[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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