I 

113TH CONGRESS 

1ST SESSION H. R. 2477 

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 

JUNE 25, 2013 

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 cancer care planning and coordination 

under the Medicare program. 

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. 

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

5 ‘‘Planning Actively for Cancer Treatment (PACT) Act of 

6 2013’’. 

7 (b) FINDINGS.—Congress makes the following find8 ings: 


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1 (1) Individuals with cancer often do not have 

2 access to a cancer care system that incorporates 

3 shared decision-making and the coordination of all 

4 elements of care. 

5 (2) The cancer care system has not traditionally 

6 offered individuals with cancer a shared decision7 making process, a prospective and comprehensive 

8 plan for treatment, symptom management and sup9 portive care, strategies for updating and evaluating 

10 such plan with the assistance of a health care pro11 fessional, and a follow-up plan for monitoring and 

12 treating possible late effects of cancer and its treat13 ment. 

14 (3) Cancer survivors often experience the 

15 under-diagnosis and under-treatment of the symp16 toms of cancer, a problem that begins at the time 

17 of diagnosis and may become more severe with dis18 ease progression and at the end of life. The failure 

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

20 of cancer and cancer treatment may have a serious 

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

22 and quality of life of cancer survivors. 

23 (4) The 1999 Institute of Medicine report enti24 tled ‘‘The Unequal Burden of Cancer’’ found that 

25 low-income people often lack access to adequate canVerDate Mar 15 2010 01:32 Jun 27, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.IH H2477

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1 cer care and that ethnic minorities have not bene2 fitted fully from cancer treatment advances. 

3 (5) Individuals with cancer often do not partici4 pate in a shared decision-making process that con5 siders all treatment options and do not benefit from 

6 coordination of all elements of active treatment and 

7 palliative care. 

8 (6) Quality cancer care should incorporate ac9 cess to psychosocial services and management of the 

10 symptoms of cancer and the symptoms of cancer 

11 treatment, including pain, nausea, vomiting, fatigue, 

12 and depression. 

13 (7) Quality cancer care should include a means 

14 for engaging cancer survivors in a shared decision15 making process that produces a comprehensive care 

16 summary and a plan for follow-up care after primary 

17 treatment to ensure that cancer survivors have ac18 cess to follow-up monitoring and treatment of pos19 sible late effects of cancer and cancer treatment, in20 cluding appropriate psychosocial services. 

21 (8) The Institute of Medicine report entitled 

22 ‘‘Ensuring Quality Cancer Care’’ described the ele23 ments of quality care for an individual with cancer 

24 to include— 


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1 (A) the development of initial treatment 

2 recommendations by an experienced health care 

3 provider; 

4 (B) the development of a plan for the 

5 course of treatment of the individual and com6 munication of the plan to the individual; 

7 (C) access to the resources necessary to 

8 implement the course of treatment; 

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

10 (E) a mechanism to coordinate services for 

11 the treatment of the individual; and 

12 (F) psychosocial support services and com13 passionate care for the individual. 

14 (9) In its report ‘‘From Cancer Patient to Can15 cer Survivor: Lost in Transition’’, the Institute of 

16 Medicine recommended that individuals with cancer 

17 completing primary treatment be provided a com18 prehensive summary of their care along with a fol19 low-up survivorship plan of treatment. 

20 (10) In ‘‘Cancer Care for the Whole Patient’’, 

21 the Institute of Medicine stated that the develop22 ment of a plan that includes biomedical and psycho23 social care should be a standard for quality cancer 

24 care in any quality measurement system. 


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1 (11) Because more than half of all cancer diag2 noses occur among elderly Medicare beneficiaries, 

3 cancer care inadequacies should be addressed 

4 through the Medicare program. 

5 (12) Shortcomings in providing cancer care, re6 sulting in a lack of shared decision-making, inad7 equate management of cancer symptoms, and insuf8 ficient monitoring and treatment of late effects of 

9 cancer and its treatment, relate in part to the inad10 equacy of Medicare payments for such planning and 

11 coordination services. 

12 (13) Changes in Medicare payment for cancer 

13 care planning and coordination will support shared 

14 decision-making that reviews all treatment options 

15 and will contribute to improved care for individuals 

16 with cancer from the time of diagnosis through the 

17 end of the life. 

18 SEC. 2. COVERAGE OF CANCER CARE PLANNING AND CO19 ORDINATION SERVICES. 

20 (a) IN GENERAL.—Section 1861 of the Social Secu21 rity Act (42 U.S.C. 1395x) is amended— 

22 (1) in subsection (s)(2)— 

23 (A) by striking ‘‘and’’ at the end of sub24 paragraph (EE); 


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1 (B) by adding ‘‘and’’ at the end of sub2 paragraph (FF); and 

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

4 subparagraph: 

5 ‘‘(GG) cancer care planning and coordination 

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

7 (2) by adding at the end the following new sub8 section: 

9 ‘‘Cancer Care Planning and Coordination Services 

10 ‘‘(iii)(1) The term ‘cancer care planning and coordi11 nation services’ means— 

12 ‘‘(A) with respect to an individual who is diag13 nosed with cancer, the development of a treatment 

14 plan by a physician, nurse practitioner, or physician 

15 assistant that— 

16 ‘‘(i) includes an assessment of the individ17 ual’s diagnosis, health status, treatment needs, 

18 functional status, pain control, and psychosocial 

19 needs; 

20 ‘‘(ii) engages the individual in a shared de21 cision-making process that reviews all treatment 

22 options; 

23 ‘‘(iii) details, to the greatest extent prac24 ticable all aspects of the care to be provided to 

25 the individual with respect to the treatment of 


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1 such cancer, including any curative treatment, 

2 comprehensive symptom management, and pal3 liative care; 

4 ‘‘(iv) is furnished in person, in written 

5 form, to the individual within a period specified 

6 by the Secretary that is as soon as practicable 

7 after the date on which the individual is so di8 agnosed; 

9 ‘‘(v) is furnished, to the greatest extent 

10 practicable, in a form that appropriately takes 

11 into account cultural and linguistic needs of the 

12 individual in order to make the plan accessible 

13 to the individual; and 

14 ‘‘(vi) is in accordance with standards de15 termined by the Secretary to be appropriate; 

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

17 treatment plan has been developed under subpara18 graph (A), the revision of such treatment plan as 

19 necessary to account for any substantial change in 

20 the condition of the individual, recurrence of disease, 

21 changes in the individual’s treatment preferences, or 

22 significant revision of the elements of curative care 

23 or symptom management for the individual, if such 

24 revision— 


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1 ‘‘(i) is in accordance with clauses (i), (ii), 

2 (iv) and (v) of such subparagraph; and 

3 ‘‘(ii) is furnished in written form to the in4 dividual within a period specified by the Sec5 retary that is as soon as practicable after the 

6 date of such revision; 

7 ‘‘(C) with respect to an individual who has com8 pleted the primary treatment for cancer, as defined 

9 by the Secretary, the development of a follow-up sur10 vivorship care plan that— 

11 ‘‘(i) includes an assessment of the individ12 ual’s diagnosis, health status, treatment needs, 

13 functional status, pain control, and psychosocial 

14 needs; 

15 ‘‘(ii) engages the individual in a shared de16 cision-making process that reviews all survivor17 ship care options; 

18 ‘‘(iii) describes the elements of the primary 

19 treatment, including symptom management and 

20 palliative care, furnished to such individual; 

21 ‘‘(iv) provides recommendations for the 

22 subsequent care of the individual with respect 

23 to the cancer involved; 

24 ‘‘(v) is furnished, in person, in written 

25 form, to the individual within a period specified 


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1 by the Secretary that is as soon as practicable 

2 after the completion of such primary treatment; 

3 ‘‘(vi) is furnished, to the greatest extent 

4 practicable, in a form that appropriately takes 

5 into account cultural and linguistic needs of the 

6 individual in order to make the plan accessible 

7 to the individual; and 

8 ‘‘(vii) is in accordance with standards de9 termined by the Secretary to be appropriate; 

10 and 

11 ‘‘(D) with respect to an individual for whom a 

12 follow-up cancer care plan has been developed under 

13 subparagraph (C), the revision of such plan as nec14 essary to account for any substantial change in the 

15 condition of the individual, diagnosis of a second 

16 cancer, change in the individual’s preference for sur17 vivorship care, or significant revision of the plan for 

18 follow-up care, if such revision— 

19 ‘‘(i) is in accordance with clauses (i), (ii), 

20 (iii), (v), and (vi) of such subparagraph; and 

21 ‘‘(ii) is furnished in written form to the in22 dividual within a period specified by the Sec23 retary that is as soon as practicable after the 

24 date of such revision. 


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1 ‘‘(2) The Secretary shall establish standards to carry 

2 out paragraph (1) in consultation with appropriate organi3 zations representing suppliers and providers of services re4 lated to cancer treatment and organizations representing 

5 survivors of cancer. Such standards shall include stand6 ards for determining the need and frequency for revisions 

7 of the treatment plans and follow-up survivorship care 

8 plans based on changes in the condition of the individual 

9 or elements and intent of treatment and standards for the 

10 communication of the plan to the individual. 

11 ‘‘(3) In this subsection, the term ‘shared decision12 making process’ means, with respect to an individual, a 

13 process in which the individual and the individual’s health 

14 care providers consider the individual’s diagnosis, treat15 ment options, the medical evidence related to treatment 

16 options, the risks and benefits of all treatment options, 

17 and the individual’s preferences regarding treatment, and 

18 then jointly develop and implement a treatment plan.’’. 

19 (b) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

20 (1) IN GENERAL.—Section 1848(j)(3) of the 

21 Social Security Act (42 U.S.C. 1395w–4(j)(3)) is 

22 amended by inserting ‘‘(GG),’’ after ‘‘health risk as23 sessment),’’. 

24 (2) INITIAL RATES.—Unless the Secretary of 

25 Health and Human Services otherwise provides, the 


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1 payment rate specified under the physician fee 

2 schedule under the amendment made by paragraph 

3 (1) for cancer care planning and coordination serv4 ices shall be the same payment rate as provided for 

5 transitional care management services (as defined in 

6 CPT code 99496). 

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

8 this section shall apply to services furnished on or after 

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

10 the date of the enactment of this Act. 

Æ 


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