[Congressional Record Volume 155, Number 147 (Tuesday, October 13, 2009)]
[Senate]
[Pages S10363-S10366]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. LANDRIEU:
  S. 1773. A bill to amend title XVIII of the Social Security Act to 
provide for coverage of comprehensive cancer care planning under the 
Medicare Program and to improve the care furnished to individuals 
diagnosed with cancer by establishing a Medicare hospice care 
demonstration program and grant programs for cancer palliative care and 
symptom management programs, provider education, and related research; 
to the Committee on Finance.
  Ms. LANDRIEU. Mr. President, it is my pleasure today to introduce the 
Comprehensive Cancer Care Improvement Act, a bill to improve cancer 
care quality by encouraging the development of written plans for cancer 
care. The U.S. has a system of cancer care that is the envy of all 
nations for its technical superiority and the sophistication of 
treatment offered to many patients. Unfortunately, not all Americans 
receive the best care the Nation has to offer.
  The Comprehensive Cancer Care Improvement Act would take a step 
towards ensuring that all Americans have access to cancer care of the 
highest quality. The bill would authorize a Medicare service for cancer 
care planning and encourage the adoption of care planning as a routine 
practice in all cancer care settings. The Institute of Medicine, IOM, 
has identified as critical to high-quality cancer care the development 
of plans of care at the beginning of cancer treatment and at the 
transition to survivorship. Moreover, the debate on health care reform 
has highlighted care coordination to improve efficiency and reduce 
unnecessary utilization of health care resources. Care planning 
facilitates the coordination of cancer care.
  The need for this legislation was first brought to my attention in 
dramatic

[[Page S10364]]

fashion in the aftermath of Hurricane Katrina, when cancer patients and 
their physicians scurried to recreate their records in order to 
minimize interruptions in care and to prevent any duplication of care. 
Some of the problems that cancer patients encountered could have been 
eliminated if they had possessed written care plans. In a moving 
statement at a Hill briefing in 2007, one of my constituents described 
her efforts to create her own care plan by grabbing various documents 
that had been supplied by her oncologist as she was being evacuated 
from her home. Although not as useful as a clear care plan, these 
documents helped that patient and her new physician chart her course of 
care. The experience taught us that key recommendations from the IOM 
related to cancer care--and especially the recommendation for cancer 
care planning should be taken off the shelf and put into action.
  There are many advantages of written cancer care plans for patients, 
physicians, and the entire health care system. Patients report that 
they are empowered by receiving care plans that spell out choices, 
facilitate the coordination of treatment and symptom management, and 
identify the follow-up services they will need post-treatment. 
Physicians say that communication with their patients is improved by 
developing and sharing care plans that are clear and concise, and some 
practices that have adopted care planning say that they are observing 
the identification and elimination of duplicative tests and procedures 
and an overall greater efficiency in care, all achieved while enhancing 
quality of care and patient satisfaction.
  The Comprehensive Cancer Care Improvement Act, introduced in the 
House of Representatives by Representatives Lois Capps and Charles 
Boustany, establishes a new Medicare service for cancer care planning 
and authorizes programs that are aimed at increasing the utilization of 
care planning in all cancer care settings and ensuring access to care 
plans by underserved populations. I urge my colleagues to join me in 
cosponsoring this legislation to enhance cancer patients' access to 
quality care.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1773

       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 
     ``Comprehensive Cancer Care Improvement 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 CARE UNDER THE MEDICARE PROGRAM

Sec. 101. Coverage of cancer care planning services.
Sec. 102. Demonstration project to provide comprehensive cancer care 
              symptom management services under Medicare.

TITLE II--COMPREHENSIVE PALLIATIVE CARE AND SYMPTOM MANAGEMENT PROGRAMS

Sec. 201. Grants for comprehensive palliative care and symptom 
              management programs.

  TITLE III--PROVIDER EDUCATION REGARDING PALLIATIVE CARE AND SYMPTOM 
                               MANAGEMENT

Sec. 301. Grants to improve health professional education.
Sec. 302. Grants to improve Continuing Professional Education.

      TITLE IV--RESEARCH ON END-OF-LIFE TOPICS FOR CANCER PATIENTS

Sec. 401. Research program.

     SEC. 2. FINDINGS.

       The Congress makes the following findings:
       (1) Individuals with cancer often do not have access to a 
     cancer care system that provides comprehensive and 
     coordinated care of high quality.
       (2) The cancer care system has not traditionally offered 
     individuals with cancer a prospective and comprehensive plan 
     for treatment and symptom management, 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 often becomes more severe 
     at the end of life. The failure to treat the symptoms, side 
     effects, and late effects of cancer and its treatment may 
     have a serious adverse impact on the health, well-being, and 
     quality of life of cancer survivors.
       (4) Cancer survivors who are members of racial and ethnic 
     minority groups may face special obstacles in receiving 
     cancer care that is coordinated and includes appropriate 
     management of cancer symptoms and treatment side effects.
       (5) Individuals with cancer are sometimes put in the 
     untenable position of choosing between potentially curative 
     therapies and palliative care instead of being assured access 
     to comprehensive care that includes appropriate treatment and 
     symptom management.
       (6) Comprehensive cancer care should incorporate access to 
     psychosocial services and management of the symptoms of 
     cancer (and the symptoms of its treatment), including pain, 
     nausea and vomiting, fatigue, and depression.
       (7) Comprehensive cancer care should include a means for 
     providing cancer survivors with 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.
       (8) The Institute of Medicine report, ``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) Since more than half of all cancer diagnoses occur 
     among elderly Medicare beneficiaries, the problems of 
     providing cancer care are problems of the Medicare program.
       (11) Shortcomings in providing cancer care, resulting in 
     inadequate management of cancer symptoms and insufficient 
     monitoring and treatment of late effects of cancer and its 
     treatment, are related to problems of Medicare payments for 
     such care, inadequate professional training, and insufficient 
     investment in research on symptom management.
       (12) Changes in Medicare payment for comprehensive cancer 
     care, enhanced public and professional education regarding 
     symptom management, and more research related to symptom 
     management and palliative care will enhance patient decision-
     making about treatment options and will contribute to 
     improved care for individuals with cancer from the time of 
     diagnosis of the individual through the end of the life of 
     the individual.

     TITLE I--COMPREHENSIVE CANCER CARE UNDER THE MEDICARE PROGRAM

     SEC. 101. COVERAGE OF CANCER CARE PLANNING 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 (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 care planning services (as 
     defined in subsection (hhh));''; and
       (2) by adding at the end the following new subsection:

             ``Comprehensive Cancer Care Planning Services

       ``(hhh)(1) The term `comprehensive cancer care planning 
     services' means--
       ``(A) with respect to an individual who is diagnosed with 
     cancer, the development of a plan of care that--
       ``(i) 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 and comprehensive symptom management (such 
     as palliative care) involved;
       ``(ii) is furnished in written form to the individual in 
     person within a period specified by the Secretary that is as 
     soon as practicable after the date on which the individual is 
     so diagnosed;
       ``(iii) 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
       ``(iv) is in accordance with standards determined by the 
     Secretary to be appropriate;
       ``(B) with respect to an individual for whom a plan of care 
     has been developed under subparagraph (A), the revision of 
     such plan of care as necessary to account for any substantial 
     change in the condition of the individual, if such revision--
       ``(i) is in accordance with clauses (i) and (iii) 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;

[[Page S10365]]

       ``(C) with respect to an individual who has completed the 
     primary treatment for cancer, as defined by the Secretary 
     (such as completion of chemotherapy or radiation treatment), 
     the development of a follow-up cancer care plan that--
       ``(i) describes the elements of the primary treatment, 
     including symptom management, furnished to such individual;
       ``(ii) provides recommendations for the subsequent care of 
     the individual with respect to the cancer involved;
       ``(iii) is furnished in written form to the individual in 
     person within a period specified by the Secretary that is as 
     soon as practicable after the completion of such primary 
     treatment;
       ``(iv) 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
       ``(v) 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, if 
     such revision--
       ``(i) is in accordance with clauses (i), (ii), and (iv) 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 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 plans of care and 
     follow-up plans based on changes in the condition of the 
     individual and standards for the communication of the plan to 
     the patient.''.
       (b) Payment.--Section 1833(a)(1) of the Social Security Act 
     (42 U.S.C. 1395l(a)(1)) is amended by striking ``and'' before 
     ``(W)'' and inserting before the semicolon at the end the 
     following: ``, and (X) with respect to comprehensive cancer 
     care planning services described in any of subparagraphs (A) 
     through (D) of section 1861(hhh)(1), the amount paid shall be 
     an amount equal to the sum of (i) the national average amount 
     under the physician fee schedule established under section 
     1848 for a new patient office consultation of the highest 
     level of service in the non-facility setting, and (ii) the 
     national average amount under such fee schedule for a 
     physician certification described in section 1814(a)(2) for 
     home health services furnished to an individual by a home 
     health agency under a home health plan of care''.
       (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.

     SEC. 102. DEMONSTRATION PROJECT TO PROVIDE COMPREHENSIVE 
                   CANCER CARE SYMPTOM MANAGEMENT SERVICES UNDER 
                   MEDICARE.

       (a) In General.--Beginning not later than 180 days after 
     the date of the enactment of this Act, the Secretary of 
     Health and Human Services (in this section referred to as the 
     ``Secretary'') shall conduct a two-year demonstration project 
     (in this section referred to as the ``demonstration 
     project'') under title XVIII of the Social Security Act under 
     which payment shall be made under such title for 
     comprehensive cancer care symptom management services, 
     including items and services described in subparagraphs (A) 
     through (I) of section 1861(dd)(1) of the Social Security 
     Act, furnished by an eligible entity, in accordance with a 
     plan developed under subparagraph (A) or (C) of section 
     1861(hhh)(1) of such Act, as added by section 101(a). 
     Sections 1812(d) and 1814(a)(7) of such Act (42 U.S.C. 
     1395d(d), 1395f(a)(7)) are not applicable to items and 
     services furnished under the demonstration project. 
     Participation of Medicare beneficiaries in the demonstration 
     project shall be voluntary.
       (b) Qualifications and Selection of Eligible Entities.--
       (1) Qualifications.--For purposes of subsection (a), the 
     term ``eligible entity'' means an entity (such as a cancer 
     center, hospital, academic health center, hospice program, 
     physician practice, school of nursing, visiting nurse 
     association, or other home health agency) that the Secretary 
     determines is capable, directly or through an arrangement 
     with a hospice program (as defined in section 1861(dd)(2) of 
     the Social Security Act (42 U.S.C. 1395x(dd)(2))), of 
     providing the items and services described in such 
     subsection.
       (2) Selection.--The Secretary shall select not more than 10 
     eligible entities to participate in the demonstration 
     project. Such entities shall be selected in a manner so that 
     the demonstration project is conducted in different regions 
     across the United States and in urban and rural locations.
       (c) Evaluation and Report.--
       (1) Evaluation.--The Secretary shall conduct a 
     comprehensive evaluation of the demonstration project to 
     determine--
       (A) the effectiveness of the project in improving patient 
     outcomes;
       (B) the cost of providing comprehensive symptom management, 
     including palliative care, from the time of diagnosis;
       (C) the effect of comprehensive cancer care planning and 
     the provision of comprehensive symptom management on patient 
     outcomes, cancer care expenditures, and the utilization of 
     hospitalization and emergent care services; and
       (D) potential savings to the Medicare program demonstrated 
     by the project.
       (2) Report.--Not later than the date that is one year after 
     the date on which the demonstration project concludes, the 
     Secretary shall submit to Congress a report on the evaluation 
     conducted under paragraph (1).

TITLE II--COMPREHENSIVE PALLIATIVE CARE AND SYMPTOM MANAGEMENT PROGRAMS

     SEC. 201. GRANTS FOR COMPREHENSIVE PALLIATIVE CARE AND 
                   SYMPTOM MANAGEMENT PROGRAMS.

       (a) In General.--The Secretary of Health and Human Services 
     shall make grants to eligible entities for the purpose of--
       (1) establishing a new palliative care and symptom 
     management program for cancer patients; or
       (2) expanding an existing palliative care and symptom 
     management program for cancer patients.
       (b) Authorized Activities.--Activities funded through a 
     grant under this section may include--
       (1) securing consultative services and advice from 
     institutions with extensive experience in developing and 
     managing comprehensive palliative care and symptom management 
     programs;
       (2) expanding an existing program to serve more patients or 
     enhance the range or quality of services, including cancer 
     treatment patient education services, that are provided;
       (3) developing a program that would ensure the inclusion of 
     cancer treatment patient education in the coordinated cancer 
     care model; and
       (4) establishing an outreach program to partner with an 
     existing comprehensive care program and obtain expert 
     consultative services and advice.
       (c) Distribution of Funds.--In making grants and 
     distributing the funds under this section, the Secretary 
     shall ensure that--
       (1) two-thirds of the funds appropriated to carry out this 
     section for each fiscal year are used for establishing new 
     palliative care and symptom management programs, of which not 
     less than half of such two-thirds shall be for programs in 
     medically underserved communities to address issues of racial 
     and ethnic disparities in access to cancer care; and
       (2) one-third of the funds appropriated to carry out this 
     section for each fiscal year are used for expanding existing 
     palliative care and symptom management programs.
       (d) Definitions.--In this section:
       (1) The term ``eligible entity'' includes--
       (A) an academic medical center, a cancer center, a 
     hospital, a school of nursing, or a health system capable of 
     administering a palliative care and symptom management 
     program for cancer patients;
       (B) a physician practice with care teams, including nurses 
     and other professionals trained in palliative care and 
     symptom management;
       (C) a visiting nurse association or other home care agency 
     with experience administering a palliative care and symptom 
     management program;
       (D) a hospice; and
       (E) any other health care agency or entity, as the 
     Secretary determines appropriate.
       (2) The term ``medically underserved community'' has the 
     meeting given to that term in section 799B(6) of the Public 
     Health Service Act (42 U.S.C. 295p(6)).
       (3) The term ``Secretary'' means the Secretary of Health 
     and Human Services.
       (e) Authorization of Appropriations.--To carry out this 
     section, there are authorized to be appropriated such sums as 
     may be necessary for each of the fiscal years 2010 through 
     2014.

  TITLE III--PROVIDER EDUCATION REGARDING PALLIATIVE CARE AND SYMPTOM 
                               MANAGEMENT

     SEC. 301. GRANTS TO IMPROVE HEALTH PROFESSIONAL EDUCATION.

       (a) In General.--The Secretary of Health and Human Services 
     shall make grants to eligible entities to enable the entities 
     to improve the quality of graduate and postgraduate training 
     of physicians, nurses, and other health care providers in 
     palliative care and symptom management for cancer patients.
       (b) Application.--To seek a grant under this section, an 
     eligible entity shall submit an application at such time, in 
     such manner, and containing such information as the Secretary 
     may require. At a minimum, the Secretary shall require that 
     each such application demonstrate--
       (1) the ability to incorporate palliative care and symptom 
     management into training programs; and
       (2) the ability to collect and analyze data related to the 
     effectiveness of educational efforts.
       (c) Evaluation.--The Secretary shall develop and implement 
     a plan for evaluating the effects of professional training 
     programs funded through this section.
       (d) Definitions.--In this section:
       (1) The term ``eligible entity'' means a cancer center 
     (including an NCI-designated cancer center), an academic 
     health center, a physician practice, a school of nursing, or 
     a visiting nurse association or other home care agency.
       (2) The term ``NCI-designated cancer center'' means a 
     cancer center receiving funds

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     through a P30 Cancer Center Support Grant of the National 
     Cancer Institute.
       (3) The term ``Secretary'' means the Secretary of Health 
     and Human Services.
       (e) Authorization of Appropriations.--To carry out this 
     section, there are authorized to be appropriated such sums as 
     may be necessary for each of the fiscal years 2010 through 
     2014.

     SEC. 302. GRANTS TO IMPROVE CONTINUING PROFESSIONAL 
                   EDUCATION.

       (a) In General.--The Secretary of Health and Human Services 
     shall make grants to eligible entities to improve the quality 
     of continuing professional education provided to qualified 
     individuals regarding palliative care and symptom management.
       (b) Application.--To seek a grant under this section, an 
     eligible entity shall submit an application at such time, in 
     such manner, and containing such information as the Secretary 
     may require. At a minimum, the Secretary shall require that 
     each such application demonstrate--
       (1) experience in sponsoring continuing professional 
     education programs;
       (2) the ability to reach health care providers and other 
     professionals who are engaged in cancer care;
       (3) the capacity to develop innovative training programs; 
     and
       (4) the ability to evaluate the effectiveness of 
     educational efforts.
       (c) Evaluation.--The Secretary shall develop and implement 
     a plan for evaluating the effects of continuing professional 
     education programs funded through this section.
       (d) Definitions.--In this section:
       (1) The term ``eligible entity'' means a cancer center 
     (including an NCI-designated cancer center), an academic 
     health center, a school of nursing, or a professional society 
     that supports continuing professional education programs.
       (2) The term ``NCI-designated cancer center'' means a 
     cancer center receiving funds through a P30 Cancer Center 
     Support Grant of the National Cancer Institute.
       (3) The term ``qualified individual'' means a physician, 
     nurse, social worker, chaplain, psychologist, or other 
     individual who is involved in providing palliative care and 
     symptom management services to cancer patients.
       (4) The term ``Secretary'' means the Secretary of Health 
     and Human Services.
       (e) Authorization of Appropriations.--To carry out this 
     section, there are authorized to be appropriated such sums as 
     may be necessary for each of the fiscal years 2010 through 
     2014.

      TITLE IV--RESEARCH ON END-OF-LIFE TOPICS FOR CANCER PATIENTS

     SEC. 401. RESEARCH PROGRAM.

       (a) In General.--The Director of the National Institutes of 
     Health shall establish a program of grants for research on 
     palliative care, symptom management, communication skills, 
     and other end-of-life topics for cancer patients.
       (b) Inclusion of National Research Institutes.--In carrying 
     out the program established under this section, the Director 
     should 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 in subsection (a).
       (c) Definitions.--In this section:
       (1) The term ``Director'' means the Director of the 
     National Institutes of Health.
       (2) The term ``national research institute'' has the 
     meaning given to that term in section 401(g) of the Public 
     Health Service Act (42 U.S.C. 281(g)).
       (d) Authorization of Appropriations.--To carry out this 
     section, there are authorized to be appropriated such sums as 
     may be necessary for each of the fiscal years 2010 through 
     2014.
                                 ______