate treatment options 
to patients. 
(D) A mechanism to coordinate services. 
(3) According to the Institute of Medicine, the 
quality of cancer care must be measured by using a 
core set of quality measures. Cancer care quality 
measures should be used to hold providers, including 
health care systems, health plans, and physicians, 
accountable for demonstrating that they provide and 
improve quality of care. 
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(4) In its report, ‘‘From Cancer Patient to 
Cancer Survivor: Lost in Transition’’, the Institute 
of Medicine recommended that individuals with can-
cer completing primary treatment be provided a 
comprehensive summary of their care along with a 
follow-up survivorship plan of treatment. 
(5) The medical literature suggests that adher-
ence to quality metrics and evidence-based guidelines 
help lower costs by reducing use of physician serv-
ices, hospitalizations, and supplemental and expen-
sive drugs. 
(6) Although treatment planning and follow-up 
cancer care planning are recognized critical compo-
nents of cancer care, none of the 153 quality meas-
ures in the Centers for Medicare & Medicaid Serv-
ices (CMS) 2009 Physician Quality Reporting Initia-
tive (PQRI) addresses overall treatment planning or 
follow-up care planning for cancer patients. 
SEC. 3. MEDICARE QUALITY CANCER CARE DEMONSTRA-
TION PROJECT. 
(a) ESTABLISHMENT.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall establish a quality cancer care demonstra-
tion project under this section (in this section referred to 
as the ‘‘QCCD project’’) for the purpose of establishing 
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quality metrics and aligning Medicare payment incentives 
in the areas of treatment planning and follow-up cancer 
care planning for Medicare beneficiaries with cancer. 
(b) TEST
METRICS
AND
REPORTING
SYSTEMS 
THROUGH
A
PAY-FOR-REPORTING
INCENTIVE
PRO-
GRAM.—Under the QCCD project, the Secretary shall do 
the following: 
(1) Identify and address gaps in current quality 
measures related to the areas of active treatment 
planning and follow-up cancer care planning by re-
fining the performance measures described in para-
graphs (1) and (2) of subsection (d) relating to ac-
tive treatment planning and follow-up cancer plan-
ning for clinician-level reporting. 
(2) Use quality assessment programs of oncol-
ogy professional societies to report quality data to 
the extent feasible and explore the potential to re-
port quality data through other registries and other 
electronic means for treatment planning and follow- 
up cancer care planning, including identifying data 
elements necessary to measure quality of treatment 
planning and follow-up cancer care planning and de-
termine how those elements could be collected 
through claims data or registries or other electronic 
means. 
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(3) Test and validate identified treatment plan-
ning and follow-up cancer care planning quality 
measures through a pay-for-reporting program with 
oncologists, which program— 
(A) ensures that oncologists are able to ac-
curately report on measures through simple 
HCPCS coding mechanisms; and 
(B) tests processes of submitting treat-
ment planning and follow-up cancer care plan-
ning measures through registries or other elec-
tronic means. 
(c) INCENTIVE PAYMENT.— 
(1) IN GENERAL.—Under the QCCD project, 
the Secretary shall provide for a separate payment 
under section 1848 of the Social Security Act (42 
U.S.C. 1395w–4), to be divided into a baseline pay-
ment amount and an additional payment amount, as 
specified by the Secretary, for a treatment planning 
code and follow-up cancer care planning code. The 
amount of such payments under the project shall be 
designed to total $300,000,000 each year. Payments 
under the project shall be designed to be paid on an 
ongoing basis as claims are submitted. 
(2) REQUIREMENT TO SATISFY BASELINE MAN-
DATORY
MEASURES
TO
RECEIVE
BASELINE
PAY-
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MENT.—In order for a physician to receive any pay-
ment under the QCCD project for treatment plan-
ning or follow-up cancer care planning, a physician 
must report in a manner specified under the project 
that all of the baseline mandatory measures de-
scribed in paragraph (1)(A) or (2)(A), respectively, 
of subsection (d) were satisfied. 
(3) REQUIREMENT TO SATISFY ALL MEASURES 
TO RECEIVE ADDITIONAL PAYMENT.—In order for a 
physician to receive the additional payment amount 
described in paragraph (1) under this subsection for 
treatment planning or follow-up cancer care plan-
ning, a physician must report in a manner specified 
under the project that all of measures described in 
paragraph (1) or (2), respectively, of subsection (d) 
were satisfied. 
(d) MEASURES.— 
(1) TREATMENT
PLANNING
MEASURES.—The 
specific measures related to treatment planning and 
any subsequent modifications described in this para-
graph are as follows: 
(A) BASELINE MANDATORY MEASURES.— 
(i) Documented pathology report. 
(ii) Documented clinical staging prior 
to initiation of first course of treatment. 
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(iii) Performed treatment education 
by oncology nursing staff. 
(iv) Provided the patient with a writ-
ten care plan for patients in active treat-
ment, which advises patient of relevant op-
tions. 
(B) AUGMENTED.— 
(i) 
Implemented 
practice-endorsed 
treatment plan consistent with nationally 
recognized evidence based guidelines. 
(ii) Documented clinical trial dis-
cussed with the patient, or that no clinical 
trial available. 
(iii) Documented discussion or coordi-
nation with other physicians involved in 
the patient’s care. 
(2) FOLLOW-UP CANCER PLANNING.—The spe-
cific measures related to follow-up cancer planning 
described in this paragraph are as follows: 
(A) BASELINE MANDATORY.— 
(i) Documented conclusion of primary 
cancer care treatment. 
(ii) Documented session with the pa-
tient to provide recommendations for the 
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subsequent care of the patient with respect 
to the cancer involved. 
(B) AUGMENTED.—Provision of a written 
document to the patient that— 
(i) describes the elements of the com-
pleted primary treatment, including past 
symptom management, furnished to such 
patient; 
(ii) provides recommendations for the 
subsequent care of the patient with respect 
to the cancer involved; 
(iii) is furnished to the individual in 
person within a period specified by the 
Secretary that is as soon as practicable 
after the completion of such primary treat-
ment; and 
(iv) is furnished, to the greatest ex-
tent practicable, in a form that appro-
priately takes into account cultural and 
linguistic needs of the individual in order 
to make the plan accessible to the indi-
vidual. 
(e) DURATION OF PROJECT.— 
(1) IN GENERAL.—The Secretary shall conduct 
the demonstration project over a sufficient period (of 
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not less than 2 years) to allow for refinement of 
metrics and reporting methodologies and for anal-
yses. The project shall continue, subject to para-
graph (2), to operate until the Secretary has devel-
oped and implemented under part B of the Medicare 
program a payment system that relates payment 
under such part for professional oncology services to 
performance on measures developed and refined 
under the demonstration project. 
(2) TRANSITION.—The Secretary shall provide 
for a transition period over the course of 2 years 
during which oncologists are permitted to transition 
from the payment system under the demonstration 
project to the payment system described in para-
graph (1). 
(f) PROJECT EVALUATION.— 
(1) IN GENERAL.—The Secretary shall conduct 
an evaluation of the QCCD project— 
(A) to determine oncologist participation in 
the project; 
(B) to assess the cost effectiveness of the 
project, including an analyses of the cost sav-
ings (if any) to the Medicare part A and B pro-
grams resulting from a general reduction in 
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physician services, hospitalizations, and supple-
mental care drug costs; 
(C) to compare outcomes of patients par-
ticipating in the project to outcomes for those 
not participating in the project; 
(D) to determine the satisfaction of pa-
tients participating in the project; and 
(E) to evaluate other such matters as the 
Secretary determines is appropriate. 
(2) REPORTING.—Not later than 90 days after 
the completion of the second year following the com-
mencement of the QCCD project, the Secretary shall 
submit to Congress a report on the evaluation con-
ducted under paragraph (1) together which such rec-
ommendations for legislation or administrative ac-
tion as the Secretary determines is appropriate. 
Æ 
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