I 

115TH CONGRESS 

2D SESSION H. R. 5160 

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 

MARCH 5, 2018 

Mr. DESAULNIER (for himself and Mr. POE of Texas) 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 ‘‘Cancer Care Planning and Communications Act of 

6 2018’’. 

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


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1 (1) Cancer care in the United States is often 

2 described as the best in the world because patients 

3 have access to many treatment options, including 

4 cutting-edge therapies that save lives and improve 

5 the quality of life. 

6 (2) Access to the best treatment options is not 

7 equal across all populations and in all communities. 

8 The 1999 Institute of Medicine report entitled ‘‘The 

9 Unequal Burden of Cancer’’ found that low-income 

10 people often lack access to adequate cancer care and 

11 that ethnic minorities have not benefitted fully from 

12 cancer treatment advances. 

13 (3) In addition, despite access to high-quality 

14 treatment options for many, individuals with cancer 

15 often do not have access to a cancer care system 

16 that incorporates shared decision-making and the co17 ordination of all elements of care. 

18 (4) Cancer survivors often experience the 

19 under-diagnosis and under-treatment of the symp20 toms of cancer and side effects of cancer treatment, 

21 a problem that begins at the time of diagnosis and 

22 may become more severe with disease progression 

23 and at the end of life. The failure to treat the symp24 toms, side effects, and late effects of cancer and can25 cer treatment may have a serious adverse impact on 


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1 the health, survival, well-being, and quality of life of 

2 cancer survivors. 

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) The Commission on Cancer has encour2 aged survivorship care planning by making the de3 velopment of such plans for patients one of the 

4 standards of accreditation for cancer care providers, 

5 but cancer care professionals report difficulties com6 pleting the plans. 

7 (12) Because more than half of all cancer diag8 noses occur among elderly Medicare beneficiaries, 

9 addressing cancer care inadequacies through Medi10 care reforms will provide benefits to millions of 

11 Americans. Providing Medicare beneficiaries more 

12 routine access to cancer care plans and survivorship 

13 care plans is a key to shared decisionmaking and 

14 better coordination of care. 

15 (13) Important payment and delivery reforms 

16 that incorporate cancer care planning and coordina17 tion are already being tested in the Medicare pro18 gram; the Oncology Care Model has been imple19 mented in a number of oncology practices, and addi20 tional models that will include care planning have 

21 been proposed. 

22 (14) The alternative payment models, including 

23 the Oncology Care Model, provide access to cancer 

24 care planning for Medicare beneficiaries who receive 

25 their cancer care in practices that are part of the 


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1 Oncology Care Model. Other Medicare beneficiaries 

2 who are not enrolled in these delivery demonstra3 tions may not have access to a cancer care plan or 

4 appropriate care coordination. 

5 (15) The failure to provide a cancer care plan 

6 to patients in many care settings relates in part to 

7 inadequate Medicare payment for such planning and 

8 coordination services. 

9 (16) Changes in Medicare payment for cancer 

10 care planning and coordination will support shared 

11 decisionmaking that reviews all treatment options 

12 and will contribute to improved care for individuals 

13 with cancer from the time of diagnosis through the 

14 end of the life. Medicare payment for cancer care 

15 planning may begin a reform process that helps us 

16 realize the well-planned and well-coordinated cancer 

17 care that has been recommended by the Institute of 

18 Medicine/National Academy of Medicine and that is 

19 preferred by cancer patients across the Nation. 

20 SEC. 2. COVERAGE OF CANCER CARE PLANNING AND CO21 ORDINATION SERVICES. 

22 (a) IN GENERAL.—Section 1861 of the Social Secu23 rity Act (42 U.S.C. 1395x) is amended— 

24 (1) in subsection (s)(2)— 


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1 (A) by striking ‘‘and’’ at the end of sub2 paragraph (FF); 

3 (B) by adding ‘‘and’’ at the end of sub4 paragraph (GG); and 

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

6 subparagraph: 

7 ‘‘(HH) cancer care planning and coordination 

8 services (as defined in subsection (jjj))’’; and 

9 (2) by adding at the end the following new sub10 section: 

11 ‘‘Cancer Care Planning and Coordination Services 

12 ‘‘(jjj)(1) The term ‘cancer care planning and coordi13 nation services’ means— 

14 ‘‘(A) with respect to an individual who is diag15 nosed with cancer, the development of a treatment 

16 plan by a physician, nurse practitioner, or physician 

17 assistant that— 

18 ‘‘(i) includes an assessment of the individ19 ual’s diagnosis, health status, treatment needs, 

20 functional status, pain control, and psychosocial 

21 needs; 

22 ‘‘(ii) engages the individual in a shared de23 cision-making process that reviews all treatment 

24 options; 


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1 ‘‘(iii) 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 ‘‘(iv) 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 ‘‘(v) 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 ‘‘(vi) is in accordance with standards de18 termined by the Secretary to be appropriate; 

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

20 treatment plan has been developed under subpara21 graph (A), the revision of such treatment plan as 

22 necessary to account for any substantial change in 

23 the condition of the individual, recurrence of disease, 

24 changes in the individual’s treatment preferences, or 

25 significant revision of the elements of curative care 


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1 or symptom management for the individual, if such 

2 revision— 

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

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

5 ‘‘(ii) is furnished in written form to the in6 dividual within a period specified by the Sec7 retary that is as soon as practicable after the 

8 date of such revision; 

9 ‘‘(C) with respect to an individual who has com10 pleted the primary treatment for cancer, as defined 

11 by the Secretary, the development of a follow-up sur12 vivorship care plan that— 

13 ‘‘(i) includes an assessment of the individ14 ual’s diagnosis, health status, treatment needs, 

15 functional status, pain control, and psychosocial 

16 needs; 

17 ‘‘(ii) engages the individual in a shared de18 cision-making process that reviews all survivor19 ship care options; 

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

21 treatment, including symptom management and 

22 palliative care, furnished to such individual; 

23 ‘‘(iv) provides recommendations for the 

24 subsequent care of the individual with respect 

25 to the cancer involved; 


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

2 form, to the individual within a period specified 

3 by the Secretary that is as soon as practicable 

4 after the completion of such primary treatment; 

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

6 practicable, in a form that appropriately takes 

7 into account cultural and linguistic needs of the 

8 individual in order to make the plan accessible 

9 to the individual; and 

10 ‘‘(vii) is in accordance with standards de11 termined by the Secretary to be appropriate; 

12 and 

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

14 follow-up cancer care plan has been developed under 

15 subparagraph (C), the revision of such plan as nec16 essary to account for any substantial change in the 

17 condition of the individual, diagnosis of a second 

18 cancer, change in the individual’s preference for sur19 vivorship care, or significant revision of the plan for 

20 follow-up care, if such revision— 

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

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

23 ‘‘(ii) is furnished in written form to the in24 dividual within a period specified by the SecVerDate Sep 11 2014 21:45 Mar 09, 2018 Jkt 079200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5160.IH H5160

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1 retary that is as soon as practicable after the 

2 date of such revision. 

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

4 out paragraph (1) in consultation with appropriate organi5 zations representing suppliers and providers of services re6 lated to cancer treatment and organizations representing 

7 survivors of cancer. Such standards shall include stand8 ards for determining the need and frequency for revisions 

9 of the treatment plans and follow-up survivorship care 

10 plans based on changes in the condition of the individual 

11 or elements and intent of treatment and standards for the 

12 communication of the plan to the individual. 

13 ‘‘(3) In this subsection, the term ‘shared decision14 making process’ means, with respect to an individual, a 

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

16 care providers consider the individual’s diagnosis, treat17 ment options, the medical evidence related to treatment 

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

19 and the individual’s preferences regarding treatment, and 

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

21 (b) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

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

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

24 amended by inserting ‘‘(HH),’’ after ‘‘health risk as25 sessment),’’. 


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

2 Health and Human Services otherwise provides, the 

3 payment rate specified under the physician fee 

4 schedule under the amendment made by paragraph 

5 (1) for cancer care planning and coordination serv6 ices shall be the same payment rate as provided for 

7 transitional care management services (as defined in 

8 CPT code 99496). 

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

10 this section shall apply to services furnished on or after 

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

12 the date of the enactment of this Act. 

Æ 


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