I 
111TH CONGRESS 
1ST SESSION H. R. 1844 
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 
APRIL 1, 2009 
Mrs. CAPPS (for herself and Mr. BOUSTANY) 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 subse-
quently 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 estab-
lishing a Medicare hospice care demonstration program 
and grants programs for cancer palliative care and symp-
tom management programs, provider education, and re-
lated research. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Comprehensive Cancer Care Improvement Act of 2009’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
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 health professional education. 
Sec. 302. Grants to Improve Continuing Professional Education. 
TITLE IV—RESEARCH ON END-OF-LIFE TOPICS FOR CANCER 
PATIENTS 
Sec. 401. Research program. 
SEC. 2. FINDINGS. 
The Congress makes the following findings: 
(1) Individuals with cancer often do not have 
access to a cancer care system that provides com-
prehensive and coordinated care of high quality. 
(2) The cancer care system has not traditionally 
offered individuals with cancer a prospective and 
comprehensive plan for treatment and symptom 
management, strategies for updating and evaluating 
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such plan with the assistance of a health care pro-
fessional, and a follow-up plan for monitoring and 
treating possible late effects of cancer and its treat-
ment. 
(3) Cancer survivors often experience the 
under-diagnosis and under-treatment of the symp-
toms of cancer, a problem that begins at the time 
of diagnosis and often becomes more severe at the 
end of life. The failure to treat the symptoms, side 
effects, and late effects of cancer and its treatment 
may have a serious adverse impact on the health, 
well-being, and quality of life of cancer survivors. 
(4) Cancer survivors who are members of racial 
and ethnic minority groups may face special obsta-
cles in receiving cancer care that is coordinated and 
includes appropriate management of cancer symp-
toms and treatment side effects. 
(5) Individuals with cancer are sometimes put 
in the untenable position of choosing between poten-
tially curative therapies and palliative care instead of 
being assured access to comprehensive care that in-
cludes appropriate treatment and symptom manage-
ment. 
(6) Comprehensive cancer care should incor-
porate access to psychosocial services and manage-
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ment of the symptoms of cancer (and the symptoms 
of its treatment), including pain, nausea and vom-
iting, fatigue, and depression. 
(7) Comprehensive cancer care should include a 
means for providing cancer survivors with a com-
prehensive care summary and a plan for follow-up 
care after primary treatment to ensure that cancer 
survivors have access to follow-up monitoring and 
treatment of possible late effects of cancer and can-
cer treatment. 
(8) The Institute of Medicine report, ‘‘Ensuring 
Quality Cancer Care’’, described the elements of 
quality care for an individual with cancer to in-
clude— 
(A) the development of initial treatment 
recommendations by an experienced health care 
provider; 
(B) the development of a plan for the 
course of treatment of the individual and com-
munication of the plan to the individual; 
(C) access to the resources necessary to 
implement the course of treatment; 
(D) access to high-quality clinical trials; 
(E) a mechanism to coordinate services for 
the treatment of the individual; and 
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(F) psychosocial support services and com-
passionate care for the individual. 
(9) In its report, ‘‘From Cancer Patient to 
Cancer Survivor: Lost in Transition’’, the Institute 
of Medicine recommended that individuals with can-
cer completing primary treatment be provided a 
comprehensive summary of their care along with a 
follow-up survivorship plan of treatment. 
(10) Since more than half of all cancer diag-
noses occur among elderly Medicare beneficiaries, 
the problems of providing cancer care are problems 
of the Medicare program. 
(11) Shortcomings in providing cancer care, re-
sulting in inadequate management of cancer symp-
toms and insufficient monitoring and treatment of 
late effects of cancer and its treatment, are related 
to problems of Medicare payments for such care, in-
adequate professional training, and insufficient in-
vestment in research on symptom management. 
(12) Changes in Medicare payment for com-
prehensive cancer care, enhanced public and profes-
sional education regarding symptom management, 
and more research related to symptom management 
and palliative care will enhance patient decision- 
making about treatment options and will contribute 
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to improved care for individuals with cancer from 
the time of diagnosis of the individual through the 
end of the life of the individual. 
TITLE I—COMPREHENSIVE CAN-
CER CARE UNDER THE MEDI-
CARE PROGRAM 
SEC. 101. COVERAGE OF CANCER CARE PLANNING SERV-
ICES. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act is amended— 
(1) in subsection (s)(2)— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (DD); 
(B) by adding ‘‘and’’ at the end of sub-
paragraph (EE); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(FF) comprehensive cancer care planning 
services (as defined in subsection (hhh));’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘Comprehensive Cancer Care Planning Services 
‘‘(hhh)(1) The term ‘comprehensive cancer care plan-
ning services’ means— 
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‘‘(A) with respect to an individual who is 
diagnosed with cancer, the development of a 
plan of care that— 
‘‘(i) details, to the greatest extent 
practicable, all aspects of the care to be 
provided to the individual, with respect to 
the treatment of such cancer, including 
any curative treatment and comprehensive 
symptom management (such as palliative 
care) involved; 
‘‘(ii) is furnished in written form to 
the individual in person within a period 
specified by the Secretary that is as soon 
as practicable after the date on which the 
individual is so diagnosed; 
‘‘(iii) is furnished, to the greatest ex-
tent practicable, in a form that appro-
priately takes into account cultural and 
linguistic needs of the individual in order 
to make the plan accessible to the indi-
vidual; and 
‘‘(iv) is in accordance with standards 
determined by the Secretary to be appro-
priate; 
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‘‘(iii) is furnished in written form to 
the individual in person within a period 
specified by the Secretary that is as soon 
as practicable after the completion of such 
primary treatment; 
‘‘(iv) is furnished, to the greatest ex-
tent practicable, in a form that appro-
priately takes into account cultural and 
linguistic needs of the individual in order 
to make the plan accessible to the indi-
vidual; and 
‘‘(v) is in accordance with standards 
determined by the Secretary to be appro-
priate; and 
‘‘(D) with respect to an individual for 
whom a follow-up cancer care plan has been de-
veloped under subparagraph (C), the revision of 
such plan as necessary to account for any sub-
stantial change in the condition of the indi-
vidual, if such revision— 
‘‘(i) is in accordance with clauses (i), 
(ii), and (iv) of such subparagraph; and 
‘‘(ii) is furnished in written form to 
the individual within a period specified by 
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the Secretary that is as soon as practicable 
after the date of such revision. 
‘‘(2) The Secretary shall establish standards to carry 
out paragraph (1) in consultation with appropriate organi-
zations representing providers of services related to cancer 
treatment and organizations representing survivors of can-
cer. Such standards shall include standards for deter-
mining the need and frequency for revisions of the plans 
of care and follow-up plans based on changes in the condi-
tion of the individual and standards for the communica-
tion of the plan to the patient.’’. 
(b) PAYMENT.—Section 1833(a)(1) of the Social Se-
curity Act (42 U.S.C. 1395l(a)(1)) is amended by striking 
‘‘and’’ before ‘‘(W)’’ and inserting before the semicolon 
at the end the following: ‘‘, and (X) with respect to com-
prehensive cancer care planning services described in any 
of 
subparagraphs 
(A) 
through 
(D) 
of 
section 
1861(hhh)(1), the amount paid shall be an amount equal 
to the sum of (i) the national average amount under the 
physician fee schedule established under section 1848 for 
a new patient office consultation of the highest level of 
service in the non-facility setting, and (ii) the national av-
erage amount under such fee schedule for a physician cer-
tification described in section 1814(a)(2) for home health 
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services furnished to an individual by a home health agen-
cy under a home health plan of care’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
the first day of the first calendar year that begins after 
the date of the enactment of this Act. 
SEC. 102. DEMONSTRATION PROJECT TO PROVIDE COM-
PREHENSIVE CANCER CARE SYMPTOM MAN-
AGEMENT SERVICES UNDER MEDICARE. 
(a) IN GENERAL.—Beginning not later than 180 
days after the date of the enactment of this Act, the Sec-
retary of Health and Human Services (in this section re-
ferred to as the ‘‘Secretary’’) shall conduct a two-year 
demonstration project (in this section referred to as the 
‘‘demonstration project’’) under title XVIII of the Social 
Security Act under which payment shall be made under 
such title for comprehensive cancer care symptom man-
agement services, including items and services described 
in subparagraphs (A) through (I) of section 1861(dd)(1) 
of the Social Security Act, furnished by an eligible entity, 
in accordance with a plan developed under subparagraph 
(A) or (C) of section 1861(hhh)(1) of such Act, as added 
by section 101(a). Sections 1812(d) and 1814(a)(7) of 
such Act (42 U.S.C. 1395d(d), 1395f(a)(7)) are not appli-
cable to items and services furnished under the dem-
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onstration project. Participation of Medicare beneficiaries 
in the demonstration project shall be voluntary. 
(b) QUALIFICATIONS AND SELECTION OF ELIGIBLE 
ENTITIES.— 
(1) QUALIFICATIONS.—For purposes of sub-
section (a), the term ‘‘eligible entity’’ means an enti-
ty (such as a cancer center, hospital, academic 
health center, hospice program, physician practice, 
school of nursing, visiting nurse association, or other 
home health agency) that the Secretary determines 
is capable, directly or through an arrangement with 
a 
hospice 
program 
(as 
defined 
in 
section 
1861(dd)(2) of the Social Security Act (42 U.S.C. 
1395x(dd)(2))), of providing the items and services 
described in such subsection. 
(2) SELECTION.—The Secretary shall select not 
more than 10 eligible entities to participate in the 
demonstration project. Such entities shall be selected 
in a manner so that the demonstration project is 
conducted in different regions across the United 
States and in urban and rural locations. 
(c) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary shall conduct 
a comprehensive evaluation of the demonstration 
project to determine— 
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(A) the effectiveness of the project in im-
proving patient outcomes; 
(B) the cost of providing comprehensive 
symptom management, including palliative care, 
from the time of diagnosis; 
(C) the effect of comprehensive cancer care 
planning and the provision of comprehensive 
symptom management on patient outcomes, 
cancer care expenditures, and the utilization of 
hospitalization and emergent care services; and 
(D) potential savings to the Medicare pro-
gram demonstrated by the project. 
(2) REPORT.—Not later than the date that is 
one year after the date on which the demonstration 
project concludes, the Secretary shall submit to Con-
gress a report on the evaluation conducted under 
paragraph (1). 
TITLE II—COMPREHENSIVE PAL-
LIATIVE CARE AND SYMPTOM 
MANAGEMENT PROGRAMS 
SEC. 201. GRANTS FOR COMPREHENSIVE PALLIATIVE CARE 
AND SYMPTOM MANAGEMENT PROGRAMS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall make grants to eligible entities for 
the purpose of— 
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(1) establishing a new palliative care and symp-
tom management program for cancer patients; or 
(2) expanding an existing palliative care and 
symptom management program for cancer patients. 
(b) AUTHORIZED
ACTIVITIES.—Activities funded 
through a grant under this section may include— 
(1) securing consultative services and advice 
from institutions with extensive experience in devel-
oping and managing comprehensive palliative care 
and symptom management programs; 
(2) expanding an existing program to serve 
more patients or enhance the range or quality of 
services, including cancer treatment patient edu-
cation services, that are provided; 
(3) developing a program that would ensure the 
inclusion of cancer treatment patient education in 
the coordinated cancer care model; and 
(4) establishing an outreach program to partner 
with an existing comprehensive care program and 
obtain expert consultative services and advice. 
(c) DISTRIBUTION OF FUNDS.—In making grants 
and distributing the funds under this section, the Sec-
retary shall ensure that— 
(1) two-thirds of the funds appropriated to 
carry out this section for each fiscal year are used 
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