[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1844 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 1844
To amend title XVIII of the Social Security Act to provide for coverage
of comprehensive cancer care planning under the Medicare Program and to
improve the care furnished to individuals diagnosed with cancer by
establishing a Medicare hospice care demonstration program and grants
programs for cancer palliative care and symptom management programs,
provider education, and related research.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 1, 2009
Mrs. Capps (for herself and Mr. Boustany) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for coverage
of comprehensive cancer care planning under the Medicare Program and to
improve the care furnished to individuals diagnosed with cancer by
establishing a Medicare hospice care demonstration program and grants
programs for cancer palliative care and symptom management programs,
provider education, and related research.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Comprehensive
Cancer Care Improvement Act of 2009''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I--COMPREHENSIVE CANCER CARE UNDER THE MEDICARE PROGRAM
Sec. 101. Coverage of cancer care planning services.
Sec. 102. Demonstration project to provide comprehensive cancer care
symptom management services under Medicare.
TITLE II--COMPREHENSIVE PALLIATIVE CARE AND SYMPTOM MANAGEMENT PROGRAMS
Sec. 201. Grants for comprehensive palliative care and symptom
management programs.
TITLE III--PROVIDER EDUCATION REGARDING PALLIATIVE CARE AND SYMPTOM
MANAGEMENT
Sec. 301. Grants to improve health professional education.
Sec. 302. Grants to Improve Continuing Professional Education.
TITLE IV--RESEARCH ON END-OF-LIFE TOPICS FOR CANCER PATIENTS
Sec. 401. Research program.
SEC. 2. FINDINGS.
The Congress makes the following findings:
(1) Individuals with cancer often do not have access to a
cancer care system that provides comprehensive and coordinated
care of high quality.
(2) The cancer care system has not traditionally offered
individuals with cancer a prospective and comprehensive plan
for treatment and symptom management, strategies for updating
and evaluating such plan with the assistance of a health care
professional, and a follow-up plan for monitoring and treating
possible late effects of cancer and its treatment.
(3) Cancer survivors often experience the under-diagnosis
and under-treatment of the symptoms of cancer, a problem that
begins at the time of diagnosis and often becomes more severe
at the end of life. The failure to treat the symptoms, side
effects, and late effects of cancer and its treatment may have
a serious adverse impact on the health, well-being, and quality
of life of cancer survivors.
(4) Cancer survivors who are members of racial and ethnic
minority groups may face special obstacles in receiving cancer
care that is coordinated and includes appropriate management of
cancer symptoms and treatment side effects.
(5) Individuals with cancer are sometimes put in the
untenable position of choosing between potentially curative
therapies and palliative care instead of being assured access
to comprehensive care that includes appropriate treatment and
symptom management.
(6) Comprehensive cancer care should incorporate access to
psychosocial services and management of the symptoms of cancer
(and the symptoms of its treatment), including pain, nausea and
vomiting, fatigue, and depression.
(7) Comprehensive cancer care should include a means for
providing cancer survivors with a comprehensive care summary
and a plan for follow-up care after primary treatment to ensure
that cancer survivors have access to follow-up monitoring and
treatment of possible late effects of cancer and cancer
treatment.
(8) The Institute of Medicine report, ``Ensuring Quality
Cancer Care'', described the elements of quality care for an
individual with cancer to include--
(A) the development of initial treatment
recommendations by an experienced health care provider;
(B) the development of a plan for the course of
treatment of the individual and communication of the
plan to the individual;
(C) access to the resources necessary to implement
the course of treatment;
(D) access to high-quality clinical trials;
(E) a mechanism to coordinate services for the
treatment of the individual; and
(F) psychosocial support services and compassionate
care for the individual.
(9) In its report, ``From Cancer Patient to Cancer
Survivor: Lost in Transition'', the Institute of Medicine
recommended that individuals with cancer completing primary
treatment be provided a comprehensive summary of their care
along with a follow-up survivorship plan of treatment.
(10) Since more than half of all cancer diagnoses occur
among elderly Medicare beneficiaries, the problems of providing
cancer care are problems of the Medicare program.
(11) Shortcomings in providing cancer care, resulting in
inadequate management of cancer symptoms and insufficient
monitoring and treatment of late effects of cancer and its
treatment, are related to problems of Medicare payments for
such care, inadequate professional training, and insufficient
investment in research on symptom management.
(12) Changes in Medicare payment for comprehensive cancer
care, enhanced public and professional education regarding
symptom management, and more research related to symptom
management and palliative care will enhance patient decision-
making about treatment options and will contribute to improved
care for individuals with cancer from the time of diagnosis of
the individual through the end of the life of the individual.
TITLE I--COMPREHENSIVE CANCER CARE UNDER THE MEDICARE PROGRAM
SEC. 101. COVERAGE OF CANCER CARE PLANNING SERVICES.
(a) In General.--Section 1861 of the Social Security Act is
amended--
(1) in subsection (s)(2)--
(A) by striking ``and'' at the end of subparagraph
(DD);
(B) by adding ``and'' at the end of subparagraph
(EE); and
(C) by adding at the end the following new
subparagraph:
``(FF) comprehensive cancer care planning services (as
defined in subsection (hhh));''; and
(2) by adding at the end the following new subsection:
``Comprehensive Cancer Care Planning Services
``(hhh)(1) The term `comprehensive cancer care planning services'
means--
``(A) with respect to an individual who is
diagnosed with cancer, the development of a plan of
care that--
``(i) details, to the greatest extent
practicable, all aspects of the care to be
provided to the individual, with respect to the
treatment of such cancer, including any
curative treatment and comprehensive symptom
management (such as palliative care) involved;
``(ii) is furnished in written form to the
individual in person within a period specified
by the Secretary that is as soon as practicable
after the date on which the individual is so
diagnosed;
``(iii) is furnished, to the greatest
extent practicable, in a form that
appropriately takes into account cultural and
linguistic needs of the individual in order to
make the plan accessible to the individual; and
``(iv) is in accordance with standards
determined by the Secretary to be appropriate;
``(B) with respect to an individual for whom a plan
of care has been developed under subparagraph (A), the
revision of such plan of care as necessary to account
for any substantial change in the condition of the
individual, if such revision--
``(i) is in accordance with clauses (i) and
(iii) of such subparagraph; and
``(ii) is furnished in written form to the
individual within a period specified by the
Secretary that is as soon as practicable after
the date of such revision;
``(C) with respect to an individual who has
completed the primary treatment for cancer, as defined
by the Secretary (such as completion of chemotherapy or
radiation treatment), the development of a follow-up
cancer care plan that--
``(i) describes the elements of the primary
treatment, including symptom management,
furnished to such individual;
``(ii) provides recommendations for the
subsequent care of the individual with respect
to the cancer involved;
``(iii) is furnished in written form to the
individual in person within a period specified
by the Secretary that is as soon as practicable
after the completion of such primary treatment;
``(iv) is furnished, to the greatest extent
practicable, in a form that appropriately takes
into account cultural and linguistic needs of
the individual in order to make the plan
accessible to the individual; and
``(v) is in accordance with standards
determined by the Secretary to be appropriate;
and
``(D) with respect to an individual for whom a
follow-up cancer care plan has been developed under
subparagraph (C), the revision of such plan as
necessary to account for any substantial change in the
condition of the individual, if such revision--
``(i) is in accordance with clauses (i),
(ii), and (iv) of such subparagraph; and
``(ii) is furnished in written form to the
individual within a period specified by the
Secretary that is as soon as practicable after
the date of such revision.
``(2) The Secretary shall establish standards to carry out
paragraph (1) in consultation with appropriate organizations
representing providers of services related to cancer treatment and
organizations representing survivors of cancer. Such standards shall
include standards for determining the need and frequency for revisions
of the plans of care and follow-up plans based on changes in the
condition of the individual and standards for the communication of the
plan to the patient.''.
(b) Payment.--Section 1833(a)(1) of the Social Security Act (42
U.S.C. 1395l(a)(1)) is amended by striking ``and'' before ``(W)'' and
inserting before the semicolon at the end the following: ``, and (X)
with respect to comprehensive cancer care planning services described
in any of subparagraphs (A) through (D) of section 1861(hhh)(1), the
amount paid shall be an amount equal to the sum of (i) the national
average amount under the physician fee schedule established under
section 1848 for a new patient office consultation of the highest level
of service in the non-facility setting, and (ii) the national average
amount under such fee schedule for a physician certification described
in section 1814(a)(2) for home health services furnished to an
individual by a home health agency under a home health plan of care''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the first day of the first
calendar year that begins after the date of the enactment of this Act.
SEC. 102. DEMONSTRATION PROJECT TO PROVIDE COMPREHENSIVE CANCER CARE
SYMPTOM MANAGEMENT SERVICES UNDER MEDICARE.
(a) In General.--Beginning not later than 180 days after the date
of the enactment of this Act, the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'') shall
conduct a two-year demonstration project (in this section referred to
as the ``demonstration project'') under title XVIII of the Social
Security Act under which payment shall be made under such title for
comprehensive cancer care symptom management services, including items
and services described in subparagraphs (A) through (I) of section
1861(dd)(1) of the Social Security Act, furnished by an eligible
entity, in accordance with a plan developed under subparagraph (A) or
(C) of section 1861(hhh)(1) of such Act, as added by section 101(a).
Sections 1812(d) and 1814(a)(7) of such Act (42 U.S.C. 1395d(d),
1395f(a)(7)) are not applicable to items and services furnished under
the demonstration project. Participation of Medicare beneficiaries in
the demonstration project shall be voluntary.
(b) Qualifications and Selection of Eligible Entities.--
(1) Qualifications.--For purposes of subsection (a), the
term ``eligible entity'' means an entity (such as a cancer
center, hospital, academic health center, hospice program,
physician practice, school of nursing, visiting nurse
association, or other home health agency) that the Secretary
determines is capable, directly or through an arrangement with
a hospice program (as defined in section 1861(dd)(2) of the
Social Security Act (42 U.S.C. 1395x(dd)(2))), of providing the
items and services described in such subsection.
(2) Selection.--The Secretary shall select not more than 10
eligible entities to participate in the demonstration project.
Such entities shall be selected in a manner so that the
demonstration project is conducted in different regions across
the United States and in urban and rural locations.
(c) Evaluation and Report.--
(1) Evaluation.--The Secretary shall conduct a
comprehensive evaluation of the demonstration project to
determine--
(A) the effectiveness of the project in improving
patient outcomes;
(B) the cost of providing comprehensive symptom
management, including palliative care, from the time of
diagnosis;
(C) the effect of comprehensive cancer care
planning and the provision of comprehensive symptom
management on patient outcomes, cancer care
expenditures, and the utilization of hospitalization
and emergent care services; and
(D) potential savings to the Medicare program
demonstrated by the project.
(2) Report.--Not later than the date that is one year after
the date on which the demonstration project concludes, the
Secretary shall submit to Congress a report on the evaluation
conducted under paragraph (1).
TITLE II--COMPREHENSIVE PALLIATIVE CARE AND SYMPTOM MANAGEMENT PROGRAMS
SEC. 201. GRANTS FOR COMPREHENSIVE PALLIATIVE CARE AND SYMPTOM
MANAGEMENT PROGRAMS.
(a) In General.--The Secretary of Health and Human Services shall
make grants to eligible entities for the purpose of--
(1) establishing a new palliative care and symptom
management program for cancer patients; or
(2) expanding an existing palliative care and symptom
management program for cancer patients.
(b) Authorized Activities.--Activities funded through a grant under
this section may include--
(1) securing consultative services and advice from
institutions with extensive experience in developing and
managing comprehensive palliative care and symptom management
programs;
(2) expanding an existing program to serve more patients or
enhance the range or quality of services, including cancer
treatment patient education services, that are provided;
(3) developing a program that would ensure the inclusion of
cancer treatment patient education in the coordinated cancer
care model; and
(4) establishing an outreach program to partner with an
existing comprehensive care program and obtain expert
consultative services and advice.
(c) Distribution of Funds.--In making grants and distributing the
funds under this section, the Secretary shall ensure that--
(1) two-thirds of the funds appropriated to carry out this
section for each fiscal year are used for establishing new
palliative care and symptom management programs, of which not
less than half of such two-thirds shall be for programs in
medically underserved communities to address issues of racial
and ethnic disparities in access to cancer care; and
(2) one-third of the funds appropriated to carry out this
section for each fiscal year are used for expanding existing
palliative care and symptom management programs.
(d) Definitions.--In this section:
(1) The term ``eligible entity'' includes--
(A) an academic medical center, a cancer center, a
hospital, a school of nursing, or a health system
capable of administering a palliative care and symptom
management program for cancer patients;
(B) a physician practice with care teams, including
nurses and other professionals trained in palliative
care and symptom management;
(C) a visiting nurse association or other home care
agency with experience administering a palliative care
and symptom management program;
(D) a hospice; and
(E) any other health care agency or entity, as the
Secretary determines appropriate.
(2) The term ``medically underserved community'' has the
meeting given to that term in section 799B(6) of the Public
Health Service Act (42 U.S.C. 295p(6)).
(3) The term ``Secretary'' means the Secretary of Health
and Human Services.
(e) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of the fiscal years 2010 through 2014.
TITLE III--PROVIDER EDUCATION REGARDING PALLIATIVE CARE AND SYMPTOM
MANAGEMENT
SEC. 301. GRANTS TO IMPROVE HEALTH PROFESSIONAL EDUCATION.
(a) In General.--The Secretary of Health and Human Services shall
make grants to eligible entities to enable the entities to improve the
quality of graduate and postgraduate training of physicians, nurses,
and other health care providers in palliative care and symptom
management for cancer patients.
(b) Application.--To seek a grant under this section, an eligible
entity shall submit an application at such time, in such manner, and
containing such information as the Secretary may require. At a minimum,
the Secretary shall require that each such application demonstrate--
(1) the ability to incorporate palliative care and symptom
management into training programs; and
(2) the ability to collect and analyze data related to the
effectiveness of educational efforts.
(c) Evaluation.--The Secretary shall develop and implement a plan
for evaluating the effects of professional training programs funded
through this section.
(d) Definitions.--In this section:
(1) The term ``eligible entity'' means a cancer center
(including an NCI-designated cancer center), an academic health
center, a physician practice, a school of nursing, or a
visiting nurse association or other home care agency.
(2) The term ``NCI-designated cancer center'' means a
cancer center receiving funds through a P30 Cancer Center
Support Grant of the National Cancer Institute.
(3) The term ``Secretary'' means the Secretary of Health
and Human Services.
(e) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of the fiscal years 2010 through 2014.
SEC. 302. GRANTS TO IMPROVE CONTINUING PROFESSIONAL EDUCATION.
(a) In General.--The Secretary of Health and Human Services shall
make grants to eligible entities to improve the quality of continuing
professional education provided to qualified individuals regarding
palliative care and symptom management.
(b) Application.--To seek a grant under this section, an eligible
entity shall submit an application at such time, in such manner, and
containing such information as the Secretary may require. At a minimum,
the Secretary shall require that each such application demonstrate--
(1) experience in sponsoring continuing professional
education programs;
(2) the ability to reach health care providers and other
professionals who are engaged in cancer care;
(3) the capacity to develop innovative training programs;
and
(4) the ability to evaluate the effectiveness of
educational efforts.
(c) Evaluation.--The Secretary shall develop and implement a plan
for evaluating the effects of continuing professional education
programs funded through this section.
(d) Definitions.--In this section:
(1) The term ``eligible entity'' means a cancer center
(including an NCI-designated cancer center), an academic health
center, a school of nursing, or a professional society that
supports continuing professional education programs.
(2) The term ``NCI-designated cancer center'' means a
cancer center receiving funds through a P30 Cancer Center
Support Grant of the National Cancer Institute.
(3) The term ``qualified individual'' means a physician,
nurse, social worker, chaplain, psychologist, or other
individual who is involved in providing palliative care and
symptom management services to cancer patients.
(4) The term ``Secretary'' means the Secretary of Health
and Human Services.
(e) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of the fiscal years 2010 through 2014.
TITLE IV--RESEARCH ON END-OF-LIFE TOPICS FOR CANCER PATIENTS
SEC. 401. RESEARCH PROGRAM.
(a) In General.--The Director of the National Institutes of Health
shall establish a program of grants for research on palliative care,
symptom management, communication skills, and other end-of-life topics
for cancer patients.
(b) Inclusion of National Research Institutes.--In carrying out the
program established under this section, the Director should provide for
the participation of the National Cancer Institute, the National
Institute of Nursing Research, and any other national research
institute that has been engaged in research described in subsection
(a).
(c) Definitions.--In this section:
(1) The term ``Director'' means the Director of the
National Institutes of Health.
(2) The term ``national research institute'' has the
meaning given to that term in section 401(g) of the Public
Health Service Act (42 U.S.C. 281(g)).
(d) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of the fiscal years 2010 through 2014.
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