I 
113TH CONGRESS 
1ST SESSION H. R. 1661 
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 
APRIL 19, 2013 
Mr. ISRAEL (for himself and Mr. TIBERI) 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 provi-
sions 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Improving Cancer Treatment Education Act of 2013’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
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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 edu-
cation services. 
TITLE II—RESEARCH ON CANCER SYMPTOM MANAGEMENT 
IMPROVEMENT 
Sec. 201. Sense of Congress. 
Sec. 202. NIH Research on cancer symptom management improvement. 
SEC. 2. FINDINGS. 
The Congress makes the following findings: 
(1) Many people with cancer experience side ef-
fects, symptoms, and late complications associated 
with their disease and their treatment, which can 
have a serious adverse impact on their health, well- 
being, and quality of life. 
(2) Many side effects and symptoms associated 
with cancer and its treatment can be reduced or con-
trolled by the provision of timely symptom manage-
ment and services and also by educating people with 
cancer and their caregivers about the potential ef-
fects before treatment begins. 
(3) Studies have found that individualized edu-
cational intervention for cancer pain management 
from a registered nurse was effective for patients 
with cancer being treated in outpatient and home- 
based settings. Similarly, the number of caregivers 
who said they were well informed and confident 
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about caregiving after attending a family caregiver 
cancer education program increased after program 
attendance. 
(4) People with cancer benefit from having an 
educational session with oncology nurses in advance 
of the initiation of treatment to learn how to reduce 
the risk of and manage adverse effects and maximize 
well-being. Helping patients to manage their side ef-
fects reduces adverse events and the need for urgent 
or inpatient care. 
(5) The Oncology Nursing Society has received 
reports from its members that, because the Medicare 
program and other payers do not cover the provision 
of patient treatment education, patients and their 
caregivers often do not receive adequate education 
before the onset of such patients’ treatment for can-
cer regarding the course of such treatment and the 
possible side effects and symptoms such patients 
may experience. The Oncology Nursing Society rec-
ommends that all patients being treated for cancer 
have a one-on-one educational session with a nurse 
in advance of the onset of such treatment so that 
such patients and their caregivers receive the infor-
mation they need to help minimize adverse events re-
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lated to such treatment and maximize the well-being 
of such patients. 
(6) Insufficient or non-existent Medicare pay-
ments coupled with poor investment in symptom 
management research contribute to the inadequate 
education of patients, poor management and moni-
toring of cancer symptoms, and inadequate handling 
of late effects of cancer and its treatment. 
(7) People with cancer often do not have the 
symptoms associated with their disease and the asso-
ciated treatment managed in a comprehensive or ap-
propriate manner. 
(8) People with cancer deserve to have access to 
comprehensive care that includes appropriate treat-
ment and symptom management. 
(9) Patients who receive infused chemotherapy 
likely obtain some treatment education during the 
course of the administration of their treatment; yet, 
many do not, and individuals who may receive a dif-
ferent type of cancer care, such as radiation or sur-
gical interventions or oral chemotherapy taken at 
home, likely do not receive treatment education dur-
ing their treatment. 
(10) Comprehensive cancer care must include 
access to services and management associated with 
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nausea, vomiting, fatigue, depression, pain, and 
other symptoms. 
(11) The Institute of Medicine report, ‘‘Ensur-
ing Quality Cancer Care’’ asserts that ‘‘much can be 
done to relieve the symptoms, ease distress, provide 
comfort, and in other ways improve the quality of 
life of someone with cancer. For a person with can-
cer, maintenance of quality of life requires, at a min-
imum, relief from pain and other distressing symp-
toms, relief from anxiety and depressions, including 
the fear of pain, and a sense of security that assist-
ance will be readily available if needed.’’. 
(12) The Institute of Medicine report, ‘‘Cancer 
Care for the Whole Patient: Meeting Psychosocial 
Health Needs’’ recognizes that cancer patients’ psy-
chosocial needs include information about their 
therapies and the potential side effects. 
(13) As more than half of all cancer diagnoses 
occur among individuals age 65 and older, the chal-
lenges of managing cancer symptoms are growing 
for patients enrolled in the Medicare program. 
(14) Provision of Medicare payment for com-
prehensive cancer patient treatment education, cou-
pled with expanded cancer symptom management re-
search, will help improve care and quality of life for 
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people with cancer from the time of diagnosis 
through survivorship or end of life. 
TITLE I—COMPREHENSIVE CAN-
CER 
PATIENT 
TREATMENT 
EDUCATION 
UNDER 
THE 
MEDICARE PROGRAM 
SEC. 101. MEDICARE COVERAGE OF COMPREHENSIVE CAN-
CER PATIENT TREATMENT EDUCATION SERV-
ICES. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (EE); 
(B) by adding ‘‘and’’ at the end of sub-
paragraph (FF); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(GG) comprehensive cancer patient treatment 
education 
services 
(as 
defined 
in 
subsection 
(iii)(1));’’; and 
(2) by adding at the end the following new sub-
section: 
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‘‘Comprehensive Cancer Patient Treatment Education 
Services 
‘‘(iii)(1) The term ‘comprehensive cancer patient 
treatment education services’ means— 
‘‘(A) in the case of an individual who is diag-
nosed with cancer, the provision of a one-hour pa-
tient treatment education session delivered by a reg-
istered nurse that— 
‘‘(i) is furnished to the individual and the 
caregiver (or caregivers) of the individual in ad-
vance of the onset of treatment and to the ex-
tent practicable, is not furnished on the day of 
diagnosis or on the first day of treatment; 
‘‘(ii) educates the individual and such care-
giver (or caregivers) to the greatest extent prac-
ticable, about all aspects of the care to be fur-
nished to the individual, informs the individual 
regarding any potential symptoms, side-effects, 
or adverse events, and explains ways in which 
side effects and adverse events can be mini-
mized and health and well-being maximized, 
and provides guidance regarding those side ef-
fects to be reported and to which health care 
provider the side effects should be reported; 
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‘‘(iii) includes the provision, in written 
form, of information about the course of treat-
ment, any responsibilities of the individual with 
respect to self-dosing, and ways in which to ad-
dress symptoms and side-effects; and 
‘‘(iv) is furnished, to the greatest extent 
practicable, in an oral, written, or electronic 
form that appropriately takes into account cul-
tural and linguistic needs of the individual in 
order to make the information comprehensible 
to the individual and such caregiver (or care-
givers); and 
‘‘(B) with respect to an individual for whom a 
course of cancer treatment or therapy is materially 
modified, a one-hour patient treatment education 
session described in subparagraph (A), including up-
dated information on the matters described in such 
subparagraph should the individual’s oncologic 
health care professional deem it appropriate and 
necessary. 
‘‘(2) In establishing standards to carry out paragraph 
(1), the Secretary shall consult with appropriate organiza-
tions representing providers of oncology patient treatment 
education services and organizations representing people 
with cancer.’’. 
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(b) PAYMENT.—Section 1833(a)(1) of such Act (42 
U.S.C. 1395l(a)(1)) is amended— 
(1) by striking ‘‘and’’ before ‘‘(Z)’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and (AA) with respect to com-
prehensive cancer patient treatment education serv-
ices (as defined in section 1861(iii)(1)), 150 percent 
of the payment rate established under section 1848 
for diabetes outpatient self-management training 
services (as defined in section 1861(qq)), determined 
and applied without regard to any coinsurance’’. 
(c) COVERAGE.—Section 1862(a)(1) of such Act (42 
U.S.C. 1395y(a)(1)) is amended— 
(1) in subparagraph (O), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (P), by striking the semi-
colon at the end and inserting ‘‘, and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(Q) in the case of comprehensive cancer pa-
tient treatment education services (as defined in 
subsection (iii)(1)) which are performed more fre-
quently than is covered under such section;’’. 
(d) NO IMPACT ON PAYMENT FOR OTHER SERV-
ICES.—Nothing in this section shall be construed to affect 
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or otherwise authorize any reduction or modification, in 
the Medicare payment amounts otherwise established for 
chemotherapy infusion or injection codes with respect to 
the calculation and payment of minutes for chemotherapy 
teaching or related services. 
(e) 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. 
TITLE II—RESEARCH ON CAN-
CER SYMPTOM MANAGEMENT 
IMPROVEMENT 
SEC. 201. SENSE OF CONGRESS. 
It is the sense of Congress that— 
(1) many people with cancer experience side ef-
fects, symptoms, and late side effects associated with 
their disease and their treatment, and such effects 
can have a serious adverse impact on the effective-
ness of their treatment, their health, well-being, and 
quality of life; 
(2) with the number of cancer survivors con-
tinuing to grow, addressing the effects of their 
symptoms and side effects is becoming increasingly 
critical in reducing the burden of cancer and its 
treatments; 
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(3) although research is producing new insights 
into the causes of and cures for cancer, efforts to 
manage the symptoms and side effects of the disease 
and its treatments have not kept pace; and 
(4) the National Institutes of Health should 
continue to support research in the area of symptom 
management and the role that nurses play in pro-
viding those interventions. 
SEC. 202. NIH RESEARCH ON CANCER SYMPTOM MANAGE-
MENT IMPROVEMENT. 
(a) IN GENERAL.—The Director of the National In-
stitutes of Health shall expand, intensify, and coordinate 
programs for the conduct and support of research with 
respect to— 
(1) improving the treatment and management 
of symptoms and side effects associated with cancer 
and cancer treatment; and 
(2) evaluating the role of nursing interventions 
in the amelioration of such symptoms and side ef-
fects. 
(b) ADMINISTRATION.—The Director of the National 
Institutes of Health is encouraged to carry out this section 
through the Director of the National Cancer Institute, in 
collaboration with at least the directors of the National 
Institute of Nursing Research, the National Institute of 
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Neurological Disorders and Stroke, the National Institute 
of Mental Health, the National Center on Minority Health 
and Health Disparities, the National Center for Com-
plementary and Alternative Medicine, and the Agency for 
Healthcare Research and Quality. 
Æ 
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