[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1927 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 1927

      To amend title XVIII of the Social Security Act to provide 
  comprehensive cancer patient treatment education under the Medicare 
     Program and to provide for research to improve cancer symptom 
                              management.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 2, 2009

Mr. Israel (for himself and Mr. Tiberi) 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 
  comprehensive cancer patient treatment education under the Medicare 
     Program and to provide for research to improve cancer symptom 
                              management.

    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 ``Assuring and 
Improving Cancer Treatment Education and Cancer Symptom Management 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 PATIENT TREATMENT EDUCATION UNDER THE 
                            MEDICARE PROGRAM

Sec. 101. Medicare coverage of comprehensive cancer patient treatment 
                            education services.
      TITLE II--RESEARCH ON CANCER SYMPTOM MANAGEMENT IMPROVEMENT

Sec. 201. Expansion of research.
Sec. 202. Nursing intervention research grants.
Sec. 203. Institute of Medicine study on the provision of symptom 
                            management and supportive care in people 
                            with cancer.

SEC. 2. FINDINGS.

    The Congress makes the following findings:
            (1) Many people with cancer experience side effects, 
        symptoms, and late complications associated with their disease 
        and their treatment, which can have a serious adverse impact on 
        their health, well-being, and quality of life.
            (2) Many side effects and symptoms associated with cancer 
        and its treatment can be reduced or controlled by the provision 
        of timely symptom management and services and also by educating 
        people with cancer and their caregivers about the potential 
        effects before treatment begins.
            (3) Studies have found that individualized educational 
        intervention for cancer pain management from a registered nurse 
        was effective for patients with cancer being treated in 
        outpatient and home-based settings. Similarly, the number of 
        caregivers who said they were well informed and confident about 
        caregiving after attending a family caregiver cancer education 
        program which increased after program attendance.
            (4) People with cancer benefit from having an educational 
        session with oncology nurses in advance of the initiation of 
        treatment to learn how to reduce the risk of and manage adverse 
        effects and maximize well-being. Helping patients to manage 
        their side effects reduces adverse events and the need for 
        urgent or inpatient care.
            (5) The Oncology Nursing Society has received reports from 
        its members that, because the Medicare program and other payers 
        do not cover the provision of patient treatment education, 
        patients and their caregivers often do not receive adequate 
        education before the onset of such patients' treatment for 
        cancer regarding the course of such treatment and the possible 
        side effects and symptoms such patients may experience. The 
        Oncology Nursing Society recommends that all patients being 
        treated for cancer have a one-on-one educational session with a 
        nurse in advance of the onset of such treatment so that such 
        patients and their caregivers receive the information they need 
        to help minimize adverse events related to such treatment and 
        maximize the well-being of such patients.
            (6) Insufficient or non-existent Medicare payments coupled 
        with poor investment in symptom management research contribute 
        to the inadequate education of patients, poor management and 
        monitoring of cancer symptoms, and inadequate handling of late 
        effects of cancer and its treatment.
            (7) People with cancer often do not have the symptoms 
        associated with their disease and the associated treatment 
        managed in a comprehensive or appropriate manner.
            (8) People with cancer deserve to have access to 
        comprehensive care that includes appropriate treatment and 
        symptom management.
            (9) Patients who receive infused chemotherapy likely obtain 
        some treatment education during the course of the 
        administration of their treatment; yet, many do not, and 
        individuals who may receive a different type of cancer care, 
        such as radiation or surgical interventions or oral 
        chemotherapy taken at home, likely do not receive treatment 
        education during their treatment.
            (10) Comprehensive cancer care must include access to 
        services and management associated with nausea, vomiting, 
        fatigue, depression, pain, and other symptoms.
            (11) The Institute of Medicine report, ``Ensuring Quality 
        Cancer Care'' asserts that ``much can be done to relieve the 
        symptoms, ease distress, provide comfort, and in other ways 
        improve the quality of life of someone with cancer. For a 
        person with cancer, maintenance of quality of life requires, at 
        a minimum, relief from pain and other distressing symptoms, 
        relief from anxiety and depressions, including the fear of 
        pain, and a sense of security that assistance with be readily 
        available if needed.''.
            (12) The Institute of Medicine report, ``Cancer Care for 
        the Whole Patient: Meeting Psychosocial Health Needs'' 
        recognizes that cancer patients' psychosocial needs include 
        information about their therapies and the potential side 
        effects.
            (13) As more than half of all cancer diagnoses occur among 
        individuals age 65 and older, the challenges of managing cancer 
        symptoms are growing for patients enrolled in the Medicare 
        program.
            (14) Provision of Medicare payment for comprehensive cancer 
        patient treatment education, coupled with expanded cancer 
        symptom management research, will help improve care and quality 
        of life for people with cancer from the time of diagnosis 
        through survivorship or end of life.

  TITLE I--COMPREHENSIVE CANCER PATIENT TREATMENT EDUCATION UNDER THE 
                            MEDICARE PROGRAM

SEC. 101. MEDICARE COVERAGE OF COMPREHENSIVE CANCER PATIENT TREATMENT 
              EDUCATION SERVICES.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x), as amended by section 152 of the Medicare Improvements for 
Patients and Providers Act of 2008 (Public Law 110-275), 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 patient treatment education 
        services (as defined in subsection (hhh)(1));''; and
            (2) by adding at the end the following new subsection:

      ``Comprehensive Cancer Patient Treatment Education Services

    ``(hhh)(1) The term `comprehensive cancer patient treatment 
education services' means--
            ``(A) in the case of an individual who is diagnosed with 
        cancer, the provision of a one-hour patient treatment education 
        session delivered by a registered nurse that--
                    ``(i) is furnished to the individual and the 
                caregiver (or caregivers) of the individual in advance 
                of the onset of treatment and to the extent 
                practicable, is not furnished on the day of diagnosis 
                or on the first day of treatment;
                    ``(ii) educates the individual and such caregiver 
                (or caregivers) to the greatest extent practicable, 
                about all aspects of the care to be furnished to the 
                individual, informs the individual regarding any 
                potential symptoms, side-effects, or adverse events, 
                and explains ways in which side effects and adverse 
                events can be minimized and health and well-being 
                maximized, and provides guidance regarding those side 
                effects to be reported and to which health care 
                provider the side effects should be reported;
                    ``(iii) includes the provision, in written form, of 
                information about the course of treatment, any 
                responsibilities of the individual with respect to 
                self-dosing, and ways in which to address symptoms and 
                side-effects; and
                    ``(iv) is furnished, to the greatest extent 
                practicable, in an oral, written, or electronic form 
                that appropriately takes into account cultural and 
                linguistic needs of the individual in order to make the 
                information comprehensible to the individual and such 
                caregiver (or caregivers); and
            ``(B) with respect to an individual for whom a course of 
        cancer treatment or therapy is materially modified, a one-hour 
        patient treatment education session described in subparagraph 
        (A), including updated information on the matters described in 
        such subparagraph should the individual's oncologic health care 
        professional deem it appropriate and necessary.
    ``(2) In establishing standards to carry out paragraph (1), the 
Secretary shall consult with appropriate organizations representing 
providers of oncology patient treatment education services and 
organizations representing people with cancer.''.
    (b) Payment.--Section 1833(a)(1) of such Act (42 U.S.C. 
1395l(a)(1)), as amended by section 101 of the Medicare Improvements 
for Patients and Providers Act of 2008 (Public Law 110-275), is 
amended--
            (1) by striking ``and'' before ``(W)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (X) with respect to comprehensive cancer 
        patient treatment education service (as defined in section 
        1861(hhh)(1)), 150 percent of the payment rate established 
        under section 1848 for diabetes outpatient self-management 
        training services (as defined in section 1861(qq)), determined 
        and applied without regard to any coinsurance''.
    (c) Coverage.--Section 1862(a)(1) of such Act (42 U.S.C. 
1395y(a)(1)) is amended--
            (1) in subparagraph (M), by striking ``or'' at the end;
            (2) in subparagraph (N), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
            ``(O) in the case of comprehensive cancer patient treatment 
        education services (as defined in subsection (hhh)(1)) which 
        are performed more frequently than is covered under such 
        section;''.
    (d) No Impact on Payment for Other Services.--Nothing in this 
section shall be construed to affect or otherwise authorize any 
reduction or modification, in the Medicare payment amounts otherwise 
established for chemotherapy infusion or injection codes with respect 
to the calculation and payment of minutes for chemotherapy teaching or 
related services.
    (e) 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.

      TITLE II--RESEARCH ON CANCER SYMPTOM MANAGEMENT IMPROVEMENT

SEC. 201. EXPANSION OF 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 adding at the end the following:

``SEC. 417G. RESEARCH ON CANCER SYMPTOM MANAGEMENT IMPROVEMENT.

    ``(a) In General.--The Director of NIH shall expand, intensify, and 
coordinate programs for the conduct and support of research with 
respect to--
            ``(1) improving the treatment and management of symptoms 
        and side effects associated with cancer and cancer treatment; 
        and
            ``(2) evaluating the role of nursing interventions in the 
        amelioration of such symptoms and side effects.
    ``(b) Administration.--The Director of NIH shall carry out this 
section--
            ``(1) through the Director of the Institute; and
            ``(2) in collaboration with the directors of the National 
        Institute of Nursing Research, the National Institute of Mental 
        Health, the National Center on Minority Health and Health 
        Disparities, the National Center for Complementary and 
        Alternative Medicine, and the Agency for Healthcare Research 
        and Quality.''.

SEC. 202. NURSING INTERVENTION RESEARCH GRANTS.

    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 201, is amended by 
adding at the end the following:

``SEC. 417H. NURSING INTERVENTION RESEARCH GRANTS.

    ``(a) In General.--The Director of NIH shall make grants for 
research to be conducted--
            ``(1) with a registered nurse as the principal 
        investigator; and
            ``(2) for the purpose of studying cancer symptom management 
        care and services delivered by registered nurses to cancer 
        patients.
    ``(b) Inclusion of National Research Institutes.--In carrying out 
this section, the Director of NIH shall 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 subsection (a)(2).
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for fiscal years 2010 through 2014.''.

SEC. 203. INSTITUTE OF MEDICINE STUDY ON THE PROVISION OF SYMPTOM 
              MANAGEMENT AND SUPPORTIVE CARE IN PEOPLE WITH CANCER.

    (a) Report.--
            (1) In general.--Not later than 2 months after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (in this section referred to as the ``Secretary'') 
        shall enter into an arrangement under which the Institute of 
        Medicine of the National Academy of Sciences (in this section 
        referred to as the ``Institute'') shall conduct a study and 
        evaluation, including a report, on the current state of symptom 
        management, patient treatment education, and supportive care 
        given to people with cancer.
            (2) Specific matters evaluated.--In conducting the study 
        and evaluation under paragraph (1), the Institute shall--
                    (A) analyze any barriers to access to, and delivery 
                of, symptom management, patient treatment education, 
                and supportive care to people with cancer;
                    (B) catalogue and evaluate the incentives and 
                disincentives in the current reimbursement system that 
                influence whether individuals receive comprehensive 
                symptom management, patient treatment education, and 
                supportive care, including adequate and ongoing patient 
                treatment education;
                    (C) evaluate the importance of nursing 
                interventions in the management of symptoms and side 
                effects of cancer and the associated treatment;
                    (D) consider such other matters as the Institute 
                determines appropriate; and
                    (E) make recommendations to address any barriers, 
                challenges, or other issues identified through the 
                study and evaluation.
            (3) Scope of review.--In conducting such study and 
        evaluation, the Institute shall consider a variety of 
        perspectives, including the perspectives of patients and their 
        family caregivers, registered nurses, including nurses 
        certified in oncology, physicians, social workers, 
        psychologists, other health care professionals, and other 
        experts and stakeholders.
    (b) Report.--Not later than 18 months after the date of enactment 
of this Act, the arrangement under subsection (a) shall provide for the 
Institute to submit to the Secretary and to Congress a report on the 
study evaluation conducted under such subsection. Such report shall 
contain a detailed description of the findings of such study and 
evaluation and recommendations for improving the provision of symptom 
management, patient treatment education, and supportive care to people 
with cancer.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for the purposes of 
conducting the study and evaluation, and preparing the report, required 
by this section.
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