Community Cancer Care Preservation Act of 2006 - Amends title XVIII (Medicare) of the Social Security Act to subject to quarterly reconciliation any payments to physicians for drugs or biologicals made according to average sales price payment methodology in order to assure that they do not exceed or fall short of the actual average sales price during any preceding period.
Requires the Secretary of Health and Human Services to review all such payments in the preceding quarter and compare them to the verified average sales price reported by the manufacturer for such quarter.
Removes prompt pay discounts from the calculation of the manufacturer's average sales price.
Extends through December 31, 2006, the current demonstration project to identify and assess oncology services that positively affect cancer outcomes.
Requires the Secretary to make an additional 2% drug administration services payment to physicians for overhead and related costs.
Directs the Secretary to develop indicators for the evaluation of the quality of oncology services provided in the physician office setting.
Requires the Director of the National Cancer Institute to develop a strategic plan to increase the number of cancer patients who enroll in clinical trials.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2340 Introduced in Senate (IS)]
109th CONGRESS
2d Session
S. 2340
To amend title XVIII of the Social Security Act to preserve access to
community cancer care by Medicare beneficiaries.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 28, 2006
Mr. Specter (for himself, Mr. Coleman, and Mr. Isakson) introduced the
following bill; which was read twice and referred to the Committee on
Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to preserve access to
community cancer care by Medicare beneficiaries.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Community Cancer
Care Preservation Act of 2006''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Use of average sales price methodology.
Sec. 3. Improved payment for oncologist services.
Sec. 4. Quality measures for cancer care.
Sec. 5. Improved patient participation in clinical trials.
Sec. 6. CBO report.
SEC. 2. USE OF AVERAGE SALES PRICE METHODOLOGY.
(a) Findings.--Congress finds that--
(1) in 2005, Medicare reimbursement for certain outpatient
cancer drugs was changed to reflect average sales price rather
than average wholesale price; and
(2) the average sales price methodology does not timely
reflect changes in manufacturer's prices for drugs.
(b) Adjustment to Average Sales Price Calculation.--Section 1847A
of the Social Security Act (42 U.S.C. 1395w-3a) is amended--
(1) in subsection (b), by adding at the end the following
new paragraph:
``(6) Reconciliation.--Payments made pursuant to this
subsection are subject to reconciliation to assure that such
payments do not exceed or fall short of the actual average
sales price during any preceding period. Such reconciliation
shall be conducted on a quarterly basis and the Secretary shall
review all payments made to physicians under this subsection in
the preceding quarter and compare such payment to the verified
average sales price reported by the manufacturer under
subsection (c) for such quarter.''; and
(2) in subsection (c)(3)--
(A) in the first sentence, by striking ``prompt pay
discounts,''; and
(B) in the second sentence, by inserting ``other
than prompt pay discounts,'' after ``other price
concessions,''.
SEC. 3. IMPROVED PAYMENT FOR ONCOLOGIST SERVICES.
(a) Findings.--Congress finds that--
(1) in 2005, the Centers for Medicare & Medicaid Services
implemented a $300 million demonstration project to identify
and assess certain oncology services in an office-based
oncology practice that positively affect cancer outcomes in the
Medicare population; and
(2) oncologists and cancer patients benefited from the
demonstration project.
(b) Continuation of Current Demonstration Project to Identify and
Assess Oncology Services That Positively Affect Cancer Outcomes.--
(1) In general.--The existing demonstration project,
developed by the Secretary of Health and Human Services
pursuant to the Secretary's authority under sections
402(a)(1)(B) and 402(a)(2) of the Social Security Amendments of
1967 and implemented in the Federal Register, ``Revisions to
Payment Policies Under the Physician Fee Schedule for Calendar
Year 2005,'' 69 Fed. Reg. 66,236 (November 15, 2004), for
purposes of identifying and assessing certain oncology services
that positively affect outcomes in the Medicare population,
shall be extended until December 31, 2006.
(2) Implementation.--The Secretary shall continue to
operate such project in the same manner as originally
implemented.
(3) Funding.--Under the demonstration project over the
duration of the project, the Secretary shall apply the
methodology and funding consistent with that established for
the existing project.
(4) Report.--Not later than July 1, 2007, the Secretary
shall submit to Congress a report on the project, together with
recommendations for such legislation and administrative action
as the Secretary determines to be appropriate.
(c) Adjustment to Physician Fee Schedule.--Section 1848(c)(2) of
the Social Security Act (42 U.S.C. 1395w-4(c)(2)) is amended--
(1) in subparagraph (B)(iv)--
(A) in subclause (II), by striking ``and'';
(B) in subclause (III), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(IV) subparagraph (K) insofar as
it relates to a physician fee schedule
for 2006 shall not be taken into
account in applying clause (ii)(II) for
drug administration services under the
fee schedule for such year.''; and
(2) by adding at the end the following new subparagraph:
``(K) Adjustment in payment rates for overhead
costs.--In establishing the physician fee schedule
under subsection (b) with respect to payments for drug
administration services furnished on or after January
1, 2006, and in order to take into account overhead and
related expenses, the Secretary shall provide for an
additional payment in an amount equal to 2 percent of
the amount determined under section 1847A for the drug
administered.''.
SEC. 4. QUALITY MEASURES FOR CANCER CARE.
(a) Findings.--Congress finds that--
(1) existing quality indicators relating to the quality of
care furnished to cancer patients in physician offices are
inconsistent across practice settings and are not based on
uniform, evidence-based and consistently applied standards; and
(2) physician reimbursement should reflect improvements in
the quality of care provided.
(b) Development of Quality Indicators.--In collaboration with
practicing physicians, the Secretary of Health and Human Services shall
develop indicators for the evaluation of the quality of oncology
services provided in the physician office setting. Such indicators
shall not be implemented for any purpose unless the Secretary has
provided for an assessment of the proposed indicators by the physician
community.
(c) Pilot and Demonstration Projects.--The Secretary may conduct
pilot projects and demonstration projects to test such indicators as
appropriate.
SEC. 5. IMPROVED PATIENT PARTICIPATION IN CLINICAL TRIALS.
(a) Findings.--Congress finds that--
(1) the current report of the President's Cancer Panel has
documented the increasing incidence and costs of cancer to the
United States; and
(2) the current report of the President's Cancer Panel has
identified problems in translating research into effective
cancer care.
(b) Strategic Plan for Improved Patient Participation.--
(1) In general.--In collaboration with practicing
physicians, the Director of the National Cancer Institute shall
develop a strategic plan to increase the number of cancer
patients who enroll in clinical trials.
(2) Components of plan.--Such plan shall include components
designed to--
(A) improve patient education regarding clinical
trials;
(B) facilitate the clinical trial process; and
(C) ensure the viability of conducting clinical
research in all settings where treatment is provided.
(c) Report.--Not later than January 1, 2007, the Secretary of
Health and Human Services shall submit to Congress a report on the
strategic plan under subsection (b) together with recommendations for
such legislation and administrative action as the Secretary determines
to be appropriate.
SEC. 6. CBO REPORT.
Not later than one year after the date of the enactment of this
Act, the Director of the Congressional Budget Office shall submit to
Congress a report that describes the impact of the provisions of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003
(Public Law 108-173) as implemented on oncologists and other physicians
who provide cancer care and a comparison of such impact with the impact
of such law estimated by such Office before its enactment.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S1547-1548)
Read twice and referred to the Committee on Finance.
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