I 

113TH CONGRESS 

1ST SESSION H. R. 1661 

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 

APRIL 19, 2013 

Mr. ISRAEL (for himself and Mr. TIBERI) 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 ‘‘Improving Cancer Treatment Education Act of 2013’’. 

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

7 this Act is as follows: 


smartinez on DSK6TPTVN1PROD with BILLS
2 

•HR 1661 IH

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. Sense of Congress. 

Sec. 202. NIH Research on cancer symptom management improvement. 

1 SEC. 2. FINDINGS. 

2 The Congress makes the following findings: 

3 (1) Many people with cancer experience side ef4 fects, symptoms, and late complications associated 

5 with their disease and their treatment, which can 

6 have a serious adverse impact on their health, well7 being, and quality of life. 

8 (2) Many side effects and symptoms associated 

9 with cancer and its treatment can be reduced or con10 trolled by the provision of timely symptom manage11 ment and services and also by educating people with 

12 cancer and their caregivers about the potential ef13 fects before treatment begins. 

14 (3) Studies have found that individualized edu15 cational intervention for cancer pain management 

16 from a registered nurse was effective for patients 

17 with cancer being treated in outpatient and home18 based settings. Similarly, the number of caregivers 

19 who said they were well informed and confident 


smartinez on DSK6TPTVN1PROD with BILLS
3 

•HR 1661 IH

1 about caregiving after attending a family caregiver 

2 cancer education program increased after program 

3 attendance. 

4 (4) People with cancer benefit from having an 

5 educational session with oncology nurses in advance 

6 of the initiation of treatment to learn how to reduce 

7 the risk of and manage adverse effects and maximize 

8 well-being. Helping patients to manage their side ef9 fects reduces adverse events and the need for urgent 

10 or inpatient care. 

11 (5) The Oncology Nursing Society has received 

12 reports from its members that, because the Medicare 

13 program and other payers do not cover the provision 

14 of patient treatment education, patients and their 

15 caregivers often do not receive adequate education 

16 before the onset of such patients’ treatment for can17 cer regarding the course of such treatment and the 

18 possible side effects and symptoms such patients 

19 may experience. The Oncology Nursing Society rec20 ommends that all patients being treated for cancer 

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

22 in advance of the onset of such treatment so that 

23 such patients and their caregivers receive the infor24 mation they need to help minimize adverse events reVerDate Mar 15 2010 22:11 Apr 30, 2013 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1661.IH H1661

smartinez on DSK6TPTVN1PROD with BILLS
4 

•HR 1661 IH

1 lated to such treatment and maximize the well-being 

2 of such patients. 

3 (6) Insufficient or non-existent Medicare pay4 ments coupled with poor investment in symptom 

5 management research contribute to the inadequate 

6 education of patients, poor management and moni7 toring of cancer symptoms, and inadequate handling 

8 of late effects of cancer and its treatment. 

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

10 symptoms associated with their disease and the asso11 ciated treatment managed in a comprehensive or ap12 propriate manner. 

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

14 comprehensive care that includes appropriate treat15 ment and symptom management. 

16 (9) Patients who receive infused chemotherapy 

17 likely obtain some treatment education during the 

18 course of the administration of their treatment; yet, 

19 many do not, and individuals who may receive a dif20 ferent type of cancer care, such as radiation or sur21 gical interventions or oral chemotherapy taken at 

22 home, likely do not receive treatment education dur23 ing their treatment. 

24 (10) Comprehensive cancer care must include 

25 access to services and management associated with 


smartinez on DSK6TPTVN1PROD with BILLS
5 

•HR 1661 IH

1 nausea, vomiting, fatigue, depression, pain, and 

2 other symptoms. 

3 (11) The Institute of Medicine report, ‘‘Ensur4 ing Quality Cancer Care’’ asserts that ‘‘much can be 

5 done to relieve the symptoms, ease distress, provide 

6 comfort, and in other ways improve the quality of 

7 life of someone with cancer. For a person with can8 cer, maintenance of quality of life requires, at a min9 imum, relief from pain and other distressing symp10 toms, relief from anxiety and depressions, including 

11 the fear of pain, and a sense of security that assist12 ance will be readily available if needed.’’. 

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

14 Care for the Whole Patient: Meeting Psychosocial 

15 Health Needs’’ recognizes that cancer patients’ psy16 chosocial needs include information about their 

17 therapies and the potential side effects. 

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

19 occur among individuals age 65 and older, the chal20 lenges of managing cancer symptoms are growing 

21 for patients enrolled in the Medicare program. 

22 (14) Provision of Medicare payment for com23 prehensive cancer patient treatment education, cou24 pled with expanded cancer symptom management re25 search, will help improve care and quality of life for 


smartinez on DSK6TPTVN1PROD with BILLS
6 

•HR 1661 IH

1 people with cancer from the time of diagnosis 

2 through survivorship or end of life. 

3 TITLE I—COMPREHENSIVE CAN4 CER PATIENT TREATMENT 

5 EDUCATION UNDER THE 

6 MEDICARE PROGRAM 

7 SEC. 101. MEDICARE COVERAGE OF COMPREHENSIVE CAN8 CER PATIENT TREATMENT EDUCATION SERV9 ICES. 

10 (a) IN GENERAL.—Section 1861 of the Social Secu11 rity Act (42 U.S.C. 1395x) is amended— 

12 (1) in subsection (s)(2)— 

13 (A) by striking ‘‘and’’ at the end of sub14 paragraph (EE); 

15 (B) by adding ‘‘and’’ at the end of sub16 paragraph (FF); and 

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

18 subparagraph: 

19 ‘‘(GG) comprehensive cancer patient treatment 

20 education services (as defined in subsection 

21 (iii)(1));’’; and 

22 (2) by adding at the end the following new sub23 section: 


smartinez on DSK6TPTVN1PROD with BILLS
7 

•HR 1661 IH

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; 


smartinez on DSK6TPTVN1PROD with BILLS
8 

•HR 1661 IH

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.’’. 


smartinez on DSK6TPTVN1PROD with BILLS
9 

•HR 1661 IH

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 ices (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 


smartinez on DSK6TPTVN1PROD with BILLS
10 

•HR 1661 IH

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. SENSE OF CONGRESS. 

14 It is the sense of Congress that— 

15 (1) many people with cancer experience side ef16 fects, symptoms, and late side effects associated with 

17 their disease and their treatment, and such effects 

18 can have a serious adverse impact on the effective19 ness of their treatment, their health, well-being, and 

20 quality of life; 

21 (2) with the number of cancer survivors con22 tinuing to grow, addressing the effects of their 

23 symptoms and side effects is becoming increasingly 

24 critical in reducing the burden of cancer and its 

25 treatments; 


smartinez on DSK6TPTVN1PROD with BILLS
11 

•HR 1661 IH

1 (3) although research is producing new insights 

2 into the causes of and cures for cancer, efforts to 

3 manage the symptoms and side effects of the disease 

4 and its treatments have not kept pace; and 

5 (4) the National Institutes of Health should 

6 continue to support research in the area of symptom 

7 management and the role that nurses play in pro8 viding those interventions. 

9 SEC. 202. NIH RESEARCH ON CANCER SYMPTOM MANAGE10 MENT IMPROVEMENT. 

11 (a) IN GENERAL.—The Director of the National In12 stitutes of Health shall expand, intensify, and coordinate 

13 programs for the conduct and support of research with 

14 respect to— 

15 (1) improving the treatment and management 

16 of symptoms and side effects associated with cancer 

17 and cancer treatment; and 

18 (2) evaluating the role of nursing interventions 

19 in the amelioration of such symptoms and side ef20 fects. 

21 (b) ADMINISTRATION.—The Director of the National 

22 Institutes of Health is encouraged to carry out this section 

23 through the Director of the National Cancer Institute, in 

24 collaboration with at least the directors of the National 

25 Institute of Nursing Research, the National Institute of 


smartinez on DSK6TPTVN1PROD with BILLS
12 

•HR 1661 IH

1 Neurological Disorders and Stroke, the National Institute 

2 of Mental Health, the National Center on Minority Health 

3 and Health Disparities, the National Center for Com4 plementary and Alternative Medicine, and the Agency for 

5 Healthcare Research and Quality. 

Æ 


smartinez on DSK6TPTVN1PROD with BILLS