I 

110TH CONGRESS 

2D SESSION H. R. 5585 

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 

MARCH 11, 2008 

Mr. ISRAEL 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 2008’’. 


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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 Aug 31 2005 22:18 Mar 12, 2008 Jkt 069200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5585.IH H5585

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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 114(a) 

14 of the Medicare, Medicaid, and SCHIP Extension Act of 

15 2007, is amended— 

16 (1) in subsection (s)(2)— 

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

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

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

22 subparagraph: 

23 ‘‘(BB) comprehensive cancer patient treatment 

24 education services (as defined in subsection 

25 (ddd)(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 ‘‘(ddd)(1) The term ‘comprehensive cancer patient 

6 treatment education services’ means— 

7 ‘‘(A) in the case of an individual who is di8 agnosed with cancer, the provision of a one9 hour patient treatment education session deliv10 ered by a registered nurse that— 

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

12 the caregiver (or caregivers) of the indi13 vidual in advance of the onset of treatment 

14 and to the extent practicable, is not fur15 nished on the day of diagnosis or on the 

16 first day of treatment; 

17 ‘‘(ii) educates the individual and such 

18 caregiver (or caregivers) to the greatest ex19 tent practicable, about all aspects of the 

20 care to be furnished to the individual, in21 forms the individual regarding any poten22 tial symptoms, side-effects, or adverse 

23 events, and explains ways in which side ef24 fects and adverse events can be minimized 

25 and health and well-being maximized, and 


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1 provides guidance regarding those side ef2 fects to be reported and to which health 

3 care provider the side effects should be re4 ported; 

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

6 form, of information about the course of 

7 treatment, any responsibilities of the indi8 vidual with respect to self-dosing, and ways 

9 in which to address symptoms and side-ef10 fects; and 

11 ‘‘(iv) is furnished, to the greatest ex12 tent practicable, in an oral, written, or 

13 electronic form that appropriately takes 

14 into account cultural and linguistic needs 

15 of the individual in order to make the in16 formation comprehensible to the individual 

17 and such caregiver (or caregivers); and 

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

19 whom a course of cancer treatment or therapy 

20 is materially modified, a one-hour patient treat21 ment education session described in subpara22 graph (A), including updated information on 

23 the matters described in such subparagraph 

24 should the individual’s oncologic health care 

25 professional deem it appropriate and necessary. 


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1 ‘‘(2) In establishing standards to carry out 

2 paragraph (1), the Secretary shall consult with ap3 propriate organizations representing providers of on4 cology patient treatment education services and or5 ganizations representing people with cancer.’’. 

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

7 U.S.C. 1395l(a)(1)) is amended— 

8 (1) by striking ‘‘and’’ before ‘‘(V)’’; and 

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

10 the following: ‘‘, and (W) with respect to comprehen11 sive cancer patient treatment education service (as 

12 defined in section 1861(ddd)(1)), 150 percent of the 

13 payment rate established under section 1848 for dia14 betes outpatient self-management training services 

15 (as defined in section 1861(qq)), determined and ap16 plied without regard to any coinsurance’’. 

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

18 U.S.C. 1395y(a)(1)) is amended— 

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

20 the end; 

21 (2) in subparagraph (N), by striking the semi22 colon at the end and inserting ‘‘, and’’; and 

23 (3) by adding at the end the following new sub24 paragraph: 


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1 ‘‘(O) in the case of comprehensive cancer pa2 tient treatment education services (as defined in 

3 subsection (ddd)(1)) which are performed more fre4 quently than is covered under such section;’’. 

5 (d) NO IMPACT ON PAYMENT FOR OTHER SERV6 ICES.—Nothing in this section shall be construed to affect 

7 or otherwise authorize any reduction or modification, in 

8 the Medicare payment amounts otherwise established for 

9 chemotherapy infusion or injection codes with respect to 

10 the calculation and payment of minutes for chemotherapy 

11 teaching or related services. 

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

13 this section shall apply to services furnished on or after 

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

15 the date of the enactment of this Act. 

16 TITLE II—RESEARCH ON CAN17 CER SYMPTOM MANAGEMENT 

18 IMPROVEMENT 

19 SEC. 201. EXPANSION OF RESEARCH. 

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

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

22 at the end the following: 


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1 ‘‘SEC. 417E. RESEARCH ON CANCER SYMPTOM MANAGE2 MENT IMPROVEMENT. 

3 ‘‘(a) IN GENERAL.—The Director of NIH shall ex4 pand, intensify, and coordinate programs for the conduct 

5 and support of research with respect to— 

6 ‘‘(1) improving the treatment and management 

7 of symptoms and side effects associated with cancer 

8 and cancer treatment; and 

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

10 in the amelioration of such symptoms and side ef11 fects. 

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

13 carry out this section— 

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

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

16 National Institute of Nursing Research, the Na17 tional Institute of Mental Health, the National Cen18 ter on Minority Health and Health Disparities, the 

19 National Center for Complementary and Alternative 

20 Medicine, and the Agency for Healthcare Research 

21 and Quality.’’. 

22 SEC. 202. NURSING INTERVENTION RESEARCH GRANTS. 

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

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

25 201, is amended by adding at the end the following: 


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1 ‘‘SEC. 417F. NURSING INTERVENTION RESEARCH GRANTS. 

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

3 grants for research to be conducted— 

4 ‘‘(1) with a registered nurse as the principal in5 vestigator; and 

6 ‘‘(2) for the purpose of studying cancer symp7 tom management care and services delivered by reg8 istered nurses to cancer patients. 

9 ‘‘(b) INCLUSION OF NATIONAL RESEARCH INSTI10 TUTES.—In carrying out this section, the Director of NIH 

11 shall provide for the participation of the National Cancer 

12 Institute, the National Institute of Nursing Research, and 

13 any other national research institute that has been en14 gaged in research described subsection (a)(2). 

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

16 are authorized to be appropriated to carry out this section 

17 such sums as may be necessary for fiscal years 2009 

18 through 2013.’’. 

19 SEC. 203. INSTITUTE OF MEDICINE STUDY ON THE PROVI20 SION OF SYMPTOM MANAGEMENT AND SUP21 PORTIVE CARE IN PEOPLE WITH CANCER. 

22 (a) REPORT.— 

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

24 after the date of enactment of this Act, the Sec25 retary of Health and Human Services (in this sec26 tion referred to as the ‘‘Secretary’’) shall enter into 


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1 an arrangement under which the Institute of Medi2 cine of the National Academy of Sciences (in this 

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

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

5 current state of symptom management, patient 

6 treatment education, and supportive care given to 

7 people with cancer. 

8 (2) SPECIFIC MATTERS EVALUATED.—In con9 ducting the study and evaluation under paragraph 

10 (1), the Institute shall— 

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

12 delivery of, symptom management, patient 

13 treatment education, and supportive care to 

14 people with cancer; 

15 (B) catalogue and evaluate the incentives 

16 and disincentives in the current reimbursement 

17 system that influence whether individuals re18 ceive comprehensive symptom management, pa19 tient treatment education, and supportive care, 

20 including adequate and ongoing patient treat21 ment education; 

22 (C) evaluate the importance of nursing 

23 interventions in the management of symptoms 

24 and side effects of cancer and the associated 

25 treatment; 


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1 (D) consider such other matters as the In2 stitute determines appropriate; and 

3 (E) make recommendations to address any 

4 barriers, challenges, or other issues identified 

5 through the study and evaluation. 

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

7 study and evaluation, the Institute shall consider a 

8 variety of perspectives, including the perspectives of 

9 patients and their family caregivers, registered 

10 nurses, including nurses certified in oncology, physi11 cians, social workers, psychologists, other health care 

12 professionals, and other experts and stakeholders. 

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

14 date of enactment of this Act, the arrangement under sub15 section (a) shall provide for the Institute to submit to the 

16 Secretary and to Congress a report on the study evalua17 tion conducted under such subsection. Such report shall 

18 contain a detailed description of the findings of such study 

19 and evaluation and recommendations for improving the 

20 provision of symptom management, patient treatment edu21 cation, and supportive care to people with cancer. 

22 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated such sums as may be 

24 necessary for the purposes of conducting the study and 


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1 evaluation, and preparing the report, required by this sec2 tion. 

Æ 


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