Community Cancer Care Preservation Act of 2007 - Amends title XVIII (Medicare) of the Social Security Act to require determination and calculation of the manufacturer's average sales price for a drug or biological on a monthly instead of a quarterly basis. Requires the payment amounts to be updated and applied by the Secretary of Health and Human Services based on the manufacturer's average sales price for the drug or biological calculated for the most recent month for which data are available. Removes prompt pay discounts from the calculation of such price.
Provides for an increase in the Medicare part B (Supplementary Medical Insurance) payment for chemotherapy administration services.
Directs the Secretary to make an additional 2% for any drug administration services payment to physicians, taking into account pharmacy facilities management costs.
Directs the Secretary to develop new CPT codes for reporting and billing of physician's services associated with pharmacy facilities management and with medical oncology treatment planning.
[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1190 Introduced in House (IH)]
110th CONGRESS
1st Session
H. R. 1190
To amend title XVIII of the Social Security Act to preserve access to
community cancer care by Medicare beneficiaries.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 27, 2007
Mr. Davis of Alabama (for himself and Mr. Ramstad) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, 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 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 2007''.
(b) 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 chemotherapy
administration.
Sec. 4. Provisions for the appropriate reporting and billing of
physicians' services associated with
pharmacy facilities management and medical
oncology treatment planning.
SEC. 2. APPLICATION OF AVERAGE SALES PRICE PAYMENT METHODOLOGY.
(a) Requiring Monthly and Not Quarterly Determinations.--
(1) In general.--Section 1847A(c) of the Social Security
Act (42 U.S.C. 1395w-3a(c)) is amended--
(A) in paragraph (1)--
(i) in the matter preceding subparagraph
(A) and in subparagraph (A), by striking
``calendar quarter'' and inserting ``month''
each place it appears; and
(ii) in subparagraph (B), by striking
``quarter'' and inserting ``month'';
(B) in paragraph (4)--
(i) in the heading, by striking ``quarter''
and inserting ``month''; and
(ii) by striking ``calendar quarter'' and
inserting ``month''; and
(C) in paragraph (5)--
(i) in subparagraph (A), by striking
``quarterly'' and inserting ``monthly'' each
place it appears; and
(ii) by amending subparagraph (B) to read
as follows:
``(B) 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.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to payment amounts for months beginning on or after
January 1, 2008.
(b) Adjustment to Average Sales Price Calculation.--
(1) In general.--Section 1847A(c) of such Act (42 U.S.C.
1395w-3(a)(c)) is further amended in paragraph (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,''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to payment amounts for months beginning on or after
January 1, 2008.
SEC. 3. INCREASE IN MEDICARE PART B REIMBURSEMENT FOR CERTAIN
CHEMOTHERAPY ADMINISTRATION.
(a) 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:
``(5) Special rule for ceratin chemotherapy
administration.--
``(A) 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:
``(i) 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.
``(ii) 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.
``(B) 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):
``(i) CPT code 96413 (relating to
intravenous infusions of initial drug up to one
hour).
``(ii) CPT code 96417 (relating to
additional, sequential intravenous infusions of
different drugs up to one hour).
``(iii) CPT code 96422 (relating to inter-
arterial infusions for up to one hour).
``(iv) CPT code 96415 (relating to
intravenous infusions for subsequent hours).
``(v) CPT code 96423 (relating to inter-
arterial infusions for subsequent hours).''.
SEC. 4. PROVISIONS FOR THE APPROPRIATE REPORTING AND BILLING OF
PHYSICIANS' SERVICES ASSOCIATED WITH PHARMACY FACILITIES
MANAGEMENT AND MEDICAL ONCOLOGY TREATMENT PLANNING.
(a) In General.--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
(C) by adding at the end the following new
subclauses:
``(IV) 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
``(V) 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
(2) by adding at the end the following new subparagraphs:
``(K) 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.
``(L) Provisions for the appropriate reporting and
billing of physicians' services associated with
pharmacy facilities management and medical oncology
treatment planning.--
``(i) Creation of new cpt codes.--
``(I) 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).
``(II) 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.
``(ii) Use of existing processes.--In
carrying out clause (i), the Secretary shall
use existing processes for the implementation
of such coding changes, as appropriate.
``(iii) 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.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line