,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #cbie  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #af1 #bjac,ms4
 ,ca/or ( ,florida introduc$ ! foll[+   
bill2 :i* 0 ref]r$ to ! ,committee on   
,ways & ,means1 & 9 addition to !       
,committee on ,en]gy & ,comm]ce1 = a    
p]iod to be subsequ5tly det]m9$ by !    
,speak]1 9 ea* case = consid]ation ( su*
 provisions z fall )9 ! jurisdiction ( !
 committee conc]n$  ,a ,,bill  ,to am5d 
title ,,xviii ( ! ,social ,security ,act
 to elim9ate contribut+ factors to      
disp>ities 9 brea/ canc] treatm5t ?r\gh 
! developm5t ( a uni=m set (            
cons5sus-bas$ brea/ canc] treatm5t      
p]=mance measures = a #f-ye> quality    
report+ sy/em & value-bas$ pur*as+ sy/em
 "u ! ,m$ic>e program4  #a4 ,%ort title 
,?is ,act may be cit$ z ! ,elim9at+     
,disp>ities 9 ,brea/ ,canc] ,treatm5t   
,act ( #bjac4  #b4 ,f9d+s ,congress f9ds
 ! foll[+3 7#a7 ,delays 9 receiv+ c>e   
aft] brea/ canc] diagnosis are report$  
to be great] = ,african-,am]ican wom5   

?an ,:ite wom54  7#b7 ,rec5t /udies     
indicate t ,african-,am]ican wom5 )     
brea/ canc] are less likely to receive  
/&>d !rapy ?an ,:ite wom54  7#c7        
,african-,am]ican & ,hispanic pati5ts   
are significantly m likely ?an ,:ite    
pati5ts to be diagnos$ at a m advanc$   
/age ( brea/ canc]4  7#d7 ,inve/igators 
f\nd t reg>dless ( insurance /atus1     
,african-,am]ican wom5 are #a4i times m 
likely to be diagnos$ ) an advanc$ /age 
( brea/ canc] ?an ,:ite wom5 & ,hispanic
 wom5 are #a4d times m likely to be     
diagnos$ ) an advanc$ /age ( brea/ canc]
 ?an ,:ite wom54  7#e7 ,african-,am]ican
 wom5 are t5 p]c5t m likely n to receive
 te/s to det]m9e if brea/ canc] has     
spread to axill>y 7und]>m7 lymph nodes4 
,/udies %[ t heal? insurance /atus1     
race1 income1 & educational backgr\nd   
are directly l9k$ to irregul>ity 9      
adm9i/]+ ?is vital scre5+4  7#f7        
,accord+ to ,am]ican ,canc] ,society    
rese>*]s1 sub/antial disp>ities rema9 or
 p]si/ reg>d+ canc] diagnosis &         

treatm5t4  #c4 ,purpose ,! purpose ( ?is
 ,act is to promote ! implem5tation (   
/&>diz$ heal? c>e practices = brea/     
canc] treatm5t "u ! ,m$ic>e program to  
elim9ate disp>ities 9 ! provision ( c>e 
to su* pati5ts bas$ on race1 level (    
education1 income1 & heal? insurance    
/atus ( su* pati5ts4  #d4 ,cons5sus-bas$
 brea/ canc] treatm5t p]=mance measures 
sy/em "u ,m$ic>e ,title ,,xviii ( !     
,social ,security ,act is am5d$ by add+ 
at ! end ! foll[+ new section3          
#ahii;,b4 ,brea/ canc] treatm5t p]=mance
 measures sy/em  7a7 ,9 g5]al ,n lat]   
?an ,octob] #a1 #bjad1 ! ,secret>y %all 
e/abli%1 9 accordance ) ! provisions (  
?is section1 a #f-ye> brea/ canc]       
treatm5t quality p]=mance sy/em 79 ?is  
section ref]r$ to z ! sy/em7 to-- 7#a7  
assess & publicly disclose1 ?r\gh ! use 
( quality measures1 ! quality ( c>e     
provid$ = ! treatm5t ( brea/ canc] by   
specifi$ heal? c>e provid]s2 &  7#b7    
beg9n+ ,octob] #a1 #bjag1 base paym5t "u
 ?is title to su* provid]s = su*        

treatm5t on ! p]=mance ( su* provid]s   
bas$ on su* measures4  7b7 ,specifi$    
heal? c>e provid]s  7#a7 ,9 g5]al ,!    
,secret>y %all specify classes (        
provid]s ( s]vices & suppli]s1 includ+  
hospitals1 canc] c5t]s1 physicians1     
prim>y c>e provid]s1 & specialty        
provid]s1 to :i* ! provisions ( ?is     
section %all apply4  7#b7 ,def9ition ,= 
purposes ( ?is section1 ! t]m specifi$  
heal? c>e provid] means a provid] (     
s]vices or suppli] specifi$ "u p>agraph 
7#a74  7c7 ,id5tification & endorsem5t (
 brea/ canc] treatm5t p]=mance measures 
7#a7 ,9 g5]al ,"u ! sy/em1 ! ,secret>y  
%all ent] into agreem5ts ) ! ,national  
,quality ,=um1 an organization t op]ates
 z a volunt>y cons5sus /&>ds body z     
def9$ = purposes ( section #ab7;d7 ( !  
,national ,te*nology ,transf] &         
,advancem5t ,act ( #aiie 7,public ,law  
#ajd-aac7 & ,(fice ( ,managem5t &       
,budget ,revis$ ,circul> ,a-#aai        
7publi%$ 9 ! ,f$]al ,regi/] on ,febru>y 
#aj1 #aiih71 "u :i* ! ,national ,quality

 ,=um %all id5tify a uni=m set (        
cons5sus-bas$ p]=mance measures to      
evaluate ! quality ( c>e provid$ by     
specifi$ heal? c>e provid]s = ! treatm5t
 ( brea/ canc]1 endorse su* set (       
measures ?r\gh its multi/akehold]       
cons5sus developm5t process1 & annually 
update su* set ( measures4  7#b7        
,measures describ$ ,! set ( measures    
describ$ 9 p>agraph 7#a7 %all include1 )
 respect to ! treatm5t ( brea/ canc]1   
measures ( pati5t outcomes1 ! process = 
deliv]+ m$ical c>e relat$ to su*        
treatm5t1 pati5t c\nsel+ & engagem5t 9  
decisionmak+1 pati5t exp]i5ce ( c>e1    
res\rce use1 & practice capabilities1   
su* z c>e coord9ation4  7d7 ,report+    
process  7#a7 ,9 g5]al ,"u ! sy/em1 =   
p]iods 7z specifi$ by ! ,secret>y7      
beg9n+ on or aft] ,octob] #a1 #bjad1 !  
,secret>y %all e/abli% a report+        
process1 ) respect to treatm5t furni%$ =
 brea/ canc]1 t provides = a me?od =    
specifi$ heal? c>e provid]s to submit to
 ! ,secret>y data on ! p]=mance ( su*   

provid]s dur+ ea* p]iod ?r\gh use ( !   
p]=mance measures develop$ pursuant to  
subsection 7c77#a74 ,su* data %all be   
submitt$ 9 a =m & mann] & at a "t       
specifi$ by ! ,secret>y4  7#b7 ,volunt>y
 submission dur+ initial #c ye>s ,!     
report+ process "u p>agraph 7#a7 %all   
provide = ! volunt>y submission ( data  
7& inc5tives = su* submission7 "u !     
process = p]iods end+ be=e ,octob] #a1  
#bjag4  7#c7 ,*>act]i/ics ( data        
submitt$ "u report+ process ,data       
submitt$ by a specifi$ heal? c>e provid]
 "u ! report+ process "u p>agraph 7#a7  
%all-- 7,a7 take into acc\nt ! quality (
 brea/ canc] treatm5t furni%$ to all    
pati5ts ( ! provid]1 reg>dless ( ! type 
( heal? insurance cov]age ( ! pati5t or 
:e!r or n ! pati5t has su* cov]age2 &   
7,b7 be /ructur$ 9 a mann] t all[s =    
comp>ison accord+ to race1 educational  
level1 income1 insurance /atus1 & any   
o!r category specifi$ by ! ,secret>y4   
7e7 ,public disclosure ,"u ! sy/em1 !   
,secret>y %all e/abli% proc$ures to     

require t in=mation ) respect to !      
quality demon/rat$ by a specifi$ heal?  
c>e provid] ( treatm5t furni%$ = brea/  
canc] dur+ a p]iod 7bas$ on ! p]=mance  
measures data submitt$ pursuant to      
subsection 7c77#a7 by ! provid] = su*   
p]iod7 is made available on ! (ficial   
public ,int]net site ( ! ,dep>tm5t (    
,heal? & ,human ,s]vices 9 a cle> &     
und]/&able =m4 ,su* proc$ures %all      
ensure t a specifi$ heal? c>e provid]   
has ! opportunity to review ! in=mation 
t is to be made public ) respect to !   
provid] at lea/ #cj days prior to su*   
data be+ made public & %all provide = an
 appeals process 9 ! case a provid]     
claims su* in=mation to be incorrect or 
incomplete4  7f7 ,value-,bas$ pur*as+ = 
p]iods beg9n+ ,octob] #a1 #bjag  7#a7 ,9
 g5]al ,"u ! sy/em1 = p]iods beg9n+ on  
or aft] ,octob] #a1 #bjag1 & end+ be=e  
,octob] #a1 #bjbj1 ! ,secret>y %all     
e/abli% & implem5t1 a value-bas$ pur*as+
 program1 ) respect to specifi$ heal?   
c>e provid]s t furni% treatm5t = brea/  

canc] dur+ su* a p]iod1 "u :i*-- 7,a7 9 
! case ( su* a provid] t does n submit  
data 9 accordance ) ! report+ process "u
 subsection 7d77#a7 = su* treatm5t      
furni%$ dur+ su* p]iod1 ! ,secret>y %all
 r$uce ! am\nt t w\ld o!rwise be paid to
 su* provid] "u ?is title = su* treatm5t
 by an am\nt specifi$ by ! ,secret>y2 & 
7,b7 9 ! case ( su* a provid] t submits 
data 9 accordance ) ! report+ process "u
 subsection 7d77#a7 = su* treatm5t      
furni%$ dur+ su* p]iod-- 7i7 subject to 
clause 7ii71 if ! ,secret>y det]m9es su*
 provid] furni%$ l[ quality c>e 79      
accordance ) a me?od specifi$ by !      
,secret>y7 = su* treatm5t1 ! ,secret>y  
%all r$uce ! am\nt t w\ld o!rwise be    
paid to su* provid] "u ?is title = su*  
treatm5t by an am\nt specifi$ by !      
,secret>y2  7ii7 if ! ,secret>y det]m9es
 su* provid] furni%$ l[ quality c>e 79  
accordance ) ! me?od specifi$ "u clause 
7i77 = su* treatm5t1 b ! quality ( c>e  
has improv$ z comp>$ to ! quality ( c>e 
! provid] furni%$ dur+ ! previ\s p]iod1 

! ,secret>y %all r$uce ! am\nt t w\ld   
o!rwise be paid to su* provid] "u ?is   
title = su* treatm5t 9 accordance ) an  
increm5tal me?od e/abli%$ by ! ,secret>y
 t ensures t ! am\nt ( su* r$uction--   
7,i7 is less ?an ! am\nt specifi$ by !  
,secret>y "u clause 7i72 &  7,,ii7 is   
bas$ on ! ext5t ( improvem5t 9 ! quality
 ( c>e2 &  7iii7 if ! ,secret>y det]m9es
 su* provid] did n furni% l[ quality c>e
 79 accordance ) ! me?od specifi$ "u    
clause 7i77 = su* treatm5t1 ! ,secret>y 
%all provide to su* provid] ! am\nt to  
be paid to su* provid] "u ?is title =   
su* treatm5t4  7#b7 ,results-bas$       
paym5ts ,! am\nt ( a r$uction "u        
subp>agraph 7,a7 or 7,b77i7 ( p>agraph  
7#a7 %all be det]m9$ 9 accordance ) a   
me?od e/abli%$ by ! ,secret>y4  7g7     
,reports ,n lat] ?an ,octob] #a1 #bjae1 
& = ea* #f-mon? p]iod !reaft] 7be=e     
fiscal ye> #bjba71 ! ,secret>y %all     
submit to ,congress a report t evaluates
 ! developm5t & implem5tation ( ! sy/em1
 includ+-- 7#a7 an evaluation ( ! numb] 

( specifi$ heal? c>e provid]s t submit  
data pursuant to subsection 7c77#a72    
7#b7 an analysis ( ! effect ( su* sy/em 
on r$uc+ disp>ities 9 ! provision (     
brea/ canc] treatm5t to pati5ts bas$ on 
race1 level ( education1 income1 & heal?
 insurance /atus ( su* pati5ts2 &  7#c7 
recomm5dations on :e!r 7& to :at ext5t7 
to ext5d ! sy/em "u ?is section4  7h7   
,application to "p ,c ,! ,secret>y %all 
provide = a me?od to apply ! provisions 
( ?is section to treatm5t furni%$ "u a  
plan "u "p ,c4  4