,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #chce  ,,in ,,the ,,house ,,of  
,,representatives  ,july #ah1 #bjai,mr4 
,de,saulnier 7for himself and ,mr4      
,carter of ,georgia7 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   
for coverage of cancer care planning and
 coordination under the ,medicare       
program4  #a4 ,short title  7a7 ,short  
title ,this ,act may be cited as the    
,cancer ,care ,planning and             
,communications ,act of #bjai4  7b7     
,findings ,congress makes the following 
findings3  7#a7 ,cancer care in the     
,united ,states is often described as   
the best in the world because patients  

have access to many treatment options1  
including cutting-edge therapies that   
save lives and improve the quality of   
life4  7#b7 ,access to the best         
treatment options is not equal across   
all populations and in all communities4 
,the #aiii ,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 
advances4  7#c7 ,in addition1 despite   
access to high-quality treatment options
 for many1 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 care4  7#d7 ,cancer         
survivors often experience the          
under-diagnosis and under-treatment of  
the symptoms of cancer and side effects 
of cancer treatment1 a problem that     
begins at the time of diagnosis and may 
become more severe with disease         

progression and at the end of life4 ,the
 failure to treat the symptoms1 side    
effects1 and late effects of cancer and 
cancer treatment may have a serious     
adverse impact on the health1 survival1 
well-being1 and quality of life of      
cancer survivors4  7#e7 ,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 care4  7#f7 ,quality cancer  
care should incorporate access to       
psychosocial services and management of 
the symptoms of cancer and the symptoms 
of cancer treatment1 including pain1    
nausea1 vomiting1 fatigue1 and          
depression4  7#g7 ,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       
treatment1 including appropriate        
psychosocial services4  7#h7 ,the       
,institute of ,medicine report entitled 
,ensuring ,quality ,cancer ,care        
described the elements of quality care  
for an individual with cancer to        
include-- 7,a7 the development of       
initial treatment recommendations by an 
experienced health care provider2  7,b7 
the development of a plan for the course
 of treatment of the individual and     
communication of the plan to the        
individual2  7,c7 access to the         
resources necessary to implement the    
course of treatment2  7,d7 access to    
high-quality clinical trials2  7,e7 a   
mechanism to coordinate services for the
 treatment of the individual2 and  7,f7 
psychosocial support services and       
compassionate care for the individual4  
7#i7 ,in its report ,from ,cancer       
,patient to ,cancer ,survivor3 ,lost in 

,transition1 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 treatment4  7#aj7  
,in ,cancer ,care for the ,whole        
,patient1 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 system4  7#aa7 ,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 providers1 but cancer   
care professionals report difficulties  
completing the plans4  7#ab7 ,because   
more than half of all cancer diagnoses  
occur among elderly ,medicare           
beneficiaries1 addressing cancer care   
inadequacies through ,medicare reforms  
will provide benefits to millions of    

,americans4 ,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 care4  7#ac7
 ,important payment and delivery reforms
 that incorporate cancer care planning  
and coordination are already being      
tested in the ,medicare program2 the    
,oncology ,care ,model has been         
implemented in a number of oncology     
practices1 and additional models that   
will include care planning have been    
proposed4  7#ad7 ,the alternative       
payment models1 including the ,oncology 
,care ,model1 provide access to cancer  
care planning for ,medicare             
beneficiaries who receive their cancer  
care in practices that are part of the  
,oncology ,care ,model4 ,other ,medicare
 beneficiaries who are not enrolled in  
these delivery demonstrations may not   
have access to a cancer care plan or    
appropriate care coordination4  7#ae7   
,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 services4  7#af7 ,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 life4 ,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 ,nation4  #b4
 ,coverage of cancer care planning and  
coordination 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,,gg72  7,b7 by adding and at the end  
of subparagraph 7,,hh72 and  7,c7 by    
adding at the end the following new     
subparagraph3  7,,ii7 cancer care       
planning and coordination services 7as  
defined in subsection 7kkk77  2 and     
7#b7 by adding at the end the following 
new subsection3  7kkk7 ,cancer ,care    
,planning and ,coordination ,services   
7#a7 ,the term cancer care planning and 
coordination services means--  7,a7 with
 respect to an individual who is        
diagnosed with cancer1 the development  
of a treatment plan by a physician1     
nurse practitioner1 or physician        
assistant that--  7i7 includes an       
assessment of the individual's          
diagnosis1 health status1 treatment     
needs1 functional status1 pain control1 
and psychosocial needs2  7ii7 engages   
the individual in a shared              
decision-making process that reviews all
 treatment options2  7iii7 details1 to  
the greatest extent practicable all     
aspects of the care to be provided to   

the individual with respect to the      
treatment of such cancer1 including any 
curative treatment1 comprehensive       
symptom management1 and palliative care2
  7iv7 is furnished in person1 in       
written form1 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      
diagnosed2  7v7 is furnished1 to the    
greatest extent practicable1 in a form  
that appropriately takes into account   
cultural and linguistic needs of the    
individual in order to make the plan    
accessible to the individual2 and  7vi7 
is in accordance with standards         
determined by the ,secretary to be      
appropriate2  7,b7 with respect to an   
individual for whom a treatment plan has
 been developed under subparagraph 7,a71
 the revision of such treatment plan as 
necessary to account for any substantial
 change in the condition of the         
individual1 recurrence of disease1      
changes in the individual's treatment   

preferences1 or significant revision of 
the elements of curative care or symptom
 management for the individual1 if such 
revision--  7i7 is in accordance with   
clauses 7i71 7ii71 7iv71 and 7v7 of such
 subparagraph2 and  7ii7 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 revision2  7,c7 with       
respect to an individual who has        
completed the primary treatment for     
cancer1 as defined by the ,secretary1   
the development of a follow-up          
survivorship care plan that--  7i7      
includes an assessment of the           
individual's diagnosis1 health status1  
treatment needs1 functional status1 pain
 control1 and psychosocial needs2  7ii7 
engages the individual in a shared      
decision-making process that reviews all
 survivorship care options2  7iii7      
describes the elements of the primary   
treatment1 including symptom management 
and palliative care1 furnished to such  

individual2  7iv7 provides              
recommendations for the subsequent care 
of the individual with respect to the   
cancer involved2  7v7 is furnished1 in  
person1 in written form1 to the         
individual within a period specified by 
the ,secretary that is as soon as       
practicable after the completion of such
 primary treatment2  7vi7 is furnished1 
to the greatest extent practicable1 in a
 form that appropriately takes into     
account cultural and linguistic needs of
 the individual in order to make the    
plan accessible to the individual2 and  
7vii7 is in accordance with standards   
determined by the ,secretary to be      
appropriate2 and  7,d7 with respect to  
an individual for whom a follow-up      
cancer care plan has been developed     
under subparagraph 7,c71 the revision of
 such plan as necessary to account for  
any substantial change in the condition 
of the individual1 diagnosis of a second
 cancer1 change in the individual's     
preference for survivorship care1 or    

significant revision of the plan for    
follow-up care1 if such revision--  7i7 
is in accordance with clauses 7i71 7ii71
 7iii71 7v71 and 7vi7 of such           
subparagraph2 and  7ii7 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 revision4  7#b7 ,the ,secretary
 shall establish standards to carry out 
paragraph 7#a7 in consultation with     
appropriate organizations representing  
suppliers and providers of services     
related to cancer treatment and         
organizations representing survivors of 
cancer4 ,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        
individual4  7#c7 ,in this subsection1  
the term shared decision-making process 

means1 with respect to an individual1 a 
process in which the individual and the 
individual's health care providers      
consider the individual's diagnosis1    
treatment options1 the medical evidence 
related to treatment options1 the risks 
and benefits of all treatment options1  
and the individual's preferences        
regarding treatment1 and then jointly   
develop and implement a treatment plan4 
4  7b7 ,payment under physician fee     
schedule  7#a7 ,in general ,section     
#ahdh7;j77#c7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77  
is amended by inserting 7,,ii71 after   
health risk assessment714  7#b7 ,initial
 rates ,unless the ,secretary of ,health
 and ,human ,services otherwise         
provides1 the payment rate specified    
under the physician fee schedule under  
the amendment made by paragraph 7#a7 for
 cancer care planning and coordination  
services shall be the same payment rate 
as provided for transitional care       
management services 7as defined in ,,cpt

 code #iidif74  7c7 ,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