I 

111TH CONGRESS 

1ST SESSION H. R. 1844 

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 a Medicare hospice care demonstration program and 

grants programs for cancer palliative care and symptom management 

programs, provider education, and related research. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 1, 2009 

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 a Medicare hospice care demonstration program 

and grants programs for cancer palliative care and symptom management programs, 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 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Comprehensive Cancer Care Improvement Act of 2009’’. 

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

5 this Act is as follows: 

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. 

Sec. 102. Demonstration project to provide comprehensive cancer care symptom 

management services under Medicare. 

TITLE II—COMPREHENSIVE PALLIATIVE CARE AND SYMPTOM 

MANAGEMENT PROGRAMS 

Sec. 201. Grants for comprehensive palliative care and symptom management 

programs. 

TITLE III—PROVIDER EDUCATION REGARDING PALLIATIVE CARE 

AND SYMPTOM MANAGEMENT 

Sec. 301. Grants to improve health professional education. 

Sec. 302. Grants to Improve Continuing Professional Education. 

TITLE IV—RESEARCH ON END-OF-LIFE TOPICS FOR CANCER 

PATIENTS 

Sec. 401. Research program. 

6 SEC. 2. FINDINGS. 

7 The Congress makes the following findings: 

8 (1) Individuals with cancer often do not have 

9 access to a cancer care system that provides com10 prehensive and coordinated care of high quality. 

11 (2) The cancer care system has not traditionally 

12 offered individuals with cancer a prospective and 

13 comprehensive plan for treatment and symptom 

14 management, strategies for updating and evaluating 


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1 such plan with the assistance of a health care pro2 fessional, and a follow-up plan for monitoring and 

3 treating possible late effects of cancer and its treat4 ment. 

5 (3) Cancer survivors often experience the 

6 under-diagnosis and under-treatment of the symp7 toms of cancer, a problem that begins at the time 

8 of diagnosis and often becomes more severe at the 

9 end of life. The failure to treat the symptoms, side 

10 effects, and late effects of cancer and its treatment 

11 may have a serious adverse impact on the health, 

12 well-being, and quality of life of cancer survivors. 

13 (4) Cancer survivors who are members of racial 

14 and ethnic minority groups may face special obsta15 cles in receiving cancer care that is coordinated and 

16 includes appropriate management of cancer symp17 toms and treatment side effects. 

18 (5) Individuals with cancer are sometimes put 

19 in the untenable position of choosing between poten20 tially curative therapies and palliative care instead of 

21 being assured access to comprehensive care that in22 cludes appropriate treatment and symptom manage23 ment. 

24 (6) Comprehensive cancer care should incor25 porate access to psychosocial services and manageVerDate Nov 24 2008 22:59 Apr 02, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1844.IH H1844

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1 ment of the symptoms of cancer (and the symptoms 

2 of its treatment), including pain, nausea and vom3 iting, fatigue, and depression. 

4 (7) Comprehensive cancer care should include a 

5 means for providing cancer survivors with a com6 prehensive care summary and a plan for follow-up 

7 care after primary treatment to ensure that cancer 

8 survivors have access to follow-up monitoring and 

9 treatment of possible late effects of cancer and can10 cer treatment. 

11 (8) The Institute of Medicine report, ‘‘Ensuring 

12 Quality Cancer Care’’, described the elements of 

13 quality care for an individual with cancer to in14 clude— 

15 (A) the development of initial treatment 

16 recommendations by an experienced health care 

17 provider; 

18 (B) the development of a plan for the 

19 course of treatment of the individual and com20 munication of the plan to the individual; 

21 (C) access to the resources necessary to 

22 implement the course of treatment; 

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

24 (E) a mechanism to coordinate services for 

25 the treatment of the individual; and 


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1 (F) psychosocial support services and com2 passionate care for the individual. 

3 (9) In its report, ‘‘From Cancer Patient to 

4 Cancer Survivor: Lost in Transition’’, the Institute 

5 of Medicine recommended that individuals with can6 cer completing primary treatment be provided a 

7 comprehensive summary of their care along with a 

8 follow-up survivorship plan of treatment. 

9 (10) Since more than half of all cancer diag10 noses occur among elderly Medicare beneficiaries, 

11 the problems of providing cancer care are problems 

12 of the Medicare program. 

13 (11) Shortcomings in providing cancer care, re14 sulting in inadequate management of cancer symp15 toms and insufficient monitoring and treatment of 

16 late effects of cancer and its treatment, are related 

17 to problems of Medicare payments for such care, in18 adequate professional training, and insufficient in19 vestment in research on symptom management. 

20 (12) Changes in Medicare payment for com21 prehensive cancer care, enhanced public and profes22 sional education regarding symptom management, 

23 and more research related to symptom management 

24 and palliative care will enhance patient decision25 making about treatment options and will contribute 


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1 to improved care for individuals with cancer from 

2 the time of diagnosis of the individual through the 

3 end of the life of the individual. 

4 TITLE I—COMPREHENSIVE CAN5 CER CARE UNDER THE MEDI6 CARE PROGRAM 

7 SEC. 101. COVERAGE OF CANCER CARE PLANNING SERV8 ICES. 

9 (a) IN GENERAL.—Section 1861 of the Social Secu10 rity Act is amended— 

11 (1) in subsection (s)(2)— 

12 (A) by striking ‘‘and’’ at the end of sub13 paragraph (DD); 

14 (B) by adding ‘‘and’’ at the end of sub15 paragraph (EE); and 

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

17 subparagraph: 

18 ‘‘(FF) comprehensive cancer care planning 

19 services (as defined in subsection (hhh));’’; and 

20 (2) by adding at the end the following new sub21 section: 

22 ‘‘Comprehensive Cancer Care Planning Services 

23 ‘‘(hhh)(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 and comprehensive 

9 symptom management (such as palliative 

10 care) involved; 

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

12 the individual in person within a period 

13 specified by the Secretary that is as soon 

14 as practicable after the date on which the 

15 individual is so diagnosed; 

16 ‘‘(iii) is furnished, to the greatest ex17 tent practicable, in a form that appro18 priately takes into account cultural and 

19 linguistic needs of the individual in order 

20 to make the plan accessible to the indi21 vidual; and 

22 ‘‘(iv) is in accordance with standards 

23 determined by the Secretary to be appro24 priate; 


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

2 whom a plan of care has been developed under 

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

4 care as necessary to account for any substantial 

5 change in the condition of the individual, if 

6 such revision— 

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

8 and (iii) 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 completion of 

16 chemotherapy or radiation treatment), the de17 velopment of a follow-up cancer care plan 

18 that— 

19 ‘‘(i) describes the elements of the pri20 mary treatment, including symptom man21 agement, furnished to such individual; 

22 ‘‘(ii) provides recommendations for 

23 the subsequent care of the individual with 

24 respect to the cancer involved; 


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

2 the individual in person 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, if such revision— 

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

22 (ii), and (iv) of such subparagraph; and 

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

24 the individual within a period specified by 


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1 the Secretary that is as soon as practicable 

2 after the date of such revision. 

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

4 out paragraph (1) in consultation with appropriate organi5 zations representing providers of services related to cancer 

6 treatment and organizations representing survivors of can7 cer. Such standards shall include standards for deter8 mining the need and frequency for revisions of the plans 

9 of care and follow-up plans based on changes in the condi10 tion of the individual and standards for the communica11 tion of the plan to the patient.’’. 

12 (b) PAYMENT.—Section 1833(a)(1) of the Social Se13 curity Act (42 U.S.C. 1395l(a)(1)) is amended by striking 

14 ‘‘and’’ before ‘‘(W)’’ and inserting before the semicolon 

15 at the end the following: ‘‘, and (X) with respect to com16 prehensive cancer care planning services described in any 

17 of subparagraphs (A) through (D) of section 

18 1861(hhh)(1), the amount paid shall be an amount equal 

19 to the sum of (i) the national average amount under the 

20 physician fee schedule established under section 1848 for 

21 a new patient office consultation of the highest level of 

22 service in the non-facility setting, and (ii) the national av23 erage amount under such fee schedule for a physician cer24 tification described in section 1814(a)(2) for home health 


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1 services furnished to an individual by a home health agen2 cy under a home health plan of care’’. 

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

4 this section shall apply to services furnished on or after 

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

6 the date of the enactment of this Act. 

7 SEC. 102. DEMONSTRATION PROJECT TO PROVIDE COM8 PREHENSIVE CANCER CARE SYMPTOM MAN9 AGEMENT SERVICES UNDER MEDICARE. 

10 (a) IN GENERAL.—Beginning not later than 180 

11 days after the date of the enactment of this Act, the Sec12 retary of Health and Human Services (in this section re13 ferred to as the ‘‘Secretary’’) shall conduct a two-year 

14 demonstration project (in this section referred to as the 

15 ‘‘demonstration project’’) under title XVIII of the Social 

16 Security Act under which payment shall be made under 

17 such title for comprehensive cancer care symptom man18 agement services, including items and services described 

19 in subparagraphs (A) through (I) of section 1861(dd)(1) 

20 of the Social Security Act, furnished by an eligible entity, 

21 in accordance with a plan developed under subparagraph 

22 (A) or (C) of section 1861(hhh)(1) of such Act, as added 

23 by section 101(a). Sections 1812(d) and 1814(a)(7) of 

24 such Act (42 U.S.C. 1395d(d), 1395f(a)(7)) are not appli25 cable to items and services furnished under the demVerDate Nov 24 2008 22:59 Apr 02, 2009 Jkt 079200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1844.IH H1844

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1 onstration project. Participation of Medicare beneficiaries 

2 in the demonstration project shall be voluntary. 

3 (b) QUALIFICATIONS AND SELECTION OF ELIGIBLE

4 ENTITIES.— 

5 (1) QUALIFICATIONS.—For purposes of sub6 section (a), the term ‘‘eligible entity’’ means an enti7 ty (such as a cancer center, hospital, academic 

8 health center, hospice program, physician practice, 

9 school of nursing, visiting nurse association, or other 

10 home health agency) that the Secretary determines 

11 is capable, directly or through an arrangement with 

12 a hospice program (as defined in section 

13 1861(dd)(2) of the Social Security Act (42 U.S.C. 

14 1395x(dd)(2))), of providing the items and services 

15 described in such subsection. 

16 (2) SELECTION.—The Secretary shall select not 

17 more than 10 eligible entities to participate in the 

18 demonstration project. Such entities shall be selected 

19 in a manner so that the demonstration project is 

20 conducted in different regions across the United 

21 States and in urban and rural locations. 

22 (c) EVALUATION AND REPORT.— 

23 (1) EVALUATION.—The Secretary shall conduct 

24 a comprehensive evaluation of the demonstration 

25 project to determine— 


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1 (A) the effectiveness of the project in im2 proving patient outcomes; 

3 (B) the cost of providing comprehensive 

4 symptom management, including palliative care, 

5 from the time of diagnosis; 

6 (C) the effect of comprehensive cancer care 

7 planning and the provision of comprehensive 

8 symptom management on patient outcomes, 

9 cancer care expenditures, and the utilization of 

10 hospitalization and emergent care services; and 

11 (D) potential savings to the Medicare pro12 gram demonstrated by the project. 

13 (2) REPORT.—Not later than the date that is 

14 one year after the date on which the demonstration 

15 project concludes, the Secretary shall submit to Con16 gress a report on the evaluation conducted under 

17 paragraph (1). 

18 TITLE II—COMPREHENSIVE PAL19 LIATIVE CARE AND SYMPTOM 

20 MANAGEMENT PROGRAMS 

21 SEC. 201. GRANTS FOR COMPREHENSIVE PALLIATIVE CARE 

22 AND SYMPTOM MANAGEMENT PROGRAMS. 

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

24 Human Services shall make grants to eligible entities for 

25 the purpose of— 


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1 (1) establishing a new palliative care and symp2 tom management program for cancer patients; or 

3 (2) expanding an existing palliative care and 

4 symptom management program for cancer patients. 

5 (b) AUTHORIZED ACTIVITIES.—Activities funded 

6 through a grant under this section may include— 

7 (1) securing consultative services and advice 

8 from institutions with extensive experience in devel9 oping and managing comprehensive palliative care 

10 and symptom management programs; 

11 (2) expanding an existing program to serve 

12 more patients or enhance the range or quality of 

13 services, including cancer treatment patient edu14 cation services, that are provided; 

15 (3) developing a program that would ensure the 

16 inclusion of cancer treatment patient education in 

17 the coordinated cancer care model; and 

18 (4) establishing an outreach program to partner 

19 with an existing comprehensive care program and 

20 obtain expert consultative services and advice. 

21 (c) DISTRIBUTION OF FUNDS.—In making grants 

22 and distributing the funds under this section, the Sec23 retary shall ensure that— 

24 (1) two-thirds of the funds appropriated to 

25 carry out this section for each fiscal year are used 


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1 for establishing new palliative care and symptom 

2 management programs, of which not less than half 

3 of such two-thirds shall be for programs in medically 

4 underserved communities to address issues of racial 

5 and ethnic disparities in access to cancer care; and 

6 (2) one-third of the funds appropriated to carry 

7 out this section for each fiscal year are used for ex8 panding existing palliative care and symptom man9 agement programs. 

10 (d) DEFINITIONS.—In this section: 

11 (1) The term ‘‘eligible entity’’ includes— 

12 (A) an academic medical center, a cancer 

13 center, a hospital, a school of nursing, or a 

14 health system capable of administering a pallia15 tive care and symptom management program 

16 for cancer patients; 

17 (B) a physician practice with care teams, 

18 including nurses and other professionals trained 

19 in palliative care and symptom management; 

20 (C) a visiting nurse association or other 

21 home care agency with experience administering 

22 a palliative care and symptom management pro23 gram; 

24 (D) a hospice; and 


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1 (E) any other health care agency or entity, 

2 as the Secretary determines appropriate. 

3 (2) The term ‘‘medically underserved commu4 nity’’ has the meeting given to that term in section 

5 799B(6) of the Public Health Service Act (42 

6 U.S.C. 295p(6)). 

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

8 of Health and Human Services. 

9 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

10 out this section, there are authorized to be appropriated 

11 such sums as may be necessary for each of the fiscal years 

12 2010 through 2014. 

13 TITLE III—PROVIDER EDU14 CATION REGARDING PALLIA15 TIVE CARE AND SYMPTOM 

16 MANAGEMENT 

17 SEC. 301. GRANTS TO IMPROVE HEALTH PROFESSIONAL 

18 EDUCATION. 

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

20 Human Services shall make grants to eligible entities to 

21 enable the entities to improve the quality of graduate and 

22 postgraduate training of physicians, nurses, and other 

23 health care providers in palliative care and symptom man24 agement for cancer patients. 


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1 (b) APPLICATION.—To seek a grant under this sec2 tion, an eligible entity shall submit an application at such 

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

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

5 shall require that each such application demonstrate— 

6 (1) the ability to incorporate palliative care and 

7 symptom management into training programs; and 

8 (2) the ability to collect and analyze data re9 lated to the effectiveness of educational efforts. 

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

11 implement a plan for evaluating the effects of professional 

12 training programs funded through this section. 

13 (d) DEFINITIONS.—In this section: 

14 (1) The term ‘‘eligible entity’’ means a cancer 

15 center (including an NCI-designated cancer center), 

16 an academic health center, a physician practice, a 

17 school of nursing, or a visiting nurse association or 

18 other home care agency. 

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

20 means a cancer center receiving funds through a 

21 P30 Cancer Center Support Grant of the National 

22 Cancer Institute. 

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

24 of Health and Human Services. 


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1 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there are authorized to be appropriated 

3 such sums as may be necessary for each of the fiscal years 

4 2010 through 2014. 

5 SEC. 302. GRANTS TO IMPROVE CONTINUING PROFES6 SIONAL EDUCATION. 

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

8 Human Services shall make grants to eligible entities to 

9 improve the quality of continuing professional education 

10 provided to qualified individuals regarding palliative care 

11 and symptom management. 

12 (b) APPLICATION.—To seek a grant under this sec13 tion, an eligible entity shall submit an application at such 

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

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

16 shall require that each such application demonstrate— 

17 (1) experience in sponsoring continuing profes18 sional education programs; 

19 (2) the ability to reach health care providers 

20 and other professionals who are engaged in cancer 

21 care; 

22 (3) the capacity to develop innovative training 

23 programs; and 

24 (4) the ability to evaluate the effectiveness of 

25 educational efforts. 


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

2 implement a plan for evaluating the effects of continuing 

3 professional education programs funded through this sec4 tion. 

5 (d) DEFINITIONS.—In this section: 

6 (1) The term ‘‘eligible entity’’ means a cancer 

7 center (including an NCI-designated cancer center), 

8 an academic health center, a school of nursing, or a 

9 professional society that supports continuing profes10 sional education programs. 

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

12 means a cancer center receiving funds through a 

13 P30 Cancer Center Support Grant of the National 

14 Cancer Institute. 

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

16 physician, nurse, social worker, chaplain, psycholo17 gist, or other individual who is involved in providing 

18 palliative care and symptom management services to 

19 cancer patients. 

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

21 of Health and Human Services. 

22 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

23 out this section, there are authorized to be appropriated 

24 such sums as may be necessary for each of the fiscal years 

25 2010 through 2014. 


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1 TITLE IV—RESEARCH ON END2 OF-LIFE TOPICS FOR CANCER 

3 PATIENTS 

4 SEC. 401. RESEARCH PROGRAM. 

5 (a) IN GENERAL.—The Director of the National In6 stitutes of Health shall establish a program of grants for 

7 research on palliative care, symptom management, com8 munication skills, and other end-of-life topics for cancer 

9 patients. 

10 (b) INCLUSION OF NATIONAL RESEARCH INSTI11 TUTES.—In carrying out the program established under 

12 this section, the Director should provide for the participa13 tion of the National Cancer Institute, the National Insti14 tute of Nursing Research, and any other national research 

15 institute that has been engaged in research described in 

16 subsection (a). 

17 (c) DEFINITIONS.—In this section: 

18 (1) The term ‘‘Director’’ means the Director of 

19 the National Institutes of Health. 

20 (2) The term ‘‘national research institute’’ has 

21 the meaning given to that term in section 401(g) of 

22 the Public Health Service Act (42 U.S.C. 281(g)). 

23 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

24 out this section, there are authorized to be appropriated 


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1 such sums as may be necessary for each of the fiscal years 

2 2010 through 2014. 

Æ 


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