II
110th CONGRESS
1st Session
S. 1750
IN THE SENATE OF THE UNITED STATES
July 9, 2007
Mr. Specter (for himself and Mr. Casey) 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.
Short title; table of contents
Short title
This Act may be cited as the Community Cancer Care Preservation Act of
2007
.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Application of average sales price payment methodology.
Sec. 3. Increase in Medicare part B reimbursement for certain chemotherapy administration.
Sec. 4. Provisions for the appropriate reporting and billing of physicians’ services associated with pharmacy facilities management and medical oncology treatment planning.
Application of average sales price payment methodology
Requiring monthly and not quarterly determinations
In general
Section 1847A(c) of the Social Security Act (42 U.S.C. 1395w–3a(c)) is amended—
in paragraph (1)—
in
the matter preceding subparagraph (A) and in subparagraph (A), by striking
calendar quarter
and inserting month
each place
it appears; and
in
subparagraph (B), by striking quarter
and inserting
month
;
in paragraph (4)—
in
the heading, by striking quarter
and inserting
month
; and
by
striking calendar quarter
and inserting month
;
and
in paragraph (5)—
in
subparagraph (A), by striking quarterly
and inserting
monthly
each place it appears; and
by amending subparagraph (B) to read as follows:
Updates in payment amounts
The payment amounts under subsection (b) shall be updated and applied by the Secretary based upon the manufacturer’s average sales price for a drug or biological calculated for the most recent month for which data are available. This update shall be made no later than two months following publication of such data by the manufacturer.
.
Effective date
The amendments made by paragraph (1) shall apply to payment amounts for months beginning on or after January 1, 2008.
Adjustment to average sales price calculation
In general
Section 1847A(c) of such Act (42 U.S.C. 1395w–3(a)(c)) is further amended in paragraph (3)—
in the first
sentence, by striking prompt pay discounts,
; and
in the second
sentence, by inserting (other than prompt pay discounts),
after
other price concessions,
.
Effective date
The amendments made by paragraph (1) shall apply to payment amounts for months beginning on or after January 1, 2008.
Increase in Medicare part B reimbursement for certain chemotherapy administration
In general
Section 1848(a) of the Social Security Act (42 U.S.C. 1395w–4(a)) is amended by adding at the end the following new paragraph:
Special rule for certain chemotherapy administration
In general
In the case of Medicare chemotherapy administration services furnished on or after January 1, 2008, the fee schedule amount to be applied shall be equal to the following:
First hour of chemotherapy infusions
For such services described in clause (i), (ii), or (iii) of subparagraph (B), an amount equal to 132 percent of the fee schedule amount otherwise applicable under this section (without regard to this paragraph) for such respective services.
Subsequent hours of chemotherapy infusions
For such services described in clause (iv) or (v) of subparagraph (B), an amount equal to 70 percent of the amount determined under clause (i) for services described in clause (i) or (iii), respectively, of such subparagraph.
Medicare chemotherapy administration services defined
For purposes of this paragraph, the term Medicare chemotherapy administration services means physicians’ services identified, as of January 1, 2007, by any of the following codes (or any successor to such a code as identified by the Secretary) for which payments are made under subsection (b):
CPT code 96413 (relating to intravenous infusions of initial drug up to one hour).
CPT code 96417 (relating to additional, sequential intravenous infusions of different drugs up to one hour).
CPT code 96422 (relating to inter-arterial infusions for up to one hour).
CPT code 96415 (relating to intravenous infusions for subsequent hours).
CPT code 96423 (relating to inter-arterial infusions for subsequent hours).
.
Provisions for the appropriate reporting and billing of physicians’ services associated with pharmacy facilities management and medical oncology treatment planning
In general
Section 1848(c)(2) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)) is amended—
in subparagraph (B)(iv)—
in subclause (II),
by striking and
;
in subclause (III), by striking the period; and
by adding at the end the following new subclauses:
subparagraph (K) insofar as it relates to a physician fee schedule for 2008 and each subsequent year shall not be taken into account in applying clause (ii)(II) for drug administration services under the fee schedule for such year; and
subparagraph (L) insofar as it relates to a physician fee schedule for 2008 and each subsequent year shall not be taken into account in applying clause (ii)(II) for medical oncology treatment planning services under the fee schedule for such year.
; and
by adding at the end the following new subparagraphs:
Adjustment in payment rates for pharmacy facilities management costs
In establishing the physician fee schedule under subsection (b) with respect to payments for drug administration services furnished on or after January 1, 2008, and in order to take into account pharmacy facilities management costs, the Secretary shall provide for an additional payment for such services in an amount equal to 2 percent of the amount determined under section 1847A for the drug administered.
Provisions for the appropriate reporting and billing of physicians’ services associated with pharmacy facilities management and medical oncology treatment planning
Creation of new CPT codes
Pharmacy facilities management
Not later than one year after the date of the enactment of this subparagraph, in carrying out subparagraph (K), the Secretary shall issue appropriate CPT codes for the reporting and billing of pharmacy facilities management services that would correspond to the additional payment provided under subparagraph (K).
Medical oncology treatment planning
Not later than one year after the date of the enactment of this subparagraph, the Secretary shall issue two new CPT codes, one moderate and one complex, for the reporting and billing of medical oncology treatment planning services furnished by physicians and other professional staff in the specialties of hematology, hematology-oncology, and medical oncology.
Use of existing processes
In carrying out clause (i), the Secretary shall use existing processes for the implementation of such coding changes, as appropriate.
Consultation
In carrying out clause (i), the Secretary shall consult with representatives of physicians in the specialties of hematology, hematology-oncology, and medical oncology affected by the adoption of such coding changes.
.