I 

118TH CONGRESS 

1ST SESSION H. R. 5183 

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 

AUGUST 11, 2023 

Mr. DESAULNIER (for himself, Mr. RASKIN, Ms. BLUNT ROCHESTER, Ms. 

WILD, Mr. KHANNA, Ms. CLARKE of New York, Mrs. WATSON COLEMAN, 

Mr. BISHOP of Georgia, Ms. NORTON, and Ms. WASSERMAN SCHULTZ) 

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’’. 

6 (b) FINDINGS.—Congress makes the following find7 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 decision making 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 decision making 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 inserting ‘‘and’’ at the end of sub2 paragraph (JJ); and 

3 (B) by adding at the end the following new 

4 subparagraph: 

5 ‘‘(KK) cancer care planning and coordination 

6 services (as defined in subsection (nnn));’’; and 

7 (2) by adding at the end the following new sub8 section: 

9 ‘‘Cancer Care Planning and Coordination Services 

10 ‘‘(nnn)(1) The term ‘cancer care planning and coordi11 nation services’ means, with respect to an individual who 

12 is diagnosed with cancer, the development of a treatment 

13 plan by a physician, physician assistant, or nurse practi14 tioner that— 

15 ‘‘(A) includes each component of the Institute 

16 of Medicine Care Management Plan (as described in 

17 the article entitled ‘Delivering High-Quality Cancer 

18 Care: Charting a New Course for a System in Crisis’ 

19 published by the Institute of Medicine); 

20 ‘‘(B) is furnished in written form or electroni21 cally, at the visit of such individual with such physi22 cian, physician assistant, or nurse practitioner, or as 

23 soon after the date of the visit as practicable; and 

24 ‘‘(C) is furnished, to the greatest extent prac25 ticable, in an appropriate form that appropriately 


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1 takes into account cultural and linguistic needs of 

2 the individual in order to make the plan accessible 

3 to the individual. 

4 ‘‘(2) The Secretary shall establish frequencies at 

5 which services described in paragraph (1) may be fur6 nished, provided that such services may be furnished with 

7 respect to an individual— 

8 ‘‘(A) at the time such individual is diagnosed 

9 with cancer for purposes of planning treatment; 

10 ‘‘(B) if there is a change in the condition of 

11 such individual or such individual’s treatment pref12 erences; 

13 ‘‘(C) at the end of active treatment and begin14 ning of survivorship care; and 

15 ‘‘(D) if there is a recurrence of such cancer.’’. 

16 (b) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

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

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

19 amended by inserting ‘‘(2)(KK),’’ after ‘‘health risk 

20 assessment),’’. 

21 (2) INITIAL RATES.—Unless the Secretary oth22 erwise provides, the payment rate specified under 

23 the physician fee schedule under the amendment 

24 made by paragraph (1) for cancer care planning and 

25 coordination services shall be the same payment rate 


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1 as provided for transitional care management serv2 ices (as defined in CPT code 99496). 

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

4 this section shall apply to services furnished on or after 

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

6 the date of the enactment of this Act. 

Æ 


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