[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 2955 Introduced in Senate (IS)]







107th CONGRESS
  2d Session
                                S. 2955

 To improve data collection and dissemination, treatment, and research 
              relating to cancer, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 18, 2002

  Mr. Brownback (for himself and Mr. Gregg) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To improve data collection and dissemination, treatment, and research 
              relating to cancer, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``National Cancer Act of 2002''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) In 2002 an estimated 1,284,900 Americans will have been 
        diagnosed with some form of cancer.
            (2) In 2002 an estimated 555,500 Americans will die of 
        cancer.
            (3) In 2001 the National Institutes of Health estimated the 
        overall cost of cancer at $156,700,000,000.
            (4) The National Cancer Institute estimates that with the 
        expected growth and aging of the United States population, 
        expenditures for cancer treatment will nearly double over the 
        next decade, rising to just under $100,000,000,000.
            (5) In 2000, 62.6 percent of women over the age of 50 had 
        received a mammogram in the preceding year. In 2002 an 
        estimated 205,000 Americans will be newly diagnosed with breast 
        cancer, and 40,000 will die of the disease.
            (6) In 2000, 89 percent of women between the ages of 18 and 
        44 have received a pap test in the preceding 3 years. In 2002, 
        an estimated 13,000 women will be newly diagnosed with cancer 
        of the uterine cervix, and 4,100 women will die of the disease.
            (7) In 1999, only 19.1 percent of adults 50 and older had 
        received the recommended annual colon cancer screening within 
        the preceding year, and only 32.2 percent had received a 
        colonoscopy or sigmoidoscopy in the preceding 5 years. In 2002, 
        an estimated 148,300 Americans will be diagnosed with cancer of 
        the colon and rectum and 56,600 will die of the disease.
            (8) Older Americans are the most likely to be diagnosed 
        with cancer. In order to ensure high quality cancer care for 
        our Nation's seniors, medicare reimbursements must reflect the 
        true cost of treatment in every treatment setting. Medicare 
        payments should accurately reflect the cost of drug and 
        biologics as well as the cost of administering drugs and 
        supportive care and therapies.
            (9) Despite an aging population, the rates of new cancer 
        cases and deaths declined in the United States between 1990 and 
        1997.
            (10) Despite an aging population, death rates for the 4 
        most common cancer sites--lung, colorectal, breast, and 
        prostate continue to drop.
            (11) Despite an aging population, 1997 marked the first 
        time the total number of cancer deaths did not rise from the 
        previous year.
            (12) In May 2001, Gleevec, the first in what is expected to 
        be a number of cancer treatments which rely on molecular 
        targeting, was approved for use by the Food and Drug 
        Administration. Gleevec appears to be effective in stopping the 
        growth of deadly Chronic Myeloid Leukemia cells within 3 months 
        of use.

SEC. 3. SENSE OF THE SENATE.

    It is the sense of the Senate that the United States is at a point 
in history in which we must take the proper steps to reach the goal of 
making cancer survivorship the rule and cancer deaths rare by the year 
2015.

                   TITLE I--PUBLIC HEALTH PROVISIONS

SEC. 101. NATIONAL PROGRAM OF CANCER REGISTRIES.

    (a) Strategic Plan.--Part M of title III of the Public Health 
Service Act (42 U.S.C. 280e et seq.) is amended by inserting after 
section 399B the following:

``SEC. 399B-1. ENHANCING CANCER REGISTRIES AND PREPARING FOR THE 
              FUTURE.

    ``(a) Strategic Plan.--
            ``(1) In general.--The Secretary shall develop a plan that 
        outlines strategies by which the State cancer registries funded 
        with grants under section 399B and the Surveillance, 
        Epidemiology, and End Results program of the National Cancer 
        Institute can share information to ensure more comprehensive 
        cancer data.
            ``(2) Report.--Not later than 1 year after the date of 
        enactment of this section, the Secretary shall submit to the 
        appropriate committees of Congress a report--
                    ``(A) outlining the capabilities and data collected 
                by the State cancer registries funded with grants under 
                section 399B;
                    ``(B) outlining the capabilities and data collected 
                by the Surveillance, Epidemiology, and End Results 
                program of the National Cancer Institute; and
                    ``(C) containing the plan described in paragraph 
                (1).
    ``(b) Preparing Cancer Registries for the Future.--
            ``(1) In general.--The Secretary shall enter into a 
        contract with the General Accounting Office for the completion 
        of a study and report identifying specific indicators that 
        State cancer registries should maintain and disseminate in 
        order to ensure maximum usefulness for patients, advocates, 
        health care providers, and researchers.
            ``(2) Contents.--The study and report described in 
        paragraph (1) shall--
                    ``(A) examine studies conducted by the National 
                Cancer Institute and the American Society of Clinical 
                Oncology;
                    ``(B) describe the hardware and software needed to 
                collect and disseminate necessary registry data; and
                    ``(C) examine strategies registries may take to 
                ensure data collection from the greatest number of 
                health care facilities possible.
            ``(3) Report.--Not later than 6 months after the date of 
        enactment of this section the Secretary shall submit to 
        Congress a report containing the results of the General 
        Accounting Office study authorized under this section.''.

SEC. 102. ENHANCING EXISTING SCREENING EFFORTS.

    (a) Grant and Contract Authority of States.--Section 1501(b)(2) of 
the Public Health Service Act (42 U.S.C. 300k(b)(2)) is amended to read 
as follows:
            ``(2) Certain applications.--
                    ``(A) Strategies for colorectal cancer screening.--
                If any entity submits an application to a State to 
                receive an award of a grant or contract pursuant to 
                paragraph (1) that includes strategies for colorectal 
                cancer screening and outreach, the State may give 
                priority to the application submitted by that entity in 
                any case in which the State determines that the quality 
                of such application is equivalent to the quality of the 
                application submitted by the other entities.
                    ``(B) Women diagnosed with cancer.--If any entity 
                submits an application to a State to receive an award 
                of a grant or contract pursuant to paragraph (1) that 
                includes strategies for the provision of treatment for 
                uninsured women diagnosed with cancer discovered in the 
                course of the screening, the State may give priority to 
                the application submitted by that entity in any case in 
                which the State determines that the quality of such 
                application is equivalent to the quality of the 
                application submitted by the other entities.''.
    (b) Breast and Cervical Cancer Program.--Section 1510(a) of the 
Public Health Service Act (42 U.S.C. 300n-5(a)) is amended by striking 
``for each of the fiscal years 1995 through 2003.'' and inserting ``for 
each of the fiscal years 2003 through 2007.''.
    (c) Report on the Comprehensive Colorectal Cancer Initiative.--Not 
later than 6 months after the date of enactment of this Act, the 
Director of the Centers for Disease Control and Prevention shall submit 
to the appropriate committees of Congress a report containing--
            (1) an assessment of the success of the Comprehensive 
        Colorectal Cancer Initiative (within the Centers for Disease 
        Control and Prevention) in--
                    (A) increasing public awareness of colorectal 
                cancer;
                    (B) increasing awareness of screening guidelines 
                among health care providers;
                    (C) monitoring national colorectal cancer screening 
                rates;
                    (D) promoting increased patient-provider 
                communication about colorectal cancer screening;
                    (E) supporting quantitative and qualitative 
                research efforts; and
                    (F) providing funding to State programs to 
                implement colorectal cancer priorities. 
            (2) recommendations about the resources needed by the 
        Centers for Disease Control and Prevention in order to improve 
        the areas described in paragraph (1).

SEC. 103. ENHANCE PAIN MANAGEMENT AND PALLIATIVE CARE FOR CANCER 
              PATIENTS.

    (a) Patient Education Program.--Part P of title III of the Public 
Health Service Act (42 U.S.C. 280g et seq.) is amended by adding at the 
end the following:

``SEC. 399O. PAIN MANAGEMENT AND PALLIATIVE CARE PROGRAM GRANTS AND 
              STUDY.

    ``(a) Grants Authorized.--The Secretary is authorized to award 
grants to eligible entities to implement programs to educate patients 
and their families about the availability of effective medical 
techniques to reduce and prevent pain and suffering for those with 
cancer. Such programs shall focus on the entire course of cancer 
treatment and care.
    ``(b) Application.--An eligible entity desiring a grant under this 
section shall submit to the Secretary an application at such time, in 
such manner, and containing such information as the Secretary may 
require.
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary.
    (b) Practitioner Education Program.--Section 414 of the Public 
Health Service Act (42 U.S.C. 285a-3) is amended by adding at the end 
the following:
    ``(d) Requirement.--A center described under subsection (a) shall 
maintain a program for disseminating to patients and research 
participants, as well as their caregivers, the latest information about 
pain and symptom management and palliative care in order to receive 
funding under this section.''.
    (c) Elevating the Importance of Pain and Symptom Management 
Throughout the Nation's Cancer Programs.--
            (1) National cancer program.--Section 411 of the Public 
        Health Service Act (42 U.S.C. 285a) is amended--
                    (A) by striking ``of (1) an expanded'' and 
                inserting the following: ``of--
            ``(1) an expanded''; and
                    (B) by striking ``carcinogens'' and all that 
                follows and inserting the following:
            ``(2) pain and symptom management for cancer patients; and
            ``(3) the other programs and activities of the 
        Institute.''.
            (2) Cancer control programs.--Section 412(2) of the Public 
        Health Service Act (42 U.S.C. 285a-1(2)) is amended--
                    (A) in subparagraph (A), by striking ``and'' at the 
                end; and
                    (B) by adding at the end the following:
                    ``(C) appropriate methods of pain and symptom 
                management for individuals with cancer, including end-
                of-life care, and''.
            (3) Special authorities of the director.--Section 413(a)(2) 
        of the Public Health Service Act (42 U.S.C. 285a-2(a)(2)) is 
        amended--
                    (A) in subparagraph (D) by striking ``and'' at the 
                end;
                    (B) in subparagraph (E) by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(F) assess and improve pain and symptom management of 
        cancer throughout the course of treatment.''.
            (4) Breast and gynecological cancers.--Section 417 of the 
        Public Health Service Act (42 U.S.C. 285a-6) is amended--
                    (A) in subsection (c)(1)--
                            (i) in subparagraph (D), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (E), by striking the 
                        period and inserting ``; and''; and
                            (iii) by inserting after subparagraph (E) 
                        the following:
                    ``(F) basic, clinical, and applied research 
                concerning pain and symptom management.''; and
                    (B) in subsection (d)--
                            (i) in paragraph (4), by striking ``and'' 
                        at the end;
                            (ii) in paragraph (5), by striking the 
                        period and inserting ``and;''; and
                            (iii) by adding at the end the following:
            ``(6) basic, clinical, and applied research concerning pain 
        and symptom management.''.
            (5) Prostate cancer.--Section 417A(c)(1) of the Public 
        Health Service Act (42 U.S.C. 285a-7(c)(1)) is amended--
                    (A) in subparagraph (F), by striking ``and'' at the 
                end;
                    (B) in subparagraph (G), by striking the period and 
                inserting ``; and''; and
                    (C) by inserting after subparagraph (G) the 
                following:
                    ``(H) basic and clinical research concerning pain 
                and symptom management.''.

SEC. 104. SURVIVORSHIP RESEARCH PROGRAM.

    (a) In General.--Subpart 1 of part C of title IV of the Public 
Health Service Act (42 U.S.C. 285 et seq.) is amended by adding at the 
end the following:

``SEC. 417E. SURVIVORSHIP RESEARCH PROGRAM.

    ``(a) Establishment.--There is established, within the Institute, 
an Office on Cancer Survivorship (in this section referred to as the 
`Office'), which may be headed by an Associate Director, to implement 
and direct the expansion and coordination of the activities of the 
Institute with respect to cancer survivorship research.
    ``(b) Collaboration Among Agencies.--In carrying out the activities 
described in subsection (a), the Office shall collaborate with other 
institutes, centers, and offices within the National Institutes of 
Health that are determined appropriate by the Office.
    ``(c) Report.--Not later than 1 year after the date of enactment of 
this section, the Secretary shall prepare and submit to the appropriate 
committees of Congress a report providing a description of the 
survivorship activities of the Office and strategies for future 
activities.''.
    (b) Funding.--Section 417B(d)(2) of the Public Health Service Act 
(42 U.S.C. 285a-8(d)(2)) is amended--
            (1) in subparagraph (B), by striking ``and'' after the 
        semicolon;
            (2) in subparagraph (C), by striking ``each subsequent 
        fiscal year.'' and inserting ``each fiscal year through 2002; 
        and''; and
            (3) by adding at the end the following:
                    ``(D) 11.5 percent, in the case of fiscal year 2003 
                and 13 percent, in the case of fiscal year 2004 and 
                each subsequent fiscal year, of which not less than 1.5 
                percent in fiscal year 2003, 2 percent in fiscal year 
                2004, and 3 percent in fiscal year 2005 and each 
                subsequent fiscal year shall be for the Office on 
                Survivorship under section 417E.''.

                     TITLE II--RESEARCH PROVISIONS

SEC. 201. NATIONAL CANCER INSTITUTE.

    (a) Other Transactions Authority.--Subpart 1 of Part C of title IV 
of the Public Health Service Act (42 U.S.C. 285 et seq.) is amended by 
adding at the end the following:

``SEC. 417D. OTHER TRANSACTIONS AUTHORITY.

    ``Notwithstanding any other provision of this subpart, the Director 
of the National Cancer Institute may co-fund grant projects with 
private entities for any purpose described in this subpart.''. 
    (b) NCI Report to Congress on the Bypass Budget.--Section 413 of 
the Public Health Service Act (42 U.S.C. 285a-2) is amended--
            (1) in subsection (b), by striking paragraph (9) and 
        inserting the following:
            ``(9) notwithstanding section 405(a), shall prepare and 
        submit, directly to the President for review and transmittal to 
        the Committee on the Budget of the Senate and the Committee on 
        the Budget of the House of Representatives, an annual budget 
        estimate (including an estimate of the number and type of 
        personnel needs for the Institute) for the National Cancer 
        Institute program, after reasonable opportunity for comment by 
        the Secretary, the Director of NIH, the Institute's advisory 
        council, and the National Cancer Advisory Board.''; and
            (2) by adding at the end the following:
    ``(c) The National Cancer Advisory Board shall accept comments on 
the budget described in subsection (b)(9) from nongovernment 
organizations and shall compile significant suggestions into a report 
for the Director of the Institute pursuant to subsection (b)(9). The 
Director of the Institute shall respond, as appropriate, to such 
suggestions prior to submitting such budget.''.
    (c) Sense of the Senate on a Central Internal Review Board.--It is 
the sense of the Senate that--
            (1) the current procedure of sending 1 clinical trial 
        through multiple local internal review boards may not be the 
        most efficient method for the protection of patients enrolled 
        in the trial and may delay the process of bringing life saving 
treatment to cancer patients;
            (2) the National Cancer Institute should be commended for 
        its work in centralizing the internal review board process; and
            (3) the research community should continue to streamline 
        the internal review board process in order to bring life saving 
        treatments to patients as quickly as possible.
    (d) Patient and Provider Outreach Opportunities With Experimental 
Therapies.--For the purpose of enhancing patient access to experimental 
therapies, the National Cancer Institute shall conduct the following 
activities:
            (1) Integrate, to the maximum extent practicable, trials 
        being conducted by private manufacturers into the National 
        Cancer Institute's clinical trials online database. Such 
        integration may require specific awareness-raising and outreach 
        activities by the National Cancer Institute to private 
        industry.
            (2) Establish an education program which provides patients 
        and providers with--
                    (A) information about how to access and use the 
                National Cancer Institute clinical trials database 
                online; and
                    (B) information about the Food and Drug 
                Administration process for approving the use of drugs 
                and biologics for a single patient.

                     TITLE III--MEDICARE PROVISIONS

SEC. 301. SENSE OF THE SENATE REGARDING REIMBURSEMENT FOR ITEMS AND 
              SERVICES USED IN THE COURSE OF CANCER THERAPY.

    It is the sense of the Senate that--
            (1) the medicare program under title XVIII of the Social 
        Security Act should neither over-reimburse nor under-reimburse 
        for the cost of drugs and biologicals used in the course of 
        cancer therapy;
            (2) the medicare program should neither over-reimburse nor 
        under-reimburse for the skilled nursing services, supplies, and 
        equipment that are essential to the delivery of high quality 
        cancer care; and
            (3) the goal of any change to medicare reimbursement policy 
        for cancer care should be in the interest of ensuring that 
        medicare beneficiaries with cancer have access to the highest 
        quality care in the greatest number of health care facilities 
        available.

SEC. 302. SENSE OF THE SENATE REGARDING PAYMENT RATE FOR DRUGS AND 
              BIOLOGICALS UNDER THE MEDICARE HOSPITAL OUTPATIENT 
              DEPARTMENT PROSPECTIVE PAYMENT SYSTEM.

    (a) Findings.--The Senate finds the following:
            (1) Payments for drugs and biologicals under the medicare 
        hospital outpatient department prospective payment system under 
        section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) 
        should be based on all of the costs of delivering outpatient 
        pharmacy therapy (involving the drug or biological) in the 
        outpatient hospital setting, including acquisition, storage, 
        handling, processing, quality control, disposal, and pharmacy 
        overhead costs.
            (2) The payment rates proposed by the Centers for Medicare 
        & Medicaid Services, in the ``Medicare Program; Changes to the 
        Hospital Outpatient Prospective Payment System and Calendar 
        Year 2003 Payment Rates and Changes to Payment Suspension for 
        Unified Cost Report''; Proposed Rule, 67 Fed. Reg, 52092 et 
        seq. (August 9, 2002), for most drugs and biologicals are based 
        only on the estimated acquisition cost of the drug or 
        biological and do not reflect other related costs.
            (3) The methodology used by the Centers for Medicare & 
        Medicaid Services to estimate such acquisition costs is flawed 
        because the methodology--
                    (A) derives such estimates from what hospitals 
                charged for individual products on patient bills 
                without appropriate adjustment for hospital charging 
                practices; and
                    (B) relies on data that are several years old.
            (4) The methodology described in paragraph (3) 
        substantially underestimates the acquisition costs of newer, 
        more expensive drugs and biologicals and this underestimation 
        disproportionately affects drugs and biologicals used to treat 
        cancer.
            (5) Medicare beneficiary access may be jeopardized in the 
        outpatient hospital setting for those drugs and biologicals for 
        which medicare program payments are substantially below the 
        costs of delivery.
            (6) The payment rates proposed for most drugs and 
        biologicals under the medicare hospital outpatient department 
        prospective payment system for calendar year 2003 are less than 
        the payment rates established for such drugs and biologicals in 
        2002, with the payment reductions exceeding 30 percent in most 
        cases.
            (7) The methodology used to develop the payment rates in 
        2003 described in paragraph (6) produces erratic and unreliable 
        results, including--
                    (A) the payment rate for 1 product increasing 700 
                percent and the rates for many others exceeding 100 
                percent of their average wholesale price (AWP); and
                    (B) the payment rates for 9 drugs and biologicals 
                used in cancer therapy experiencing rate reductions of 
                between 50 and 90 percent.
    (b) Sense of the Senate.--It is the sense of the Senate that the 
Administrator of the Centers for Medicare & Medicaid Services should 
address the consequences of the proposed payments rates for drugs and 
biologicals in 2003 under the medicare hospital outpatient department 
prospective payment system under section 1833(t) of the Social Security 
Act (42 U.S.C. 1395l(t)) by either--
            (1) revising the payment rates for drugs and biologicals 
        under such system; or
            (2) suspending the proposed rule establishing such payment 
        rates and extending the period of data collection for the 
        purposes of establishing a more rational payment structure for 
        drugs and biologicals under such system in the future.

SEC. 303. SENSE OF THE SENATE REGARDING COVERING PALLIATIVE CARE 
              THROUGHOUT CANCER TREATMENT.

    (a) Findings.--The Senate finds the following:
            (1) Serious chronic pain is one of the most widespread 
        public health problems in the American adult population.
            (2) Because so few federal research dollars are devoted to 
        pain there are no exact figures, however, best estimates 
        indicate that up to 75,000,000 Americans suffer serious pain 
        annually, 50,000,000 enduring serious chronic pain (pain 
        lasting six months or longer), and 25,000,000 experiencing 
        acute pain (from injuries, accidents, surgeries, etc.).
            (3) The medicare and medicaid programs pay for pain 
        medication when administered as part of routine acute, skilled 
        nursing, hospice, or other specialized health care benefits, 
        such as doctor-administered infusion medication.
            (4) Without coverage for self-administered prescription 
        drugs to alleviate pain, many of the approximately 1,500 people 
        that die from cancer each day and the more than 9,000,000 
        cancer survivors may need to live without appropriate access to 
adequate pain care.
    (b) Sense of the Senate.--It is the Sense of the Senate that--
            (1) patients experiencing pain should be identified at the 
        earliest detection of discomfort to best treat the condition 
        before the pain becomes prohibitive and debilitating;
            (2) early treatment of pain will improve clinical outcomes, 
        quality of care and comfort, and ultimately improve the quality 
        of life for cancer patients;
            (3) medicare beneficiaries experiencing pain, even at the 
        end of life, are frequently under-treated for pain and other 
        symptoms associated with cancer, in part because of the lack of 
        an outpatient prescription drug benefit under the medicare 
        program;
            (4) the medicare program's approach to reimbursement for 
        those patients with intense pain should be modified to ensure 
        access to technologies and therapies for cancer pain patients 
        well in advance of qualifying for hospice care; and
            (5) each head of an agency that is responsible for the 
        operation a federal health care program should--
                    (A) review coverage under the program for effective 
                pain prevention and management services, including 
                outpatient prescription medications; and
                    (B) submit to the Senate a report on such review by 
                not later than December 31, 2003.

SEC. 304. SENSE OF THE SENATE REGARDING IMPROVING THE COVERAGE OF 
              HOSPICE CARE.

    (a) Findings.--The Senate finds the following:
            (1) While 23 percent of the medicare beneficiaries who died 
        in 2000 received hospice care, 60 percent of medicare 
        beneficiaries who died in 2000 of cancer received hospice care.
            (2) By the time medicare hospice patients are exposed to a 
        variety of pain management tools, it is often too late and the 
        cancer has progressed beyond the point of lucid patient 
        decision-making.
            (3) The medicare hospice reimbursement structure contains 
        built-in disincentives to providing palliative therapies that 
        have high early costs, even when these therapies may become 
        cost-effective after a certain period of time. Small hospices 
        in particular are often unable to cover the costs of these 
        treatments to palliate symptoms.
            (4) Median lengths of stay in a hospice care program 
        decreased from 26 days in 1992 to 19 days in 1998.
            (5) In 2001, \1/2\ the patients in hospice care programs 
        were there for 3 weeks or less.
            (6) A recent study of hospice patients found that 33 
        percent of patients die within 7 days of receiving hospice 
        care.
            (7) Because of the requirement under the medicare program 
        that patients receive no curative therapy while receiving 
        hospice care, the medicare hospice reimbursement structure 
        contains built-in disincentives to entering hospice care 
        programs and receiving palliative therapies that could extend 
        life and improve the quality of life for terminal patients.
            (8) Recent studies published by Harvard University and 
        Medicare Payment Advisory Commission have suggested that 
        medicare might have the ability to provide improved coverage 
        for cancer pain patients and realize a cost savings by 
        modifying existing policy to create and utilize an outlier 
        payment system.
            (9) At the present time, the medicare program will 
        reimburse physicians for consulting with patients about end-of-
        life care. In practice, however, it is often a registered nurse 
        or social worker who provides patients with end-of life-care. 
        These services are complex, sensitive and time consuming.
            (10) Registered nurses and medical social workers with an 
        expertise in palliative or hospice care are qualified to 
        perform end-of-life services and are able to make home visits 
        when necessary. Their services should be reimbursed under the 
        medicare program.
            (11) A payment source is needed for patients who require 
        palliative care and who are terminally ill but do not meet the 
        medicare hospice criteria or who still want to receive 
        aggressive treatment.
    (b) Sense of the Senate.--It is the sense of the Senate that the 
Administrator of the Centers for Medicare & Medicaid Services should--
            (1) restructure the hospice benefit under the medicare 
        program for high cost outliers;
            (2) increase medicare hospice care reimbursement for short 
        stays;
            (3) provide for reimbursement under the medicare program 
        for nurses and social workers with expertise in hospice care 
        for consultations and home visits provided to terminally ill 
        patients who, for a variety of reasons, may not have elected 
        access the hospice benefit;
            (4) create a payment source for palliative care for 
        terminally ill patients who do not elect hospice care or do not 
        meet the medicare hospice benefit criteria;
            (5) improve the medicare hospice benefit through approaches 
        such as--
                    (A) increasing the reimbursement on the day of 
                admission and the day of death, to offset the cost of 
                late referrals;
                    (B) increasing the reimbursement rate for the last 
                7 days a patient spends on the benefit; and
                    (C) using a case-mix reimbursement rate rather than 
                the flat-rate, four-category per diem benefit.

SEC. 305. SENSE OF THE SENATE REGARDING THE COVERAGE OF ALL TREATMENTS 
              FOR CANCER PATIENTS.

    (a) Findings.--The Senate finds the following:
            (1) While cancer treatments are often treated within the 
        setting of a health care facility, many of the latest treatment 
        advances afford patients the opportunity to treat themselves at 
        home.
            (2) The medicare program often does not provide for 
        reimbursement for the most efficient and effective treatments 
        based on the fact that the treatments are self-injectable or 
        taken orally.
    (b) Sense of the Senate.--It is the sense of the Senate that--
            (1) medicare patients should have access to the best 
        treatment available;
            (2) the lack of reimbursement for certain treatments can 
        serve as a disincentive for researchers to investigate more 
        efficient and effective treatments for elderly cancer patients; 
        and
            (3) in the event that a comprehensive outpatient 
        prescription drug benefit under the medicare program is not 
        enacted into law during the 107th Congress, the Senate should 
        consider a targeted outpatient prescription medication benefit 
        under the medicare program for cancer patients.
                                 <all>