[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5901 Introduced in House (IH)]
110th CONGRESS
2d Session
H. R. 5901
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 purchasing system under the Medicare Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 24, 2008
Ms. Castor (for herself and Mrs. Christensen) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committee on Energy 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 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 purchasing system under the Medicare Program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Eliminating Disparities in Breast
Cancer Treatment Act of 2008''.
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-American women
with breast cancer are less likely to receive 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 cancer.
(4) Investigators found that regardless of insurance
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, race, income, and educational background are
directly linked to irregularity in administering this vital
screening.
(6) According to American Cancer Society researchers,
substantial disparities remain or persist regarding cancer
diagnosis and treatment.
SEC. 3. PURPOSE.
The purpose of this Act is to promote the implementation of
standardized health care practices for breast cancer 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. 1898. BREAST CANCER TREATMENT PERFORMANCE MEASURES SYSTEM.
``(a) In General.--Not later than October 1, 2009, the Secretary
shall establish, in accordance with the provisions of this section, a
6-year breast cancer treatment quality performance system (in this
section referred to as the `system') to--
``(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, 2012, 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, including 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 section, 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 Measures.--
``(1) In general.--Under the system, the Secretary, shall
enter into agreements with the National Quality Forum, an
organization that operates as a voluntary consensus standards
body as defined for purposes of section 12(d) of the National
Technology 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 measures to evaluate the
quality of care provided by specified 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 measures described in
paragraph (1) shall include, with respect to the treatment of
breast cancer, measures of patient outcomes, the process for
delivering medical care related to such treatment, patient
counseling and engagement in decision-making, patient
experience of care, resource use, and practice capabilities,
such as care coordination.
``(d) Reporting Process.--
``(1) In general.--Under the system, for periods (as
specified by the Secretary) beginning on or after October 1,
2009, the Secretary shall establish a reporting process, with
respect to treatment furnished 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, 2012.
``(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 patients 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 level,
income, insurance status, and any other category
specified by the Secretary.
``(e) Public Disclosure.--Under the system, the Secretary shall
establish procedures to require that information with respect to the
quality demonstrated by a specified health care provider of treatment
furnished for breast cancer during a period (based on the performance
measures data submitted pursuant to subsection (c)(1) by the provider
for such period) is made available on the official public Internet site
of the Department of Health and Human Services in a clear and
understandable form. Such procedures shall ensure that a specified
health care provider has the opportunity to review the information that
is to be made public with respect to the provider at least 30 days
prior to such data being made public and shall provide for an appeals
process in the case a provider claims such information to be incorrect
or incomplete.
``(f) Value-Based Purchasing for Periods Beginning October 1,
2012.--
``(1) In general.--Under the system, for periods beginning
on or after October 1, 2012 and ending before October 1, 2015,
the Secretary shall establish and implement, a value-based
purchasing program, with respect to specified health care
providers that furnish treatment for breast cancer during such
a period, under which--
``(A) in the case of such a provider that does not
submit data in accordance with the reporting process
under subsection (d)(1) for such treatment furnished
during such period, the Secretary shall reduce payment
under this title for such treatment by an amount
specified by the Secretary; and
``(B) in the case of such a provider that submits
data in accordance with the reporting process under
subsection (d)(1) for such treatment furnished during
such period--
``(i) subject to clause (ii), if the
Secretary determines such provider furnished
low quality care (in accordance with a method
specified by the Secretary) for such treatment,
the Secretary shall reduce the amount that
would otherwise be paid to such provider under
this title for such treatment by an amount
specified by the Secretary;
``(ii) if the Secretary determines such
provider furnished low quality care (in
accordance with the method specified under
clause (i)) for such treatment, but the quality
of care has improved as compared to the quality
of care the provider furnished during the
previous period, the Secretary shall reduce the
amount that would otherwise be paid to such
provider under this title for such treatment in
accordance with an incremental method
established by the Secretary that ensures that
the amount of such reduction--
``(I) is less than the amount
specified by the Secretary under clause
(i); and
``(II) is based on the extent of
improvement in the quality of care; and
``(iii) if the Secretary determines such
provider did not furnish low quality care (in
accordance with the method specified under
clause (i)) for such treatment, the Secretary
shall provide to such provider the amount to be
paid to such provider under this title for such
treatment.
``(2) Results-based payments.--The amount of a reduction
under subparagraph (A) or (B)(i) of paragraph (1) shall be
determined in accordance with a method established by the
Secretary.
``(g) Reports.--Not later than October 1, 2010, and for each 6-
month period thereafter (before fiscal year 2016), the Secretary shall
submit to Congress a report that evaluates the development and
implementation of the system, including--
``(1) an evaluation of the number of specified health care
providers that submit data pursuant to subsection (c)(1);
``(2) an analysis of the effect of such system on reducing
disparities in the provision of breast cancer treatment to
patients based on race, level of education, income, and health
insurance status of such patients;
``(3) recommendations on whether (and to what extent) to
extend the system under this section.
``(h) Application to Part C.--The Secretary shall provide for a
method to apply the provisions of this section to treatment furnished
under a plan under part C.''.
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