I 

109TH CONGRESS 

2D SESSION H. R. 5465 

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 

MAY 24, 2006 

Mrs. CAPPS (for herself and Mr. TOM DAVIS of Virginia) 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 2006’’. 

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 medical 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. 

10 (4) Individuals with cancer are sometimes put 

11 in the untenable position of choosing between poten12 tially curative therapies and palliative care instead of 

13 being assured access to comprehensive care that in14 cludes appropriate treatment and symptom manage15 ment. 

16 (5) Comprehensive cancer care should incor17 porate access to psychosocial services and manage18 ment of the symptoms of cancer (and the symptoms 

19 of its treatment), including pain, nausea and vom20 iting, fatigue, and depression. 

21 (6) Comprehensive cancer care should include a 

22 means for providing cancer survivors with a com23 prehensive care summary and a plan for follow-up 

24 care after primary treatment to ensure that cancer 

25 survivors have access to follow-up monitoring and 


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1 treatment of possible late effects of cancer and can2 cer treatment. 

3 (7) The Institute of Medicine report, ‘‘Ensuring 

4 Quality Cancer Care’’, described the elements of 

5 quality care for an individual with cancer to in6 clude— 

7 (A) the development of initial treatment 

8 recommendations by an experienced health care 

9 provider; 

10 (B) the development of a plan for the 

11 course of treatment of the individual and com12 munication of the plan to the individual; 

13 (C) access to the resources necessary to 

14 implement the course of treatment; 

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

16 (E) a mechanism to coordinate services for 

17 the treatment of the individual; and 

18 (F) psychosocial support services and com19 passionate care for the individual. 

20 (8) In its report, ‘‘From Cancer Patient to 

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

22 of Medicine recommended that individuals with can23 cer completing primary treatment be provided a 

24 comprehensive summary of their care along with a 

25 follow-up survivorship plan of treatment. 


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1 (9) Since more than half of all cancer diagnoses 

2 occur among elderly Medicare beneficiaries, the 

3 problems of providing cancer care are problems of 

4 the Medicare program. 

5 (10) Shortcomings in providing cancer care, re6 sulting in inadequate management of cancer symp7 toms and insufficient monitoring and treatment of 

8 late effects of cancer and its treatment, are related 

9 to problems of Medicare payments for such care, in10 adequate professional training, and insufficient in11 vestment in research on symptom management. 

12 (11) Changes in Medicare payment for com13 prehensive cancer care, enhanced public and profes14 sional education regarding symptom management, 

15 and more research related to symptom management 

16 and palliative care will enhance patient decision17 making about treatment options and will contribute 

18 to improved care for individuals with cancer from 

19 the time of diagnosis of the individual through the 

20 end of the life of the individual. 


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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, as amended by section 5112 of the Deficit Reduc8 tion Act of 2005 (Public Law 109–171), is amended— 

9 (1) in subsection (s)(2)— 

10 (A) by striking ‘‘and’’ at the end of sub11 paragraph (Z); 

12 (B) by adding ‘‘and’’ at the end of sub13 paragraph (AA); and 

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

15 subparagraph: 

16 ‘‘(BB) comprehensive cancer care planning 

17 services (as defined in subsection (ccc));’’; and 

18 (2) by adding at the end the following new sub19 section: 

20 ‘‘Comprehensive Cancer Care Planning Services 

21 ‘‘(ccc)(1) The term ‘comprehensive cancer care plan22 ning services’ means— 

23 ‘‘(A) with respect to an individual who is 

24 diagnosed with cancer, the development of a 

25 plan of care that— 


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1 ‘‘(i) details, to the greatest extent 

2 practicable, all aspects of the care to be 

3 provided to the individual, with respect to 

4 the treatment of such cancer, including 

5 any curative treatment and comprehensive 

6 symptom management (such as palliative 

7 care) involved; 

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

9 the individual in person within a period 

10 specified by the Secretary that is as soon 

11 as practicable after the date on which the 

12 individual is so diagnosed; and 

13 ‘‘(iii) is in accordance with standards 

14 determined by the Secretary to be appro15 priate; 

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

17 whom a plan of care has been developed under 

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

19 care as necessary to account for any substantial 

20 change in the condition of the individual, if 

21 such revision— 

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

23 and (iii) of such subparagraph; and 

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

25 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 ‘‘(C) with respect to an individual who has 

4 completed the primary treatment for cancer, as 

5 defined by the Secretary (such as completion of 

6 chemotherapy or radiation treatment), the de7 velopment of a follow-up cancer care plan 

8 that— 

9 ‘‘(i) describes the elements of the pri10 mary treatment, including symptom man11 agement, furnished to such individual; 

12 ‘‘(ii) provides recommendations for 

13 the subsequent care of the individual with 

14 respect to the cancer involved; 

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

16 the individual in person within the seven17 day period after the completion of such 

18 primary treatment; and 

19 ‘‘(iv) is in accordance with standards 

20 determined by the Secretary to be appro21 priate; and 

22 ‘‘(D) with respect to an individual for 

23 whom a follow-up cancer care plan has been de24 veloped under subparagraph (C), the revision of 

25 such plan as necessary to account for any subVerDate Aug 31 2005 00:37 May 31, 2006 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5465.IH H5465

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1 stantial change in the condition of the indi2 vidual, if such revision— 

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

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

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

6 the individual within a period specified by 

7 the Secretary that is as soon as practicable 

8 after the date of such revision. 

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

10 out paragraph (1) in consultation with appropriate organi11 zations representing providers of services related to cancer 

12 treatment and organizations representing survivors of can13 cer. Such standards shall include standards for deter14 mining the need and frequency for revisions of the plans 

15 of care and follow-up plans based on changes in the condi16 tion of the individual.’’. 

17 (b) PAYMENT.—Section 1833(a)(1) of the Social Se18 curity Act (42 U.S.C. 1395l(a)(1)) is amended by striking 

19 ‘‘and’’ before ‘‘(V)’’ and inserting before the semicolon at 

20 the end the following: ‘‘, and (W) with respect to com21 prehensive cancer care planning services described in any 

22 of subparagraphs (A) through (D) of section 1861(ccc)(1), 

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

24 (i) national average amount under the physician fee sched25 ule established under section 1848 for a new patient office 


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1 consultation of the highest level of service in the non-facil2 ity setting, and (ii) the national average amount under 

3 such fee schedule for a physician certification described 

4 in section 1814(a)(2) for home health services furnished 

5 to an individual by a home health agency under a home 

6 health plan of care’’. 

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. 

11 SEC. 102. DEMONSTRATION PROJECT TO PROVIDE COM12 PREHENSIVE CANCER CARE SYMPTOM MAN13 AGEMENT SERVICES UNDER MEDICARE. 

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

15 days after the date of the enactment of this Act, the Sec16 retary of Health and Human Services (in this section re17 ferred to as the ‘‘Secretary’’) shall conduct a two-year 

18 demonstration project (in this section referred to as the 

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

20 Security Act under which payment shall be made under 

21 such title for comprehensive cancer care symptom man22 agement services, including items and services described 

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

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

25 in accordance with a plan developed under subparagraph 


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

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

3 such Act (42 U.S.C. 1395d(d), 1395f(a)(7)) are not appli4 cable to items and services furnished under the dem5 onstration project. Participation of medicare beneficiaries 

6 in the demonstration project shall be voluntary. 

7 (b) QUALIFICATIONS AND SELECTION OF ELIGIBLE

8 ENTITIES.— 

9 (1) QUALIFICATIONS.—For purposes of sub10 section (a), the term ‘‘eligible entity’’ means an enti11 ty (such as a cancer center, hospital, academic 

12 health center, hospice program, physician practice, 

13 visiting nurse association, or other home health 

14 agency) that the Secretary determines is capable, di15 rectly or through an arrangement with a hospice 

16 program (as defined in section 1861(dd)(2) of the 

17 Social Security Act (42 U.S.C. 1395x(dd)(2))), of 

18 providing the items and services described in such 

19 subsection. 

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

21 more than 10 eligible entities to participate in the 

22 demonstration project. Such entities shall be selected 

23 in a manner so that the demonstration project is 

24 conducted in different regions across the United 

25 States and in urban and rural locations. 


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1 (c) EVALUATION AND REPORT.— 

2 (1) EVALUATION.—The Secretary shall conduct 

3 a comprehensive evaluation of the demonstration 

4 project to determine— 

5 (A) the effectiveness of the project in im6 proving patient outcomes; 

7 (B) the cost of providing comprehensive 

8 symptom management, including palliative care, 

9 from the time of diagnosis; 

10 (C) the effect of comprehensive cancer care 

11 planning and the provision of comprehensive 

12 symptom management on patient outcomes, 

13 cancer care expenditures, and the utilization of 

14 hospitalization and emergent care services; and 

15 (D) potential savings to the Medicare pro16 gram demonstrated by the project. 

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

18 one year after the date on which the demonstration 

19 project concludes, the Secretary shall submit to Con20 gress a report on the evaluation conducted under 

21 paragraph (1). 


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1 TITLE II—COMPREHENSIVE PAL2 LIATIVE CARE AND SYMPTOM 

3 MANAGEMENT PROGRAMS 

4 SEC. 201. GRANTS FOR COMPREHENSIVE PALLIATIVE CARE 

5 AND SYMPTOM MANAGEMENT PROGRAMS. 

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

7 Human Services shall make grants to eligible entities for 

8 the purpose of— 

9 (1) establishing a new palliative care and symp10 tom management program for cancer patients; or 

11 (2) expanding an existing palliative care and 

12 symptom management program for cancer patients. 

13 (b) AUTHORIZED ACTIVITIES.—Activities funded 

14 through a grant under this section may include— 

15 (1) securing consultative services and advice 

16 from institutions with extensive experience in devel17 oping and managing comprehensive palliative care 

18 and symptom management programs; 

19 (2) expanding an existing program to serve 

20 more patients or enhance the range or quality of 

21 services provided; and 

22 (3) establishing an outreach program to partner 

23 with an existing comprehensive care program and 

24 obtain expert consultative services and advice. 


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

2 and distributing the funds under this section, the Sec3 retary shall ensure that— 

4 (1) two thirds of the funds appropriated to 

5 carry out this section for each fiscal year are used 

6 for establishing new palliative care and symptom 

7 management programs, of which not less than half 

8 of such two thirds shall be for programs in medically 

9 underserved communities; and 

10 (2) one third of the funds appropriated to carry 

11 out this section for each fiscal year are used for ex12 panding existing palliative care and symptom man13 agement programs. 

14 (d) DEFINITIONS.—In this section: 

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

16 (A) an academic medical center, a cancer 

17 center, a hospital, or a health system capable of 

18 administering a palliative care and symptom 

19 management program for cancer patients; 

20 (B) a physician practice with care teams, 

21 including nurses and other professionals trained 

22 in palliative care and symptom management; 

23 (C) a visiting nurse association or other 

24 home care agency with experience administering 


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1 a palliative care and symptom management pro2 gram; 

3 (D) a hospice; and 

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

5 as the Secretary determines appropriate. 

6 (2) The term ‘‘medically underserved commu7 nity’’ has the meeting given to that term in section 

8 799B(6) of the Public Health Service Act (42 

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

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

11 of Health and Human Services. 

12 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

13 out this section, there are authorized to be appropriated 

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

15 2007 through 2011. 

16 TITLE III—PROVIDER EDU17 CATION REGARDING PALLIA18 TIVE CARE AND SYMPTOM 

19 MANAGEMENT. 

20 SEC. 301. GRANTS TO IMPROVE MEDICAL EDUCATION. 

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

22 Human Services shall make grants to eligible entities to 

23 enable the entities to improve the quality of graduate and 

24 postgraduate training of physicians, nurses, and other 


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1 health care providers in palliative care and symptom man2 agement for cancer patients. 

3 (b) APPLICATION.—To seek a grant under this sec4 tion, an eligible entity shall submit an application at such 

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

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

7 shall require that each such application demonstrate— 

8 (1) the ability to incorporate palliative care and 

9 symptom management into training programs; and 

10 (2) the ability to collect and analyze data re11 lated to the effectiveness of educational efforts. 

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

13 implement a plan for evaluating the effects of professional 

14 training programs funded through this section. 

15 (d) DEFINITIONS.—In this section: 

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

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

18 an academic health center, a physician practice, or 

19 a visiting nurse association or other home care agen20 cy. 

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

22 means a cancer center receiving funds through a 

23 P30 Cancer Center Support Grant of the National 

24 Cancer Institute. 


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

2 of Health and Human Services. 

3 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

4 out this section, there are authorized to be appropriated 

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

6 2007 through 2011. 

7 SEC. 302. GRANTS TO IMPROVE CONTINUING PROFES8 SIONAL EDUCATION. 

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

10 Human Services shall make grants to eligible entities to 

11 improve the quality of continuing professional education 

12 provided to qualified individuals regarding palliative care 

13 and symptom management. 

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; 

24 (3) the capacity to develop innovative training 

25 programs; and 


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1 (4) the ability to evaluate the effectiveness of 

2 educational efforts. 

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

4 implement a plan for evaluating the effects of continuing 

5 professional education programs funded through this sec6 tion. 

7 (d) DEFINITIONS.—In this section: 

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

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

10 an academic health center, or a professional society 

11 that supports continuing medical education pro12 grams. 

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

14 means a cancer center receiving funds through a 

15 P30 Cancer Center Support Grant of the National 

16 Cancer Institute. 

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

18 physician, nurse, social worker, chaplain, psycholo19 gist, or other individual who is involved in providing 

20 palliative care and symptom management services to 

21 cancer patients. 

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

23 of Health and Human Services. 

24 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

25 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 2007 through 2011. 

3 TITLE IV—RESEARCH ON END4 OF-LIFE TOPICS FOR CANCER 

5 PATIENTS 

6 SEC. 401. RESEARCH PROGRAM. 

7 (a) IN GENERAL.—The Director of the National In8 stitutes of Health shall establish a program of grants for 

9 research on palliative care, symptom management, com10 munication skills, and other end-of-life topics for cancer 

11 patients. 

12 (b) INCLUSION OF NATIONAL RESEARCH INSTI13 TUTES.—In carrying out the program established under 

14 this section, the Director should provide for the participa15 tion of the National Cancer Institute, the National Insti16 tute of Nursing Research, and any other national research 

17 institute that has been engaged in research described in 

18 subsection (a). 

19 (c) DEFINITIONS.—In this section: 

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

21 the National Institutes of Health. 

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

23 the meaning given to that term in section 401(d) of 

24 the Public Health Service Act (42 U.S.C. 281(d)). 


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1 (d) 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 2007 through 2011. 

Æ 


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