I 
114TH CONGRESS 
1ST SESSION H. R. 2846 
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 
JUNE 23, 2015 
Mrs. CAPPS (for herself and Mr. BOUSTANY) 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 subse-
quently 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 
‘‘Planning Actively for Cancer Treatment (PACT) Act of 
2015’’. 
(b) FINDINGS.—Congress makes the following find-
ings: 
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(1) Individuals with cancer often do not have 
access to a cancer care system that incorporates 
shared decision-making and the coordination of all 
elements of care. 
(2) The cancer care system has not traditionally 
offered individuals with cancer a shared decision- 
making process, a prospective and comprehensive 
plan for treatment, symptom management and sup-
portive care, strategies for updating and evaluating 
such plan with the assistance of a health care pro-
fessional, and a follow-up plan for monitoring and 
treating possible late effects of cancer and its treat-
ment. 
(3) Cancer survivors often experience the 
under-diagnosis and under-treatment of the symp-
toms of cancer, a problem that begins at the time 
of diagnosis and may become more severe with dis-
ease progression and at the end of life. The failure 
to treat the symptoms, side effects, and late effects 
of cancer and cancer treatment may have a serious 
adverse impact on the health, survival, well-being, 
and quality of life of cancer survivors. 
(4) The 1999 Institute of Medicine report enti-
tled ‘‘The Unequal Burden of Cancer’’ found that 
low-income people often lack access to adequate can-
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cer care and that ethnic minorities have not bene-
fitted fully from cancer treatment advances. 
(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) Because more than half of all cancer diag-
noses occur among elderly Medicare beneficiaries, 
cancer care inadequacies should be addressed 
through the Medicare program. 
(12) Shortcomings in providing cancer care, re-
sulting in a lack of shared decision-making, inad-
equate management of cancer symptoms, and insuf-
ficient monitoring and treatment of late effects of 
cancer and its treatment, relate in part to the inad-
equacy of Medicare payments for such planning and 
coordination services. 
(13) 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. 
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)— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (EE); 
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(B) by adding ‘‘and’’ at the end of sub-
paragraph (FF); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(GG) cancer care planning and coordination 
services (as defined in subsection (iii))’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘Cancer Care Planning and Coordination Services 
‘‘(iii)(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; 
‘‘(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 
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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 
or symptom management for the individual, if such 
revision— 
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‘‘(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; 
‘‘(v) is furnished, in person, in written 
form, to the individual within a period specified 
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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-
retary that is as soon as practicable after the 
date of such revision. 
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‘‘(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 ‘‘(GG),’’ after ‘‘health risk as-
sessment),’’. 
(2) INITIAL RATES.—Unless the Secretary of 
Health and Human Services otherwise provides, the 
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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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