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 sub-
sequently 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Cancer Care Planning and Communications Act of 
2018’’. 
(b) FINDINGS.—Congress makes the following find-
ings: 
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(1) Cancer care in the United States is often 
described as the best in the world because patients 
have access to many treatment options, including 
cutting-edge therapies that save lives and improve 
the quality of life. 
(2) Access to the best treatment options is not 
equal across all populations and in all communities. 
The 1999 Institute of Medicine report entitled ‘‘The 
Unequal Burden of Cancer’’ found that low-income 
people often lack access to adequate cancer care and 
that ethnic minorities have not benefitted fully from 
cancer treatment advances. 
(3) In addition, despite access to high-quality 
treatment options for many, individuals with cancer 
often do not have access to a cancer care system 
that incorporates shared decision-making and the co-
ordination of all elements of care. 
(4) Cancer survivors often experience the 
under-diagnosis and under-treatment of the symp-
toms of cancer and side effects of cancer treatment, 
a problem that begins at the time of diagnosis and 
may become more severe with disease progression 
and at the end of life. The failure to treat the symp-
toms, side effects, and late effects of cancer and can-
cer treatment may have a serious adverse impact on 
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the health, survival, well-being, and quality of life of 
cancer survivors. 
(5) Individuals with cancer often do not partici-
pate in a shared decision-making process that con-
siders all treatment options and do not benefit from 
coordination of all elements of active treatment and 
palliative care. 
(6) Quality cancer care should incorporate ac-
cess to psychosocial services and management of the 
symptoms of cancer and the symptoms of cancer 
treatment, including pain, nausea, vomiting, fatigue, 
and depression. 
(7) Quality cancer care should include a means 
for engaging cancer survivors in a shared decision- 
making process that produces a comprehensive care 
summary and a plan for follow-up care after primary 
treatment to ensure that cancer survivors have ac-
cess to follow-up monitoring and treatment of pos-
sible late effects of cancer and cancer treatment, in-
cluding appropriate psychosocial services. 
(8) The Institute of Medicine report entitled 
‘‘Ensuring Quality Cancer Care’’ described the ele-
ments of quality care for an individual with cancer 
to include— 
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(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 
(F) psychosocial support services and com-
passionate care for the individual. 
(9) In its report ‘‘From Cancer Patient to Can-
cer Survivor: Lost in Transition’’, the Institute of 
Medicine recommended that individuals with cancer 
completing primary treatment be provided a com-
prehensive summary of their care along with a fol-
low-up survivorship plan of treatment. 
(10) In ‘‘Cancer Care for the Whole Patient’’, 
the Institute of Medicine stated that the develop-
ment of a plan that includes biomedical and psycho-
social care should be a standard for quality cancer 
care in any quality measurement system. 
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(11) The Commission on Cancer has encour-
aged survivorship care planning by making the de-
velopment of such plans for patients one of the 
standards of accreditation for cancer care providers, 
but cancer care professionals report difficulties com-
pleting the plans. 
(12) Because more than half of all cancer diag-
noses occur among elderly Medicare beneficiaries, 
addressing cancer care inadequacies through Medi-
care reforms will provide benefits to millions of 
Americans. Providing Medicare beneficiaries more 
routine access to cancer care plans and survivorship 
care plans is a key to shared decisionmaking and 
better coordination of care. 
(13) Important payment and delivery reforms 
that incorporate cancer care planning and coordina-
tion are already being tested in the Medicare pro-
gram; the Oncology Care Model has been imple-
mented in a number of oncology practices, and addi-
tional models that will include care planning have 
been proposed. 
(14) The alternative payment models, including 
the Oncology Care Model, provide access to cancer 
care planning for Medicare beneficiaries who receive 
their cancer care in practices that are part of the 
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Oncology Care Model. Other Medicare beneficiaries 
who are not enrolled in these delivery demonstra-
tions may not have access to a cancer care plan or 
appropriate care coordination. 
(15) The failure to provide a cancer care plan 
to patients in many care settings relates in part to 
inadequate Medicare payment for such planning and 
coordination services. 
(16) Changes in Medicare payment for cancer 
care planning and coordination will support shared 
decisionmaking that reviews all treatment options 
and will contribute to improved care for individuals 
with cancer from the time of diagnosis through the 
end of the life. Medicare payment for cancer care 
planning may begin a reform process that helps us 
realize the well-planned and well-coordinated cancer 
care that has been recommended by the Institute of 
Medicine/National Academy of Medicine and that is 
preferred by cancer patients across the Nation. 
SEC. 2. COVERAGE OF CANCER CARE PLANNING AND CO-
ORDINATION SERVICES. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
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‘‘(iii) details, to the greatest extent prac-
ticable all aspects of the care to be provided to 
the individual with respect to the treatment of 
such cancer, including any curative treatment, 
comprehensive symptom management, and pal-
liative care; 
‘‘(iv) is furnished in person, in written 
form, to the individual within a period specified 
by the Secretary that is as soon as practicable 
after the date on which the individual is so di-
agnosed; 
‘‘(v) is furnished, to the greatest extent 
practicable, in a form that appropriately takes 
into account cultural and linguistic needs of the 
individual in order to make the plan accessible 
to the individual; and 
‘‘(vi) is in accordance with standards de-
termined by the Secretary to be appropriate; 
‘‘(B) with respect to an individual for whom a 
treatment plan has been developed under subpara-
graph (A), the revision of such treatment plan as 
necessary to account for any substantial change in 
the condition of the individual, recurrence of disease, 
changes in the individual’s treatment preferences, or 
significant revision of the elements of curative care 
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or symptom management for the individual, if such 
revision— 
‘‘(i) is in accordance with clauses (i), (ii), 
(iv) and (v) of such subparagraph; and 
‘‘(ii) is furnished in written form to the in-
dividual within a period specified by the Sec-
retary that is as soon as practicable after the 
date of such revision; 
‘‘(C) with respect to an individual who has com-
pleted the primary treatment for cancer, as defined 
by the Secretary, the development of a follow-up sur-
vivorship care plan that— 
‘‘(i) includes an assessment of the individ-
ual’s diagnosis, health status, treatment needs, 
functional status, pain control, and psychosocial 
needs; 
‘‘(ii) engages the individual in a shared de-
cision-making process that reviews all survivor-
ship care options; 
‘‘(iii) describes the elements of the primary 
treatment, including symptom management and 
palliative care, furnished to such individual; 
‘‘(iv) provides recommendations for the 
subsequent care of the individual with respect 
to the cancer involved; 
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‘‘(v) is furnished, in person, in written 
form, to the individual within a period specified 
by the Secretary that is as soon as practicable 
after the completion of such primary treatment; 
‘‘(vi) is furnished, to the greatest extent 
practicable, in a form that appropriately takes 
into account cultural and linguistic needs of the 
individual in order to make the plan accessible 
to the individual; and 
‘‘(vii) is in accordance with standards de-
termined by the Secretary to be appropriate; 
and 
‘‘(D) with respect to an individual for whom a 
follow-up cancer care plan has been developed under 
subparagraph (C), the revision of such plan as nec-
essary to account for any substantial change in the 
condition of the individual, diagnosis of a second 
cancer, change in the individual’s preference for sur-
vivorship care, or significant revision of the plan for 
follow-up care, if such revision— 
‘‘(i) is in accordance with clauses (i), (ii), 
(iii), (v), and (vi) of such subparagraph; and 
‘‘(ii) is furnished in written form to the in-
dividual within a period specified by the Sec-
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retary 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 suppliers and providers of services re-
lated to cancer treatment and organizations representing 
survivors of cancer. Such standards shall include stand-
ards for determining the need and frequency for revisions 
of the treatment plans and follow-up survivorship care 
plans based on changes in the condition of the individual 
or elements and intent of treatment and standards for the 
communication of the plan to the individual. 
‘‘(3) In this subsection, the term ‘shared decision- 
making process’ means, with respect to an individual, a 
process in which the individual and the individual’s health 
care providers consider the individual’s diagnosis, treat-
ment options, the medical evidence related to treatment 
options, the risks and benefits of all treatment options, 
and the individual’s preferences regarding treatment, and 
then jointly develop and implement a treatment plan.’’. 
(b) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 
(1) IN
GENERAL.—Section 1848(j)(3) of the 
Social Security Act (42 U.S.C. 1395w–4(j)(3)) is 
amended by inserting ‘‘(HH),’’ after ‘‘health risk as-
sessment),’’. 
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(2) INITIAL RATES.—Unless the Secretary of 
Health and Human Services otherwise provides, the 
payment rate specified under the physician fee 
schedule under the amendment made by paragraph 
(1) for cancer care planning and coordination serv-
ices shall be the same payment rate as provided for 
transitional care management services (as defined in 
CPT code 99496). 
(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. 
Æ 
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