[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 2965 Introduced in Senate (IS)]







107th CONGRESS
  2d Session
                                S. 2965

 To amend the Public Health Service Act to improve the quality of care 
                  for cancer, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 18, 2002

 Mr. Kennedy (for himself, Mr. Frist, Mrs. Feinstein, Mrs. Hutchison, 
 Mr. Harkin, Ms. Collins, Mr. Biden, Mr. Bond, Ms. Landrieu, Mr. Reid, 
 Mr. Bingaman, Mr. Dodd, Mrs. Clinton, Mr. Hollings, and Mr. Edwards) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act to improve the quality of care 
                  for 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 ``Quality of Care for Individuals With 
Cancer Act''.

SEC. 2. TABLE OF CONTENTS.

Sec. 1. Short title.
Sec. 2. Table of contents.
             TITLE I--MEASURING THE QUALITY OF CANCER CARE

Sec. 101. Development of core sets of quality of cancer care measures.
                  TITLE II--ENHANCING DATA COLLECTION

Sec. 201. Expansion of national program of cancer registries.
Sec. 202. Reauthorization of national program of cancer registries.
Sec. 203. Relationship to certification.
    TITLE III--MONITORING AND EVALUATING QUALITY OF CANCER CARE AND 
                                OUTCOMES

Sec. 301. Partnerships to develop model systems for monitoring and 
                            evaluating quality of cancer care and 
                            outcomes.
          TITLE IV--STRENGTHENING COMPREHENSIVE CANCER CONTROL

Sec. 401. Comprehensive cancer control program.
         TITLE V--IMPROVING NAVIGATION AND SYSTEM COORDINATION

Sec. 501. Enhancing cancer care through improved navigation.
Sec. 502. Cancer care coordination.
           TITLE VI--ESTABLISHING PROGRAMS IN PALLIATIVE CARE

Sec. 601. Programs to improve palliative care.
             TITLE VII--ESTABLISHING SURVIVORSHIP PROGRAMS

Sec. 701. Programs for survivorship.
Sec. 702. Cancer control programs.
               TITLE VIII--PROGRAMS FOR END-OF-LIFE CARE

Sec. 801. Programs for end-of-life care.
                TITLE IX--DEVELOPING TRAINING CURRICULA

Sec. 901. Curriculum development.
Sec. 902. Cancer care workforce and translational research.
                      TITLE X--CONDUCTING REPORTS

Sec. 1001. Studies and reports by the Institute of Medicine.

             TITLE I--MEASURING THE QUALITY OF CANCER CARE

SEC. 101. DEVELOPMENT OF CORE SETS OF QUALITY OF CANCER CARE MEASURES.

    (a) Development of Core Sets of Quality of Cancer Care Measures.--
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. DEVELOPMENT OF CORE SETS OF QUALITY OF CANCER CARE 
              MEASURES.

    ``(a) In General.--The Secretary shall award a contract to a 
national voluntary consensus organization to identify core sets of 
quality of cancer care measures.
    ``(b) Quality of Cancer Care Measures.--An entity that receives a 
contract under this section shall identify core sets of quality of 
cancer care measures in consultation with a panel or advisory group of 
interested parties, including significant participation from consumer 
representatives (which shall include survivors of cancer and their 
families and members of organizations representing such survivors and 
their families), health care providers, cancer researchers, payers and 
purchasers of cancer care services and insurance, and public and 
private organizations that monitor, accredit, or seek to improve the 
quality of cancer care.
    ``(c) Report by Entity.--Not later than 24 months after the date of 
enactment of this section, an eligible entity that receives a contract 
under this section shall submit to the Secretary a report that--
            ``(1) lists existing measures used to assess and improve 
        the quality of cancer care;
            ``(2) identifies those measures that have been 
        scientifically validated, those measures that still require 
        validation, and those aspects of cancer care for which 
        additional measures need to be developed or validated;
            ``(3) recommends a core set of validated quality of cancer 
        care measures, reflecting a voluntary consensus of interested 
        parties, for measuring and improving the quality of cancer 
        care;
            ``(4) summarizes the process used to develop the consensus 
        recommendations in paragraph (3), including a statement of any 
        minority views; and
            ``(5) develops a process for updating the core sets of 
        validated quality of cancer care measures as new scientific 
        evidence becomes available.
    ``(d) Recommendations by Secretary.--Not later than 6 months after 
the date the Secretary receives the report described in subsection (c), 
the Secretary shall issue recommendations on the areas described in 
paragraphs (1) through (5) of such subsection and shall transmit such 
recommendations to the President.
    ``(e) Report by President.--Not later than 6 months after receipt 
of the report described in subsection (d), the President shall, in 
consultation with the Quality Interagency Coordination Task Force 
(established by a Presidential Directive in 1998)--
            ``(1) provide to the appropriate committees of Congress a 
        report that describes a plan to use the core sets of quality of 
        cancer care measures in programs administered by the Federal 
        Government, including outlining activities to support the 
        widespread dissemination of the report, and provide any other 
        recommendations the President determines to be appropriate; and
            ``(2) provide updated reports, in accordance with 
        subsection (c)(5), if new quality measures or scientific 
        evidence on quality of cancer care develops.
    ``(f) Technical Support.--The Secretary may provide scientific and 
technical support to ensure that the scientific evaluation requirements 
in this section are met.
    ``(g) AHRQ.--
            ``(1) Annual report.--The Agency for Healthcare Research 
        and Quality shall include in the annual report required under 
        section 913(b)(2) the core set of quality of cancer care 
        measures developed under this section that are suitable for 
        quality monitoring.
            ``(2) Requirement.--The Secretary shall ensure that all 
        agencies within the Department of Health and Human Services 
        shall provide the information necessary for the report 
        described in paragraph (1) regarding quality of cancer care 
        measures.
    ``(h) Support.--The Director of the Agency for Healthcare Research 
and Quality, acting in collaboration with the Director of the National 
Cancer Institute and the Director of the Centers for Disease Control 
and Prevention, shall support the development and validation of 
measures identified by the report in subsection (d).
    ``(i) Definitions of Hospice Care; Palliative Care; Quality of 
Cancer Care.--In this section the terms `hospice care', `palliative 
care' and `quality of cancer care' have the meanings given such terms 
in section 399AA.
    ``(j) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $3,000,000 for fiscal year 
2003, and such sums as may be necessary for each of fiscal years 2004 
through 2007.''.
    (b) Monitoring.--Not later than 4 years after the date of the 
transmission of the report required under section 417E(e) of the Public 
Health Service Act, the Comptroller of the General Accounting Office 
shall submit to the appropriate committees of Congress a report that 
evaluates the extent to which Federal and private sector health care 
delivery programs, States, and State cancer plans are utilizing the 
core sets of quality of cancer care measures (developed under section 
417E of the Public Health Service Act) and the extent to which its 
adoption is affecting the quality of cancer care.

                  TITLE II--ENHANCING DATA COLLECTION

SEC. 201. EXPANSION OF NATIONAL PROGRAM OF CANCER REGISTRIES.

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

``SEC. 399E-1. MONITORING AND EVALUATING THE QUALITY OF CANCER CARE.

    ``(a) Demonstration Projects.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, and in 
coordination with the Director of the National Cancer Institute, shall 
award competitive grants to State cancer registries that receive funds 
under this part to enable such registries to expand their ability to 
monitor and evaluate the quality of cancer care, to develop information 
concerning the quality of cancer care, and to monitor cancer 
survivorship.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), a State cancer registry shall be certified by the North 
American Association of Central Cancer Registries or other similar 
certification organization.
    ``(c) Application.--A State cancer registry desiring a grant under 
this section shall submit an application to the Secretary at such time, 
in such manner, and containing such information as the Secretary may 
require.
    ``(d) Contracting Authority.--A State cancer registry receiving a 
grant under this section may enter into contracts with academic 
institutions, cancer centers, and other entities determined to be 
appropriate by the Secretary, to carry out the activities authorized 
under this section.
    ``(e) Use of Funds.--A State cancer registry receiving a grant 
under this section shall use amounts received under such grant to--
            ``(1) collect information for public health surveillance 
        and quality improvement activities using the quality of cancer 
        care measures developed under section 417E (where appropriate), 
        including data concerning traditionally underserved populations 
        and populations within the State that may have a disparity in 
        incidence or survival from cancer;
            ``(2) develop linkages between State cancer registry data 
        and other databases, including those that collect outpatient 
        data, to gather information concerning the quality of cancer 
        care;
            ``(3) identify, develop, and disseminate evidence-based 
        best practices relating to cancer care regarding how States use 
        registry data and how to better link and coordinate the sharing 
        of such data;
            ``(4) identify geographic areas and populations within the 
        State that have an increased need for awareness regarding 
        cancer risk reduction, screening, prevention, and treatment 
        activities;
            ``(5) increase coordination between State cancer registries 
        and other entities, including academic institutions, hospitals, 
        health centers, researchers, health care providers, cancer 
        centers, or nonprofit organizations;
            ``(6) incorporate the collection of data on cancer 
        survivors for the purpose of improving the quality of cancer 
        care;
            ``(7) identify the impact of co-morbidity of other diseases 
        on survival from cancer; or
            ``(8) develop methods of determining whether cancer 
        survivors are at an increased risk for other chronic or 
        disabling conditions.
    ``(f) Privacy.--A State cancer registry receiving a grant or an 
entity receiving a contract under this section shall comply with 
appropriate security and privacy protocols (including protocols 
required under the regulations  promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 
1320d-2 note)), if applicable, with respect to information collected 
under this title. Nothing in this section shall be construed to 
supersede applicable Federal or State privacy laws.
    ``(g) Databases.--
            ``(1) In general.--In carrying out this section, a State 
        cancer registry may utilize appropriate databases, including--
                    ``(A) the National Death Index;
                    ``(B) databases related to claims under the 
                medicare and medicaid programs under titles XVIII and 
                XIX of the Social Security Act; and
                    ``(C) other databases maintained by the Department 
                of Health and Human Services (including those 
                maintained at the Agency for Healthcare Research and 
                Quality, the Centers for Disease Control and 
                Prevention, the Centers for Medicare & Medicaid 
                Services, and the National Institutes of Health).
            ``(2) Additional data.--A State cancer registry may utilize 
        data in addition to the databases described in paragraph (1), 
        including data maintained by private insurance plans and health 
        care delivery organizations.
    ``(h) Rule of Construction.--Nothing in this section shall be 
construed to require an individual or entity to submit information to a 
State cancer registry under this section.
    ``(i) Definitions.--In this section:
            ``(1) Health center.--The term `health center' has the 
        meaning given the term `federally qualified health center' in 
        section 1861(aa)(4) of the Social Security Act (12 U.S.C. 
        1395x(aa)(4)).
            ``(2) Quality of cancer care.--The term `quality of cancer 
        care' has the meaning given such term in section 399AA.
    ``(j) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $3,000,000 for fiscal year 2003 
and such sums as may be necessary for each of fiscal years 2004 through 
2007.

``SEC. 399E-2. CANCER SURVEILLANCE SYSTEM.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, and in coordination 
with the Director of the National Cancer Institute, shall--
            ``(1) establish the Cancer Surveillance System (referred to 
        in this section as the `System') to monitor State cancer 
        registries funded under section 399B; and
            ``(2) provide for the development, expansion, and 
        evaluation of such registries.
    ``(b) Duties.--The System shall--
            ``(1) facilitate timely access to and exchange of accurate 
        quality of cancer care information among State cancer 
        registries including the use of the quality of cancer care 
        measures developed under section 417E, where appropriate;
            ``(2) develop guidelines permitting State cancer registries 
        to access the national registry clearinghouse established under 
        paragraph (3);
            ``(3) establish and maintain a registry information 
        clearinghouse to collect, synthesize, and disseminate 
        information concerning evidence-based best practices for the 
        creative use of State cancer registries, including maintaining 
        an Internet website where such information may be accessed;
            ``(4) determine the feasibility of monitoring the quality 
        of palliative care by State cancer registries;
            ``(5) identify and develop evidence-based best practices 
        for coordination between cancer registries and other entities; 
        and
            ``(6) update information collected or made available under 
        this section as determined to be necessary by the Secretary.
    ``(c) Privacy.--The System shall comply with appropriate security 
and privacy protocols (including protocols required under the 
regulations promulgated under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note)), 
if applicable, with respect to information collected by the System. 
Nothing in this section shall be construed to supersede applicable 
Federal or State privacy laws.
    ``(d) Definitions.--In this section, the terms `palliative care' 
and `quality of cancer care' have the meanings given such terms in 
section 399AA.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $6,000,000 for fiscal year 2003 
and such sums as may be necessary for each of fiscal years 2004 through 
2007.''.

SEC. 202. REAUTHORIZATION OF NATIONAL PROGRAM OF CANCER REGISTRIES.

    Section 399F(a) of the Public Health Service Act (42 U.S.C. 280e-
4(a)) is amended--
            (1) by striking ``this part,'' and inserting ``this part, 
        other than sections 399E-1 and 399E-2),''; and
            (2) by striking ``2003'' and inserting ``2008''.

SEC. 203. MATCHING FUNDS; RELATIONSHIP TO CERTIFICATION.

    (a) Matching Funds.--Section 399B(b)(1) of the Public Health 
Service Act (42 U.S.C. 280e(B)(1)) is amended by striking ``$3'' and 
inserting ``$5''.
    (b) Relationship to Certification.--Section 399E of the Public 
Health Service Act (42 U.S.C. 280e-3) is amended--
            (1) by redesignating subsections (d) and (e) as subsections 
        (e) and (f), respectively; and
            (2) by inserting after subsection (c) the following:
    ``(d) Relationship to Certification.--The Centers for Disease 
Control and Prevention is encouraged to work with eligible entities 
through the provision of technical assistance and funding authority 
under the National Program of Cancer Registries to assist such entities 
in complying with the certification process of the North American 
Association of Central Cancer Registries or similar certification 
organization.''.

    TITLE III--MONITORING AND EVALUATING QUALITY OF CANCER CARE AND 
                                OUTCOMES

SEC. 301. PARTNERSHIPS TO DEVELOP MODEL SYSTEMS FOR MONITORING AND 
              EVALUATING QUALITY OF CANCER CARE AND OUTCOMES.

    (a) Quality of Cancer Care.--Part A of title IX of the Public 
Health Service Act (42 U.S.C. 299 et seq.) is amended by adding at the 
end the following:

``SEC. 904. AREAS OF SPECIAL EMPHASIS.

    ``(a) Quality of Cancer Care.--The Secretary, acting through the 
Director and in collaboration with the Director of the Centers for 
Disease Control and Prevention and the Director of the National Cancer 
Institute, shall conduct and support research pertaining to the 
measurement, evaluation, and improvement of the quality of cancer care, 
take steps to enhance the usefulness of such research to improve 
patient care, and appropriately disseminate such information by--
            ``(1) expanding the evidence base concerning effective 
        interventions for improving the quality of cancer care;
            ``(2) ensuring effective analysis of data collected by 
        State cancer registries funded under section 399B by developing 
        evidence-based best practices for--
                    ``(A) the real-time recording of and automated 
                transfer of cancer care data to State cancer care 
                registries; and
                    ``(B) the linkage of registry data with private 
                sector claims data and other existing data systems for 
                purposes of analytic academic research;
            ``(3) developing and validating quality of cancer care 
        indicators and evaluate their use and usefulness; and
            ``(4) developing volume-based quality indicators, as 
        appropriate, and evaluate ongoing efforts to integrate volume-
        based measures into cancer quality improvement programs and 
        their impact on patient decisionmaking.
    ``(b) Partnerships To Speed the Pace of Improvements in the Quality 
of Cancer Care.--
            ``(1) In general.--The Secretary, acting through the 
        Director and in collaboration with the Director of the Centers 
        for Disease Control and Prevention and the Director of the 
        National Cancer Institute, shall award competitive grants, 
        contracts, or enter into cooperative agreements with eligible 
        entities to--
                    ``(A) foster the development or adoption of model 
                systems of cancer care;
                    ``(B) speed the pace of improvement in the quality 
                of cancer care; or
                    ``(C) when appropriate, carry out the other 
                requirements of this section.
            ``(2) Eligibility.--In accordance with the limitations of 
        section 926(c), an applicant eligible to receive a grant, 
        contract, or cooperative agreement under this subsection shall 
        be a consortium consisting of public- and private-sector 
        entities. Each consortium shall include an institution of 
        higher learning or other research entity and 1 or more of the 
        following:
                    ``(A) An entity that delivers or purchases cancer 
                care.
                    ``(B) A professional society or societies that 
                represent health care providers and other cancer 
                caregivers, including hospice programs.
                    ``(C) A consumer or patient organization.
                    ``(D) An entity involved in the monitoring of 
                quality of cancer care or efforts to improve cancer 
                care (including a State or local health department).
    ``(d) Collaboration.--In carrying out this section, the Secretary, 
acting through the Director, shall ensure coordination with appropriate 
Federal and State agencies, private quality improvement entities, and 
accreditation or licensure organizations with an interest in improving 
the quality of cancer care.
    ``(e) Definitions.--In this section, the term `quality of cancer 
care' has the meaning given such term in section 399AA.''.
    (b) Authorization of Appropriations.--Section 927 of the Public 
Health Service Act (42 U.S.C. 299c-6) is amended by adding at the end 
the following:
    ``(e) Quality of Cancer Care.--For the purpose of carrying out the 
activities under section 904, there is authorized to be appropriated 
$5,000,000 for fiscal year 2003, and such sums as may be necessary for 
each of fiscal years 2004 through 2007.''.

          TITLE IV--STRENGTHENING COMPREHENSIVE CANCER CONTROL

SEC. 401. COMPREHENSIVE CANCER CONTROL PROGRAM.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by adding at the end the following:

``SEC. 320B. COMPREHENSIVE CANCER CONTROL PROGRAM.

    ``(a) Establishment.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention and in consultation with 
the Director of the Agency for Healthcare Research and Quality and the 
Director of the National Cancer Institute, shall establish a National 
Comprehensive Cancer Control Program (referred to in this section as 
the `Program') to improve the quality of cancer care.
    ``(b) Program.--In carrying out the Program the Secretary shall--
            ``(1) establish guidelines regarding the design and 
        implementation of comprehensive cancer control plans; and
            ``(2) award competitive grants to eligible entities to 
        develop, update, implement, and evaluate comprehensive cancer 
        control plans.
    ``(c) Eligibility.--An entity is eligible to receive assistance 
under the Program if such entity is a State health department, 
territory, Indian tribe, or tribal organization or its designee.
    ``(d) Application.--An eligible entity desiring a grant under this 
section shall submit an application to the Secretary at such time, in 
such manner, and containing such information as the Secretary may 
require, including--
            ``(1) a description of how assistance under such grant will 
        be used to develop and implement comprehensive cancer control 
        programs, including programs to monitor the quality of cancer 
        care (which may include the use of quality of cancer care 
        measures developed under section 417E);
            ``(2) a description of how the applicant will integrate its 
        activities with academic institutions, nonprofit organizations, 
        or other appropriate entities in planning and implementing 
        comprehensive cancer control plans; and
            ``(3) a description of how activities carried out by the 
        applicant will be evaluated.
    ``(e) Use of Funds.--An entity shall use assistance received under 
this section to--
            ``(1) convene stakeholders, including stakeholders from the 
        public, private, and nonprofit sectors, to determine priorities 
        for the State, territory, or tribe involved;
            ``(2) develop, update, implement, or evaluate comprehensive 
        cancer control plans;
            ``(3) assess disparities in cancer risk reduction, 
        prevention, diagnosis, or quality of cancer care; and
            ``(4) develop and disseminate best practices, where 
        appropriate, and evaluate the application of such practices as 
        necessary.
    ``(f) Definitions.--In this section:
            ``(1) Comprehensive cancer control plan.--The term 
        `comprehensive cancer control plan' means a plan developed with 
        assistance provided under this section that provides for an 
        integrated and coordinated approach to reducing the incidence, 
        morbidity, and mortality of cancer, with a particular emphasis 
        on preventing and controlling cancer among populations most at 
        risk and reducing cancer disparities among underserved 
        populations.
            ``(2) Comprehensive cancer control program.--The term 
        `comprehensive cancer control program' means a program to 
        fulfill the comprehensive control plan.
            ``(3) Quality of cancer care.--The term `quality of cancer 
        care' has the meaning given such term in section 399AA.
            ``(4) Indian tribe; tribal organization.--The terms `Indian 
        tribe' and `tribal organization' have the meanings given such 
        terms in subsections (b) and (c) of section 4 of the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 
        450b).
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $15,000,000 for fiscal year 
2003 and such sums as may be necessary for each of fiscal years 2004 
through 2007.''.

         TITLE V--IMPROVING NAVIGATION AND SYSTEM COORDINATION

SEC. 501. ENHANCING CANCER CARE THROUGH IMPROVED NAVIGATION AND CANCER 
              CARE COORDINATION.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following:

               ``Part R--Cancer Prevention and Treatment

``SEC. 399AA. DEFINITIONS; AUTHORIZATION OF APPROPRIATIONS.

    (a) Definitions.--In this part:
            ``(1) Health center.--The term `health center' has the 
        meaning given such term in section 399E-1.
            ``(2) Hospice care.--The term `hospice care' has the 
        meaning given such term in section 1861(dd)(1) of the Social 
        Security Act (42 U.S.C. 1395x(dd)(1)).
            ``(3) Hospice program.--The term `hospice program' has the 
        meaning given such term in section 1861(dd)(2) of the Social 
        Security Act (42 U.S.C. 1395x(dd)(2)).
            ``(4) Palliative care.--The term `palliative care' means 
        comprehensive, interdisciplinary, coordinated, and appropriate 
        care and services provided throughout all stages of disease, 
        from the time of diagnosis to the end of life, relating to pain 
        and other symptom management, including psychosocial needs, 
        that seeks to improve quality of life and prevent and alleviate 
        suffering for an individual and, if appropriate, that 
        individual's family or caregivers.
            ``(5) Quality of cancer care.--The term `quality of cancer 
        care' means the provision of cancer-related, timely, evidence-
        based (whenever there is scientific evidence on the 
        effectiveness of interventions), patient-centered care and 
        services of individuals in a technically and culturally 
        competent and appropriate manner, using effective communication 
        and shared decisionmaking to improve clinical outcomes, 
        survival, or quality of life which encompasses--
                    ``(A) the various stages of care, including care 
                and services provided to individuals with a family 
                history of cancer, with an abnormal cancer screening 
                test, or who are clinically diagnosed with cancer, 
                beginning with risk reduction, prevention, and early 
                detection through survivorship, remission, and end-of-
                life care, and including risk counseling, screening, 
                diagnosis, treatment, followup care, monitoring, 
                rehabilitation, and hospice care; and
                    ``(B) appropriate care and services which should be 
                provided throughout the continuum of care including 
                palliative care and information on treatment options 
                including information regarding clinical trials.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this part, other than section 399FF, such 
sums as may be necessary for each of fiscal years 2003 through 2007.

``SEC. 399BB. ENHANCING CANCER CARE THROUGH IMPROVED NAVIGATION.

    ``(a) Demonstration Projects.--The Secretary shall award 
competitive grants to eligible entities to develop, implement, and 
evaluate cancer case management programs to enhance the quality of 
cancer care through improved access and navigation.
    ``(b) Eligibility.--An entity is eligible to receive a grant under 
this section if such entity is a hospital; health center; an academic 
institution; a hospice program; a palliative care program, or a program 
offering a continuum of hospice care, palliative care, and other 
appropriate care to children and their families; a State health agency; 
an Indian Health Service hospital or clinic, Indian tribal health 
facility, or urban Indian facility; a nonprofit organization; a health 
plan; a primary care practice-based research network as defined by the 
Agency for Healthcare Research and Quality; a cancer center; or any 
other entity determined to be appropriate by the Secretary.
    ``(c) Application.--An eligible entity seeking a grant under this 
section shall submit an application to the Secretary at such time, in 
such manner, and containing such information as the Secretary may 
require, including assurances that the eligible entity will--
            ``(1) target patient populations with an unequal burden of 
        cancer through specific outreach activities;
            ``(2) coordinate culturally competent and appropriate care 
        specified in observance of existing, relevant departmental 
        guidelines, including a special emphasis on underserved 
        populations and how their values and priorities influence 
        screening and treatment decisions;
            ``(3) coordinate with relevant ombudsman programs and other 
        existing coordination and navigation efforts and services, 
        where possible; and
            ``(4) evaluate activities and disseminate findings 
        including findings related to repeated difficulties in 
        accessing navigation.
    ``(d) Use of Funds.--An eligible entity shall use amounts received 
under a grant under this section to carry out programs in which--
            ``(1) trained individuals (such as representatives from the 
        community, nurses, social workers, cancer survivors, 
        physicians, or patient advocates) are assigned to act as 
        contacts--
                    ``(A) within the community; or
                    ``(B) within the health care system,
        to facilitate access to quality cancer care and cancer 
        preventive services;
            ``(2) partnerships are created with community organizations 
        (which may include cancer centers, hospitals, health centers, 
        hospice programs, palliative care programs, health care 
        providers, home care, nonprofit organizations, health plans, or 
        other entities determined appropriate by the Secretary) to help 
        facilitate access or to improve the quality of cancer care;
            ``(3) activities are conducted to coordinate cancer care 
        and preventive services and referrals, including referrals to 
        hospice programs, and palliative care programs; or
            ``(4) the grantee negotiates, mediates, or arbitrates on 
        behalf of the patient with relevant entities to resolve issues 
        that impede access to care.
    ``(e) Models.--Not later than 3 years after the date of enactment 
of this section, the Secretary shall develop or modify models to 
improve the navigation of cancer care for grantees under this section. 
The Secretary shall update such models as may be necessary to ensure 
that the best cancer case management practices are being utilized.

``SEC. 399CC. CANCER CARE COORDINATION.

    ``(a) Demonstration Projects.--The Secretary shall award 
competitive grants to eligible entities to facilitate the development 
of a coordinated system to improve the quality of cancer care.
    ``(b) Eligibility.--An entity is eligible to receive a grant under 
this section if such entity is a hospital; a health center; an academic 
institution; a hospice program; a palliative care program; a program 
offering a continuum of hospice care, palliative care, and other 
appropriate care to children and their families; a State health agency; 
a nonprofit organization; a health plan; a primary care practice-based 
research network as defined by the Agency for Healthcare Research and 
Quality; a cancer center; or any other entity determined to be 
appropriate by the Secretary.
    ``(c) Application.--An eligible entity desiring a grant under this 
section shall prepare and submit to the Secretary an application at 
such time, in such manner, and containing such information as the 
Secretary may require.
    ``(d) Use of Funds.--An eligible entity shall use amounts received 
under a grant under this section to improve coordination of the quality 
of cancer care, by--
            ``(1) creating partnerships and enhancing collaboration 
        with health care providers (which may include cancer centers, 
        hospitals, health centers, hospice programs, health care 
        providers, experts in palliative care, preventive service 
        providers) to improve the provision of quality of cancer care;
            ``(2) developing best practices for the quality of cancer 
        care coordination (with special emphasis provided to those 
        cancers that have low survival rates or individuals with 
        advanced disease), including the development of model systems; 
        and
            ``(3) evaluating overall activities to identify optimal 
        designs and essential components for cancer practices and 
        models to improve the coordination of cancer care services and 
        activities.
    ``(e) Dissemination.--The Secretary shall disseminate findings made 
as a result of activities conducted under this section to the public in 
coordination with the Agency for Healthcare Research and Quality, the 
Centers for Medicare & Medicaid Services, or other appropriate Federal 
agencies.''.

           TITLE VI--ESTABLISHING PROGRAMS IN PALLIATIVE CARE

SEC. 601. PROGRAMS TO IMPROVE PALLIATIVE CARE.

    Part R of title III of the Public Health Service Act (as added by 
section 501), is further amended by adding at the end the following:

``SEC. 399DD. PROGRAMS TO IMPROVE PALLIATIVE CARE.

    ``(a) Demonstration Projects.--The Secretary shall award 
competitive grants to eligible entities to develop, implement, and 
evaluate model programs for the delivery of palliative care throughout 
all stages of disease for individuals with cancer (with a special 
emphasis on children) and their families.
    ``(b) Eligibility.--An entity is eligible to receive a grant under 
this section if such entity is a hospital; an academic institution; a 
hospice program; a palliative care program; a program offering a 
continuum of hospice care, palliative care, and other appropriate care 
to children and their families; a nonprofit organization; a State 
health agency; a health center; a cancer center; or any other entity 
determined to be appropriate by the Secretary.
    ``(c) Application.--An eligible entity desiring a grant under this 
section shall prepare and submit to the Secretary an application at 
such time, in such manner, and containing such information as the 
Secretary may require.
    ``(d) Use of Funds.--An entity shall use amounts received under a 
grant under this section to--
            ``(1) integrate palliative care with such entities as 
        academic institutions, community organizations, hospice 
        programs, hospitals, cancer patient and survivorship 
        organizations, health care providers, cancer centers, or other 
        entities determined appropriate by the Secretary;
            ``(2) conduct outreach and education activities to 
        encourage the dissemination of evidence-based clinical best 
        practices relating to palliative care;
            ``(3) increase public awareness, including outreach 
        campaigns, particularly to underserved populations;
            ``(4) disseminate evidence-based information to health care 
        providers and individuals with cancer and their families 
        regarding available palliative care programs and services;
            ``(5) provide and evaluate education and training programs 
        in palliative care for health care providers, including--
                    ``(A) establishing pilot training programs 
                (including faculty training programs) in medicine, 
                including oncology (including pediatric oncology), 
                family medicine, psychiatry, psychology, pain, nursing, 
                pharmacology, physical therapy, occupational therapy, 
                social work, and other relevant disciplines; or
                    ``(B) developing, implementing, and evaluating 
                pilot training programs for the staff of hospices, 
                nursing homes, hospitals, home health agencies, 
                outpatient care clinics, and other entities determined 
                appropriate by the Secretary;
            ``(6) design or implement model palliative care programs 
        for individuals with cancer and their families including 
        improving access to clinical trials, where appropriate;
            ``(7) develop and evaluate pilot programs to address the 
        special needs of children or other underserved populations and 
        their families in palliative care programs;
            ``(8) conduct demonstration projects to enhance or develop 
        online support networks for individuals with cancer and their 
        families, including those networks for individuals who are 
        homebound, and develop other methods to reach underserved 
        cancer patients; or
            ``(9) determine whether strategies developed for palliative 
        care for individuals with cancer and their families would be 
        applicable to individuals with other diseases.
    ``(e) Dissemination.--The Secretary shall disseminate findings made 
as a result of activities conducted under this section to the public in 
coordination with the Director of the Agency for Healthcare Research 
and Quality, the Administrator of the Centers for Medicare & Medicaid 
Services, and the heads other appropriate Federal agencies.''.

             TITLE VII--ESTABLISHING SURVIVORSHIP PROGRAMS

SEC. 701. PROGRAMS FOR SURVIVORSHIP.

    Subpart 1 of Part C of title IV of the Public Health Service Act 
(42 U.S.C. 285 et seq.) (as amended by section 101), is further amended 
by adding at the end the following:

``SEC. 417F. PROGRAMS FOR SURVIVORSHIP.

    ``(a) Demonstration Projects.--The Secretary shall conduct and 
support research regarding the unique health challenges associated with 
cancer survivorship and carry out demonstration projects to develop and 
implement post-treatment public health programs and services including 
followup care and monitoring to support and improve the long-term 
quality of life for cancer survivors, including children.
    ``(b) Eligibility.--An entity is eligible to receive a competitive 
grant under this section if such entity is an academic institution, 
nonprofit organization, State health agency, cancer center, health 
center, or other entity determined to be appropriate by the Secretary.
    ``(c) Application.--An entity desiring a grant under this section 
shall prepare and submit to the Secretary an application at such time, 
in such manner, and containing such information as the Secretary may 
require.
    ``(d) Use of Funds.--An entity shall use amounts received under a 
grant under this section to plan, implement, and evaluate demonstration 
projects that--
            ``(1) design protocols for followup care, monitoring, and 
        other survivorship programs (including peer support and mentor 
        programs);
            ``(2) increase public awareness about appropriate followup 
        care, monitoring and other survivorship programs (including 
        peer support and mentor programs) by disseminating information 
        to health care providers and survivors and their families; and
            ``(3) support programs to improve the quality of life among 
        cancer survivors, referenced by the quality of cancer care 
        measures developed under section 417E (where appropriate), with 
        particular emphasis on underserved populations, including 
        children.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2003 through 2007.''.

SEC. 702. CANCER CONTROL PROGRAMS.

    Section 412 of the Public Health Service Act (42 U.S.C. 285a-1) is 
amended--
            (1) in the matter preceding paragraph (1), by striking 
        ``cancer and for rehabilitation and counseling respecting 
        cancer.'' and inserting ``cancer and for survivorship, 
        rehabilitation, and counseling respecting cancer.'';
            (2) in paragraph (1)(B), by striking ``and the families of 
        cancer patients'' and inserting ``the families of cancer 
        patients, and cancer survivors''; and
            (3) in paragraph (3), by striking ``diagnosis, and 
        treatment and control of cancer'' and inserting ``diagnosis, 
        treatment, survivorship programs, and control of cancer.''.

               TITLE VIII--PROGRAMS FOR END-OF-LIFE CARE

SEC. 801. PROGRAMS FOR END-OF-LIFE CARE.

    Part R of title III of the Public Health Service Act (as amended by 
section 601), is further amended by adding the following:

``SEC. 399EE. PROGRAMS FOR END-OF-LIFE CARE.

    ``(a) Demonstration Projects.--The Secretary shall award 
competitive grants to eligible entities to develop, implement, and 
evaluate evidence-based programs for the delivery of quality of cancer 
care during the end-of-life to individuals with cancer (with a special 
emphasis on children) and their families.
    ``(b) Eligibility.--An entity is eligible to receive a grant under 
this section if such entity is a hospital; an academic institution; a 
hospice program; a palliative care program; a program offering a 
continuum of hospice care, palliative care, and other appropriate care 
to children and their families; a nonprofit organization; a State 
health agency; a health center; a cancer center; or any other entity 
determined to be appropriate by the Secretary.
    ``(c) Application.--An entity desiring a grant under this section 
shall prepare and submit to the Secretary an application at such time, 
in such manner, and containing such information as the Secretary may 
require.
    ``(d) Use of Funds.--An entity shall use amounts received under a 
grant under this section to--
            ``(1) integrate palliative care or end-of-life care 
        programs with entities including academic institutions, 
        community organizations, hospice programs, hospitals, cancer 
        patient and survivorship organizations, health care providers, 
        cancer centers, or other entities determined appropriate by the 
        Secretary;
            ``(2) conduct outreach and education activities to 
        encourage the dissemination of evidence-based clinical best 
        practices relating to end-of-life care;
            ``(3) increase public awareness, including outreach 
        campaigns, particularly to underserved populations;
            ``(4) disseminate information to health care providers and 
        individuals with cancer and their families regarding available 
        end-of-life programs, including hospice programs;
            ``(5) provide and evaluate education and training in end-
        of-life care for health care providers, including--
                    ``(A) establishing pilot training programs 
                (including faculty training programs) in medicine 
                including oncology (including pediatric oncology), 
                family medicine, psychiatry, psychology, pain, nursing, 
                pharmacology and social work, and other disciplines; or
                    ``(B) developing, implementing, and evaluating 
                pilot training programs for the staff of hospices, 
                nursing homes, hospitals, home health agencies, 
                outpatient care clinics, and other entities determined 
                appropriate by the Secretary;
            ``(6) design or implement model end-of-life care programs 
        for individuals with cancer and their families including 
        improving access to clinical trials where appropriate;
            ``(7) develop and evaluate pilot programs to address the 
        special needs of children or other underserved populations and 
        their families in end-of-life programs;
            ``(8) integrate palliative care and hospice care activities 
        in the delivery of end-of-life care; or
            ``(9) determine whether strategies developed for end-of-
        life care for individuals with cancer and their families would 
        be applicable to individuals with other diseases.
    ``(e) Dissemination.--The Secretary shall disseminate findings made 
as a result of activities conducted under this section to the public in 
coordination with the Director of the Agency for Healthcare Research 
and Quality, the Administrator of the Centers for Medicare & Medicaid 
Services, and the heads of other appropriate Federal agencies.''.

                TITLE IX--DEVELOPING TRAINING CURRICULA

SEC. 901. CURRICULUM DEVELOPMENT.

    Part R of title III of the Public Health Service Act (as amended by 
section 801), is further amended by adding at the end the following:

``SEC. 399FF. CURRICULUM DEVELOPMENT.

    ``(a) In General.--The Secretary shall award competitive grants for 
the development of curricula for health care provider training 
regarding the assessment, monitoring, improvement, and delivery of 
quality of cancer care.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall be an academic institution, nonprofit 
organization, cancer center, health center, medical school, or other 
entity determined appropriate by the Secretary.
    ``(c) Application.--An entity desiring a grant under this section 
shall prepare and submit to the Secretary an application at such time, 
in such manner, and containing such information as the Secretary may 
require.
    ``(d) Use of Funds.--An entity shall use amounts received under a 
grant under this subsection to--
            ``(1) evaluate methods of delivery of the quality of cancer 
        care, including palliative care, hospice care, end-of-life 
        care, or cancer survivorship by health care providers;
            ``(2) develop curricula concerning the delivery of quality 
        of cancer care including palliative care, hospice care, end-of-
        life care, or cancer survivorship; and
            ``(3) provide recommendations for training protocols for 
        medical and nursing education, fellowships, and continuing 
        education in quality of cancer care including palliative care, 
        hospice care, survivorship, or end-of-life care for health care 
        providers.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $3,000,000 for fiscal year 2003 
and such sums as may be necessary for each of fiscal years 2004 through 
2007.''.

SEC. 902. CANCER CARE WORKFORCE AND TRANSLATIONAL RESEARCH.

    (a) Cancer Control Programs.--Section 412 of the Public Health 
Service Act (42 U.S.C. 285a-1) is amended--
            (1) by striking ``The Director of the Institute'' and 
        inserting the following:
    ``(a) In General.--The Director of the Institute'';
            (2) by striking paragraph (2) and inserting the following:
            ``(2) annual and long-term training goals to assure an 
        adequate and diverse cancer care workforce including--
                    ``(A) preparing and implementing a plan to provide 
                assistance to health professionals in health 
                professions experiencing the most severe shortages 
                including the provision of grants, scholarships, 
                fellowships, post-doctoral stipends, or loans to 
                eligible individuals to increase the cancer care 
                workforce; and
                    ``(B) educating students of health professions and 
                health professionals in--
                            ``(i) effective methods for the prevention 
                        and early detection of cancer;
                            ``(ii) the identification of individuals 
                        with a high risk of developing cancer;
                            ``(iii) improved methods of patient 
                        referral to appropriate centers for early 
                        diagnosis and treatment of cancer;
                            ``(iv) methods to deliver culturally 
                        competent care; and
                            ``(v) other appropriate methods for 
                        providing quality of cancer care; and''; and
            (3) by adding at the end the following:
    ``(b) Coordination With Existing Programs.--In carrying out the 
activities under subsection (a)(2), the Director of the Institute shall 
coordinate with existing programs, including programs at the Health 
Resources and Services Administration, to prevent duplication.''.
    (b) National Cancer Research and Demonstration Centers.--Section 
414(b) of the Public Health Service Act (42 U.S.C. 285a-3(b)) is 
amended by striking paragraph (3) and inserting the following:
            ``(3) clinical training (including training for allied 
        health professionals), loan forgiveness or post-doctoral 
        stipends for bench researchers, continuing education for health 
        professionals and allied health professionals, and information 
        programs for the public regarding cancer; and''.
    (c) Translational Cancer Research.--Subpart 1 of part C of title IV 
of the Public Health Service Act (42 U.S.C. 285 et seq.) is amended by 
inserting after section 414 the following:

``SEC. 414A. TRANSLATIONAL CANCER RESEARCH.

    ``(a) In General.--The Director of the Institute shall enter into 
cooperative agreements with, and make grants to, public or nonprofit 
entities to conduct multidisciplinary, translational cancer research.
    ``(b) Use of Funds.--
            ``(1) In general.--The Director of the Institute may use 
        funds provided under this section to establish networks and 
        partnerships to link community cancer providers to programs 
        funded under this section.
            ``(2) Construction of New Facilities.--Funds provided under 
        this section shall not be used for the construction of new 
        facilities.
    ``(c) Strategic Plan.--Not later than October 1, 2004, the Director 
of the Institute shall develop and implement a strategic plan, in 
collaboration with entities performing translational research, for 
identifying, expanding, and disseminating the results of translational 
cancer research to health care providers.
    ``(d) Duties.--An entity receiving a grant under this section 
shall--
            ``(1) conduct research with the potential to improve the 
        prevention, diagnosis, and treatment of cancer and to improve 
        the quality of cancer care, including palliation;
            ``(2) conduct clinical research studies on promising cancer 
        treatments including clinical trials; and
            ``(3) evaluate tests, techniques, or technologies in 
        individuals being evaluated for the presence of cancer.
    ``(e) Definition of Translational Cancer Research.--As used in this 
section, the term `translational cancer research' means scientific 
laboratory and clinical research and testing necessary to transform 
scientific or medical discoveries into new approaches, products, or 
processes that can assist in preventing, diagnosing, or controlling 
cancer.''
    (d) Authorization of Appropriations.--Section 417B(a) of the Public 
Health Service Act (42 U.S.C. 285a-8(a)) is amended by striking 
``1996'' and inserting ``2007''.

                      TITLE X--CONDUCTING REPORTS

SEC. 1001. STUDIES AND REPORTS BY THE INSTITUTE OF MEDICINE.

    (a) Contract.--The Secretary shall enter into a contract with the 
Institute of Medicine to--
            (1) evaluate Federal and State activities relating to 
        comprehensive cancer control programs and activities;
            (2) evaluate the quality of cancer care (including 
        palliative care, end-of-life care, and survivorship) that 
        medicare and medicaid beneficiaries receive and the extent to 
        which medicare and medicaid coverage and reimbursement policies 
        affect access to quality cancer care;
            (3) evaluate data from the Centers for Medicare & Medicaid 
        Services and other agencies on volume-outcome relationships;
            (4) evaluate access to clinical trials and the relationship 
        of such access to the quality of cancer care, especially with 
        respect to medically underserved populations; and
            (5) assess existing gaps in and impediments to the quality 
        of cancer care, including gaps in data, research and 
        translation, seamless patient care and navigation, palliative 
        care, and care provided to underserved populations.
    (b) Reports.--
            (1) In general.--Not later than 4 years after the date of 
        enactment of this Act, the Institute of Medicine shall submit 
        to the Secretary of Health and Human Services a report 
        containing information on the evaluation conducted under 
        paragraphs (1) through (5) of subsection (a), including data 
        collected at the State level through contracts with appropriate 
        organizations as designated by the Institute of Medicine.
            (2) 8 years.--Not later than 8 years after the date of 
        enactment of this Act, the Institute of Medicine shall submit 
        to the Secretary of Health and Human Services a report 
        containing information and recommendations on the areas 
        described in subsection (a), including data collected from 
        relevant demonstration projects.
            (3) Reports.--The Secretary of Health and Human Services 
        shall submit the reports described in paragraphs (1) and (2) to 
        the relevant committees of Congress.
    (c) Definitions.--
            (1) Palliative care; quality of cancer care.--The terms 
        `palliative care' and `quality of cancer care' have the 
        meanings given such term in section 399AA of the Public Health 
        Service Act.
            (2) Comprehensive cancer control program.--The term 
        `comprehensive cancer control program' has the meaning given 
        such term in section 320B of the Public Health Service Act.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $2,500,000 for fiscal year 
2003, and such sums as may be necessary for each of fiscal years 2004 
through 2007.
                                 <all>