[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5183 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 5183
To amend title XVIII of the Social Security Act to provide for coverage
of cancer care planning and coordination under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 11, 2023
Mr. DeSaulnier (for himself, Mr. Raskin, Ms. Blunt Rochester, Ms. Wild,
Mr. Khanna, Ms. Clarke of New York, Mrs. Watson Coleman, Mr. Bishop of
Georgia, Ms. Norton, and Ms. Wasserman Schultz) 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 provide for coverage
of cancer care planning and coordination under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
(a) Short Title.--This Act may be cited as the ``Cancer Care
Planning and Communications Act''.
(b) Findings.--Congress makes the following findings:
(1) Cancer care in the United States is often described as
the best in the world because patients have access to many
treatment options, including cutting-edge therapies that save
lives and improve the quality of life.
(2) Access to the best treatment options is not equal
across all populations and in all communities. The 1999
Institute of Medicine report entitled ``The Unequal Burden of
Cancer'' found that low-income people often lack access to
adequate cancer care and that ethnic minorities have not
benefitted fully from cancer treatment advances.
(3) In addition, despite access to high-quality treatment
options for many, individuals with cancer often do not have
access to a cancer care system that incorporates shared
decision making and the coordination of all elements of care.
(4) Cancer survivors often experience the under-diagnosis
and under-treatment of the symptoms of cancer and side effects
of cancer treatment, a problem that begins at the time of
diagnosis and may become more severe with disease progression
and at the end of life. The failure to treat the symptoms, side
effects, and late effects of cancer and cancer treatment may
have a serious adverse impact on the health, survival, well-
being, and quality of life of cancer survivors.
(5) Individuals with cancer often do not participate in a
shared decision-making process that considers all treatment
options and do not benefit from coordination of all elements of
active treatment and palliative care.
(6) Quality cancer care should incorporate access to
psychosocial services and management of the symptoms of cancer
and the symptoms of cancer treatment, including pain, nausea,
vomiting, fatigue, and depression.
(7) Quality cancer care should include a means for engaging
cancer survivors in a shared decision-making process that
produces a comprehensive care summary and a plan for follow-up
care after primary treatment to ensure that cancer survivors
have access to follow-up monitoring and treatment of possible
late effects of cancer and cancer treatment, including
appropriate psychosocial services.
(8) The Institute of Medicine report entitled ``Ensuring
Quality Cancer Care'' described the elements of quality care
for an individual with cancer to include--
(A) the development of initial treatment
recommendations by an experienced health care provider;
(B) the development of a plan for the course of
treatment of the individual and communication of the
plan to the individual;
(C) access to the resources necessary to implement
the course of treatment;
(D) access to high-quality clinical trials;
(E) a mechanism to coordinate services for the
treatment of the individual; and
(F) psychosocial support services and compassionate
care for the individual.
(9) In its report ``From Cancer Patient to Cancer Survivor:
Lost in Transition'', the Institute of Medicine recommended
that individuals with cancer completing primary treatment be
provided a comprehensive summary of their care along with a
follow-up survivorship plan of treatment.
(10) In ``Cancer Care for the Whole Patient'', the
Institute of Medicine stated that the development of a plan
that includes biomedical and psychosocial care should be a
standard for quality cancer care in any quality measurement
system.
(11) The Commission on Cancer has encouraged survivorship
care planning by making the development of such plans for
patients one of the standards of accreditation for cancer care
providers, but cancer care professionals report difficulties
completing the plans.
(12) Because more than half of all cancer diagnoses occur
among elderly Medicare beneficiaries, addressing cancer care
inadequacies through Medicare reforms will provide benefits to
millions of Americans. Providing Medicare beneficiaries more
routine access to cancer care plans and survivorship care plans
is a key to shared decision making and better coordination of
care.
(13) Important payment and delivery reforms that
incorporate cancer care planning and coordination are already
being tested in the Medicare program; the Oncology Care Model
has been implemented in a number of oncology practices, and
additional models that will include care planning have been
proposed.
(14) The alternative payment models, including the Oncology
Care Model, provide access to cancer care planning for Medicare
beneficiaries who receive their cancer care in practices that
are part of the Oncology Care Model. Other Medicare
beneficiaries who are not enrolled in these delivery
demonstrations may not have access to a cancer care plan or
appropriate care coordination.
(15) The failure to provide a cancer care plan to patients
in many care settings relates in part to inadequate Medicare
payment for such planning and coordination services.
(16) Changes in Medicare payment for cancer care planning
and coordination will support shared decision making that
reviews all treatment options and will contribute to improved
care for individuals with cancer from the time of diagnosis
through the end of the life. Medicare payment for cancer care
planning may begin a reform process that helps us realize the
well-planned and well-coordinated cancer care that has been
recommended by the Institute of Medicine/National Academy of
Medicine and that is preferred by cancer patients across the
Nation.
SEC. 2. COVERAGE OF CANCER CARE PLANNING AND COORDINATION SERVICES.
(a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended--
(1) in subsection (s)(2)--
(A) by inserting ``and'' at the end of subparagraph
(JJ); and
(B) by adding at the end the following new
subparagraph:
``(KK) cancer care planning and coordination services (as
defined in subsection (nnn));''; and
(2) by adding at the end the following new subsection:
``Cancer Care Planning and Coordination Services
``(nnn)(1) The term `cancer care planning and coordination
services' means, with respect to an individual who is diagnosed with
cancer, the development of a treatment plan by a physician, physician
assistant, or nurse practitioner that--
``(A) includes each component of the Institute of Medicine
Care Management Plan (as described in the article entitled
`Delivering High-Quality Cancer Care: Charting a New Course for
a System in Crisis' published by the Institute of Medicine);
``(B) is furnished in written form or electronically, at
the visit of such individual with such physician, physician
assistant, or nurse practitioner, or as soon after the date of
the visit as practicable; and
``(C) is furnished, to the greatest extent practicable, in
an appropriate form that appropriately takes into account
cultural and linguistic needs of the individual in order to
make the plan accessible to the individual.
``(2) The Secretary shall establish frequencies at which services
described in paragraph (1) may be furnished, provided that such
services may be furnished with respect to an individual--
``(A) at the time such individual is diagnosed with cancer
for purposes of planning treatment;
``(B) if there is a change in the condition of such
individual or such individual's treatment preferences;
``(C) at the end of active treatment and beginning of
survivorship care; and
``(D) if there is a recurrence of such cancer.''.
(b) Payment Under Physician Fee Schedule.--
(1) In general.--Section 1848(j)(3) of the Social Security
Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting
``(2)(KK),'' after ``health risk assessment),''.
(2) Initial rates.--Unless the Secretary otherwise
provides, the payment rate specified under the physician fee
schedule under the amendment made by paragraph (1) for cancer
care planning and coordination services shall be the same
payment rate as provided for transitional care management
services (as defined in CPT code 99496).
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the first day of the first
calendar year that begins after the date of the enactment of this Act.
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