I 

111TH CONGRESS 

1ST SESSION H. R. 1927 

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 2, 2009 

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 ‘‘Assuring and Improving Cancer Treatment Education 

6 and Cancer Symptom Management Act of 2009’’. 


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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 which increased after pro6 gram 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 Nov 24 2008 03:17 Apr 08, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927

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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), as amended by section 152 

14 of the Medicare Improvements for Patients and Providers 

15 Act of 2008 (Public Law 110–275), is amended— 

16 (1) in subsection (s)(2)— 

17 (A) by striking ‘‘and’’ at the end of sub18 paragraph (DD); 

19 (B) by adding ‘‘and’’ at the end of sub20 paragraph (EE); and 

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

22 subparagraph: 

23 ‘‘(FF) comprehensive cancer patient treatment 

24 education services (as defined in subsection 

25 (hhh)(1));’’; and 


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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘Comprehensive Cancer Patient Treatment Education 

4 Services 

5 ‘‘(hhh)(1) The term ‘comprehensive cancer patient 

6 treatment education services’ means— 

7 ‘‘(A) in the case of an individual who is diag8 nosed with cancer, the provision of a one-hour pa9 tient treatment education session delivered by a reg10 istered nurse that— 

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

12 caregiver (or caregivers) of the individual in ad13 vance of the onset of treatment and to the ex14 tent practicable, is not furnished on the day of 

15 diagnosis or on the first day of treatment; 

16 ‘‘(ii) educates the individual and such care17 giver (or caregivers) to the greatest extent prac18 ticable, about all aspects of the care to be fur19 nished to the individual, informs the individual 

20 regarding any potential symptoms, side-effects, 

21 or adverse events, and explains ways in which 

22 side effects and adverse events can be mini23 mized and health and well-being maximized, 

24 and provides guidance regarding those side efVerDate Nov 24 2008 03:17 Apr 08, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927

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1 fects to be reported and to which health care 

2 provider the side effects should be reported; 

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

4 form, of information about the course of treat5 ment, any responsibilities of the individual with 

6 respect to self-dosing, and ways in which to ad7 dress symptoms and side-effects; and 

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

9 practicable, in an oral, written, or electronic 

10 form that appropriately takes into account cul11 tural and linguistic needs of the individual in 

12 order to make the information comprehensible 

13 to the individual and such caregiver (or care14 givers); and 

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

16 course of cancer treatment or therapy is materially 

17 modified, a one-hour patient treatment education 

18 session described in subparagraph (A), including up19 dated information on the matters described in such 

20 subparagraph should the individual’s oncologic 

21 health care professional deem it appropriate and 

22 necessary. 

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

24 (1), the Secretary shall consult with appropriate organiza25 tions representing providers of oncology patient treatment 


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1 education services and organizations representing people 

2 with cancer.’’. 

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

4 U.S.C. 1395l(a)(1)), as amended by section 101 of the 

5 Medicare Improvements for Patients and Providers Act of 

6 2008 (Public Law 110–275), is amended— 

7 (1) by striking ‘‘and’’ before ‘‘(W)’’; and 

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

9 the following: ‘‘, and (X) with respect to comprehen10 sive cancer patient treatment education service (as 

11 defined in section 1861(hhh)(1)), 150 percent of the 

12 payment rate established under section 1848 for dia13 betes outpatient self-management training services 

14 (as defined in section 1861(qq)), determined and ap15 plied without regard to any coinsurance’’. 

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

17 U.S.C. 1395y(a)(1)) is amended— 

18 (1) in subparagraph (M), by striking ‘‘or’’ at 

19 the end; 

20 (2) in subparagraph (N), by striking the semi21 colon at the end and inserting ‘‘, and’’; and 

22 (3) by adding at the end the following new sub23 paragraph: 

24 ‘‘(O) in the case of comprehensive cancer pa25 tient treatment education services (as defined in 


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1 subsection (hhh)(1)) which are performed more fre2 quently than is covered under such section;’’. 

3 (d) NO IMPACT ON PAYMENT FOR OTHER SERV4 ICES.—Nothing in this section shall be construed to affect 

5 or otherwise authorize any reduction or modification, in 

6 the Medicare payment amounts otherwise established for 

7 chemotherapy infusion or injection codes with respect to 

8 the calculation and payment of minutes for chemotherapy 

9 teaching or related services. 

10 (e) EFFECTIVE DATE.—The amendments made by 

11 this section shall apply to services furnished on or after 

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

13 the date of the enactment of this Act. 

14 TITLE II—RESEARCH ON CAN15 CER SYMPTOM MANAGEMENT 

16 IMPROVEMENT 

17 SEC. 201. EXPANSION OF RESEARCH. 

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

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

20 at the end the following: 

21 ‘‘SEC. 417G. RESEARCH ON CANCER SYMPTOM MANAGE22 MENT IMPROVEMENT. 

23 ‘‘(a) IN GENERAL.—The Director of NIH shall ex24 pand, intensify, and coordinate programs for the conduct 

25 and support of research with respect to— 


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1 ‘‘(1) improving the treatment and management 

2 of symptoms and side effects associated with cancer 

3 and cancer treatment; and 

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

5 in the amelioration of such symptoms and side ef6 fects. 

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

8 carry out this section— 

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

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

11 National Institute of Nursing Research, the Na12 tional Institute of Mental Health, the National Cen13 ter on Minority Health and Health Disparities, the 

14 National Center for Complementary and Alternative 

15 Medicine, and the Agency for Healthcare Research 

16 and Quality.’’. 

17 SEC. 202. NURSING INTERVENTION RESEARCH GRANTS. 

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

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

20 201, is amended by adding at the end the following: 

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

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

23 grants for research to be conducted— 

24 ‘‘(1) with a registered nurse as the principal in25 vestigator; and 


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1 ‘‘(2) for the purpose of studying cancer symp2 tom management care and services delivered by reg3 istered nurses to cancer patients. 

4 ‘‘(b) INCLUSION OF NATIONAL RESEARCH INSTI5 TUTES.—In carrying out this section, the Director of NIH 

6 shall provide for the participation of the National Cancer 

7 Institute, the National Institute of Nursing Research, and 

8 any other national research institute that has been en9 gaged in research described subsection (a)(2). 

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

11 are authorized to be appropriated to carry out this section 

12 such sums as may be necessary for fiscal years 2010 

13 through 2014.’’. 

14 SEC. 203. INSTITUTE OF MEDICINE STUDY ON THE PROVI15 SION OF SYMPTOM MANAGEMENT AND SUP16 PORTIVE CARE IN PEOPLE WITH CANCER. 

17 (a) REPORT.— 

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

19 after the date of enactment of this Act, the Sec20 retary of Health and Human Services (in this sec21 tion referred to as the ‘‘Secretary’’) shall enter into 

22 an arrangement under which the Institute of Medi23 cine of the National Academy of Sciences (in this 

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

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


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1 current state of symptom management, patient 

2 treatment education, and supportive care given to 

3 people with cancer. 

4 (2) SPECIFIC MATTERS EVALUATED.—In con5 ducting the study and evaluation under paragraph 

6 (1), the Institute shall— 

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

8 delivery of, symptom management, patient 

9 treatment education, and supportive care to 

10 people with cancer; 

11 (B) catalogue and evaluate the incentives 

12 and disincentives in the current reimbursement 

13 system that influence whether individuals re14 ceive comprehensive symptom management, pa15 tient treatment education, and supportive care, 

16 including adequate and ongoing patient treat17 ment education; 

18 (C) evaluate the importance of nursing 

19 interventions in the management of symptoms 

20 and side effects of cancer and the associated 

21 treatment; 

22 (D) consider such other matters as the In23 stitute determines appropriate; and 


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1 (E) make recommendations to address any 

2 barriers, challenges, or other issues identified 

3 through the study and evaluation. 

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

5 study and evaluation, the Institute shall consider a 

6 variety of perspectives, including the perspectives of 

7 patients and their family caregivers, registered 

8 nurses, including nurses certified in oncology, physi9 cians, social workers, psychologists, other health care 

10 professionals, and other experts and stakeholders. 

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

12 date of enactment of this Act, the arrangement under sub13 section (a) shall provide for the Institute to submit to the 

14 Secretary and to Congress a report on the study evalua15 tion conducted under such subsection. Such report shall 

16 contain a detailed description of the findings of such study 

17 and evaluation and recommendations for improving the 

18 provision of symptom management, patient treatment edu19 cation, and supportive care to people with cancer. 

20 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

21 are authorized to be appropriated such sums as may be 

22 necessary for the purposes of conducting the study and 

23 evaluation, and preparing the report, required by this sec24 tion. 

Æ 


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