SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Cancer Care Payment 
Reform Act of 2015’’. 
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 six 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 program in accord-
ance with subsection (c); 
‘‘(2) is selected by the Secretary, in accordance 
with subsection (d), to participate in the demonstra-
tion program; and 
‘‘(3) is owned by a physician, or is owned by or 
affiliated with a hospital, that submitted a claim for 
reimbursement in the prior year for an item or serv-
ice 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 program 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 medical professionals 
(including oncology nurses) inside or outside the 
practice in order to ensure that each such individual 
receives coordinated care; 
‘‘(3) 
meaningfully 
uses 
electronic 
health 
records; 
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‘‘(4) will, not later than one year after the date 
on which the practice commences its participation in 
the demonstration project, be accredited as an On-
cology Medical Home by the Commission on Cancer, 
the National Committee for Quality Assurance, or 
such other entity as the Secretary determines appro-
priate; 
‘‘(5) will repay all amounts paid by the Sec-
retary to the practice under subsection (f)(1)(A) in 
the case that the practice does not, on a date that 
is not later than 60 days after the date on which the 
practice submits an application to the Secretary 
under subsection (b)(1), submit an application to an 
entity described in paragraph (4) for accreditation 
as an Oncology Medical Home in accordance with 
such paragraph; 
‘‘(6) will, for each year in which demonstration 
project is conducted, report to the Secretary, in such 
form and manner as is specified by the Secretary, 
on— 
‘‘(A) the performance of the practice with 
respect to not less than ten of the measures de-
scribed in subsection (e), as selected by the 
practice; and 
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‘‘(B) the level of satisfaction of individuals 
who are provided with oncology services by the 
practice for which payment may be made under 
part B, as measured by a patient satisfaction 
survey based on the Consumer Assessment of 
Healthcare Providers and Systems survey or by 
such similar survey as the Secretary determines 
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 submits the application 
described in this subsection to the Secretary; 
‘‘(8) will, for each year of the demonstration 
project, meet the minimum performance require-
ments developed under subsection (e)(4)(B) with re-
spect to each of the measures on which the practice 
has agreed to report under paragraph (6)(A); and 
‘‘(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 
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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 six months after the date of the enact-
ment of this section, select oncology practices that 
submit applications to the Secretary in accordance 
with subsection (c) to participate in the demonstra-
tion program. 
‘‘(2) MAXIMUM NUMBER OF PRACTICES.—In se-
lecting an oncology practice to participate in the 
demonstration program under paragraph (1), the 
Secretary 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, increase the 
total number of oncologists who participate in the 
demonstration program to a number that is greater 
than 1,500 oncologists. 
‘‘(3) DIVERSITY OF PRACTICES.—In selecting 
oncology practices to participate in the demonstra-
tion project under paragraph (1), the Secretary 
shall, to the extent practicable, include in such selec-
tion— 
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‘‘(A) small-, medium-, and large-sized 
practices; and 
‘‘(B) practices located in different geo-
graphic areas. 
‘‘(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 paragraph (1) that has agreed to 
participate in another model, under section 1115A 
or otherwise, for payment under this title for oncol-
ogy services, such practice may not be assessed a 
penalty for electing not to participate in such other 
payment model if such practice makes such elec-
tion— 
‘‘(A) prior to the receipt by the practice of 
any payment under such model; and 
‘‘(B) in order to participate in such dem-
onstration project. 
‘‘(e) MEASURES.— 
‘‘(1) DEVELOPMENT.—The Secretary shall use 
measures described in paragraph (2), and may use 
measures developed under paragraph (3), to assess 
the performance of each participating oncology prac-
tice, as compared to other participating oncology 
practices. 
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‘‘(2) MEASURES
DESCRIBED.—The measures 
described in this paragraph, with respect to individ-
uals who receive treatment for cancer from a partici-
pating oncology practice, are the following: 
‘‘(A) PATIENT CARE MEASURES.— 
‘‘(i) The percentage of such individ-
uals that receives documented clinical or 
pathologic staging prior to initiation of a 
first course of cancer treatment. 
‘‘(ii) The percentage of such individ-
uals that is undergoing advanced imaging 
and has been diagnosed with stage I or II 
breast cancer. 
‘‘(iii) The percentage of such individ-
uals that is undergoing advanced imaging 
and has been diagnosed with stage I or II 
prostate cancer. 
‘‘(iv) The percentage of such individ-
uals that, prior to receiving cancer treat-
ment, had its performance status assessed 
by the practice. 
‘‘(v) The percentage of such individ-
uals that— 
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‘‘(3) MODIFICATION
OR
ADDITION
OF
MEAS-
URES.— 
‘‘(A) IN GENERAL.—The Secretary may, in 
conjunction with appropriate stakeholders, mod-
ify or add to the measures described in para-
graph (2). 
‘‘(B) APPROPRIATE
STAKEHOLDERS
DE-
SCRIBED.—For purposes of subparagraph (A), 
the term ‘appropriate stakeholders’ includes on-
cology societies, oncologists who provide 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-
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tice has agreed to report to the Secretary 
under subsection (c)(6)(A), as compared to 
the performance of other participating on-
cology practices with respect to such meas-
ures; and 
‘‘(ii) the extent to which the practice 
has, during such year, used breakthrough 
or other best-in-class therapies. 
‘‘(B) MINIMUM
PERFORMANCE
REQUIRE-
MENTS.—The Secretary shall, in conjunction 
with the appropriate stakeholders described in 
paragraph (3)(B), develop minimum perform-
ance requirements with respect to— 
‘‘(i) each of the measures developed 
under this subsection; and 
‘‘(ii) the level of satisfaction on which 
practices agree to report to the Secretary 
under subsection (c)(6)(B). 
‘‘(f) 
PAYMENTS
FOR
PARTICIPATING 
ONCOLOGISTS.— 
‘‘(1) 
CARE
COORDINATION
MANAGEMENT 
FEE.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graphs (D) and (E), the Secretary shall, in ad-
dition to any other payments made by the Sec-
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retary under this title to a participating oncol-
ogy practice, make payment of a care coordina-
tion management fee to each such practice. 
‘‘(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 sub-
mits the application described in sub-
section (c) to the Secretary under sub-
section (b)(1). 
‘‘(ii) The period that ends 12 months 
after the date on which the practice sub-
mits such application to the Secretary. 
‘‘(iii) Subject to subsection (c)(7)— 
‘‘(I) the period that ends 18 
months after the date on which the 
practice submits such application to 
the Secretary; and 
‘‘(II) the period that ends 24 
months after the date on which the 
practice submits such application to 
the Secretary. 
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‘‘(C) AMOUNT OF PAYMENT.—The amount 
of the care coordination management fee de-
scribed in subparagraph (A) shall be deter-
mined by the Secretary in conjunction with 
oncologists who provide oncology services for 
which payment may be made under part B. 
‘‘(2) PAYMENT IN SUBSEQUENT YEARS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graphs (C) and (D), the Secretary shall make 
payments of an ongoing management fee to 
each participating oncology practice. 
‘‘(B) TIMING OF PAYMENTS.—The ongoing 
management fee described in subparagraph (A) 
shall be paid to a participating oncology prac-
tice at the end of the third, fourth, and fifth 
years of the demonstration project. 
‘‘(C) 
AGGREGATE
AMOUNT
OF
PAY-
MENTS.—With respect to each of the dates of 
payment described in subparagraph (B), the ag-
gregate amount of payments to participating 
oncology practices on such date shall be deter-
mined by— 
‘‘(i) determining the amount by which 
the aggregate expenditures that would 
have been expended for the previous year 
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under this title if the demonstration 
project had not been implemented exceeds 
the aggregate expenditures under this title 
for such previous year; 
‘‘(ii) calculating the amount that is 
half of the amount determined 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 payment determination 
made under this subparagraph. 
‘‘(D) AMOUNT
OF
PAYMENTS
TO
INDI-
VIDUAL PRACTICES.— 
‘‘(i) MINIMUM
PERFORMANCE
RE-
QUIREMENTS.—The Secretary may not 
make payments to a practice under sub-
paragraph (A) at the end of a year of the 
demonstration project described in sub-
paragraph (B) unless the practice meets or 
exceeds the minimum performance require-
ments 
developed 
under 
subsection 
(e)(4)(B) for such year with respect to— 
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