,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #affa  ,,in ,,the ,,house ,,of  
,,representatives  ,april #ai1 #bjac    
,mr4 ,israel 7for himself and ,mr4      
,tiberi7 introduced the following bill2 
which was referred to the ,committee on 
,energy and ,commerce1 and in addition  
to the ,committee on ,ways and ,means1  
for a period to be subsequently         
determined by the ,speaker1 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 comprehensive 
cancer patient treatment education under
 the ,medicare program and to provide   
for research to improve cancer symptom  
management4  #a4 ,short title2 table of 
contents  7a7 ,short title ,this ,act   
may be cited as the ,improving ,cancer  
,treatment ,education ,act of #bjac4    
7b7 ,table of contents ,the table of    
contents of this ,act is as follows3    
,sec4 #a4 ,short title2 table of        

contents4 ,sec4 #b4 ,findings4 ,title   
,i--,comprehensive ,cancer ,patient     
,treatment ,education ,under the        
,medicare ,program ,sec4 #aja4 ,medicare
 coverage of comprehensive cancer       
patient treatment education services4   
,title ,,ii--,research on ,cancer       
,symptom ,management ,improvement ,sec4 
#bja4 ,sense of ,congress4 ,sec4 #bjb4  
,,nih ,research on cancer symptom       
management improvement4  #b4 ,findings  
,the ,congress makes the following      
findings3  7#a7 ,many people with cancer
 experience side effects1 symptoms1 and 
late complications associated with their
 disease and their treatment1 which can 
have a serious adverse impact on their  
health1 well-being1 and quality of life4
  7#b7 ,many side effects and symptoms  
associated with cancer and its treatment
 can be reduced or controlled by the    
provision of timely symptom management  
and services and also by educating      
people with cancer and their caregivers 
about the potential effects before      

treatment begins4  7#c7 ,studies have   
found that individualized educational   
intervention for cancer pain management 
from a registered nurse was effective   
for patients with cancer being treated  
in outpatient and home-based settings4  
,similarly1 the number of caregivers who
 said they were well informed and       
confident about caregiving after        
attending a family caregiver cancer     
education program increased after       
program attendance4  7#d7 ,people with  
cancer benefit from having an           
educational session with oncology nurses
 in advance of the initiation of        
treatment to learn how to reduce the    
risk of and manage adverse effects and  
maximize well-being4 ,helping patients  
to manage their side effects reduces    
adverse events and the need for urgent  
or inpatient care4  7#e7 ,the ,oncology 
,nursing ,society has received reports  
from its members that1 because the      
,medicare program and other payers do   
not cover the provision of patient      

treatment education1 patients and their 
caregivers often do not receive adequate
 education before the onset of such     
patients' treatment for cancer regarding
 the course of such treatment and the   
possible side effects and symptoms such 
patients may experience4 ,the ,oncology 
,nursing ,society recommends that all   
patients being treated for cancer have a
 one-on-one educational session with a  
nurse in advance of the onset of such   
treatment so that such patients and     
their caregivers receive the information
 they need to help minimize adverse     
events related to such treatment and    
maximize the well-being of such         
patients4  7#f7 ,insufficient or        
non-existent ,medicare payments coupled 
with poor investment in symptom         
management research contribute to the   
inadequate education of patients1 poor  
management and monitoring of cancer     
symptoms1 and inadequate handling of    
late effects of cancer and its          
treatment4  7#g7 ,people with cancer    

often do not have the symptoms          
associated with their disease and the   
associated treatment managed in a       
comprehensive or appropriate manner4    
7#h7 ,people with cancer deserve to have
 access to comprehensive care that      
includes appropriate treatment and      
symptom management4  7#i7 ,patients who 
receive infused chemotherapy likely     
obtain some treatment education during  
the course of the administration of     
their treatment2 yet1 many do not1 and  
individuals who may receive a different 
type of cancer care1 such as radiation  
or surgical interventions or oral       
chemotherapy taken at home1 likely do   
not receive treatment education during  
their treatment4  7#aj7 ,comprehensive  
cancer care must include access to      
services and management associated with 
nausea1 vomiting1 fatigue1 depression1  
pain1 and other symptoms4  7#aa7 ,the   
,institute of ,medicine report1         
,ensuring ,quality ,cancer ,care asserts
 that much can be done to relieve the   

symptoms1 ease distress1 provide        
comfort1 and in other ways improve the  
quality of life of someone with cancer4 
,for a person with cancer1 maintenance  
of quality of life requires1 at a       
minimum1 relief from pain and other     
distressing symptoms1 relief from       
anxiety and depressions1 including the  
fear of pain1 and a sense of security   
that assistance will be readily         
available if needed44  7#ab7 ,the       
,institute of ,medicine report1 ,cancer 
,care for the ,whole ,patient3 ,meeting 
,psychosocial ,health ,needs recognizes 
that cancer patients' psychosocial needs
 include information about their        
therapies and the potential side        
effects4  7#ac7 ,as more than half of   
all cancer diagnoses occur among        
individuals age #fe and older1 the      
challenges of managing cancer symptoms  
are growing for patients enrolled in the
 ,medicare program4  7#ad7 ,provision of
 ,medicare payment for comprehensive    
cancer patient treatment education1     

coupled with expanded cancer symptom    
management research1 will help improve  
care and quality of life for people with
 cancer from the time of diagnosis      
through survivorship or end of life4  ,i
 ,comprehensive ,cancer ,patient        
,treatment ,education ,under the        
,medicare ,program  #aja4 ,medicare     
coverage of comprehensive cancer patient
 treatment education services  7a7 ,in  
general ,section #ahfa of the ,social   
,security ,act 7#db ,u4,s4,c4 #aciex7 is
 amended--  7#a7 in subsection 7s77#b7--
  7,a7 by striking and at the end of    
subparagraph 7,,ee72  7,b7 by adding and
 at the end of subparagraph 7,,ff72 and 
7,c7 by adding at the end the following 
new subparagraph3  7,,gg7 comprehensive 
cancer patient treatment education      
services 7as defined in subsection      
7iii77#a772  2 and  7#b7 by adding at   
the end the following new subsection3   
7iii7 ,comprehensive cancer patient     
treatment education services  7#a7 ,the 
term comprehensive cancer patient       

treatment education services means--    
7,a7 in the case of an individual who is
 diagnosed with cancer1 the provision of
 a one-hour patient treatment education 
session delivered by a registered nurse 
that--  7i7 is furnished to the         
individual and the caregiver 7or        
caregivers7 of the individual in advance
 of the onset of treatment and to the   
extent practicable1 is not furnished on 
the day of diagnosis or on the first day
 of treatment2  7ii7 educates the       
individual and such caregiver 7or       
caregivers7 to the greatest extent      
practicable1 about all aspects of the   
care to be furnished to the individual1 
informs the individual regarding any    
potential symptoms1 side-effects1 or    
adverse events1 and explains ways in    
which side effects and adverse events   
can be minimized and health and         
well-being maximized1 and provides      
guidance regarding those side effects to
 be reported and to which health care   
provider the side effects should be     

reported2  7iii7 includes the provision1
 in written form1 of information about  
the course of treatment1 any            
responsibilities of the individual with 
respect to self-dosing1 and ways in     
which to address symptoms and           
side-effects2 and  7iv7 is furnished1 to
 the greatest extent practicable1 in an 
oral1 written1 or electronic form that  
appropriately takes into account        
cultural and linguistic needs of the    
individual in order to make the         
information comprehensible to the       
individual and such caregiver 7or       
caregivers72 and  7,b7 with respect to  
an individual for whom a course of      
cancer treatment or therapy is          
materially modified1 a one-hour patient 
treatment education session described in
 subparagraph 7,a71 including updated   
information on the matters described in 
such subparagraph should the            
individual's oncologic health care      
professional deem it appropriate and    
necessary4  7#b7 ,in establishing       

standards to carry out paragraph 7#a71  
the ,secretary shall consult with       
appropriate organizations representing  
providers of oncology patient treatment 
education services and organizations    
representing people with cancer4  4  7b7
 ,payment ,section #ahcc7;a77#a7 of such
 ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is  
amended--  7#a7 by striking and before  
7,z72 and  7#b7 by inserting before the 
semicolon at the end the following3 1   
and 7,,aa7 with respect to comprehensive
 cancer patient treatment education     
services 7as defined in section         
#ahfa7;iii77#a771 #aej percent of the   
payment rate established under section  
#ahdh for diabetes outpatient           
self-management training services 7as   
defined in section #ahfa7qq771          
determined and applied without regard to
 any coinsurance4  7c7 ,coverage        
,section #ahfb7;a77#a7 of such ,act 7#db
 ,u4,s4,c4 #aciey7a77#a77 is amended--  
7#a7 in subparagraph 7,o71 by striking  
and at the end2  7#b7 in subparagraph   

7,p71 by striking the semicolon at the  
end and inserting 1 and2 and  7#c7 by   
adding at the end the following new     
subparagraph3  7,q7 in the case of      
comprehensive cancer patient treatment  
education services 7as defined in       
subsection 7iii77#a77 which are         
performed more frequently than is       
covered under such section2  4  7d7 ,no 
impact on payment for other services    
,nothing in this section shall be       
construed to affect or otherwise        
authorize any reduction or modification1
 in the ,medicare payment amounts       
otherwise established for chemotherapy  
infusion or injection codes with respect
 to the calculation and payment of      
minutes for chemotherapy teaching or    
related services4  7e7 ,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 ,act4  ,,ii   
,research on ,cancer ,symptom           

,management ,improvement  #bja4 ,sense  
of ,congress ,it is the sense of        
,congress that--  7#a7 many people with 
cancer experience side effects1         
symptoms1 and late side effects         
associated with their disease and their 
treatment1 and such effects can have a  
serious adverse impact on the           
effectiveness of their treatment1 their 
health1 well-being1 and quality of life2
  7#b7 with the number of cancer        
survivors continuing to grow1 addressing
 the effects of their symptoms and side 
effects is becoming increasingly        
critical in reducing the burden of      
cancer and its treatments2  7#c7        
although research is producing new      
insights into the causes of and cures   
for cancer1 efforts to manage the       
symptoms and side effects of the disease
 and its treatments have not kept pace2 
and  7#d7 the ,national ,institutes of  
,health should continue to support      
research in the area of symptom         
management and the role that nurses play

 in providing those interventions4      
#bjb4 ,,nih ,research on cancer symptom 
management improvement  7a7 ,in general 
,the ,director of the ,national         
,institutes of ,health shall expand1    
intensify1 and coordinate programs for  
the conduct and support of research with
 respect to--  7#a7 improving the       
treatment and management of symptoms and
 side effects associated with cancer and
 cancer treatment2 and  7#b7 evaluating 
the role of nursing interventions in the
 amelioration of such symptoms and side 
effects4  7b7 ,administration ,the      
,director of the ,national ,institutes  
of ,health is encouraged to carry out   
this section through the ,director of   
the ,national ,cancer ,institute1 in    
collaboration with at least the         
directors of the ,national ,institute of
 ,nursing ,research1 the ,national      
,institute of ,neurological ,disorders  
and ,stroke1 the ,national ,institute of
 ,mental ,health1 the ,national ,center 
on ,minority ,health and ,health        

,disparities1 the ,national ,center for 
,complementary and ,alternative         
,medicine1 and the ,agency for          
,healthcare ,research and ,quality4