I 

112TH CONGRESS 

1ST SESSION H. R. 3705 

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 grants programs for provider education, and related research. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 16, 2011 

Mrs. CAPPS (for herself and Mr. BOUSTANY) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, 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 comprehensive cancer care planning 

under the Medicare Program and to improve the care 

furnished to individuals diagnosed with cancer by establishing grants programs for provider education, and related research. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 This Act may be cited as the ‘‘Comprehensive Cancer 

3 Care Improvement Act of 2011’’. 

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. 

TITLE II—PROVIDER EDUCATION REGARDING PALLIATIVE CARE 

AND SYMPTOM MANAGEMENT 

Sec. 201. Grants to improve health professional education. 

Sec. 202. Grants to improve continuing professional education. 

TITLE III—RESEARCH ON TOPICS RELATED TO COORDINATION 

OF CARE, SYMPTOM MANAGEMENT, AND PALLIATIVE CARE 

FOR CANCER PATIENTS 

Sec. 301. Research program. 

4 SEC. 2. FINDINGS. 

5 Congress makes the following findings: 

6 (1) Individuals with cancer often do not have 

7 access to a cancer care system that provides com8 prehensive and coordinated care of high quality. 

9 (2) The cancer care system has not traditionally 

10 offered individuals with cancer a prospective and 

11 comprehensive plan for treatment and symptom 

12 management, strategies for updating and evaluating 

13 such plan with the assistance of a health care pro14 fessional, and a follow-up plan for monitoring and 

15 treating possible late effects of cancer and its treat16 ment. 


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1 (3) Cancer survivors often experience the 

2 under-diagnosis and under-treatment of the symp3 toms of cancer, a problem that begins at the time 

4 of diagnosis and may become more severe with dis5 ease progression and at the end of life. The failure 

6 to treat the symptoms, side effects, and late effects 

7 of cancer and cancer treatment may have a serious 

8 adverse impact on the health, survival, well-being, 

9 and quality of life of cancer survivors. 

10 (4) Cancer survivors who are members of racial 

11 and ethnic minority groups may face severe obsta12 cles in receiving coordinated cancer care that in13 cludes appropriate management of cancer symptoms 

14 and treatment side effects. 

15 (5) Individuals with cancer are sometimes not 

16 provided information about their disease and treat17 ment options that might result in their request for 

18 and engagement in coordinated care that includes 

19 appropriate treatment and symptom management. 

20 (6) Comprehensive cancer care should incor21 porate access to psychosocial services and manage22 ment of the symptoms of cancer and the symptoms 

23 of cancer treatment, including pain, nausea, vom24 iting, fatigue, and depression. 


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1 (7) Comprehensive cancer care should include a 

2 means for providing cancer survivors with a com3 prehensive care summary and a plan for follow-up 

4 care after primary treatment to ensure that cancer 

5 survivors have access to follow-up monitoring and 

6 treatment of possible late effects of cancer and can7 cer treatment. 

8 (8) The Institute of Medicine report entitled 

9 ‘‘Ensuring Quality Cancer Care’’ described the ele10 ments of quality care for an individual with cancer, 

11 including— 

12 (A) the development of initial treatment 

13 recommendations by an experienced health care 

14 provider; 

15 (B) the development of a plan for the 

16 course of treatment of the individual and com17 munication of the plan to the individual; 

18 (C) access to the resources necessary to 

19 implement the course of treatment; 

20 (D) access to high-quality clinical trials; 

21 (E) a mechanism to coordinate services for 

22 the treatment of the individual; and 

23 (F) psychosocial support services and com24 passionate care for the individual. 


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1 (9) In its report ‘‘From Cancer Patient to Can2 cer Survivor: Lost in Transition’’, the Institute of 

3 Medicine recommended that individuals with cancer 

4 completing primary treatment be provided a com5 prehensive summary of their care along with a fol6 low-up survivorship plan of treatment. 

7 (10) Since more than half of all cancer diag8 noses occur among elderly Medicare beneficiaries, 

9 the problems of providing cancer care are problems 

10 of the Medicare program. 

11 (11) Shortcomings in providing cancer care, re12 sulting in inadequate management of cancer symp13 toms and insufficient monitoring and treatment of 

14 late effects of cancer and its treatment, are related 

15 to problems of Medicare payments for such care, in16 adequate professional training, and insufficient in17 vestment in research on symptom management. 

18 (12) Changes in Medicare payment for com19 prehensive cancer care, enhanced public and profes20 sional education regarding symptom management, 

21 and more research related to coordination of care, 

22 symptom management and palliative care will en23 hance patient decisionmaking about treatment op24 tions and will contribute to improved care for indi25 viduals with cancer from the time of diagnosis of the 


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1 individual through the end of the life of the indi2 vidual. 

3 TITLE I—COMPREHENSIVE CAN4 CER CARE UNDER THE MEDI5 CARE PROGRAM 

6 SEC. 101. COVERAGE OF CANCER CARE PLANNING SERV7 ICES. 

8 (a) IN GENERAL.—Section 1861 of the Social Secu9 rity Act is amended— 

10 (1) in subsection (s)(2)— 

11 (A) by striking ‘‘and’’ at the end of sub12 paragraph (EE); 

13 (B) by adding ‘‘and’’ at the end of sub14 paragraph (FF); and 

15 (C) by adding at the end the following new 

16 subparagraph: 

17 ‘‘(GG) comprehensive cancer care planning 

18 services (as defined in subsection (iii));’’; and 

19 (2) by adding at the end the following new sub20 section: 

21 ‘‘COMPREHENSIVE CANCER CARE PLANNING SERV22 ICES

23 ‘‘(iii)(1) The term ‘comprehensive cancer care plan24 ning services’ means— 


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1 ‘‘(A) with respect to an individual who is 

2 diagnosed with cancer, the development of a 

3 plan of care that— 

4 ‘‘(i) details, to the greatest extent 

5 practicable, all aspects of the care to be 

6 provided to the individual, with respect to 

7 the treatment of such cancer, including 

8 any curative treatment, comprehensive 

9 symptom management, and palliative care; 

10 ‘‘(ii) is furnished, in person, in written 

11 form, to the individual within a period 

12 specified by the Secretary that is as soon 

13 as practicable after the date on which the 

14 individual is so diagnosed; 

15 ‘‘(iii) is furnished, to the greatest ex16 tent practicable, in a form that appro17 priately takes into account cultural and 

18 linguistic needs of the individual in order 

19 to make the plan accessible to the indi20 vidual; and 

21 ‘‘(iv) is in accordance with standards 

22 determined by the Secretary to be appro23 priate; 

24 ‘‘(B) with respect to an individual for 

25 whom a plan of care has been developed under 


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1 subparagraph (A), the revision of such plan of 

2 care as necessary to account for any substantial 

3 change in the condition of the individual, recur4 rence of disease, or significant revision of the 

5 elements of curative or palliative care for the 

6 individual, if such revision— 

7 ‘‘(i) is in accordance with clauses (i), 

8 (iii), and (iv) of such subparagraph; and 

9 ‘‘(ii) is furnished in written form to 

10 the individual within a period specified by 

11 the Secretary that is as soon as practicable 

12 after the date of such revision; 

13 ‘‘(C) with respect to an individual who has 

14 completed the primary treatment for cancer, as 

15 defined by the Secretary (such as the comple16 tion of chemotherapy or radiation treatment), 

17 the development of a follow-up cancer care plan 

18 that— 

19 ‘‘(i) describes the elements of the pri20 mary treatment, including symptom man21 agement and palliative care, furnished to 

22 such individual; 

23 ‘‘(ii) provides recommendations for 

24 the subsequent care of the individual with 

25 respect to the cancer involved; 


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1 ‘‘(iii) is furnished, in person, in writ2 ten form, to the individual within a period 

3 specified by the Secretary that is as soon 

4 as practicable after the completion of such 

5 primary treatment; 

6 ‘‘(iv) is furnished, to the greatest ex7 tent practicable, in a form that appro8 priately takes into account cultural and 

9 linguistic needs of the individual in order 

10 to make the plan accessible to the indi11 vidual; and 

12 ‘‘(v) is in accordance with standards 

13 determined by the Secretary to be appro14 priate; and 

15 ‘‘(D) with respect to an individual for 

16 whom a follow-up cancer care plan has been de17 veloped under subparagraph (C), the revision of 

18 such plan as necessary to account for any sub19 stantial change in the condition of the indi20 vidual, diagnosis of a second cancer, or signifi21 cant revision of the plan for follow-up care, if 

22 such revision— 

23 ‘‘(i) is in accordance with clauses (i), 

24 (ii), (iv), and (v) of such subparagraph; 

25 and 


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1 ‘‘(ii) is furnished in written form to 

2 the individual within a period specified by 

3 the Secretary that is as soon as practicable 

4 after the date of such revision. 

5 ‘‘(2) The Secretary shall establish standards to 

6 carry out paragraph (1) in consultation with appro7 priate organizations representing providers of serv8 ices related to cancer treatment and organizations 

9 representing survivors of cancer. Such standards 

10 shall include standards for determining the need and 

11 frequency for revisions of the plans of care and fol12 low-up plans based on changes in the condition of 

13 the individual or elements and intent of treatment 

14 and standards for the communication of the plan to 

15 the patient.’’. 

16 (b) PAYMENT.—Section 1833(a)(1) of the Social Se17 curity Act (42 U.S.C. 1395l(a)(1)) is amended by striking 

18 ‘‘and’’ before ‘‘(Z)’’ and inserting before the semicolon at 

19 the end the following: ‘‘, and (AA) with respect to com20 prehensive cancer care planning services described in any 

21 of subparagraphs (A) through (D) of section 1861(iii)(1), 

22 the amount paid shall be an amount equal to the sum of 

23 (i) the national average amount under the physician fee 

24 schedule established under section 1848 for a new patient 

25 office consultation of the highest level of service in the 


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1 non-facility setting, and (ii) the national average amount 

2 under such fee schedule for a physician certification de3 scribed in section 1814(a)(2) for home health services fur4 nished to an individual by a home health agency under 

5 a home health plan of care’’. 

6 (c) EFFECTIVE DATE.—The amendments made by 

7 this section shall apply to services furnished on or after 

8 the first day of the first calendar year that begins after 

9 the date of the enactment of this Act. 

10 TITLE II—PROVIDER EDU11 CATION REGARDING PALLIA12 TIVE CARE AND SYMPTOM 

13 MANAGEMENT 

14 SEC. 201. GRANTS TO IMPROVE HEALTH PROFESSIONAL 

15 EDUCATION. 

16 (a) IN GENERAL.—The Secretary of Health and 

17 Human Services shall make grants to eligible entities to 

18 enable the entities to improve the quality of graduate and 

19 postgraduate training of physicians, nurses, and other 

20 health care providers in developing cancer care plans for 

21 cancer patients and communicating such plans to the indi22 vidual patients. 

23 (b) APPLICATION.—To seek a grant under this sec24 tion, an eligible entity shall submit an application at such 

25 time, in such manner, and containing such information as 


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1 the Secretary may require. At a minimum, the Secretary 

2 shall require that each such application demonstrate— 

3 (1) the ability to train health professionals in— 

4 (A) the provision of cancer care that fully 

5 coordinates active treatment, symptom manage6 ment, and palliative care; and 

7 (B) the communication of a written plan 

8 for coordinated cancer care to the patient; and 

9 (2) the ability to collect and analyze data re10 lated to the effectiveness of such training programs. 

11 (c) EVALUATION.—The Secretary shall develop and 

12 implement a plan for evaluating the effects of the training 

13 programs funded under this section. 

14 (d) DEFINITIONS.—In this section: 

15 (1) The term ‘‘eligible entity’’ means an entity 

16 that is a— 

17 (A) cancer center (including an NCI-des18 ignated cancer center); 

19 (B) academic health center; 

20 (C) physician practice; 

21 (D) school of nursing; 

22 (E) visiting nurse association; 

23 (F) home care agency; or 


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1 (G) a private non-profit organization with 

2 expertise and experience in health provider 

3 training. 

4 (2) The term ‘‘NCI-designated cancer center’’ 

5 means a cancer center receiving funds through a 

6 P30 Cancer Center Support Grant of the National 

7 Cancer Institute. 

8 (3) The term ‘‘Secretary’’ means the Secretary 

9 of Health and Human Services. 

10 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

11 out this section, there are authorized to be appropriated 

12 $5,000,000 for each of the fiscal years 2012 through 

13 2016. 

14 SEC. 202. GRANTS TO IMPROVE CONTINUING PROFES15 SIONAL EDUCATION. 

16 (a) IN GENERAL.—The Secretary of Health and 

17 Human Services shall make grants to eligible entities to 

18 improve the quality of continuing professional education 

19 provided to qualified individuals regarding the develop20 ment and communication of written cancer care plans that 

21 outline a system of care that coordinates active treatment 

22 and palliative care. 

23 (b) APPLICATION.—To seek a grant under this sec24 tion, an eligible entity shall submit an application at such 

25 time, in such manner, and containing such information as 


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1 the Secretary may require. At a minimum, the Secretary 

2 shall require that each such application demonstrate— 

3 (1) experience in sponsoring continuing profes4 sional education programs; 

5 (2) the ability to reach health care providers 

6 and other professionals who are engaged in cancer 

7 care with such continuing professional education 

8 programs; 

9 (3) the capacity to develop innovative training 

10 programs aimed at enhancing the delivery of coordi11 nated cancer care that includes appropriate symp12 tom management and palliative care; and 

13 (4) the ability to evaluate the effectiveness of 

14 such professional education and training programs. 

15 (c) EVALUATION.—The Secretary shall develop and 

16 implement a plan for evaluating the effects of the con17 tinuing professional education and training programs 

18 funded under this section. 

19 (d) DEFINITIONS.—In this section: 

20 (1) The term ‘‘eligible entity’’ means an entity 

21 that is a— 

22 (A) cancer center (including an NCI-des23 ignated cancer center); 

24 (B) academic health center; 

25 (C) school of nursing; 


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1 (D) professional society that supports con2 tinuing professional education programs; or 

3 (E) private non-profit organization with 

4 expertise and experience in health provider 

5 training. 

6 (2) The term ‘‘NCI-designated cancer center’’ 

7 means a cancer center receiving funds through a 

8 P30 Cancer Center Support Grant of the National 

9 Cancer Institute. 

10 (3) The term ‘‘qualified individual’’ means a 

11 physician, nurse, social worker, chaplain, psycholo12 gist, or other individual who is involved in providing 

13 comprehensive cancer care, including active treat14 ment, symptom management, and palliative care, to 

15 cancer patients. 

16 (4) The term ‘‘Secretary’’ means the Secretary 

17 of Health and Human Services. 

18 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

19 out this section, there are authorized to be appropriated 

20 $5,000,000 for each of the fiscal years 2012 through 

21 2016. 


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1 TITLE III—RESEARCH ON TOP2 ICS RELATED TO COORDINA3 TION OF CARE, SYMPTOM 

4 MANAGEMENT, AND PALLIA5 TIVE CARE FOR CANCER PA6 TIENTS 

7 SEC. 301. RESEARCH PROGRAM. 

8 (a) IN GENERAL.—The Secretary of Health and 

9 Human Services shall provide investment, through exist10 ing research programs, for research on topics related to 

11 cancer care planning, cancer care coordination, symptom 

12 management, palliative care, and comprehensive survivor13 ship care 

14 (b) In carrying out the research authorized under this 

15 section, the Secretary should provide for the participation 

16 of institutes and centers of the National Institutes of 

17 Health, the Centers for Medicare & Medicaid Services, and 

18 any other national research institute that has been en19 gaged in research described in subsection (a). 

20 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

21 out this section, there are authorized to be appropriated 

22 $5,000,000 for each of the fiscal years 2012 through 

23 2016. 

Æ 


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