I 
111TH CONGRESS 
1ST SESSION H. R. 1927 
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 2, 2009 
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 
‘‘Assuring and Improving Cancer Treatment Education 
and Cancer Symptom Management Act of 2009’’. 
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(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 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. Expansion of research. 
Sec. 202. Nursing intervention research grants. 
Sec. 203. Institute of Medicine study on the provision of symptom management 
and supportive care in people with cancer. 
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 
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with cancer being treated in outpatient and home- 
based settings. Similarly, the number of caregivers 
who said they were well informed and confident 
about caregiving after attending a family caregiver 
cancer education program which increased after pro-
gram 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 
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such patients and their caregivers receive the infor-
mation they need to help minimize adverse events re-
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. 
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(10) Comprehensive cancer care must include 
access to services and management associated with 
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 with 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-
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pled with expanded cancer symptom management re-
search, will help improve care and quality of life for 
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), as amended by section 152 
of the Medicare Improvements for Patients and Providers 
Act of 2008 (Public Law 110–275), 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 patient treatment 
education 
services 
(as 
defined 
in 
subsection 
(hhh)(1));’’; and 
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(2) by adding at the end the following new sub-
section: 
‘‘Comprehensive Cancer Patient Treatment Education 
Services 
‘‘(hhh)(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-
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fects to be reported and to which health care 
provider the side effects should be reported; 
‘‘(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 
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education services and organizations representing people 
with cancer.’’. 
(b) PAYMENT.—Section 1833(a)(1) of such Act (42 
U.S.C. 1395l(a)(1)), as amended by section 101 of the 
Medicare Improvements for Patients and Providers Act of 
2008 (Public Law 110–275), is amended— 
(1) by striking ‘‘and’’ before ‘‘(W)’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and (X) with respect to comprehen-
sive cancer patient treatment education service (as 
defined in section 1861(hhh)(1)), 150 percent of the 
payment rate established under section 1848 for dia-
betes outpatient self-management training services 
(as defined in section 1861(qq)), determined and ap-
plied 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 (M), by striking ‘‘or’’ at 
the end; 
(2) in subparagraph (N), by striking the semi-
colon at the end and inserting ‘‘, and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(O) in the case of comprehensive cancer pa-
tient treatment education services (as defined in 
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subsection (hhh)(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 
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. EXPANSION OF RESEARCH. 
Subpart 1 of part C of title IV of the Public Health 
Service Act (42 U.S.C. 285 et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 417G. RESEARCH ON CANCER SYMPTOM MANAGE-
MENT IMPROVEMENT. 
‘‘(a) IN GENERAL.—The Director of NIH shall ex-
pand, intensify, and coordinate programs for the conduct 
and support of research with respect to— 
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‘‘(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 NIH shall 
carry out this section— 
‘‘(1) through the Director of the Institute; and 
‘‘(2) in collaboration with the directors of the 
National Institute of Nursing Research, the Na-
tional Institute of Mental Health, the National Cen-
ter on Minority Health and Health Disparities, the 
National Center for Complementary and Alternative 
Medicine, and the Agency for Healthcare Research 
and Quality.’’. 
SEC. 202. NURSING INTERVENTION RESEARCH GRANTS. 
Subpart 1 of part C of title IV of the Public Health 
Service Act (42 U.S.C. 285 et seq.), as amended by section 
201, is amended by adding at the end the following: 
‘‘SEC. 417H. NURSING INTERVENTION RESEARCH GRANTS. 
‘‘(a) IN GENERAL.—The Director of NIH shall make 
grants for research to be conducted— 
‘‘(1) with a registered nurse as the principal in-
vestigator; and 
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‘‘(2) for the purpose of studying cancer symp-
tom management care and services delivered by reg-
istered nurses to cancer patients. 
‘‘(b) INCLUSION
OF NATIONAL RESEARCH INSTI-
TUTES.—In carrying out this section, the Director of NIH 
shall provide for the participation of the National Cancer 
Institute, the National Institute of Nursing Research, and 
any other national research institute that has been en-
gaged in research described subsection (a)(2). 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for fiscal years 2010 
through 2014.’’. 
SEC. 203. INSTITUTE OF MEDICINE STUDY ON THE PROVI-
SION OF SYMPTOM MANAGEMENT AND SUP-
PORTIVE CARE IN PEOPLE WITH CANCER. 
(a) REPORT.— 
(1) IN
GENERAL.—Not later than 2 months 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services (in this sec-
tion referred to as the ‘‘Secretary’’) shall enter into 
an arrangement under which the Institute of Medi-
cine of the National Academy of Sciences (in this 
section referred to as the ‘‘Institute’’) shall conduct 
a study and evaluation, including a report, on the 
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current state of symptom management, patient 
treatment education, and supportive care given to 
people with cancer. 
(2) SPECIFIC MATTERS EVALUATED.—In con-
ducting the study and evaluation under paragraph 
(1), the Institute shall— 
(A) analyze any barriers to access to, and 
delivery of, symptom management, patient 
treatment education, and supportive care to 
people with cancer; 
(B) catalogue and evaluate the incentives 
and disincentives in the current reimbursement 
system that influence whether individuals re-
ceive comprehensive symptom management, pa-
tient treatment education, and supportive care, 
including adequate and ongoing patient treat-
ment education; 
(C) evaluate the importance of nursing 
interventions in the management of symptoms 
and side effects of cancer and the associated 
treatment; 
(D) consider such other matters as the In-
stitute determines appropriate; and 
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(E) make recommendations to address any 
barriers, challenges, or other issues identified 
through the study and evaluation. 
(3) SCOPE
OF
REVIEW.—In conducting such 
study and evaluation, the Institute shall consider a 
variety of perspectives, including the perspectives of 
patients and their family caregivers, registered 
nurses, including nurses certified in oncology, physi-
cians, social workers, psychologists, other health care 
professionals, and other experts and stakeholders. 
(b) REPORT.—Not later than 18 months after the 
date of enactment of this Act, the arrangement under sub-
section (a) shall provide for the Institute to submit to the 
Secretary and to Congress a report on the study evalua-
tion conducted under such subsection. Such report shall 
contain a detailed description of the findings of such study 
and evaluation and recommendations for improving the 
provision of symptom management, patient treatment edu-
cation, and supportive care to people with cancer. 
(c) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary for the purposes of conducting the study and 
evaluation, and preparing the report, required by this sec-
tion. 
Æ 
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