I 
118TH CONGRESS 
1ST SESSION H. R. 5183 
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 
AUGUST 11, 2023 
Mr. DESAULNIER (for himself, Mr. RASKIN, Ms. BLUNT ROCHESTER, Ms. 
WILD, Mr. KHANNA, Ms. CLARKE of New York, Mrs. WATSON COLEMAN, 
Mr. BISHOP of Georgia, Ms. NORTON, and Ms. WASSERMAN SCHULTZ) 
introduced the following bill; which was referred to the Committee on En-
ergy 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 provisions as fall within the jurisdic-
tion 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’’. 
(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 decision making 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 
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 inserting ‘‘and’’ at the end of sub-
paragraph (JJ); and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(KK) cancer care planning and coordination 
services (as defined in subsection (nnn));’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘Cancer Care Planning and Coordination Services 
‘‘(nnn)(1) The term ‘cancer care planning and coordi-
nation services’ means, with respect to an individual who 
is diagnosed with cancer, the development of a treatment 
plan by a physician, physician assistant, or nurse practi-
tioner that— 
‘‘(A) includes each component of the Institute 
of Medicine Care Management Plan (as described in 
the article entitled ‘Delivering High-Quality Cancer 
Care: Charting a New Course for a System in Crisis’ 
published by the Institute of Medicine); 
‘‘(B) is furnished in written form or electroni-
cally, at the visit of such individual with such physi-
cian, physician assistant, or nurse practitioner, or as 
soon after the date of the visit as practicable; and 
‘‘(C) is furnished, to the greatest extent prac-
ticable, in an appropriate form that appropriately 
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takes into account cultural and linguistic needs of 
the individual in order to make the plan accessible 
to the individual. 
‘‘(2) The Secretary shall establish frequencies at 
which services described in paragraph (1) may be fur-
nished, provided that such services may be furnished with 
respect to an individual— 
‘‘(A) at the time such individual is diagnosed 
with cancer for purposes of planning treatment; 
‘‘(B) if there is a change in the condition of 
such individual or such individual’s treatment pref-
erences; 
‘‘(C) at the end of active treatment and begin-
ning of survivorship care; and 
‘‘(D) if there is a recurrence of such cancer.’’. 
(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)(KK),’’ after ‘‘health risk 
assessment),’’. 
(2) INITIAL RATES.—Unless the Secretary oth-
erwise provides, the payment rate specified under 
the physician fee schedule under the amendment 
made by paragraph (1) for cancer care planning and 
coordination services shall be the same payment rate 
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as provided for transitional care management serv-
ices (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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