Recognizing the importance of protecting continuous Medicaid coverage for individuals undergoing active cancer treatment.

Recognizing the importance of protecting continuous Medicaid coverage for individuals undergoing active cancer treatment.

Whereas cancer treatment may require surgery, chemotherapy, radiation, immunotherapy, medications, imaging, laboratory testing, rehabilitation, and ongoing follow up care;

Whereas cancer and cancer treatment can temporarily or permanently limit an individual’s ability to work or meet Medicaid community engagement requirements required by section 1902(xx) of the Social Security Act (42 U.S.C. 1396a(xx));

Whereas interruptions in health coverage during cancer treatment can delay care, interrupt medications and treatment, increase financial hardship, and place patients at unnecessary risk;

Whereas, according to a study from the American Society of Clinical Oncology, 75.5 percent of cancer patients reported delayed or foregone care due to administrative burdens, such as insurance interactions, provider organization interactions, and care coordination between multiple parties;

Whereas CMS–2454–IFC clarifies the exemption from community engagement requirements for certain individuals who are medically frail or have special medical needs when their condition significantly impairs their ability to meet those requirements;

Whereas States may use reliable information already available to Medicaid programs, including claims, encounter data, and other health information to determine whether an individual qualifies for such an exemption;

Whereas individuals undergoing cancer treatment should not be required to repeatedly prove medical circumstances that a State Medicaid program may already be able to verify; and

Whereas unnecessary paperwork and reporting requirements can create barriers to care for individuals already managing a serious illness: Now, therefore, be it

Resolved, That the House of Representatives—

(1) recognizes that continuity of health coverage is especially important for individuals undergoing active cancer treatment;

(2) encourages States—

(A) to establish procedures to proactively identify Medicaid beneficiaries undergoing active cancer treatment through available claims, encounter data, and other reliable health information;

(B) when those records demonstrate cancer, cancer treatment, or treatment-related effects, to determine that individual eligible for the applicable medical exemption without requiring additional reporting from the patient;

(C) to use existing Medicaid records whenever possible for subsequent verification so that patients are not repeatedly required to document the same medical circumstances;

(D) when existing records are insufficient, to permit a simple certification from the individual’s treating oncologist, physician, or other qualified health care professional;

(E) to provide clear notice, reasonable assistance, and an opportunity to establish an exemption before Medicaid coverage is suspended or terminated; and

(F) to adopt similar processes for other chronic illnesses and diseases;

(3) encourages the Centers for Medicare & Medicaid Services—

(A) to provide States with guidance and technical assistance to make these procedures as simple and automatic as possible for eligible cancer patients; and

(B) to issue similar guidance to States as it relates to other chronic diseases; and

(4) affirms that no individual undergoing active cancer treatment should have lifesaving care interrupted solely because illness, treatment, or treatment-related effects prevented that person from satisfying an administrative or community engagement requirement.