,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #cbie  ,,in ,,the ,,house ,,of  
,,representatives  ,october #af1        
#bjac,ms4 ,castor of ,florida introduced
 the following bill2 which was referred 
to the ,committee on ,ways and ,means1  
and in addition to the ,committee on    
,energy and ,commerce1 for a period to  
be subsequently determined by the       
,speaker1 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 #f-year      
quality reporting system and value-based
 purchasing system under the ,medicare  
program4  #a4 ,short title ,this ,act   
may be cited as the ,eliminating        
,disparities in ,breast ,cancer         
,treatment ,act of #bjac4  #b4 ,findings

 ,congress finds the following3 7#a7    
,delays in receiving care after breast  
cancer diagnosis are reported to be     
greater for ,african-,american women    
than ,white women4  7#b7 ,recent studies
 indicate that ,african-,american women 
with breast cancer are less likely to   
receive standard therapy than ,white    
women4  7#c7 ,african-,american and     
,hispanic patients are significantly    
more likely than ,white patients to be  
diagnosed at a more advanced stage of   
breast cancer4  7#d7 ,investigators     
found that regardless of insurance      
status1 ,african-,american women are    
#a4i times more likely to be diagnosed  
with an advanced stage of breast cancer 
than ,white women and ,hispanic women   
are #a4d times more likely to be        
diagnosed with an advanced stage of     
breast cancer than ,white women4  7#e7  
,african-,american women are ten percent
 more likely not to receive tests to    
determine if breast cancer has spread to
 axillary 7underarm7 lymph nodes4       

,studies show that health insurance     
status1 race1 income1 and educational   
background are directly linked to       
irregularity in administering this vital
 screening4  7#f7 ,according to         
,american ,cancer ,society researchers1 
substantial disparities remain or       
persist regarding cancer diagnosis and  
treatment4  #c4 ,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 race1 
level of education1 income1 and health  
insurance status of such patients4  #d4 
,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 section3      
#ahii;,b4 ,breast cancer treatment      
performance measures system  7a7 ,in    
general ,not later than ,october #a1    

#bjad1 the ,secretary shall establish1  
in accordance with the provisions of    
this section1 a #f-year breast cancer   
treatment quality performance system 7in
 this section referred to as the system7
 to-- 7#a7 assess and publicly disclose1
 through the use of quality measures1   
the quality of care provided for the    
treatment of breast cancer by specified 
health care providers2 and  7#b7        
beginning ,october #a1 #bjag1 base      
payment under this title to such        
providers for such treatment on the     
performance of such providers based on  
such measures4  7b7 ,specified health   
care providers  7#a7 ,in general ,the   
,secretary shall specify classes of     
providers of services and suppliers1    
including hospitals1 cancer centers1    
physicians1 primary care providers1 and 
specialty providers1 to which the       
provisions of this section shall apply4 
7#b7 ,definition ,for purposes of this  
section1 the term specified health care 
provider means a provider of services or

 supplier specified under paragraph     
7#a74  7c7 ,identification and          
endorsement of breast cancer treatment  
performance measures  7#a7 ,in general  
,under the system1 the ,secretary shall 
enter into agreements with the ,national
 ,quality ,forum1 an organization that  
operates as a voluntary consensus       
standards body as defined for purposes  
of section #ab7;d7 of the ,national     
,technology ,transfer and ,advancement  
,act of #aiie 7,public ,law #ajd-aac7   
and ,office of ,management and ,budget  
,revised ,circular ,a-#aai 7published in
 the ,federal ,register on ,february    
#aj1 #aiih71 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   
cancer1 endorse such set of measures    
through its multistakeholder consensus  
development process1 and annually update
 such set of measures4  7#b7 ,measures  

described ,the set of measures described
 in paragraph 7#a7 shall include1 with  
respect to the treatment of breast      
cancer1 measures of patient outcomes1   
the process for delivering medical care 
related to such treatment1 patient      
counseling and engagement in            
decisionmaking1 patient experience of   
care1 resource use1 and practice        
capabilities1 such as care coordination4
  7d7 ,reporting process  7#a7 ,in      
general ,under the system1 for periods  
7as specified by the ,secretary7        
beginning on or after ,october #a1      
#bjad1 the ,secretary shall establish a 
reporting process1 with respect to      
treatment furnished for breast cancer1  
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        
7c77#a74 ,such data shall be submitted  
in a form and manner and at a time      

specified by the ,secretary4  7#b7      
,voluntary submission during initial #c 
years ,the reporting process under      
paragraph 7#a7 shall provide for the    
voluntary submission of data 7and       
incentives for such submission7 under   
the process for periods ending before   
,october #a1 #bjag4  7#c7               
,characteristics of data submitted under
 reporting process ,data submitted by a 
specified health care provider under the
 reporting process under paragraph 7#a7 
shall-- 7,a7 take into account the      
quality of breast cancer treatment      
furnished to all patients of the        
provider1 regardless of the type of     
health insurance coverage of the patient
 or whether or not the patient has such 
coverage2 and  7,b7 be structured in a  
manner that allows for comparison       
according to race1 educational level1   
income1 insurance status1 and any other 
category specified by the ,secretary4   
7e7 ,public disclosure ,under the       
system1 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 7based on the           
performance measures data submitted     
pursuant to subsection 7c77#a7 by the   
provider for such period7 is made       
available on the official public        
,internet site of the ,department of    
,health and ,human ,services in a clear 
and understandable form4 ,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 #cj 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 incomplete4  7f7     
,value-,based purchasing for periods    
beginning ,october #a1 #bjag  7#a7 ,in  
general ,under the system1 for periods  
beginning on or after ,october #a1      

#bjag1 and ending before ,october #a1   
#bjbj1 the ,secretary shall establish   
and implement1 a value-based purchasing 
program1 with respect to specified      
health care providers that furnish      
treatment for breast cancer during such 
a period1 under which-- 7,a7 in the case
 of such a provider that does not submit
 data in accordance with the reporting  
process under subsection 7d77#a7 for    
such treatment furnished during such    
period1 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 
,secretary2 and  7,b7 in the case of    
such a provider that submits data in    
accordance with the reporting process   
under subsection 7d77#a7 for such       
treatment furnished during such period--
 7i7 subject to clause 7ii71 if the     
,secretary determines such provider     
furnished low quality care 7in          
accordance with a method specified by   
the ,secretary7 for such treatment1 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 ,secretary2  
7ii7 if the ,secretary determines such  
provider furnished low quality care 7in 
accordance with the method specified    
under clause 7i77 for such treatment1   
but the quality of care has improved as 
compared to the quality of care the     
provider furnished during the previous  
period1 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-- 7,i7 is less than   
the amount specified by the ,secretary  
under clause 7i72 and  7,,ii7 is based  
on the extent of improvement in the     
quality of care2 and  7iii7 if the      
,secretary determines such provider did 
not furnish low quality care 7in        
accordance with the method specified    

under clause 7i77 for such treatment1   
the ,secretary shall provide to such    
provider the amount to be paid to such  
provider under this title for such      
treatment4  7#b7 ,results-based payments
 ,the amount of a reduction under       
subparagraph 7,a7 or 7,b77i7 of         
paragraph 7#a7 shall be determined in   
accordance with a method established by 
the ,secretary4  7g7 ,reports ,not later
 than ,october #a1 #bjae1 and for each  
#f-month period thereafter 7before      
fiscal year #bjba71 the ,secretary shall
 submit to ,congress a report that      
evaluates the development and           
implementation of the system1           
including-- 7#a7 an evaluation of the   
number of specified health care         
providers that submit data pursuant to  
subsection 7c77#a72  7#b7 an analysis of
 the effect of such system on reducing  
disparities in the provision of breast  
cancer treatment to patients based on   
race1 level of education1 income1 and   
health insurance status of such         

patients2 and  7#c7 recommendations on  
whether 7and to what extent7 to extend  
the system under this section4  7h7     
,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 ,c4  4