[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5183 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 5183

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

                            August 11, 2023

Mr. DeSaulnier (for himself, Mr. Raskin, Ms. Blunt Rochester, Ms. Wild, 
Mr. Khanna, Ms. Clarke of New York, Mrs. Watson Coleman, Mr. Bishop of 
    Georgia, Ms. Norton, and Ms. Wasserman Schultz) 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 ``Cancer Care 
Planning and Communications Act''.
    (b) Findings.--Congress makes the following findings:
            (1) Cancer care in the United States is often described as 
        the best in the world because patients have access to many 
        treatment options, including cutting-edge therapies that save 
        lives and improve the quality of life.
            (2) Access to the best treatment options is not equal 
        across all populations and in all communities. 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.
            (3) In addition, despite access to high-quality treatment 
        options for many, 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.
            (4) Cancer survivors often experience the under-diagnosis 
        and under-treatment of the symptoms of cancer and side effects 
        of cancer treatment, 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.
            (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) The Commission on Cancer has encouraged survivorship 
        care planning by making the development of such plans for 
        patients one of the standards of accreditation for cancer care 
        providers, but cancer care professionals report difficulties 
        completing the plans.
            (12) Because more than half of all cancer diagnoses occur 
        among elderly Medicare beneficiaries, addressing cancer care 
        inadequacies through Medicare reforms will provide benefits to 
        millions of Americans. Providing Medicare beneficiaries more 
        routine access to cancer care plans and survivorship care plans 
        is a key to shared decision making and better coordination of 
        care.
            (13) Important payment and delivery reforms that 
        incorporate cancer care planning and coordination are already 
        being tested in the Medicare program; the Oncology Care Model 
        has been implemented in a number of oncology practices, and 
        additional models that will include care planning have been 
        proposed.
            (14) The alternative payment models, including the Oncology 
        Care Model, provide access to cancer care planning for Medicare 
        beneficiaries who receive their cancer care in practices that 
        are part of the Oncology Care Model. Other Medicare 
        beneficiaries who are not enrolled in these delivery 
        demonstrations may not have access to a cancer care plan or 
        appropriate care coordination.
            (15) The failure to provide a cancer care plan to patients 
        in many care settings relates in part to inadequate Medicare 
        payment for such planning and coordination services.
            (16) 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. Medicare payment for cancer care 
        planning may begin a reform process that helps us realize the 
        well-planned and well-coordinated cancer care that has been 
        recommended by the Institute of Medicine/National Academy of 
        Medicine and that is preferred by cancer patients across the 
        Nation.

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 inserting ``and'' at the end of subparagraph 
                (JJ); and
                    (B) by adding at the end the following new 
                subparagraph:
            ``(KK) cancer care planning and coordination services (as 
        defined in subsection (nnn));''; and
            (2) by adding at the end the following new subsection:

            ``Cancer Care Planning and Coordination Services

    ``(nnn)(1) The term `cancer care planning and coordination 
services' means, with respect to an individual who is diagnosed with 
cancer, the development of a treatment plan by a physician, physician 
assistant, or nurse practitioner that--
            ``(A) includes each component of the Institute of Medicine 
        Care Management Plan (as described in the article entitled 
        `Delivering High-Quality Cancer Care: Charting a New Course for 
        a System in Crisis' published by the Institute of Medicine);
            ``(B) is furnished in written form or electronically, at 
        the visit of such individual with such physician, physician 
        assistant, or nurse practitioner, or as soon after the date of 
        the visit as practicable; and
            ``(C) is furnished, to the greatest extent practicable, in 
        an appropriate form that appropriately takes into account 
        cultural and linguistic needs of the individual in order to 
        make the plan accessible to the individual.
    ``(2) The Secretary shall establish frequencies at which services 
described in paragraph (1) may be furnished, provided that such 
services may be furnished with respect to an individual--
            ``(A) at the time such individual is diagnosed with cancer 
        for purposes of planning treatment;
            ``(B) if there is a change in the condition of such 
        individual or such individual's treatment preferences;
            ``(C) at the end of active treatment and beginning of 
        survivorship care; and
            ``(D) if there is a recurrence of such cancer.''.
    (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 
        ``(2)(KK),'' after ``health risk assessment),''.
            (2) Initial rates.--Unless the Secretary 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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