II 

112TH CONGRESS 

2D SESSION S. 2097 

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 grants programs for provider education, and related research. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 9, 2012 

Ms. LANDRIEU introduced the following bill; which was read twice and 

referred to the Committee on Finance 

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 grants programs for 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, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Comprehensive Cancer Care Improvement Act of 2012’’. 


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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 CARE UNDER THE 

MEDICARE PROGRAM 

Sec. 101. Coverage of cancer care planning services. 

TITLE II—PROVIDER EDUCATION REGARDING PALLIATIVE CARE 

AND SYMPTOM MANAGEMENT 

Sec. 201. Grants to improve health professional education. 

Sec. 202. Grants to improve continuing professional education. 

TITLE III—RESEARCH ON TOPICS RELATED TO COORDINATION 

OF CARE, SYMPTOM MANAGEMENT, AND PALLIATIVE CARE 

FOR CANCER PATIENTS 

Sec. 301. Research program. 

3 SEC. 2. FINDINGS. 

4 Congress makes the following findings: 

5 (1) Individuals with cancer often do not have 

6 access to a cancer care system that provides com7 prehensive and coordinated care of high quality. 

8 (2) The cancer care system has not traditionally 

9 offered individuals with cancer a prospective and 

10 comprehensive plan for treatment and symptom 

11 management, strategies for updating and evaluating 

12 such plan with the assistance of a health care pro13 fessional, and a follow-up plan for monitoring and 

14 treating possible late effects of cancer and its treat15 ment. 

16 (3) Cancer survivors often experience the 

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1 toms of cancer, a problem that begins at the time 

2 of diagnosis and may become more severe with dis3 ease progression and at the end of life. The failure 

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

5 of cancer and cancer treatment may have a serious 

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

7 and quality of life of cancer survivors. 

8 (4) Cancer survivors who are members of racial 

9 and ethnic minority groups may face severe obsta10 cles in receiving coordinated cancer care that in11 cludes appropriate management of cancer symptoms 

12 and treatment of side effects. 

13 (5) Individuals with cancer are sometimes not 

14 provided information about their disease and treat15 ment options that might result in their request for, 

16 and engagement in, coordinated care that includes 

17 appropriate treatment and symptom management. 

18 (6) Comprehensive cancer care should incor19 porate access to psychosocial services and manage20 ment of the symptoms of cancer and the symptoms 

21 of cancer treatment, including pain, nausea, vom22 iting, fatigue, and depression. 

23 (7) Comprehensive cancer care should include a 

24 means for providing cancer survivors with a com25 prehensive care summary and a plan for follow-up 


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1 care after primary treatment to ensure that cancer 

2 survivors have access to follow-up monitoring and 

3 treatment of possible late effects of cancer and can4 cer treatment. 

5 (8) The Institute of Medicine report entitled 

6 ‘‘Ensuring Quality Cancer Care’’ described the ele7 ments of quality care for an individual with cancer, 

8 including— 

9 (A) the development of initial treatment 

10 recommendations by an experienced health care 

11 provider; 

12 (B) the development of a plan for the 

13 course of treatment of the individual and com14 munication of the plan to the individual; 

15 (C) access to the resources necessary to 

16 implement the course of treatment; 

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

18 (E) a mechanism to coordinate services for 

19 the treatment of the individual; and 

20 (F) psychosocial support services and com21 passionate care for the individual. 

22 (9) In its report ‘‘From Cancer Patient to Can23 cer Survivor: Lost in Transition’’, the Institute of 

24 Medicine recommended that individuals with cancer 

25 completing primary treatment be provided a comVerDate Mar 15 2010 05:28 Feb 10, 2012 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2097.IS S2097

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1 prehensive summary of their care along with a fol2 low-up survivorship plan of treatment. 

3 (10) Since more than half of all cancer diag4 noses occur among elderly Medicare beneficiaries, 

5 the problems of providing cancer care are problems 

6 of the Medicare program. 

7 (11) Shortcomings in providing cancer care, re8 sulting in inadequate management of cancer symp9 toms and insufficient monitoring and treatment of 

10 late effects of cancer and its treatment, are related 

11 to problems of Medicare payments for such care, in12 adequate professional training, and insufficient in13 vestment in research on symptom management. 

14 (12) Changes in Medicare payment for com15 prehensive cancer care, enhanced public and profes16 sional education regarding symptom management, 

17 and more research related to coordination of care, 

18 symptom management and palliative care will en19 hance patient decisionmaking about treatment op20 tions and will contribute to improved care for indi21 viduals with cancer from the time of diagnosis of the 

22 individual through the end of the life of the indi23 vidual. 


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1 TITLE I—COMPREHENSIVE CAN2 CER CARE UNDER THE MEDI3 CARE PROGRAM 

4 SEC. 101. COVERAGE OF CANCER CARE PLANNING SERV5 ICES. 

6 (a) IN GENERAL.—Section 1861 of the Social Secu7 rity Act is amended— 

8 (1) in subsection (s)(2)— 

9 (A) by striking ‘‘and’’ at the end of sub10 paragraph (EE); 

11 (B) by adding ‘‘and’’ at the end of sub12 paragraph (FF); and 

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

14 subparagraph: 

15 ‘‘(GG) comprehensive cancer care planning 

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

17 (2) by adding at the end the following new sub18 section: 

19 ‘‘Comprehensive Cancer Care Planning Services 

20 ‘‘(iii)(1) The term ‘comprehensive cancer care plan21 ning services’ means— 

22 ‘‘(A) with respect to an individual who is diag23 nosed with cancer, the development of a plan of care 

24 that— 


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1 ‘‘(i) details, to the greatest extent prac2 ticable, all aspects of the care to be provided to 

3 the individual, with respect to the treatment of 

4 such cancer, including any curative treatment, 

5 comprehensive symptom management, and pal6 liative care; 

7 ‘‘(ii) is furnished, in person, in written 

8 form to the individual within a period specified 

9 by the Secretary that is as soon as practicable 

10 after the date on which the individual is so di11 agnosed; 

12 ‘‘(iii) is furnished, to the greatest extent 

13 practicable, in a form that appropriately takes 

14 into account cultural and linguistic needs of the 

15 individual in order to make the plan accessible 

16 to the individual; and 

17 ‘‘(iv) is in accordance with standards de18 termined by the Secretary to be appropriate; 

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

20 plan of care has been developed under subparagraph 

21 (A), the revision of such plan of care as necessary 

22 to account for any substantial change in the condi23 tion of the individual, recurrence of disease, or sig24 nificant revision of the elements of curative or pallia25 tive care for the individual, if such revision— 


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

2 and (iv) 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 (such as completion of chemo10 therapy or radiation treatment), the development of 

11 a follow-up cancer care plan that— 

12 ‘‘(i) describes the elements of the primary 

13 treatment, including symptom management and 

14 palliative care, furnished to such individual; 

15 ‘‘(ii) provides recommendations for the 

16 subsequent care of the individual with respect 

17 to the cancer involved; 

18 ‘‘(iii) is furnished, in person, in written 

19 form, to the individual within a period specified 

20 by the Secretary that is as soon as practicable 

21 after the completion of such primary treatment; 

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

23 practicable, in a form that appropriately takes 

24 into account cultural and linguistic needs of the 


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1 individual in order to make the plan accessible 

2 to the individual; and 

3 ‘‘(v) is in accordance with standards deter4 mined by the Secretary to be appropriate; and 

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

6 follow-up cancer care plan has been developed under 

7 subparagraph (C), the revision of such plan as nec8 essary to account for any substantial change in the 

9 condition of the individual, diagnosis of a second 

10 cancer, or significant revision of the plan for follow11 up care, if such revision— 

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

13 (iv), and (v) of such subparagraph; and 

14 ‘‘(ii) is furnished in written form to the in15 dividual within a period specified by the Sec16 retary that is as soon as practicable after the 

17 date of such revision. 

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

19 out paragraph (1) in consultation with appropriate organi20 zations representing providers of services related to cancer 

21 treatment and organizations representing survivors of can22 cer. Such standards shall include standards for deter23 mining the need and frequency for revisions of the plans 

24 of care and follow-up plans based on changes in the condi25 tion of the individual or elements and intent of treatment 


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1 and standards for the communication of the plan to the 

2 patient.’’. 

3 (b) PAYMENT.—Section 1833(a)(1) of the Social Se4 curity Act (42 U.S.C. 1395l(a)(1)) is amended by striking 

5 ‘‘and’’ before ‘‘(Z)’’ and inserting before the semicolon at 

6 the end the following: ‘‘, and (AA) with respect to com7 prehensive cancer care planning services described in any 

8 of subparagraphs (A) through (D) of section 1861(iii)(1), 

9 the amount paid shall be an amount equal to the sum of 

10 (i) the national average amount under the physician fee 

11 schedule established under section 1848 for a new patient 

12 office consultation of the highest level of service in the 

13 non-facility setting, and (ii) the national average amount 

14 under such fee schedule for a physician certification de15 scribed in section 1814(a)(2) for home health services fur16 nished to an individual by a home health agency under 

17 a home health plan of care’’. 

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

19 this section shall apply to services furnished on or after 

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

21 the date of the enactment of this Act. 


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1 TITLE II—PROVIDER EDU2 CATION REGARDING PALLIA3 TIVE CARE AND SYMPTOM 

4 MANAGEMENT 

5 SEC. 201. GRANTS TO IMPROVE HEALTH PROFESSIONAL 

6 EDUCATION. 

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

8 Human Services shall make grants to eligible entities to 

9 enable the entities to improve the quality of graduate and 

10 postgraduate training of physicians, nurses, and other 

11 health care providers in developing cancer care plans for 

12 cancer patients and communicating such plans to the indi13 vidual patients. 

14 (b) APPLICATION.—To seek a grant under this sec15 tion, an eligible entity shall submit an application at such 

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

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

18 shall require that each such application demonstrate— 

19 (1) the ability to train health professionals in— 

20 (A) the provision of cancer care that fully 

21 coordinates active treatment, symptom manage22 ment, and palliative care; and 

23 (B) the communication of a written plan 

24 for coordinated cancer care to the patient; and 


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1 (2) the ability to collect and analyze data re2 lated to the effectiveness of such training programs. 

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

4 implement a plan for evaluating the effects of the training 

5 programs funded under this section. 

6 (d) DEFINITIONS.—In this section: 

7 (1) The term ‘‘eligible entity’’ means an entity 

8 that is— 

9 (A) a cancer center (including an NCI-des10 ignated cancer center); 

11 (B) an academic health center; 

12 (C) a physician practice; 

13 (D) a school of nursing; 

14 (E) a visiting nurse association; 

15 (F) a home care agency; or 

16 (G) a private nonprofit organization with 

17 expertise and experience in health provider 

18 training. 

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 $5,000,000 for each of the fiscal years 2013 through 

4 2017. 

5 SEC. 202. 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 the develop11 ment and communication of written cancer care plans that 

12 outline a system of care that coordinates active treatment 

13 and palliative care. 

14 (b) APPLICATION.—To seek a grant under this sec15 tion, an eligible entity shall submit an application at such 

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

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

18 shall require that each such application demonstrate— 

19 (1) experience in sponsoring continuing profes20 sional education programs; 

21 (2) the ability to reach health care providers 

22 and other professionals who are engaged in cancer 

23 care with such continuing professional education 

24 programs; 


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1 (3) the capacity to develop innovative training 

2 programs aimed at enhancing the delivery of coordi3 nated cancer care that includes appropriate symp4 tom management and palliative care; and 

5 (4) the ability to evaluate the effectiveness of 

6 such professional education and training programs. 

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

8 implement a plan for evaluating the effects of the con9 tinuing professional education and training programs 

10 funded under this section. 

11 (d) DEFINITIONS.—In this section: 

12 (1) The term ‘‘eligible entity’’ means an entity 

13 that is— 

14 (A) a cancer center (including an NCI-des15 ignated cancer center); 

16 (B) an academic health center; 

17 (C) a school of nursing; 

18 (D) a professional society that supports 

19 continuing professional education programs; or 

20 (E) a private nonprofit organization with 

21 expertise and experience in health provider 

22 training. 

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

24 means a cancer center receiving funds through a 


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1 P30 Cancer Center Support Grant of the National 

2 Cancer Institute. 

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

4 physician, nurse, social worker, chaplain, psycholo5 gist, or other individual who is involved in providing 

6 comprehensive cancer care, including active treat7 ment, symptom management, and palliative care, to 

8 cancer patients. 

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

10 of Health and Human Services. 

11 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

12 out this section, there are authorized to be appropriated 

13 $5,000,000 for each of the fiscal years 2013 through 

14 2017. 

15 TITLE III—RESEARCH ON TOP16 ICS RELATED TO COORDINA17 TION OF CARE, SYMPTOM 

18 MANAGEMENT, AND PALLIA19 TIVE CARE FOR CANCER PA20 TIENTS 

21 SEC. 301. RESEARCH PROGRAM. 

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

23 Human Services shall provide investment, through exist24 ing research programs, for research on topics related to 

25 cancer care planning, cancer care coordination, symptom 


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1 management, palliative care, and comprehensive survivor2 ship care. 

3 (b) PARTICIPATION.—In carrying out the research 

4 authorized under this section, the Secretary should pro5 vide for the participation of institutes and centers of the 

6 National Institutes of Health, the Centers for Medicare 

7 & Medicaid Services, and any other national research in8 stitute that has been engaged in research described in sub9 section (a). 

10 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

11 out this section, there are authorized to be appropriated 

12 $5,000,000 for each of the fiscal years 2013 through 

13 2017. 

Æ 


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