HR 5901
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.
`(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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