I 111th CONGRESS 1st Session H. R. 3095 IN THE HOUSE OF REPRESENTATIVES June 26, 2009 Mr. Griffith 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 improve the information in databases for individuals with cancer in the United States and to amend the Social Security Act to provide increased coverage for uninsured individuals upon first diagnosis of cancer.

1.

Short title; findings

(a)

Short title

This Act may be cited as the Medicare Cancer Patient Database and Coverage Act of 2009. (b)

Findings

Congress finds the following: (1)Each year, more than 1.4 million Americans receive a cancer diagnosis, and more than 11 million Americans are currently living with cancer. (2)Newly diagnosed cancer patients need access to quality health care from the time of diagnosis to ensure the best possible outcome, and those entering the period of survivorship require active monitoring and follow-up care related to effects of cancer treatment and possible second cancers. (3)More than 47 million Americans have no health insurance, and this number includes many who will be diagnosed with cancer this year. (4)Among the non-elderly who receive a cancer diagnosis, more than 10 percent are uninsured, and among minority populations the percentage of uninsured cancer patients is higher. (5)Those with no insurance receive less cancer care and receive it later: they have lower rates of cancer screening, experience delays in follow-up after abnormal test results, and are diagnosed at a more advanced stage of disease. (6)Uninsured cancer patients receive less care than the insured, and they may face substantial medical expenses leading to bankruptcy. (7)Young adults have worse cancer outcomes than young children or older adults; experts believe part of the discrepancy in cancer outcomes can be attributed to the fact this population is less likely to be insured than others. (8)The Medicare program is a source of medical insurance for more than half of all cancer patients. (9)The Medicare program eliminates financial barriers to care for its beneficiaries and provides quality care to cancer patients. (10)Access to care, better cancer outcomes, and protection from devastating out-of-pocket medical expenses could be assured to cancer patients by providing all diagnosed with cancer the opportunity to enroll in Medicare.

2.

Improving cancer database

(a)

In general

The Secretary of Health and Human Services shall collect such additional data as may be necessary to update existing databases that contain data regarding individuals with cancer in the United States in order to provide for accurate information of the number of such individuals, the types and stages of cancer, and the efficacy of different treatments for the types and stages of cancer. (b)

Data

The database under subsection (a) shall include information to monitor an individual’s full experience with cancer based upon the stage of the cancer, from the initial diagnosis to early and continued treatment until elimination of evidence of cancer or death. (c)

Increased funding

There are authorized to be appropriated to the National Cancer Institute and the National Institutes of Health such additional funding as may be necessary to apply the information in the database for improved research and treatment of cancer, including providing physicians with timely information on outcomes to improve the treatment of cancer and to promote increased quality care.

3.

Medicare coverage for uninsured cancer patients

(a)

In general

Title II of the Social Security Act is amended by inserting after section 226A the following new section:

226B.

Special provisions relating to coverage under the Medicare program for cancer for uninsured, initial cancer patients

(a)

In general

In accordance with the succeeding provisions of this section, every individual shall be entitled to benefits under part A, and eligible to enroll under parts B, C and D, of title XVIII, subject to the deductible, premium and coinsurance provisions of such title if the individual— (1)is medically determined to have an initial cancer; (2)is lawfully residing in the United States; (3)has not attained the age of 65 but would otherwise be entitled under section 226(a) to hospital benefits under part A of title XVIII; (4)is not covered by creditable coverage (as defined in subsection (e)); and (5)has filed an application for benefits under this section. (b)

Initiation and duration of benefits

The period of entitlement and eligibility described in subsection (a)— (1)shall begin on the first day of the first month following the date of the medical determination of cancer referred to in subsection (a)(1) (but no earlier than the month preceding the month of the filing of an application for benefits under this section); and (2)shall end on the date the individual becomes otherwise entitled to benefits under part A of title XVIII under section 226 or, if earlier, is covered under creditable coverage. (c)

Procedures

(1)The Secretary shall ensure that processes are established to prevent unnecessary delays in enrolling individuals with cancer under this section. Individuals shall be enrolled on a timely basis upon the filing of an application described in subsection (a)(4) that includes evidence of an initial cancer diagnosis and an attestation that the individual satisfies the requirements of paragraphs (2) and (3) of subsection (a). (2)The Secretary shall develop educational practices to help ensure that individuals enrolling under this section satisfy the criteria established under subsection (a) and shall implement post-enrollment procedures for identifying individuals who do not satisfy such criteria. (3)The Secretary shall implement procedures to ensure that the benefits available under this section are not used as a substitute for health benefits that employers or individuals could otherwise provide, obtain, or maintain, and the Secretary shall report to Congress by the end of each fiscal year on the effectiveness of such procedures. (d)

Cancers excluded

In this section, the term cancer does not include basal cell carcinoma or squamous cell carcinoma of the skin. (e)

Creditable coverage defined

In this section, the term creditable coverage has the meaning given such term in section 2701(c) of the Public Health Service Act.

. (b)

Effective date

The amendment made by subsection (a) shall apply to benefits for months beginning 6 months after the date of the enactment of this Act.

4.

Encouragement of early detection of cancer

The Secretary of Health and Human Services shall, through existing programs and other appropriate means, provide for such an educational and outreach campaign as will encourage individuals to be tested for cancer at the earliest time for which such testing may be useful in detecting the presence of cancer, based upon cancer screening recommendations of the United States Preventive Services Task Force.