I 

112TH CONGRESS 

1ST SESSION H. R. 3622 

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 management. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 8, 2011 

Mr. ISRAEL (for himself, Mr. TIBERI, Mr. GRIJALVA, Mr. HINCHEY, Mr. 

ELLISON, Mr. FRANK of Massachusetts, and Ms. NORTON) 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 

comprehensive cancer patient treatment education under 

the Medicare program and to provide for research to 

improve cancer symptom management. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Assuring and Improving Cancer Treatment Education 

6 and Cancer Symptom Management Act of 2011’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

TITLE I—COMPREHENSIVE CANCER PATIENT TREATMENT 

EDUCATION UNDER THE MEDICARE PROGRAM 

Sec. 101. Medicare coverage of comprehensive cancer patient treatment education services. 

TITLE II—RESEARCH ON CANCER SYMPTOM MANAGEMENT 

IMPROVEMENT 

Sec. 201. Expansion of research. 

Sec. 202. Nursing intervention research grants. 

Sec. 203. Institute of Medicine study on the provision of symptom management 

and supportive care in people with cancer. 

3 SEC. 2. FINDINGS. 

4 The Congress makes the following findings: 

5 (1) Many people with cancer experience side ef6 fects, symptoms, and late complications associated 

7 with their disease and their treatment, which can 

8 have a serious adverse impact on their health, well9 being, and quality of life. 

10 (2) Many side effects and symptoms associated 

11 with cancer and its treatment can be reduced or con12 trolled by the provision of timely symptom manage13 ment and services and also by educating people with 

14 cancer and their caregivers about the potential ef15 fects before treatment begins. 

16 (3) Studies have found that individualized edu17 cational intervention for cancer pain management 

18 from a registered nurse was effective for patients 


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1 with cancer being treated in outpatient and home2 based settings. Similarly, the number of caregivers 

3 who said they were well informed and confident 

4 about caregiving after attending a family caregiver 

5 cancer education program increased after program 

6 attendance. 

7 (4) People with cancer benefit from having an 

8 educational session with oncology nurses in advance 

9 of the initiation of treatment to learn how to reduce 

10 the risk of and manage adverse effects and maximize 

11 well-being. Helping patients to manage their side ef12 fects reduces adverse events and the need for urgent 

13 or inpatient care. 

14 (5) The Oncology Nursing Society has received 

15 reports from its members that, because the Medicare 

16 program and other payers do not cover the provision 

17 of patient treatment education, patients and their 

18 caregivers often do not receive adequate education 

19 before the onset of such patients’ treatment for can20 cer regarding the course of such treatment and the 

21 possible side effects and symptoms such patients 

22 may experience. The Oncology Nursing Society rec23 ommends that all patients being treated for cancer 

24 have a one-on-one educational session with a nurse 

25 in advance of the onset of such treatment so that 


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1 such patients and their caregivers receive the infor2 mation they need to help minimize adverse events re3 lated to such treatment and maximize the well-being 

4 of such patients. 

5 (6) Insufficient or non-existent Medicare pay6 ments coupled with poor investment in symptom 

7 management research contribute to the inadequate 

8 education of patients, poor management and moni9 toring of cancer symptoms, and inadequate handling 

10 of late effects of cancer and its treatment. 

11 (7) People with cancer often do not have the 

12 symptoms associated with their disease and the asso13 ciated treatment managed in a comprehensive or ap14 propriate manner. 

15 (8) People with cancer deserve to have access to 

16 comprehensive care that includes appropriate treat17 ment and symptom management. 

18 (9) Patients who receive infused chemotherapy 

19 likely obtain some treatment education during the 

20 course of the administration of their treatment; yet, 

21 many do not, and individuals who may receive a dif22 ferent type of cancer care, such as radiation or sur23 gical interventions or oral chemotherapy taken at 

24 home, likely do not receive treatment education dur25 ing their treatment. 


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1 (10) Comprehensive cancer care must include 

2 access to services and management associated with 

3 nausea, vomiting, fatigue, depression, pain, and 

4 other symptoms. 

5 (11) The Institute of Medicine report, ‘‘Ensur6 ing Quality Cancer Care’’ asserts that ‘‘much can be 

7 done to relieve the symptoms, ease distress, provide 

8 comfort, and in other ways improve the quality of 

9 life of someone with cancer. For a person with can10 cer, maintenance of quality of life requires, at a min11 imum, relief from pain and other distressing symp12 toms, relief from anxiety and depressions, including 

13 the fear of pain, and a sense of security that assist14 ance with be readily available if needed.’’. 

15 (12) The Institute of Medicine report, ‘‘Cancer 

16 Care for the Whole Patient: Meeting Psychosocial 

17 Health Needs’’ recognizes that cancer patients’ psy18 chosocial needs include information about their 

19 therapies and the potential side effects. 

20 (13) As more than half of all cancer diagnoses 

21 occur among individuals age 65 and older, the chal22 lenges of managing cancer symptoms are growing 

23 for patients enrolled in the Medicare program. 

24 (14) Provision of Medicare payment for com25 prehensive cancer patient treatment education, couVerDate Mar 15 2010 00:45 Dec 16, 2011 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3622.IH H3622

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1 pled with expanded cancer symptom management re2 search, will help improve care and quality of life for 

3 people with cancer from the time of diagnosis 

4 through survivorship or end of life. 

5 TITLE I—COMPREHENSIVE CAN6 CER PATIENT TREATMENT 

7 EDUCATION UNDER THE 

8 MEDICARE PROGRAM 

9 SEC. 101. MEDICARE COVERAGE OF COMPREHENSIVE CAN10 CER PATIENT TREATMENT EDUCATION SERV11 ICES. 

12 (a) IN GENERAL.—Section 1861 of the Social Secu13 rity Act (42 U.S.C. 1395x) is amended— 

14 (1) in subsection (s)(2)— 

15 (A) by striking ‘‘and’’ at the end of sub16 paragraph (EE); 

17 (B) by adding ‘‘and’’ at the end of sub18 paragraph (FF); and 

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

20 subparagraph: 

21 ‘‘(GG) comprehensive cancer patient treatment 

22 education services (as defined in subsection 

23 (iii)(1));’’; and 

24 (2) by adding at the end the following new sub25 section: 


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1 ‘‘Comprehensive Cancer Patient Treatment Education 

2 Services 

3 ‘‘(iii)(1) The term ‘comprehensive cancer patient 

4 treatment education services’ means— 

5 ‘‘(A) in the case of an individual who is diag6 nosed with cancer, the provision of a one-hour pa7 tient treatment education session delivered by a reg8 istered nurse that— 

9 ‘‘(i) is furnished to the individual and the 

10 caregiver (or caregivers) of the individual in ad11 vance of the onset of treatment and to the ex12 tent practicable, is not furnished on the day of 

13 diagnosis or on the first day of treatment; 

14 ‘‘(ii) educates the individual and such care15 giver (or caregivers) to the greatest extent prac16 ticable, about all aspects of the care to be fur17 nished to the individual, informs the individual 

18 regarding any potential symptoms, side-effects, 

19 or adverse events, and explains ways in which 

20 side effects and adverse events can be mini21 mized and health and well-being maximized, 

22 and provides guidance regarding those side ef23 fects to be reported and to which health care 

24 provider the side effects should be reported; 


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1 ‘‘(iii) includes the provision, in written 

2 form, of information about the course of treat3 ment, any responsibilities of the individual with 

4 respect to self-dosing, and ways in which to ad5 dress symptoms and side-effects; and 

6 ‘‘(iv) is furnished, to the greatest extent 

7 practicable, in an oral, written, or electronic 

8 form that appropriately takes into account cul9 tural and linguistic needs of the individual in 

10 order to make the information comprehensible 

11 to the individual and such caregiver (or care12 givers); and 

13 ‘‘(B) with respect to an individual for whom a 

14 course of cancer treatment or therapy is materially 

15 modified, a one-hour patient treatment education 

16 session described in subparagraph (A), including up17 dated information on the matters described in such 

18 subparagraph should the individual’s oncologic 

19 health care professional deem it appropriate and 

20 necessary. 

21 ‘‘(2) In establishing standards to carry out paragraph 

22 (1), the Secretary shall consult with appropriate organiza23 tions representing providers of oncology patient treatment 

24 education services and organizations representing people 

25 with cancer.’’. 


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1 (b) PAYMENT.—Section 1833(a)(1) of such Act (42 

2 U.S.C. 1395l(a)(1)) is amended— 

3 (1) by striking ‘‘and’’ before ‘‘(Z)’’; and 

4 (2) by inserting before the semicolon at the end 

5 the following: ‘‘, and (AA) with respect to com6 prehensive cancer patient treatment education serv7 ice (as defined in section 1861(iii)(1)), 150 percent 

8 of the payment rate established under section 1848 

9 for diabetes outpatient self-management training 

10 services (as defined in section 1861(qq)), determined 

11 and applied without regard to any coinsurance’’. 

12 (c) COVERAGE.—Section 1862(a)(1) of such Act (42 

13 U.S.C. 1395y(a)(1)) is amended— 

14 (1) in subparagraph (O), by striking ‘‘and’’ at 

15 the end; 

16 (2) in subparagraph (P), by striking the semi17 colon at the end and inserting ‘‘, and’’; and 

18 (3) by adding at the end the following new sub19 paragraph: 

20 ‘‘(Q) in the case of comprehensive cancer pa21 tient treatment education services (as defined in 

22 subsection (iii)(1)) which are performed more fre23 quently than is covered under such section;’’. 

24 (d) NO IMPACT ON PAYMENT FOR OTHER SERV25 ICES.—Nothing in this section shall be construed to affect 


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1 or otherwise authorize any reduction or modification, in 

2 the Medicare payment amounts otherwise established for 

3 chemotherapy infusion or injection codes with respect to 

4 the calculation and payment of minutes for chemotherapy 

5 teaching or related services. 

6 (e) 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—RESEARCH ON CAN11 CER SYMPTOM MANAGEMENT 

12 IMPROVEMENT 

13 SEC. 201. EXPANSION OF RESEARCH. 

14 Subpart 1 of part C of title IV of the Public Health 

15 Service Act (42 U.S.C. 285 et seq.) is amended by adding 

16 at the end the following: 

17 ‘‘SEC. 417G. RESEARCH ON CANCER SYMPTOM MANAGE18 MENT IMPROVEMENT. 

19 ‘‘(a) IN GENERAL.—The Director of NIH shall ex20 pand, intensify, and coordinate programs for the conduct 

21 and support of research with respect to— 

22 ‘‘(1) improving the treatment and management 

23 of symptoms and side effects associated with cancer 

24 and cancer treatment; and 


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1 ‘‘(2) evaluating the role of nursing interventions 

2 in the amelioration of such symptoms and side ef3 fects. 

4 ‘‘(b) ADMINISTRATION.—The Director of NIH shall 

5 carry out this section— 

6 ‘‘(1) through the Director of the Institute; and 

7 ‘‘(2) in collaboration with the directors of the 

8 National Institute of Nursing Research, the Na9 tional Institute of Mental Health, the National Cen10 ter on Minority Health and Health Disparities, the 

11 National Center for Complementary and Alternative 

12 Medicine, and the Agency for Healthcare Research 

13 and Quality.’’. 

14 SEC. 202. NURSING INTERVENTION RESEARCH GRANTS. 

15 Subpart 1 of part C of title IV of the Public Health 

16 Service Act (42 U.S.C. 285 et seq.), as amended by section 

17 201, is amended by adding at the end the following: 

18 ‘‘SEC. 417H. NURSING INTERVENTION RESEARCH GRANTS. 

19 ‘‘(a) IN GENERAL.—The Director of NIH shall make 

20 grants for research to be conducted— 

21 ‘‘(1) with a registered nurse as the principal in22 vestigator; and 

23 ‘‘(2) for the purpose of studying cancer symp24 tom management care and services delivered by reg25 istered nurses to cancer patients. 


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1 ‘‘(b) INCLUSION OF NATIONAL RESEARCH INSTI2 TUTES.—In carrying out this section, the Director of NIH 

3 shall provide for the participation of the National Cancer 

4 Institute, the National Institute of Nursing Research, and 

5 any other national research institute that has been en6 gaged in research described subsection (a)(2). 

7 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated to carry out this section 

9 such sums as may be necessary for fiscal years 2012 

10 through 2016.’’. 

11 SEC. 203. INSTITUTE OF MEDICINE STUDY ON THE PROVI12 SION OF SYMPTOM MANAGEMENT AND SUP13 PORTIVE CARE IN PEOPLE WITH CANCER. 

14 (a) REPORT.— 

15 (1) IN GENERAL.—Not later than 2 months 

16 after the date of enactment of this Act, the Sec17 retary of Health and Human Services (in this sec18 tion referred to as the ‘‘Secretary’’) shall enter into 

19 an arrangement under which the Institute of Medi20 cine of the National Academy of Sciences (in this 

21 section referred to as the ‘‘Institute’’) shall conduct 

22 a study and evaluation, including a report, on the 

23 current state of symptom management, patient 

24 treatment education, and supportive care given to 

25 people with cancer. 


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1 (2) SPECIFIC MATTERS EVALUATED.—In con2 ducting the study and evaluation under paragraph 

3 (1), the Institute shall— 

4 (A) analyze any barriers to access to, and 

5 delivery of, symptom management, patient 

6 treatment education, and supportive care to 

7 people with cancer; 

8 (B) catalogue and evaluate the incentives 

9 and disincentives in the current reimbursement 

10 system that influence whether individuals re11 ceive comprehensive symptom management, pa12 tient treatment education, and supportive care, 

13 including adequate and ongoing patient treat14 ment education; 

15 (C) evaluate the importance of nursing 

16 interventions in the management of symptoms 

17 and side effects of cancer and the associated 

18 treatment; 

19 (D) consider such other matters as the In20 stitute determines appropriate; and 

21 (E) make recommendations to address any 

22 barriers, challenges, or other issues identified 

23 through the study and evaluation. 

24 (3) SCOPE OF REVIEW.—In conducting such 

25 study and evaluation, the Institute shall consider a 


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1 variety of perspectives, including the perspectives of 

2 patients and their family caregivers, registered 

3 nurses, including nurses certified in oncology, physi4 cians, social workers, psychologists, other health care 

5 professionals, and other experts and stakeholders. 

6 (b) REPORT.—Not later than 18 months after the 

7 date of enactment of this Act, the arrangement under sub8 section (a) shall provide for the Institute to submit to the 

9 Secretary and to Congress a report on the study evalua10 tion conducted under such subsection. Such report shall 

11 contain a detailed description of the findings of such study 

12 and evaluation and recommendations for improving the 

13 provision of symptom management, patient treatment edu14 cation, and supportive care to people with cancer. 

15 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated such sums as may be 

17 necessary for the purposes of conducting the study and 

18 evaluation, and preparing the report, required by this sec19 tion. 

Æ 


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