[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2477 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 2477

To amend title XVIII of the Social Security Act to provide for coverage 
  of cancer care planning and coordination under the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 25, 2013

  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 cancer care planning and coordination under the Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    (a) Short Title.--This Act may be cited as the ``Planning Actively 
for Cancer Treatment (PACT) Act of 2013''.
    (b) Findings.--Congress makes the following findings:
            (1) Individuals with cancer often do not have access to a 
        cancer care system that incorporates shared decision-making and 
        the coordination of all elements of care.
            (2) The cancer care system has not traditionally offered 
        individuals with cancer a shared decision-making process, a 
        prospective and comprehensive plan for treatment, symptom 
        management and supportive care, 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 may become more severe with 
        disease progression and at the end of life. The failure to 
        treat the symptoms, side effects, and late effects of cancer 
        and cancer treatment may have a serious adverse impact on the 
        health, survival, well-being, and quality of life of cancer 
        survivors.
            (4) The 1999 Institute of Medicine report entitled ``The 
        Unequal Burden of Cancer'' found that low-income people often 
        lack access to adequate cancer care and that ethnic minorities 
        have not benefitted fully from cancer treatment advances.
            (5) Individuals with cancer often do not participate in a 
        shared decision-making process that considers all treatment 
        options and do not benefit from coordination of all elements of 
        active treatment and palliative care.
            (6) Quality cancer care should incorporate access to 
        psychosocial services and management of the symptoms of cancer 
        and the symptoms of cancer treatment, including pain, nausea, 
        vomiting, fatigue, and depression.
            (7) Quality cancer care should include a means for engaging 
        cancer survivors in a shared decision-making process that 
        produces 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, including 
        appropriate psychosocial services.
            (8) The Institute of Medicine report entitled ``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) In ``Cancer Care for the Whole Patient'', the 
        Institute of Medicine stated that the development of a plan 
        that includes biomedical and psychosocial care should be a 
        standard for quality cancer care in any quality measurement 
        system.
            (11) Because more than half of all cancer diagnoses occur 
        among elderly Medicare beneficiaries, cancer care inadequacies 
        should be addressed through the Medicare program.
            (12) Shortcomings in providing cancer care, resulting in a 
        lack of shared decision-making, inadequate management of cancer 
        symptoms, and insufficient monitoring and treatment of late 
        effects of cancer and its treatment, relate in part to the 
        inadequacy of Medicare payments for such planning and 
        coordination services.
            (13) Changes in Medicare payment for cancer care planning 
        and coordination will support shared decision-making that 
        reviews all treatment options and will contribute to improved 
        care for individuals with cancer from the time of diagnosis 
        through the end of the life.

SEC. 2. COVERAGE OF CANCER CARE PLANNING AND COORDINATION SERVICES.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)(2)--
                    (A) by striking ``and'' at the end of subparagraph 
                (EE);
                    (B) by adding ``and'' at the end of subparagraph 
                (FF); and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(GG) cancer care planning and coordination services (as 
        defined in subsection (iii))''; and
            (2) by adding at the end the following new subsection:

            ``Cancer Care Planning and Coordination Services

    ``(iii)(1) The term `cancer care planning and coordination 
services' means--
            ``(A) with respect to an individual who is diagnosed with 
        cancer, the development of a treatment plan by a physician, 
        nurse practitioner, or physician assistant that--
                    ``(i) includes an assessment of the individual's 
                diagnosis, health status, treatment needs, functional 
                status, pain control, and psychosocial needs;
                    ``(ii) engages the individual in a shared decision-
                making process that reviews all treatment options;
                    ``(iii) 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, comprehensive 
                symptom management, and palliative care;
                    ``(iv) is furnished in person, in written form, to 
                the individual within a period specified by the 
                Secretary that is as soon as practicable after the date 
                on which the individual is so diagnosed;
                    ``(v) 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
                    ``(vi) is in accordance with standards determined 
                by the Secretary to be appropriate;
            ``(B) with respect to an individual for whom a treatment 
        plan has been developed under subparagraph (A), the revision of 
        such treatment plan as necessary to account for any substantial 
        change in the condition of the individual, recurrence of 
        disease, changes in the individual's treatment preferences, or 
        significant revision of the elements of curative care or 
        symptom management for the individual, if such revision--
                    ``(i) is in accordance with clauses (i), (ii), (iv) 
                and (v) 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, the 
        development of a follow-up survivorship care plan that--
                    ``(i) includes an assessment of the individual's 
                diagnosis, health status, treatment needs, functional 
                status, pain control, and psychosocial needs;
                    ``(ii) engages the individual in a shared decision-
                making process that reviews all survivorship care 
                options;
                    ``(iii) describes the elements of the primary 
                treatment, including symptom management and palliative 
                care, furnished to such individual;
                    ``(iv) provides recommendations for the subsequent 
                care of the individual with respect to the cancer 
                involved;
                    ``(v) is furnished, in person, in written form, to 
                the individual within a period specified by the 
                Secretary that is as soon as practicable after the 
                completion of such primary treatment;
                    ``(vi) 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
                    ``(vii) 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, 
        diagnosis of a second cancer, change in the individual's 
        preference for survivorship care, or significant revision of 
        the plan for follow-up care, if such revision--
                    ``(i) is in accordance with clauses (i), (ii), 
                (iii), (v), and (vi) 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 suppliers and 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 treatment plans and follow-up 
survivorship care plans based on changes in the condition of the 
individual or elements and intent of treatment and standards for the 
communication of the plan to the individual.
    ``(3) In this subsection, the term `shared decision-making process' 
means, with respect to an individual, a process in which the individual 
and the individual's health care providers consider the individual's 
diagnosis, treatment options, the medical evidence related to treatment 
options, the risks and benefits of all treatment options, and the 
individual's preferences regarding treatment, and then jointly develop 
and implement a treatment plan.''.
    (b) Payment Under Physician Fee Schedule.--
            (1) In general.--Section 1848(j)(3) of the Social Security 
        Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting ``(GG),'' 
        after ``health risk assessment),''.
            (2) Initial rates.--Unless the Secretary of Health and 
        Human Services otherwise provides, the payment rate specified 
        under the physician fee schedule under the amendment made by 
        paragraph (1) for cancer care planning and coordination 
        services shall be the same payment rate as provided for 
        transitional care management services (as defined in CPT code 
        99496).
    (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.
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