Cancer Care Planning and Communications Act of 2021
Bill: H.R.4414 | Sponsor: Rep. DeSaulnier, Mark (D-CA)
Policy area: Health

Summary:
Cancer Care Planning and Communications Act of 2021
This bill provides for Medicare coverage and payment of cancer care planning and coordination services for individuals who are diagnosed with or treated for cancer, including the development of treatment plans, follow-up care, and any necessary revisions.

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 Representatives 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 of 2021''.
    (b) Findings.--Congress makes the following findings:
            (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 coordination of all elements of care.
            (4) Cancer survivors often experience the under-diagnosis 
        and under-treatment of the symptoms 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 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.
            (5) Individuals with cancer often do not participate in a 
        shared decision-making process that considers all treatment 
        options and do not benefit from coordination of all elements of 
        active treatment and palliative care.
            (6) Quality cancer care should incorporate access 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 access to follow-up monitoring and treatment of possible 
        late effects of cancer and cancer treatment, including 
        appropriate psychosocial services.
            (8) The Institute of Medicine report entitled ``Ensuring 
        Quality Cancer Care'' described the elements of quality care 
        for an individual with cancer to include--
                    (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 communication 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 compassionate 
                care for the individual.
            (9) In its report ``From Cancer Patient to Cancer Survivor: 
        Lost in Transition'', the Institute of Medicine recommended 
        that individuals with cancer completing primary treatment be 
        provided a comprehensive summary of their care along with a 
        follow-up survivorship plan of treatment.
            (10) In ``Cancer Care for the Whole Patient'', the 
        Institute of Medicine stated that the development of a plan 
        that includes biomedical and psychosocial care should be a 
        standard for quality cancer care in any quality measurement 
        system.
            (11) The Commission on Cancer has encouraged survivorship 
        care planning by making the development of such plans for 
        patients one of the standards of accreditation for cancer care 
        providers, but cancer care professionals report difficulties 
        completing the plans.
            (12) Because more than half of all cancer diagnoses occur 
        among elderly Medicare beneficiaries, addressing cancer care 
        inadequacies through Medicare 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 coordination are already 
        being tested in the Medicare program; the Oncology Care Model 
        has been implemented in a number of oncology practices, and 
        additional 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 Oncology Care Model. Other Medicare 
        beneficiaries who are not enrolled in these delivery 
        demonstrations 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 COORDINATION SERVICES.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)(2)--
                    (A) by striking ``and'' at the end of subparagraph 
                (GG);
                    (B) by adding ``and'' at the end of subparagraph 
                (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 subsection:

            ``Cancer Care Planning and Coordination Services

    ``(lll)(1) The term `cancer care planning and coordination 
services' means--
            ``(A) with respect to an individual who is diagnosed with 
        cancer, the development of a treatment plan by a physician, 
        nurse practitioner, or physician assistant that--
                    ``(i) includes an assessment of the individual's 
                diagnosis, health status, treatment needs, functional 
                status, pain control, and psychosocial needs;
                    ``(ii) engages the individual in a shared decision-
                making process that reviews all treatment options;
                    ``(iii) details, to the greatest extent practicable 
                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 palliative 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 diagnosed;
                    ``(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 determined 
                by the Secretary to be appropriate;
            ``(B) with respect to an individual for whom a treatment 
        plan has been developed under subparagraph (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--
                    ``(i) is in accordance with clauses (i), (ii), 
                (iv), and (v) of such subparagraph; and
                    ``(ii) is furnished in written form to the 
                individual within a period specified by the Secretary 
                that is as soon as practicable after the date of such 
                revision;
            ``(C) with respect to an individual who has completed the 
        primary treatment for cancer, as defined by the Secretary, the 
        development of a follow-up survivorship care plan that--
                    ``(i) includes an assessment of the individual's 
                diagnosis, health status, treatment needs, functional 
                status, pain control, and psychosocial needs;
                    ``(ii) engages the individual in a shared decision-
                making process that reviews all survivorship 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 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 determined 
                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 necessary to account for any 
        substantial change in the condition of the individual, 
        diagnosis of a second cancer, change in the individual's 
        preference for survivorship 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 
                individual within a period specified by the Secretary 
                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 organizations 
representing suppliers and providers of services related to cancer 
treatment and organizations representing survivors of cancer. Such 
standards shall include standards 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, treatment 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),''.
            (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 
        services 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.
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