Cancer Care Planning and Communications Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 3835 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 JULY 18, 2019 Mr. DESAULNIER (for himself and Mr. CARTER of Georgia) introduced the following bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committee on Ways and Means, for a pe- riod to be subsequently determined by the Speaker, in each case for con- sideration of such provisions as fall within the jurisdiction of the com- mittee 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 Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Cancer Care Planning and Communications Act of 5 2019’’. 6 (b) FINDINGS.—Congress makes the following find- 7 ings: 8 VerDate Sep 11 2014 04:29 Aug 01, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3835.IH H3835 kjohnson on DSK79L0C42 with BILLS 2 •HR 3835 IH (1) Cancer care in the United States is often 1 described as the best in the world because patients 2 have access to many treatment options, including 3 cutting-edge therapies that save lives and improve 4 the quality of life. 5 (2) Access to the best treatment options is not 6 equal across all populations and in all communities. 7 The 1999 Institute of Medicine report entitled ‘‘The 8 Unequal Burden of Cancer’’ found that low-income 9 people often lack access to adequate cancer care and 10 that ethnic minorities have not benefitted fully from 11 cancer treatment advances. 12 (3) In addition, despite access to high-quality 13 treatment options for many, individuals with cancer 14 often do not have access to a cancer care system 15 that incorporates shared decision making and the co- 16 ordination of all elements of care. 17 (4) Cancer survivors often experience the 18 under-diagnosis and under-treatment of the symp- 19 toms of cancer and side effects of cancer treatment, 20 a problem that begins at the time of diagnosis and 21 may become more severe with disease progression 22 and at the end of life. The failure to treat the symp- 23 toms, side effects, and late effects of cancer and can- 24 cer treatment may have a serious adverse impact on 25 VerDate Sep 11 2014 04:29 Aug 01, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3835.IH H3835 kjohnson on DSK79L0C42 with BILLS 3 •HR 3835 IH the health, survival, well-being, and quality of life of 1 cancer survivors. 2 (5) Individuals with cancer often do not partici- 3 pate in a shared decision-making process that con- 4 siders all treatment options and do not benefit from 5 coordination of all elements of active treatment and 6 palliative care. 7 (6) Quality cancer care should incorporate ac- 8 cess to psychosocial services and management of the 9 symptoms of cancer and the symptoms of cancer 10 treatment, including pain, nausea, vomiting, fatigue, 11 and depression. 12 (7) Quality cancer care should include a means 13 for engaging cancer survivors in a shared decision- 14 making process that produces a comprehensive care 15 summary and a plan for follow-up care after primary 16 treatment to ensure that cancer survivors have ac- 17 cess to follow-up monitoring and treatment of pos- 18 sible late effects of cancer and cancer treatment, in- 19 cluding appropriate psychosocial services. 20 (8) The Institute of Medicine report entitled 21 ‘‘Ensuring Quality Cancer Care’’ described the ele- 22 ments of quality care for an individual with cancer 23 to include— 24 VerDate Sep 11 2014 04:29 Aug 01, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3835.IH H3835 kjohnson on DSK79L0C42 with BILLS 4 •HR 3835 IH (A) the development of initial treatment 1 recommendations by an experienced health care 2 provider; 3 (B) the development of a plan for the 4 course of treatment of the individual and com- 5 munication of the plan to the individual; 6 (C) access to the resources necessary to 7 implement the course of treatment; 8 (D) access to high-quality clinical trials; 9 (E) a mechanism to coordinate services for 10 the treatment of the individual; and 11 (F) psychosocial support services and com- 12 passionate care for the individual. 13 (9) In its report ‘‘From Cancer Patient to Can- 14 cer Survivor: Lost in Transition’’, the Institute of 15 Medicine recommended that individuals with cancer 16 completing primary treatment be provided a com- 17 prehensive summary of their care along with a fol- 18 low-up survivorship plan of treatment. 19 (10) In ‘‘Cancer Care for the Whole Patient’’, 20 the Institute of Medicine stated that the develop- 21 ment of a plan that includes biomedical and psycho- 22 social care should be a standard for quality cancer 23 care in any quality measurement system. 24 VerDate Sep 11 2014 04:29 Aug 01, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3835.IH H3835 kjohnson on DSK79L0C42 with BILLS 5 •HR 3835 IH (11) The Commission on Cancer has encour- 1 aged survivorship care planning by making the de- 2 velopment of such plans for patients one of the 3 standards of accreditation for cancer care providers, 4 but cancer care professionals report difficulties com- 5 pleting the plans. 6 (12) Because more than half of all cancer diag- 7 noses occur among elderly Medicare beneficiaries, 8 addressing cancer care inadequacies through Medi- 9 care reforms will provide benefits to millions of 10 Americans. Providing Medicare beneficiaries more 11 routine access to cancer care plans and survivorship 12 care plans is a key to shared decision making and 13 better coordination of care. 14 (13) Important payment and delivery reforms 15 that incorporate cancer care planning and coordina- 16 tion are already being tested in the Medicare pro- 17 gram; the Oncology Care Model has been imple- 18 mented in a number of oncology practices, and addi- 19 tional models that will include care planning have 20 been proposed. 21 (14) The alternative payment models, including 22 the Oncology Care Model, provide access to cancer 23 care planning for Medicare beneficiaries who receive 24 their cancer care in practices that are part of the 25 VerDate Sep 11 2014 04:29 Aug 01, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3835.IH H3835 kjohnson on DSK79L0C42 with BILLS 6 •HR 3835 IH Oncology Care Model. Other Medicare beneficiaries 1 who are not enrolled in these delivery demonstra- 2 tions may not have access to a cancer care plan or 3 appropriate care coordination. 4 (15) The failure to provide a cancer care plan 5 to patients in many care settings relates in part to 6 inadequate Medicare payment for such planning and 7 coordination services. 8 (16) Changes in Medicare payment for cancer 9 care planning and coordination will support shared 10 decision making that reviews all treatment options 11 and will contribute to improved care for individuals 12 with cancer from the time of diagnosis through the 13 end of the life. Medicare payment for cancer care 14 planning may begin a reform process that helps us 15 realize the well-planned and well-coordinated cancer 16 care that has been recommended by the Institute of 17 Medicine/National Academy of Medicine and that is 18 preferred by cancer patients across the Nation. 19 SEC. 2. COVERAGE OF CANCER CARE PLANNING AND CO- 20 ORDINATION SERVICES. 21 (a) IN GENERAL.—Section 1861 of the Social Secu- 22 rity Act (42 U.S.C. 1395x) is amended— 23 (1) in subsection (s)(2)— 24 VerDate Sep 11 2014 04:29 Aug 01, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3835.IH H3835 kjohnson on DSK79L0C42 with BILLS 7 •HR 3835 IH (A) by striking ‘‘and’’ at the end of sub- 1 paragraph (GG); 2 (B) by adding ‘‘and’’ at the end of sub- 3 paragraph (HH); and 4 (C) by adding at the end the following new 5 subparagraph: 6 ‘‘(II) cancer care planning and coordination 7 services (as defined in subsection (kkk))’’; and 8 (2) by adding at the end the following new sub- 9 section: 10 ‘‘Cancer Care Planning and Coordination Services 11 ‘‘(kkk)(1) The term ‘cancer care planning and coordi- 12 nation services’ means— 13 ‘‘(A) with respect to an individual who is diag- 14 nosed with cancer, the development of a treatment 15 plan by a physician, nurse practitioner, or physician 16 assistant that— 17 ‘‘(i) includes an assessment of the individ- 18 ual’s diagnosis, health status, treatment needs, 19 functional status, pain control, and psychosocial 20 needs; 21 ‘‘(ii) engages the individual in a shared de- 22 cision-making process that reviews all treatment 23 options; 24 VerDate Sep 11 2014 04:29 Aug 01, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3835.IH H3835 kjohnson on DSK79L0C42 with BILLS 8 •HR 3835 IH ‘‘(iii) details, to the greatest extent prac- 1 ticable all aspects of the care to be provided to 2 the individual with respect to the treatment of 3 such cancer, including any curative treatment, 4 comprehensive symptom management, and pal- 5 liative care; 6 ‘‘(iv) is furnished in person, in written 7 form, to the individual within a period specified 8 by the Secretary that is as soon as practicable 9 after the date on which the individual is so di- 10 agnosed; 11 ‘‘(v) is furnished, to the greatest extent 12 practicable, in a form that appropriately takes 13 into account cultural and linguistic needs of the 14 individual in order to make the plan accessible 15 to the individual; and 16 ‘‘(vi) is in accordance with standards de- 17 termined by the Secretary to be appropriate; 18 ‘‘(B) with respect to an individual for whom a 19 treatment plan has been developed under subpara- 20 graph (A), the revision of such treatment plan as 21 necessary to account for any substantial change in 22 the condition of the individual, recurrence of disease, 23 changes in the individual’s treatment preferences, or 24 significant revision of the elements of curative care 25 VerDate Sep 11 2014 04:29 Aug 01, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3835.IH H3835 kjohnson on DSK79L0C42 with BILLS 9 •HR 3835 IH or symptom management for the individual, if such 1 revision— 2 ‘‘(i) is in accordance with clauses (i), (ii), 3 (iv), and (v) of such subparagraph; and 4 ‘‘(ii) is furnished in written form to the in- 5 dividual within a period specified by the Sec- 6 retary that is as soon as practicable after the 7 date of such revision; 8 ‘‘(C) with respect to an individual who has com- 9 pleted the primary treatment for cancer, as defined 10 by the Secretary, the development of a follow-up sur- 11 vivorship care plan that— 12 ‘‘(i) includes an assessment of the individ- 13 ual’s diagnosis, health status, treatment needs, 14 functional status, pain control, and psychosocial 15 needs; 16 ‘‘(ii) engages the individual in a shared de- 17 cision-making process that reviews all survivor- 18 ship care options; 19 ‘‘(iii) describes the elements of the primary 20 treatment, including symptom management and 21 palliative care, furnished to such individual; 22 ‘‘(iv) provides recommendations for the 23 subsequent care of the individual with respect 24 to the cancer involved; 25 VerDate Sep 11 2014 00:20 Aug 02, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3835.IH H3835 kjohnson on DSK79L0C42 with BILLS 10 •HR 3835 IH ‘‘(v) is furnished, in person, in written 1 form, to the individual within a period specified 2 by the Secretary that is as soon as practicable 3 after the completion of such primary treatment; 4 ‘‘(vi) is furnished, to the greatest extent 5 practicable, in a form that appropriately takes 6 into account cultural and linguistic needs of the 7 individual in order to make the plan accessible 8 to the individual; and 9 ‘‘(vii) is in accordance with standards de- 10 termined by the Secretary to be appropriate; 11 and 12 ‘‘(D) with respect to an individual for whom a 13 follow-up cancer care plan has been developed under 14 subparagraph (C), the revision of such plan as nec- 15 essary to account for any substantial change in the 16 condition of the individual, diagnosis of a second 17 cancer, change in the individual’s preference for sur- 18 vivorship care, or significant revision of the plan for 19 follow-up care, if such revision— 20 ‘‘(i) is in accordance with clauses (i), (ii), 21 (iii), (v), and (vi) of such subparagraph; and 22 ‘‘(ii) is furnished in written form to the in- 23 dividual within a period specified by the Sec- 24 VerDate Sep 11 2014 04:29 Aug 01, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3835.IH H3835 kjohnson on DSK79L0C42 with BILLS 11 •HR 3835 IH retary that is as soon as practicable after the 1 date of such revision. 2 ‘‘(2) The Secretary shall establish standards to carry 3 out paragraph (1) in consultation with appropriate organi- 4 zations representing suppliers and providers of services re- 5 lated to cancer treatment and organizations representing 6 survivors of cancer. Such standards shall include stand- 7 ards for determining the need and frequency for revisions 8 of the treatment plans and follow-up survivorship care 9 plans based on changes in the condition of the individual 10 or elements and intent of treatment and standards for the 11 communication of the plan to the individual. 12 ‘‘(3) In this subsection, the term ‘shared decision- 13 making process’ means, with respect to an individual, a 14 process in which the individual and the individual’s health 15 care providers consider the individual’s diagnosis, treat- 16 ment options, the medical evidence related to treatment 17 options, the risks and benefits of all treatment options, 18 and the individual’s preferences regarding treatment, and 19 then jointly develop and implement a treatment plan.’’. 20 (b) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 21 (1) IN GENERAL.—Section 1848(j)(3) of the 22 Social Security Act (42 U.S.C. 1395w–4(j)(3)) is 23 amended by inserting ‘‘(II),’’ after ‘‘health risk as- 24 sessment),’’. 25 VerDate Sep 11 2014 04:29 Aug 01, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3835.IH H3835 kjohnson on DSK79L0C42 with BILLS 12 •HR 3835 IH (2) INITIAL RATES.—Unless the Secretary of 1 Health and Human Services otherwise provides, the 2 payment rate specified under the physician fee 3 schedule under the amendment made by paragraph 4 (1) for cancer care planning and coordination serv- 5 ices shall be the same payment rate as provided for 6 transitional care management services (as defined in 7 CPT code 9949 [Text truncated for display. Full text available on Congress.gov.]