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 
decision making 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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(A) by striking ‘‘and’’ at the end of sub-
paragraph (GG); 
(B) by adding ‘‘and’’ at the end of sub-
paragraph (HH); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(II) cancer care planning and coordination 
services (as defined in subsection (lll))’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘Cancer Care Planning and Coordination Services 
‘‘(lll)(1) The term ‘cancer care planning and coordi-
nation services’ means— 
‘‘(A) with respect to an individual who is diag-
nosed with cancer, the development of a treatment 
plan by a physician, nurse practitioner, or physician 
assistant 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 treatment 
options; 
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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 ‘‘(2)(II),’’ after ‘‘health risk 
assessment),’’. 
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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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