,,ii #aaeth ,,congress #ast ,session ,s4 #dfc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #bh1 #bjag,mr4 ,cornyn 7for himself and ,mr4 ,carper7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to establish a national ,oncology ,medical ,home ,demonstration ,project under the ,medicare program for the purpose of changing the ,medicare payment for cancer care in order to enhance the quality of care and to improve cost efficiency1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,cancer ,care ,payment ,reform ,act of #bjag4 #b4 ,establishing an ,oncology ,medical ,home ,demonstration ,project under the ,medicare program to improve quality of care and cost efficiency ,title ,,xviii of the ,social ,security ,act is amended by inserting after section #ahff;,e 7#db ,u4,s4,c4 #acie;cc-#e7 the following new section3 #ahff;,f4 ,oncology ,medical ,home ,demonstration ,project 7a7 ,establishment of demonstration project ,not later than #ab months after the date of the enactment of this section1 the ,secretary shall establish an ,oncology ,medical ,home ,demonstration ,project 7in this section referred to as the demonstration project7 to make payments in the amounts specified in subsection 7f7 to each participating oncology practice 7as defined in subsection 7b774 7b7 ,definition of participating oncology practice ,for purposes of this section1 the term participating oncology practice means an oncology practice that-- 7#a7 submits to the ,secretary an application to participate in the demonstration project in accordance with subsection 7c72 7#b7 is selected by the ,secretary1 in accordance with subsection 7d71 to participate in the demonstration project2 and 7#c7 is owned by a physician1 or is owned by or affiliated with a hospital1 that submitted a claim for payment in the prior year for an item or service for which payment may be made under part ,b4 7c7 ,application ,to ,participate ,an application by an oncology practice to participate in the demonstration project shall include an attestation to the ,secretary that the practice-- 7#a7 furnishes physicians' services for which payment may be made under part ,b2 7#b7 coordinates oncology services furnished to an individual by the practice with services that are related to such oncology services and that are furnished to such individual by practitioners 7including oncology nurses7 inside or outside the practice in order to ensure that each such individual receives coordinated care2 7#c7 meaningfully uses electronic health records2 7#d7 will1 not later than one year after the date on which the practice commences its participation in the demonstration project1 be accredited as an ,oncology ,medical ,home by the ,commission on ,cancer1 the ,national ,committee for ,quality ,assurance1 or such other entity as the ,secretary determines appropriate2 7#e7 will repay all amounts paid by the ,secretary to the practice under subsection 7f77#a77;,a7 in the case that the practice does not1 on a date that is not later than #fj days after the date on which the practice's agreement period for the demonstration project begins1 as determined by the ,secretary1 submit an application to an entity described in paragraph 7#d7 for accreditation as an ,oncology ,medical ,home in accordance with such paragraph2 7#f7 will1 for each year in which the demonstration project is conducted1 report to the ,secretary1 in such form and manner as is specified by the ,secretary1 on-- 7,a7 the performance of the practice with respect to measures described in subsection 7e7 as determined by the ,secretary1 subject to subsection 7e77#a77;,b72 and 7,b7 the experience of care of individuals who are furnished oncology services by the practice for which payment may be made under part ,b1 as measured by a patient experience of care survey based on the ,consumer ,assessment of ,healthcare ,providers and ,systems survey or by such similar survey as the ,secretary determines appropriate2 7#g7 agrees not to receive the payments described in subclauses 7,i7 and 7,,ii7 of subsection 7f77#a77;,b77iii7 in the case that the practice does not report to the ,secretary in accordance with paragraph 7#f7 with respect to performance of the practice during the #ab-month period beginning on the date on which the practice's agreement period for the demonstration project begins1 as determined by the ,secretary2 7#h7 will1 for each year of the demonstration project1 meet the performance standards developed under subsection 7e77#d77;,b7 with respect to each of the measures on which the practice has agreed to report under paragraph 7#f77;,a7 and the patient experience of care on which the practice has agreed to report under paragraph 7#f77;,b72 and 7#i7 has the capacity to utilize shared decision-making tools that facilitate the incorporation of the patient needs1 preferences1 and circumstances of an individual into the medical plan of the individual and that maintain provider flexibility to tailor care of the individual based on the full range of test and treatment options available to the individual4 7d7 ,selection of participating practices 7#a7 ,in general ,the ,secretary shall1 not later than #ae months after the date of the enactment of this section1 select oncology practices that submit an application to the ,secretary in accordance with subsection 7c7 to participate in the demonstration project4 7#b7 ,maximum number of practices ,in selecting an oncology practice to participate in the demonstration project under this section1 the ,secretary shall ensure that the participation of such practice in the demonstration project does not1 on the date on which the practice commences its participation in the demonstration project-- 7,a7 increase the total number of practices participating in the demonstration project to a number that is greater than #bjj practices 7or such number as the ,secretary determines appropriate72 or 7,b7 increase the total number of oncologists who participate in the demonstration project to a number that is greater than #a1ejj oncologists 7or such number as the ,secretary determines appropriate74 7#c7 ,diversity of practices 7,a7 ,in general ,subject to subparagraph 7,b71 in selecting oncology practices to participate in the demonstration project under this section1 the ,secretary shall1 to the extent practicable1 include in such selection-- 7i7 small-1 medium-1 and large-sized practices2 and 7ii7 practices located in different geographic areas4 7,b7 ,inclusion of small oncology practices ,in selecting oncology practices to participate in the demonstration project under this section1 the ,secretary shall1 to the extent practicable1 ensure that at least #bj percent of the participating practices are small oncology practices 7as determined by the ,secretary74 7#d7 ,no penalty for certain opt-outs by practices ,in the case that the ,secretary selects an oncology practice to participate in the demonstration project under this section that has agreed to participate in a model established under section #aaae;,a for oncology services1 such practice may not be assessed a penalty for electing not to participate in such model if the practice makes such election-- 7,a7 prior to the receipt by the practice of any payment for such model that would not otherwise be paid in the absence of such model2 and 7,b7 in order to participate in the demonstration project under this section4 7e7 ,measures 7#a7 ,development 7,a7 ,in general ,the ,secretary shall use measures described in paragraph 7#b71 and may use measures developed under paragraph 7#c71 to assess the performance of each participating oncology practice1 as compared to other participating oncology practices as described in paragraph 7#d77;,a77i74 7,b7 ,determination of measures reported ,in determining measures to be reported under subsection 7c77#f77;,a71 the ,secretary1 in consultation with stakeholders1 shall ensure that reporting under such subsection is not overly burdensome and that those measures required to be reported are aligned with applicable requirements from other payors4 7#b7 ,measures described ,the measures described in this paragraph1 with respect to individuals who are attributed to a participating oncology practice1 as determined by the ,secretary1 are the following3 7,a7 ,patient care measures 7i7 ,the percentage of such individuals who receive documented clinical or pathologic staging prior to initiation of a first course of cancer treatment4 7ii7 ,the percentage of such individuals who undergo advanced imaging and have been diagnosed with stage ,i or ,,ii breast cancer4 7iii7 ,the percentage of such individuals who undergo advanced imaging and have been diagnosed with stage ,i or ,,ii prostate cancer4 7iv7 ,the percentage of such individuals who1 prior to receiving cancer treatment1 had their performance status assessed by the practice4 7v7 ,the percentage of such individuals who-- 7,i7 undergo treatment with a chemotherapy regimen provided by the practice2 7,,ii7 have at least a #bj-percent risk of developing febrile neutropenia due to a combination of regimen risk and patient risk factors2 and 7,,iii7 have received from the practice either ,,gcsf or white cell growth factor4 7vi7 ,with respect to such individuals who receive an oncology drug therapy from the practice1 the percentage of such individuals who underwent a diagnostic test to identify specific biomarkers1 genetic mutations1 or characteristics prior to receiving an oncology drug therapy1 where such a diagnostic test exists for a given cancer type4 7vii7 ,with respect to such individuals who receive chemotherapy treatment from the practice1 the percentage of such individuals so treated who receive a treatment plan prior to the administration of such chemotherapy4 7viii7 ,with respect to chemotherapy treatments administered to such individuals by the practice1 the percentage of such treatments that adhere to guidelines published by the ,national ,comprehensive ,cancer ,network or such other entity as the ,secretary determines appropriate4 7ix7 ,with respect to antiemetic drugs dispensed by the practice to individuals as part of moderately or highly emetogenic chemotherapy regimens for such individuals1 the extent to which such drugs are administered in accordance with evidence-based guidelines or pathways that are compliant with guidelines published by the ,national ,comprehensive ,cancer ,network or such other entity as the ,secretary determines appropriate4 7,b7 ,resource utilization measures 7i7 ,with respect to emergency room visits in a year by such individuals who are receiving active chemotherapy treatment administered by the practice as of the date of such visits1 the percentage of such visits that are associated with qualified cancer diagnoses of the individuals4 7ii7 ,with respect to hospital admissions in a year by such individuals who are receiving active chemotherapy treatment administered by the practice as of the date of such visits1 the percentage of such admissions that are associated with qualified cancer diagnoses of the individuals4 7,c7 ,survivorship measures 7i7 ,survival rates for such individuals who have been diagnosed with stage ,i through ,,iv breast cancer4 7ii7 ,survival rates for such individuals who have been diagnosed with stage ,i through ,,iv colorectal cancer4 7iii7 ,survival rates for such individuals who have been diagnosed with stage ,i through ,,iv lung cancer4 7iv7 ,with respect to such individuals who receive chemotherapy treatment from the practice1 the percentage of such individuals so treated who receive a survivorship plan not later than #de days after the completion of the administration of such chemotherapy4 7v7 ,with respect to such individuals who receive chemotherapy treatment from the practice1 the percentage of such individuals who receive psychological screening4 7,d7 ,end-of-life care measures 7i7 ,the number of times that such an individual receives chemotherapy treatment from the practice within an amount of time specified by the ,secretary1 in consultation with stakeholders1 prior to the death of the individual4 7ii7 ,with respect to such individuals who have a stage ,,iv disease and have received treatment for such disease from the practice1 the percentage of such individuals so treated who have had a documented end-of-life care conversation with a physician in the practice or another health care provider who is a member of the cancer care team of the practice4 7iii7 ,with respect to such an individual who is referred to hospice care by a physician in the practice or a health care provider who is a member of the cancer care team of the practice1 regardless of the setting in which such care is furnished1 the average number of days that the individual receives hospice care prior to the death of the individual4 7iv7 ,with respect to such individuals who die while receiving care from the practice1 the percentage of such deceased individuals whose death occurred in an acute care setting4 7#c7 ,modification or addition of measures 7,a7 ,in general ,the ,secretary may1 in consultation with appropriate stakeholders in a manner determined by the ,secretary1 modify1 replace1 remove1 or add to the measures described in paragraph 7#b74 7,b7 ,appropriate stakeholders described ,for purposes of subparagraph 7,a71 the term appropriate stakeholders includes oncology societies1 oncologists who furnish oncology services to one or more individuals for which payment may be made under part ,b1 allied health professionals1 health insurance issuers that have implemented alternative payment models for oncologists1 patients and organizations that represent patients1 and biopharmaceutical and other medical technology manufacturers4 7#d7 ,assessment 7,a7 ,in general ,the ,secretary shall1 for each year in which the demonstration project is conducted1 assess-- 7i7 the performance of each participating oncology practice for such year with respect to the measures on which the practice has agreed to report to the ,secretary under subsection 7c77#f77;,a71 as compared to the performance of other participating oncology practices with respect to such measures2 and 7ii7 the extent to which each participating oncology practice has1 during such year1 used breakthrough or other best-in-class therapies4 7,b7 ,performance standards ,the ,secretary shall1 in consultation with the appropriate stakeholders described in paragraph 7#c77;,b7 in a manner determined by the ,secretary1 develop performance standards with respect to-- 7i7 each of the measures described in paragraph 7#b71 including those measures as modified or added under paragraph 7#c72 and 7ii7 the patient experience of care on which participating oncology practices agree to report to the ,secretary under subsection 7c77#f77;,b74 7f7 ,payments for participating oncology practices and oncologists 7#a7 ,care coordination management fee during first two years of demonstration project 7,a7 ,in general ,the ,secretary shall1 in addition to any other payments made by the ,secretary under this title to a participating oncology practice1 pay a care coordination management fee to each such practice at each of the times specified in subparagraph 7,b74 7,b7 ,timing of payments ,the care coordination management fee described in subparagraph 7,a7 shall be paid to a participating oncology practice at the end of each of the following periods3 7i7 ,the period that ends #f months after the date on which the practice's agreement period for the demonstration project begins1 as determined by the ,secretary4 7ii7 ,the period that ends #ab months after the date on which the practice's agreement period for the demonstration project begins1 as determined by the ,secretary4 7iii7 ,subject to subsection 7c77#g7-- 7,i7 the period that ends #ah months after the date on which the practice's agreement period for the demonstration project begins1 as determined by the ,secretary2 and 7,,ii7 the period that ends #bd months after the date on which the practice's agreement period for the demonstration project begins1 as determined by the ,secretary4 7,c7 ,amount of payment ,the ,secretary shall1 in consultation with oncologists who furnish oncology services for which payment may be made under part ,b in a manner determined by the ,secretary1 determine the amount of the care coordination management fee described in subparagraph 7,a74 7#b7 ,performance incentive payments 7,a7 ,in general ,subject to subparagraphs 7,c7 and 7,e71 the ,secretary shall1 in addition to any other payments made by the ,secretary under this title to a participating oncology practice1 pay a performance incentive payment to each such practice for each year of the demonstration project described in subparagraph 7,b74 7,b7 ,timing of payments ,the performance incentive payment described in subparagraph 7,a7 shall be paid to a participating oncology practice as soon as practicable following the end of the third1 fourth1 and fifth years of the demonstration project4 7,c7 ,source of payments ,performance incentive payments made to participating oncology practices under subparagraph 7,a7 for each of the years of the demonstration project described in subparagraph 7,b7 shall be paid from the aggregate pool available for making payments for each such year determined under subparagraph 7,d71 as available for each such year4 7,d7 ,aggregate pool available for making payments ,with respect to each of the years of the demonstration project described in subparagraph 7,b71 the aggregate pool available for making performance incentive payments for each such year shall be determined by-- 7i7 estimating the amount by which the aggregate expenditures that would have been expended for the year under parts ,a and ,b for items and services furnished to individuals attributed to participating oncology practices if the demonstration project had not been implemented exceeds such aggregate expenditures for such individuals for such year of the demonstration project2 7ii7 calculating the amount that is half of the amount estimated under clause 7i72 and 7iii7 subtracting from the amount calculated under clause 7ii7 the total amount of payments made under paragraph 7#a7 that have not1 in a prior application of this clause1 previously been so subtracted from a calculation made under clause 7ii74 7,e7 ,amount of payments to individual practices that meet performance standards and achieve savings 7i7 ,payments only to practices that meet performance standards ,the ,secretary may not make performance incentive payments to a participating oncology practice under subparagraph 7,a7 with respect to a year of the demonstration project described in subparagraph 7,b7 unless the practice meets or exceeds the performance standards developed under subsection 7e77#d77;,b7 for the year with respect to-- 7,i7 the measures on which the practice has agreed to report to the ,secretary under subsection 7c77#f77;,a72 and 7,,ii7 the patient experience of care on which the practice has agreed to report to the ,secretary under subsection 7c77#f77;,b74 7ii7 ,consideration of performance assessment ,the ,secretary shall1 in consultation with the appropriate stakeholders described in subsection 7e77#c77;,b7 in a manner determined by the ,secretary1 determine the amount of a performance incentive payment to a participating oncology practice under subparagraph 7,a7 for a year of the demonstration project described in subparagraph 7,b74 ,in making a determination under the preceding sentence1 the ,secretary shall take into account the performance assessment of the practice under subsection 7e77#d77;,a7 with respect to the year and the aggregate pool available for making payments for such year determined under subparagraph 7,d71 as available for such year4 7#c7 ,issuance of guidance ,not later than the date that is #ab months after the date of the enactment of this section1 the ,secretary shall issue guidance detailing the methodology that the ,secretary will use to implement subparagraphs 7,d7 and 7,e7 of paragraph 7#b74 7g7 ,secretary reports to participating oncology practices ,the ,secretary shall inform each participating oncology practice1 on a periodic 7such as quarterly7 basis1 of-- 7#a7 the performance of the practice with respect to the measures on which the practice has agreed to report to the ,secretary under subsection 7c77#f77;,a72 and 7#b7 the estimated amount by which the expenditures that would have been expended under parts ,a and ,b for items and services furnished to individuals attributed to the practice if the demonstration project had not been implemented exceeds the actual expenditures for such individuals4 7h7 ,applications ,from ,entities ,to ,provide ,accreditations ,not later than the date that is #ah months after the date of the enactment of this section1 the ,secretary shall establish a process for the acceptance and consideration of applications from entities for purposes of determining which entities may provide accreditation to practices under subsection 7c77#d7 in addition to the entities described in such subsection4 7i7 ,revisions to demonstration project ,the ,secretary may make appropriate revisions to the demonstration project under this section in order for participating oncology practices under such demonstration project to meet the definition of an eligible alternative payment entity for purposes of section #ahcc7z74 7j7 ,waiver authority ,the ,secretary may waive such provisions of this title and title ,,xi as the ,secretary determines necessary in order to implement the demonstration project under this section4 7k7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to this section4 4