Comprehensive Cancer Survivorship Act
Bill: S.5295 | Sponsor: Sen. Klobuchar, Amy (D-MN)
Policy area: Health

Summary:
Comprehensive Cancer Survivorship Act
This bill establishes programs and requirements to support the provision of services for cancer survivors, including Medicare coverage of cancer care planning and coordination services, grant programs for navigation services for cancer survivors, and a model to provide cancer survivorship care planning for children under Medicaid and the Children's Health Insurance Program (CHIP).

To address the health of cancer survivors and unmet needs that 
  survivors face through the entire continuum of care from diagnosis 
    through active treatment and posttreatment, in order to improve 
survivorship, treatment, transition to recovery and beyond, quality of 
 life and palliative care, and long-term health outcomes, including by 
    developing a minimum standard of care for cancer survivorship, 
    irrespective of the type of cancer, a survivor's background, or 
        forthcoming survivorship needs, and for other purposes.

    Be it enacted by the Senate and House of Representatives 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 ``Comprehensive 
Cancer Survivorship Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Coverage of cancer care planning and coordination services.
Sec. 5. Survivorship transition tools.
Sec. 6. Alternative payment model.
Sec. 7. Survivorship navigation.
Sec. 8. Survivorship care demonstration program.
Sec. 9. Cancer survivor workforce assistance grants.
Sec. 10. Comprehensive cancer survivorship program.
Sec. 11. Adult cancer survivorship study.
Sec. 12. Survivorship progress report.
Sec. 13. Promoting State innovations to ease transitions to the primary 
                            care setting for children with cancer.
Sec. 14. Childhood cancer demonstration model and standard of care.
Sec. 15. Medicaid coverage of fertility preservation services for 
                            cancer patients.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) A cancer survivor is any individual with a history of 
        cancer, from the time of diagnosis through the rest of their 
        life, across the continuum of care.
            (2) Today, there are approximately 18,000,000 Americans who 
        are cancer survivors, and the number of survivors is projected 
        to reach 26,000,000 by 2040. Therefore, there is a great need 
        to be able to provide ways to sustain the care needed and to 
        offer those living with, through, and beyond cancer a safe, 
        supportive, and accommodating environment where such 
        individuals can engage in physical and social support 
        activities to sustain optimal quality of life.
            (3) Cancer survivors face difficult emotional, 
        psychological, neurological, financial, and other physical 
        challenges that persist beyond diagnosis and treatment, often 
        arising months and years after active cancer treatment ends.
            (4) Cancer survivors have unique needs and must manage 
        short- and long-term effects of their treatment, as well as 
        regular screenings for cancer recurrence or new cancers.
            (5) Cancer survivors of racial and ethnic diversity have 
        disproportionately lower health-related, quality-of-life scores 
        compared to non-Hispanic White cancer survivors.
            (6) Cancer survivors living in rural areas have less access 
        to services and have poorer outcomes than survivors in 
        metropolitan areas.
            (7) Children, adolescent, and young adult cancer survivors 
        are particularly susceptible to long-term consequences from 
        treatment, and up to 80 percent have a severe, disabling, life-
        threatening, or fatal health condition by the age of 50. Best 
        practices in this area would improve treatment, quality of 
        life, and long-term health outcomes.
            (8) Clinical trials have shown that cancer survivorship 
        programs help cancer survivors meet or exceed the recommended 
        amount of physical activity, significantly increasing their 
        cardiovascular health and overall quality of life and 
        decreasing their cancer-related fatigue.
            (9) Survivorship care refers to the medical or psychosocial 
        care of an individual who has completed their primary treatment 
        for cancer, or of an individual who is undergoing maintenance 
        or intermittent medical treatment or maintenance psychosocial 
        care for cancer, or of an individual living with metastatic 
        disease under continuous medical or psychosocial treatment.
            (10) Despite the National Cancer Institute and other 
        professional organizations' definition of a cancer survivor 
        beginning on the day of a cancer diagnosis, there is little 
        agreement among clinicians, researchers, and insurance 
        companies on what services are included in ``survivorship 
        care'' and the point at which ``survivorship care'' begins.
            (11) Cancer survivors, their families, their caregivers, 
        and their providers face many difficulties understanding and 
        coordinating the transition from specialty to primary care, and 
        for this reason communication and treatment are often 
        fragmented and inconsistent.
            (12) To avoid additional health-related or financial 
        hardships to cancer survivors and their families, comprehensive 
        and forward-thinking cancer survivorship studies and programs 
        across Federal agencies are required to engage in a coordinated 
        effort to improve health outcomes and quality of life of 
        survivors.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Cancer survivor.--The term ``cancer survivor'' means 
        anyone who remains alive from the time of a cancer diagnosis.
            (2) Caregiver.--The term ``caregiver'' means a family 
        member, friend, or other person who cares for an older person 
        or adult with a chronic or disabling condition, including 
        cancer.
            (3) Patient experience data.--The term ``patient experience 
        data'' means patient experiences, perspectives, needs, and 
        priorities related to--
                    (A) the symptoms of the patient's conditions and 
                the natural history of such conditions;
                    (B) the impact of the conditions on the patient's 
                functioning and quality of life;
                    (C) the patient's experience with treatments;
                    (D) input on which outcomes are important to the 
                patient;
                    (E) patient preferences for outcomes and 
                treatments; and
                    (F) the relative importance of any issues as 
                defined by patients.
            (4) Psychosocial effects.--The term ``psychosocial 
        effects''--
                    (A) means the psychological, behavioral, emotional, 
                and social effects of a disease, such as cancer, and 
                its treatment; and
                    (B) in the case of such effects of cancer, includes 
                changes in how a patient thinks, their feelings, moods, 
                beliefs, ways of coping, and relationships with family, 
                friends, and coworkers.
            (5) Psychosocial care.--The term ``psychosocial care'' 
        means psychological and social services and interventions that 
        enable survivors, patients, their families, and health care 
        providers to optimize health care and to manage the 
        psychological, behavioral, physical, emotional, and social 
        aspects of illness and its consequences so as to promote better 
        health and well-being.
            (6) Secretary.--Except as otherwise specified, the term 
        ``Secretary'' means the Secretary of Health and Human Services.
            (7) Survivorship.--The term ``survivorship'' means the 
        period from the time of cancer diagnosis until the end of life, 
        including any portions of such period during which 
        interventions are necessary to address--
                    (A) the physical, mental, emotional, social, and 
                financial effects of cancer that begin at diagnosis and 
                continue through treatment and beyond; and
                    (B) issues related to follow-up care (including 
                regular health and wellness checkups), late and long-
                term effects of treatment, screening for cancer 
                recurrence and new cancers, and quality of life.
            (8) Survivorship care plan.--The term ``survivorship care 
        plan''--
                    (A) means an individualized care plan for patients 
                who have been treated for cancer; and
                    (B) includes a treatment summary and any follow-up 
                care guidelines in such plan that--
                            (i) are for monitoring and maintaining the 
                        patient's medical and psychosocial health and 
                        well-being; and
                            (ii) are meant to be a transition and 
                        communication tool for the survivor, their 
                        family, their caregiver, and all their health 
                        care providers.
            (9) Survivorship navigation.--The term ``survivorship 
        navigation'' means a service that--
                    (A) helps patients overcome health care system and 
                social determinants of health barriers; and
                    (B) provides patients with timely access to high-
                quality medical, physical, and psychosocial care from 
                their cancer diagnosis through all phases of their 
                cancer experience.
            (10) Treatment summary.--The term ``treatment summary'' 
        means a detailed summary of a patient's disease, the types of 
        treatment the patient received, members of the patient's care 
        team, and any side effects or other problems, including 
        psychosocial effects, caused by treatment.

SEC. 4. 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, with respect to an individual who is diagnosed with 
cancer, the development of a treatment plan by a physician, physician 
assistant, or nurse practitioner 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 electronically, at 
        the visit of such individual with such physician, physician 
        assistant, or nurse practitioner, or as soon after the date of 
        the visit as practicable;
            ``(C) is furnished, to the greatest extent practicable, in 
        a form that appropriate 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 furnished, 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 preferences;
            ``(C) at the end of active treatment and beginning 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)(II),'' after ``health risk assessment),''.
            (2) Initial rates.--Unless the Secretary 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.

SEC. 5. SURVIVORSHIP TRANSITION TOOLS.

    (a) In General.--The head of the Office of the National Coordinator 
for Health Information Technology, in collaboration with Director of 
the Agency for Healthcare Research and Quality, shall--
            (1) evaluate existing models for survivorship care plans, 
        as they relate to both adults and children, through engagement 
        with professional societies, payors, patient advocacy 
        organizations, community-based organizations, electronic health 
        record vendors, and other stakeholders;
            (2) evaluate other existing tools for developing 
        survivorship care plans, such as--
                    (A) survivorship guidelines of the National 
                Comprehensive Cancer Network and the American Society 
                of Clinical Oncology; or
                    (B) tools such as Passport for Care;
            (3) collaborate with the Office for Civil Rights of the 
        Department of Health and Human Services to evaluate the privacy 
        and security implications of--
                    (A) consolidating treatment history and 
                survivorship guidelines into a personalized 
                survivorship care plan, as described in paragraph (4); 
                and
                    (B) patient use of computer or mobile phone-based 
                application programs described in paragraph (4)(B); and
            (4) taking into consideration the results of evaluation 
        under paragraphs (1) and (2)--
                    (A) not later than 12 months after the date of 
                enactment of this Act, publish information resources 
                for cancer patients and providers on strategies for 
                consolidating treatment history and survivorship 
                guidelines into a personalized survivorship care plan 
                to guide survivorship monitoring and follow-up care; 
                and
                    (B) include in such information resources 
                recommendations about possible patient use of 
                application programs (``apps'') to develop personalized 
                survivorship care plans.
    (b) Definition.--In this section, the term ``electronic health 
record'' means an electronic record of health-related information on an 
individual that is created, gathered, managed, and consulted by 
authorized health care clinicians and staff.

SEC. 6. ALTERNATIVE PAYMENT MODEL.

    Not later than 18 months after the date of the enactment of this 
Act, the Secretary shall submit to Congress a report containing a 
description of an alternative payment model for payment under title 
XVIII and title XIX of the Social Security Act (42 U.S.C. 1395 et seq., 
1396 et seq.) for items and services relating to cancer survivorship 
care. The report shall include the following:
            (1) A description of what event would trigger an 
        individual's entry into such a model (such as the end of the 
        individual's active cancer treatment, the beginning of the 
        individual's need for supportive care during active treatment, 
        or another event).
            (2) The length of the individual's participation under such 
        model, including a description of any ability to extend such 
        participation.
            (3) In the case that such model is based on an episode of 
        care, the appropriate length of the survivorship episode of 
        care and whether additional episodes may be triggered, if 
        necessary.
            (4) Strategies to ensure that any episode of care under 
        such a model begins with the development and dissemination of a 
        survivorship care plan for the transition from active cancer 
        treatment to follow-up care to the individual and all relevant 
        health care providers.
            (5) A description of any bundled payment packages that will 
        be used under such model.
            (6) A specification of any follow up or new screening under 
        such model for unmet needs of individuals participating in such 
        model.
            (7) How consistent, shared decisionmaking will be promoted 
        under such model so that individuals are given the knowledge 
        needed for self-management between episodes of care.
            (8) A specification of which types of health care providers 
        may furnish items and services under such model, including 
        genetic counselors and mental health professionals.
            (9) Strategies for applying evidence-based risk 
        stratification principles to direct survivors to personalized 
        care pathways that match the level of care needed to the 
        relative risks and needs of the survivor.
            (10) Strategies for coordination of care between such 
        providers, such as between specialists and primary care 
        providers, and how principal responsibility will be assigned 
        for an episode of care.
            (11) Strategies for addressing social determinants of 
        health through such model.
            (12) A description of how such model will promote--
                    (A) prevention, early detection surveillance, and 
                treatment for individuals continuing to receive 
                systemic therapy after the end of active cancer 
                treatment;
                    (B) such individuals' understanding of, and access 
                to, treatment;
                    (C) survivorship research; and
                    (D) the continuing health of cancer survivors.
            (13) An analysis of how different forms and stages of 
        cancer may require the development of different survivorship 
        plans and alternative payment models based on varying episodes 
        of care.
            (14) A plan for testing any alternative payment model 
        described in the report, including the timing of such testing, 
        an analysis of the impact of such testing, any barriers to 
        implementing such testing, and any other recommendations 
        determined appropriate by the Secretary.

SEC. 7. SURVIVORSHIP NAVIGATION.

    (a) Review of Programs and Navigation Study.--
            (1) In general.--Not later than 18 months after the date of 
        enactment of this Act, the Secretary shall--
                    (A) complete a review of previous and current 
                cancer survivorship navigation programs, including any 
                applicable standards of care such as those of the 
                Professional Oncology Navigation Task Force, and the 
                Academy of Oncology Nurse & Patient Navigators, the 
                Oncology Nursing Society; and
                    (B) submit a report to the Congress on the results 
                of such review.
            (2) Considerations.--In carrying out subsection (a), the 
        Secretary shall take into consideration each of the following:
                    (A) How cancer survivorship navigation program 
                services might be provided from diagnosis across the 
                continuum of care through survivorship, taking into 
                consideration--
                            (i) the type of navigation services that 
                        are most effective for survivors at the time of 
                        diagnosis; and
                            (ii) the type of navigation services that 
                        are most useful for survivors who are managing 
                        the late and long-term effects of cancer and 
                        cancer treatment.
                    (B) How navigation services might evolve over the 
                continuum of care and how to encourage a dynamic 
                navigation system.
                    (C) Training needs for navigators.
                    (D) Comparison and delineation of navigation 
                services provided by lay and professional navigators.
                    (E) Evaluation of optimal strategies for offering 
                survivors navigation services and encouraging their 
                utilization of such services.
                    (F) Defining--
                            (i) the continuum of care during which 
                        services are provided; and
                            (ii) the nature of services for a long-term 
                        survivor.
                    (G) The location of navigation services (such as 
                whether such services should be provided as part of 
                oncology practices or outside of oncology practices).
                    (H) Federal financing for navigation services (such 
                as whether to finance such services through a grant 
                program funded through annual discretionary 
                appropriations).
                    (I) Alternative delivery and payment models for 
                cancer survivorship navigation services, including 
                consideration of--
                            (i) an episode-of-care model for providing 
                        cancer survivorship navigation services, or a 
                        patient-focused navigation benefit that 
                        survivors could utilize in different settings, 
                        with the navigation services meeting standards 
                        set by the Secretary; and
                            (ii) services funded through the Medicare 
                        and Medicaid programs.
                    (J) Resources and the role of patient advocacy 
                organizations and peer support networks in cancer 
                survivorship navigation services.
    (b) Demonstration Program for Navigation Services for Cancer 
Survivors.--
            (1) In general.--The Secretary shall carry out a 
        demonstration program consisting of awarding grants to eligible 
        entities to provide navigation services to cancer survivors.
            (2) Timing.--The Secretary shall initiate the demonstration 
        program under this subsection not later than 12 months after 
        completing the review as required under subsection (a)(1)(A).
            (3) Eligible entities.--To be eligible to receive a grant 
        under this subsection, an entity shall--
                    (A) have staff and expertise to provide navigation 
                services; and
                    (B) be--
                            (i) a community-based organization;
                            (ii) a patient-centered education and 
                        service organization;
                            (iii) a nonprofit patient or cancer 
                        advocacy organization;
                            (iv) a community cancer provider;
                            (v) a cancer center;
                            (vi) a hospital;
                            (vii) a community health center; or
                            (viii) another type of entity as the 
                        Secretary determines appropriate.
            (4) Use of funds.--A recipient of a grant under this 
        section shall use the grant to provide navigation services to 
        cancer survivors, including by--
                    (A) offering navigation services from diagnosis 
                through the continuum of care, including long-term 
                survivorship, or offering navigation services from the 
                end of active treatment with an emphasis on 
                facilitating the transition from active treatment to 
                long-term survivorship care and throughout 
                survivorship;
                    (B) in a timely manner, assisting cancer survivors 
                to navigate cancer treatment and follow-up services, 
                such as screenings, risk assessment, mitigation, health 
                promotion activities, providing health information and 
                education, coaching, and support;
                    (C) addressing cancer care disparities in the 
                design and delivery of services;
                    (D) ensuring coordination with the survivor's 
                health care providers;
                    (E) following evidence-based survivorship care 
                guidelines in the design and delivery of survivorship 
                services;
                    (F) ensuring the delivery of culturally appropriate 
                services and materials; and
                    (G) assisting cancer survivors to meet and overcome 
                barriers to treatment and follow-up services, such as 
                any such barriers relating to food insecurity, housing, 
                transportation, labor, access to broadband 
                connectivity, the availability of telehealth, or child 
                care, with emphasis placed on high-risk populations.

SEC. 8. SURVIVORSHIP CARE DEMONSTRATION PROGRAM.

    (a) In General.--The Secretary shall carry out a demonstration 
program for a period of 5 years consisting of awarding grants to 
improve the quality of cancer survivorship care.
    (b) Timing.--The Secretary shall initiate the demonstration program 
under this section not later than 1 year after the date of enactment of 
this Act.
    (c) Demonstration Sites.--The Secretary shall ensure that grants 
are awarded under this section to improve the quality of cancer 
survivorship care at a wide diversity of sites, including--
            (1) in urban, suburban, rural, and Tribal areas; and
            (2) cancer care sites including cancer centers, academic 
        health centers, federally qualified health centers, rural 
        health clinics, physician offices, Tribal organizations, 
        community-based health care providers, and health care 
        providers serving medically underserved areas.
    (d) Areas of Focus Under the Demonstration Program.--The 
demonstration program under this section shall be designed to ensure 
the development of a variety of models for survivorship care that will 
permit evaluation of a variety of care strategies, including--
            (1) utilization of navigators to assist survivors in 
        obtaining survivorship care;
            (2) employment of risk-stratification to better determine 
        the nature and intensity of services that survivors require;
            (3) transitions of care from cancer care providers to 
        primary care providers, through transition-of-care models that 
        involve collaboration between cancer care specialists and 
        primary care providers;
            (4) the training needs of primary care providers to be 
        better equipped to work with survivors in primary care 
        settings;
            (5) utilization of survivorship care plans to facilitate 
        coordination of survivorship care;
            (6) experimentation with providing cancer survivorship care 
        at home;
            (7) use of information technology to plan and coordinate 
        care to improve the consistent identification, collection, and 
        measurement of all forms of patient experience data, including 
        patient-reported outcomes of patient-reported symptoms and 
        quality-of-life measures; and
            (8) expansion of existing successful models of survivorship 
        care.
    (e) Evaluation of Demonstration Program.--The Secretary shall--
            (1) develop a plan for evaluating the projects that are 
        conducted as part of the demonstration program under this 
        section; and
            (2) not later than 18 months after the end of the 5-year 
        demonstration program, complete such evaluation and submit a 
        report to the Congress on the results of such evaluation.

SEC. 9. CANCER SURVIVOR WORKFORCE ASSISTANCE GRANTS.

    (a) In General.--The Secretary of Labor, in consultation with the 
Secretary of Health and Human Services, shall carry out a program to 
award grants to nonprofit organizations and other entities to provide 
education and targeted assistance--
            (1) to eligible cancer survivors facing barriers to 
        employment, including those who remain in the workforce during 
        treatment, those who reduce working hours while in treatment, 
        and those who reenter the workforce after a treatment-related 
        departure; and
            (2) to the families and caregivers of such eligible cancer 
        survivors.
    (b) Program Components.--The program under this section shall 
include the following:
            (1) Assistance, career and training services, and 
        supportive services for eligible cancer survivors who stay in 
        the workforce during treatment, and for their families and 
        caregivers, including--
                    (A) transportation assistance;
                    (B) childcare assistance;
                    (C) nutritional assistance;
                    (D) physical activity assistance;
                    (E) psychosocial assistance;
                    (F) financial assistance during a period of medical 
                leave; and
                    (G) other similar assistance.
            (2) Assistance and education for eligible cancer survivors 
        who leave the workforce during treatment, and for their 
        families and caregivers, including--
                    (A) financial assistance during a period of medical 
                leave;
                    (B) assistance with premiums for continuation 
                coverage provided pursuant to part 6 of subtitle B of 
                title I of the Employee Retirement Income Security Act 
                of 1974 (29 U.S.C. 1161 et seq.), title XXII of the 
                Public Health Service Act (42 U.S.C. 300bb-1 et seq.), 
                or section 4980B of the Internal Revenue Code of 1986 
                (26 U.S.C. 4980B); and
                    (C) career and training services, including 
                upskilling and reskilling, for eligible cancer 
                survivors who are not able to return to work after 
                treatment.
            (3) Assistance, career and training services, and 
        supportive services for eligible cancer survivors who are 
        unable to work after a cancer diagnosis, and their families and 
        caregivers, including--
                    (A) assistance in applying for--
                            (i) supplemental security income benefits 
                        under title XVI of the Social Security Act (42 
                        U.S.C. 1381 et seq.);
                            (ii) disability insurance benefits under 
                        section 223 of the Social Security Act (42 
                        U.S.C. 423);
                            (iii) benefits under a State plan, or 
                        waiver of such plan, under title XIX of the 
                        Social Security Act (42 U.S.C. 1396 et seq.);
                            (iv) with respect to minimizing delays in 
                        eligibility before a cancer survivor becomes 
                        eligible for Medicare coverage, benefits under 
                        the Medicare program under title XVIII of the 
                        Social Security Act (42 U.S.C. 1801 et seq.), 
                        including with respect to enrolling in plans 
                        under part C or D of such title and 
                        supplemental plans under section 1882 of such 
                        title;
                            (v) State and private sector assistance 
                        programs for such cancer survivors; and
                            (vi) career and training services available 
                        under title I, II, or IV of the Workforce 
                        Innovation and Opportunity Act (29 U.S.C. 3101 
                        et seq.); and
                    (B) information on the eligibility of a cancer 
                survivor, and their families and caregivers, for 
                benefits or services described in any of clauses (i) 
                through (vi) of subparagraph (A).
    (c) Evidence-Based Resources.--In carrying out this section, the 
Secretary of Labor, in consultation with the Secretary of Health and 
Human Services, shall use evidence-based resources, including--
            (1) nationally recognized evidence-based guidelines; and
            (2) other resources as determined by the Secretary.
    (d) Definitions.--In this section:
            (1) The term ``eligible cancer survivor'' means a cancer 
        survivor (as defined in section 3) who--
                    (A) remains in the workforce during cancer 
                treatment;
                    (B) reduces working hours during cancer treatment;
                    (C) reenters the workforce after a cancer 
                treatment-related departure; or
                    (D) leaves the workforce as the result of a cancer 
                diagnosis or related complications.
            (2) The term ``supportive services'' has the meaning given 
        such term in section 3 of the Workforce Innovation and 
        Opportunity Act (29 U.S.C. 3102).

SEC. 10. COMPREHENSIVE CANCER SURVIVORSHIP PROGRAM.

    (a) In General.--The Secretary shall carry out a comprehensive 
cancer survivorship program that includes--
            (1) a cancer survivorship resource center in accordance 
        with subsection (b) to provide evidence-based resources to 
        cancer survivors, their families, and their caregivers;
            (2) a health care professional resource center in 
        accordance with subsection (c) to assist and educate health 
        care professionals in the delivery of high-quality survivorship 
        care;
            (3) an educational campaign in accordance with subsection 
        (d) to provide health care professionals with resources to 
        improve cancer survivorship care; and
            (4) a program of supportive care services in accordance 
        with subsection (e) to improve the quality of life and long-
        term survivorship of cancer survivors.
    (b) Cancer Survivorship Resource Center.--
            (1) Establishment.--The Secretary shall establish and 
        operate a survivorship resource center (in this subsection 
        referred to as the ``Center'') that serves as a comprehensive 
        source of information and resources related to survivorship.
            (2) Timing.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall establish and begin 
        operation of the Center.
            (3) Consultation.--In establishing and operating the 
        Center, the Secretary shall consult with cancer survivors, 
        patient organizations, health professionals, researchers, 
        health education organizations, oncology professional societies 
        and other medical societies, community-based organizations, and 
        science education organizations regarding--
                    (A) the information and resources that would assist 
                cancer survivors in managing the survivorship 
                experience and obtaining high-quality care across the 
                continuum of care;
                    (B) gaps in such information and resources that 
                need to be addressed to respond to the needs of cancer 
                survivors; and
                    (C) optimal strategies for ensuring that cancer 
                survivors have access to the Center, including 
                strategies that provide virtual options, online 
                resources, and marketing.
            (4) Use of available evidence-based resources.--In 
        establishing and operating the Center, the Secretary shall, 
        with permission and attribution, rely on and utilize the 
        evidence-based materials and resources developed, collected, 
        and distributed by cancer organizations.
    (c) Health Care Professional Resource Center.--
            (1) In general.--The Secretary shall establish and operate 
        a health care professional resource center (in this subsection 
        referred to as the ``Center'') that serves as a comprehensive 
        source of information and resources to assist health care 
        professionals in the delivery of high-quality survivorship 
        care.
            (2) Reference cancer survivorship guidelines.--In 
        establishing and operating the Center, the Secretary shall 
        reference cancer survivorship guidelines developed by cancer 
        care professional societies, patient organizations, research 
        foundations, and other health care professional societies in 
        the development of materials related to survivorship care.
            (3) Support partnerships between cancer specialty societies 
        and primary care provider organizations.--In establishing and 
        operating the Center, the Secretary shall facilitate 
        collaboration between cancer care specialty societies and 
        primary care provider organizations in the development of 
        standards for survivorship care, including standards for 
        coordination of care and transitions of care from active 
        treatment to long-term survivorship care.
    (d) Campaign To Educate Survivors and Health Care Professionals in 
Survivorship Care.--
            (1) In general.--The Secretary acting through the Director 
        of the Centers for Disease Control and Prevention (in this 
        subsection referred to as the ``Secretary'') shall--
                    (A) expand educational programs and services to--
                            (i) health care professionals; and
                            (ii) cancer survivors, their families, and 
                        caregivers; and
                    (B) enhance the continuing medical education 
                resources on cancer survivorship that are available to 
                health care professionals.
            (2) Expand collaboration with comprehensive cancer control 
        national partnership and other organizations for survivorship 
        education and support.--
                    (A) In general.--The Secretary shall expand 
                collaborations with organizations that are part of the 
                Comprehensive Cancer Control National Partnership and 
                other organizations to focus on increasing education 
                and awareness related to cancer survivorship through 
                materials, resources, and other methods as necessary.
                    (B) Collaborate with the organizations in the 
                national partnership and other organizations.--The 
                Secretary shall collaborate with the organizations that 
                are part of the Comprehensive Cancer Control National 
                Partnership and other organizations to inform cancer 
                survivors of survivorship monitoring and follow-up 
                standards, availability of survivorship care services, 
                and how to access these services.
                    (C) Reference the survivorship standards of care 
                developed and published by cancer organizations.--In 
                collaboration with the organizations that are part of 
                the Comprehensive Cancer Control National Partnership, 
                the Secretary shall--
                            (i) develop and implement a plan to 
                        distribute survivorship educational materials 
                        to ensure that such materials are accessible to 
                        all cancer survivors, their families and 
                        caregivers, and health care professionals; and
                            (ii) reference in such plan the 
                        survivorship standards of care developed and 
                        published by such organizations.
            (3) Continuing medical education.--
                    (A) In general.--The Secretary shall carry out a 
                program to support the development of continuing 
                medical education programs for survivorship care that 
                utilize and rely on the guidelines for survivorship 
                care developed and published by national organizations.
                    (B) Timing.--Not later than 12 months after the 
                date of enactment of this Act, the Secretary shall 
                initiate the program required by subparagraph (A).
                    (C) Grants for development of curriculum for 
                survivorship continuing medical education.--
                            (i) In general.--The Secretary shall award 
                        grants to eligible entities for development of 
                        diverse, equitable, and culturally appropriate 
                        curricula for survivorship care curriculum for 
                        medical care.
                            (ii) Eligible entities.--In this 
                        subparagraph, the term ``eligible entity'' 
                        includes a medical professional society, a 
                        patient organization, an academic institution, 
                        a cancer center, and any other entity with 
                        experience in continuing medical education for 
                        cancer professionals.
                            (iii) Scope of curriculum.--To receive a 
                        grant under this section, an applicant shall 
                        demonstrate its ability to develop survivorship 
                        care curriculum for medical care, taking into 
                        consideration services from the legal, social 
                        work, public health, behavioral sciences, 
                        genetic, epidemiology, and nursing fields.
            (4) Public awareness campaign.--The Secretary, at an 
        appropriate time after the availability of patient survivorship 
        materials, professional survivorship materials, and continuing 
        medical education programs under this subsection, shall 
        initiate a linguistically and cultural appropriate public 
        awareness campaign that targets the organization's catchment 
        area to ensure that cancer survivors, their families and 
        caregivers, health care professionals, and the public are aware 
        of the scope of survivorship educational and informational 
        resources available from the Centers for Disease Control and 
        Prevention.
    (e) Cancer Survivorship Quality-of-Life Program.--
            (1) In general.--The Secretary acting through the Director 
        of the Centers for Disease Control and Prevention (in this 
        subsection referred to as the ``Secretary'') shall carry out a 
        program of awarding grants to eligible entities to provide 
        services to cancer survivors to enhance their quality of life 
        and improve their long-term survival rates. Not later than 18 
        months after the date of enactment of this Act, the Secretary 
        shall commence operating such program.
            (2) Eligible entity defined.--In this subsection, the term 
        ``eligible entity'' includes an entity that is--
                    (A) a State comprehensive cancer program;
                    (B) a National Cancer Institute-designated cancer 
                center or centers; or
                    (C) a community-based organization, including a 
                patient advocacy organization, that--
                            (i) has the capacity to reach cancer 
                        survivors through local, State, or national 
                        organizations; and
                            (ii) is focused on cancer survivors and 
                        strategies for meeting their needs related to 
                        their health and well-being.
            (3) Use of funds.--A grant received under this subsection 
        shall be used to provide services to cancer survivors to 
        enhance their quality of life and improve their long-term 
        survival rates, such as by assisting survivors to--
                    (A) engage in moderate physical activity and other 
                health-promoting activities, including ceasing tobacco 
                use and increasing consumption of healthy foods;
                    (B) increase access to support services to mitigate 
                anxiety, depression, and uncertainty;
                    (C) utilize community support services to fully 
                implement survivorship care plans;
                    (D) access nutrition education and counseling; and
                    (E) adhere to a schedule for, and access, screening 
                for recurrence of cancer or the occurrence of other 
                primary cancers.
            (4) Standards for application from eligible entities.--To 
        seek a grant under this subsection, an eligible entity shall 
        submit an application, at such time as may be required by the 
        Secretary, that includes--
                    (A) an explanation of how the entity will--
                            (i) provide cancer survivors access to 
                        cancer patient navigator services;
                            (ii) overcome barriers to care for 
                        communities of color and multilingual 
                        communities;
                            (iii) provide culturally competent care; 
                        and
                            (iv) work with and support caregivers of 
                        cancer survivors;
                    (B) a description of how the entity receives 
                referrals of cancer survivors from health care 
                professionals, including health care professionals 
                serving historically disadvantaged and underserved 
                communities;
                    (C) documentation of the curriculum that will be 
                used for providers in the program, including mechanisms 
                to update the staff on curriculum changes; and
                    (D) an agreement to provide the Secretary 
                semiannual reports on--
                            (i) the number of participants served;
                            (ii) quality-of-life measures for 
                        participants; and
                            (iii) plans for fostering communication 
                        between oncology and non-oncology providers 
                        serving participants.
            (5) Responsibilities of the secretary.--The Secretary 
        shall--
                    (A) conduct outreach to inform health care 
                professionals of the availability of programs and 
                activities funded under this subsection;
                    (B) analyze the data submitted by grantees under 
                this subsection to determine the number of cancer 
                survivors served and the impact of the program under 
                this subsection on their quality of life; and
                    (C) share best practices among all grantees under 
                this subsection.

SEC. 11. ADULT CANCER SURVIVORSHIP STUDY.

    (a) In General.--Not later than 18 months after the date of 
enactment of this Act, the Secretary shall complete a landscape 
analysis that--
            (1) assesses the potential benefits of an adult version of 
        the Childhood Cancer Survivor Study;
            (2) assesses the financial costs and other burdens 
        associated with an adult cancer survivor study;
            (3) identifies sources of data on adult cancer survivors;
            (4) identifies gaps in data on adult cancer survivors, 
        compared to data collected in the Childhood Cancer Survivor 
        Study; and
            (5) identifies strategies to publish data on adult cancer 
        survivors derived from research that is conducted or supported 
        by the National Cancer Institute, in a manner that is 
        accessible to cancer survivors, health care professionals, 
        researchers, and the public.
    (b) Report.--Not later than 6 months after the date of completion 
of the feasibility analysis under subsection (a), the Secretary shall 
submit to the Congress a report on the results of such feasibility 
analysis.

SEC. 12. SURVIVORSHIP PROGRESS REPORT.

    (a) In General.--Not later than 6 months after the date of 
enactment of this Act, the Secretary shall enter into an agreement with 
the Government Accountability Office to conduct a study of the progress 
made in cancer survivorship over the period beginning on the date of 
enactment of the National Cancer Act of 1971 (Public Law 92-216).
    (b) Scope of the Study.--The study under subsection (a) shall 
investigate developments over the period described in subsection (a) 
in--
            (1) the nature and quality of survivorship care;
            (2) transitions from active treatment to survivorship care;
            (3) the quality of life of cancer survivors;
            (4) outcomes for cancer survivors;
            (5) disparities in access to care and survivorship 
        outcomes;
            (6) the health care systems for providing survivorship 
        care;
            (7) the contribution of community-based services to the 
        survivorship care system; and
            (8) payment for survivorship care by public and private 
        third-party payors.
    (c) Role of Office of Cancer Survivorship.--The study under 
subsection (a) shall--
            (1) consider the contribution of the Office of Cancer 
        Survivorship to the evolution of cancer survivorship care over 
        the last 25 years; and
            (2) assess the impact of the mission of the Office and the 
        resources provided to the Office on its leadership in cancer 
        survivorship care.
    (d) Public Meeting.--In conducting the study under subsection (a), 
the Comptroller General of the United States shall hold a public 
meeting with a broad cross section of stakeholders to inform the 
study's findings and conclusions. Such stakeholders shall include--
            (1) cancer survivors;
            (2) patient organizations representing cancer survivors;
            (3) oncologists involved in survivorship care and the 
        professional societies representing them;
            (4) primary care providers involved in survivorship care 
        and the professional societies representing them;
            (5) other health professionals providing survivorship care 
        and the professional societies representing them;
            (6) community-based organizations involved in survivorship 
        care;
            (7) representatives of the National Cancer Institute;
            (8) third-party payors;
            (9) researchers engaged in survivorship research;
            (10) epidemiologists with knowledge of trends in cancer 
        survivorship; and
            (11) such other stakeholders as the Comptroller General 
        deems important to participate in the public meeting.
    (e) Report.--The Comptroller General of the United States shall--
            (1) release a report on the results of the study under 
        subsection (a); and
            (2) in addition to the public meeting convened under 
        subsection (d)--
                    (A) convene another public meeting to be held on 
                the day of the release of the report; and
                    (B) include in such meeting all categories of 
                stakeholders listed in subsection (d).

SEC. 13. PROMOTING STATE INNOVATIONS TO EASE TRANSITIONS TO THE PRIMARY 
              CARE SETTING FOR CHILDREN WITH CANCER.

    (a) Stakeholder Group Development of Best Practices; State Medicaid 
and CHIP Program Innovation.--
            (1) Stakeholder group best practices.--Not later than 12 
        months after the date of the enactment of this Act, the 
        Secretary of Health and Human Services (in this section 
        referred to as the ``Secretary'') shall convene a stakeholder 
        group of representatives of childhood cancer advocacy 
        organizations, Medicaid and CHIP beneficiaries, providers with 
        childhood cancer expertise, the National Association of 
        Medicaid Directors, and other relevant representatives to 
        develop best practices (and submit to the Secretary and 
        Congress a report on such best practices) for States to ease 
        the transition from active oncological care to primary care of 
        children or adolescents with cancer, including best practices 
        for ensuring development of and delivery of survivorship care 
        plans to patients, families, and primary care providers and 
        best practices for such transitions occurring under the State 
        Medicaid plan under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) or State child health plan under title XXI 
        of such Act (42 U.S.C. 1397aa et seq.), as applicable. Such 
        best practices shall include practices to ensure that--
                    (A) cancer care providers transfer diagnosis and 
                treatment information to patient primary care 
                providers;
                    (B) cancer care providers develop an individualized 
                survivorship care plan of potential late effects;
                    (C) cancer care providers deliver the plan to the 
                patient and family members through an in-person visit;
                    (D) cancer care providers deliver the plan to the 
                primary care provider through electronic health records 
                or other means; and
                    (E) relevant health entities develop systems that 
                promote the coordination and effective transition of 
                care between cancer care providers, primary care 
                physicians, and other health care professionals.
            (2) State medicaid and chip program innovation.--The 
        Secretary shall work with States on innovative strategies, 
        based on the best practices developed under on the best 
        practices identified under the process described in subsection 
        (a)(1), to ease the transition from active oncological care to 
        primary care of child or adolescent with cancer ensuring 
        development of and delivery of survivorship care plans to 
        patients, families, and primary care providers and transition 
        coverage under the State Medicaid plan under title XIX of the 
        Social Security Act (42 U.S.C. 1396 et seq.) or State child 
        health plan under title XXI of such Act (42 U.S.C. 1397aa et 
        seq.), as applicable.
    (b) Guidance on Innovative Service Delivery Systems Demonstration 
Project Opportunities.--Not later than 1 year after the date the 
stakeholder group is convened under subsection (a), the Secretary, 
acting through the Administrator of the Centers for Medicare & Medicaid 
Services, shall issue guidance to State health officials, based on best 
practices developed under subsection (a)(1), regarding opportunities to 
design demonstration projects under the Social Security Act to improve 
care transitions for children and adolescents with cancer who 
transition from oncological care to primary care and who are otherwise 
eligible to receive medical assistance under title XIX of such Act (42 
U.S.C. 1396 et seq.) or title XXI of such Act (42 U.S.C. 1397aa et 
seq.).
    (c) Nonapplication of Federal Advisory Committee Act.--The Federal 
Advisory Committee Act shall not apply to the stakeholder group 
convened under paragraph (1).

SEC. 14. CHILDHOOD CANCER DEMONSTRATION MODEL AND STANDARD OF CARE.

    Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 
1315a(b)(2)) is amended--
            (1) in subparagraph (A), by striking the period at the end 
        and inserting ``, and shall include the model described in 
        clause (xxviii) of such subparagraph.''; and
            (2) in subparagraph (B), by adding at the end the following 
        new clause:
                            ``(xxviii) A local service delivery and 
                        State payment model for individuals up to age 
                        21 enrolled under a State plan (or waiver of 
                        such plan) under title XIX or a State child 
                        health plan (or waiver of such plan) under 
                        title XXI of such Act (42 U.S.C. 1397aa et 
                        seq.) who have been diagnosed with cancer and 
                        who are in the survivorship phase of their 
                        treatment. Such model shall--
                                    ``(I) provide for the creation of a 
                                survivorship plan, that can be 
                                integrated into an electronic health 
                                record, for such individuals and 
                                disseminate the plan to such 
                                individuals, families of such 
                                individuals, and the health providers 
                                of such individuals;
                                    ``(II) offer States and local 
                                providers technical assistance to 
                                develop and implement different 
                                survivorship care planning services;
                                    ``(III) develop a standard of care 
                                based on the Children's Oncology Group 
                                (COG) Long-Term Follow-Up Guidelines 
                                for Survivors of Childhood, Adolescent, 
                                and Young Adult Cancers to manage the 
                                transition of such individuals from 
                                active treatment to general care with 
                                the informed knowledge of such 
                                individuals; and
                                    ``(IV) provide incentives to health 
                                care providers for treating such 
                                individuals through such model that 
                                includes at least two survivorship care 
                                planning visits.''.

SEC. 15. MEDICAID COVERAGE OF FERTILITY PRESERVATION SERVICES FOR 
              CANCER PATIENTS.

    (a) Medicaid.--
            (1) In general.--Section 1905(a) of the Social Security Act 
        (42 U.S.C. 1396d(a)) is amended--
                    (A) in paragraph (30), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (31) as paragraph 
                (32); and
                    (C) by inserting after paragraph (30) the following 
                new paragraph:
            ``(31) standard fertility preservation services (as 
        specified by the Secretary consistent with established medical 
        practices and professional guidelines published by the American 
        Society for Reproductive Medicine, the American Society of 
        Clinical Oncology, or other professional medical organizations 
        specified by the Secretary) for individuals diagnosed with 
        cancer who--
                    ``(A) are undergoing treatment for such cancer 
                where such treatment may lead to iatrogenic 
                infertility;
                    ``(B) previously underwent such treatment and may 
                be at risk of such infertility due to such treatment; 
                or
                    ``(C) are preparing to undergo such treatment where 
                such treatment may lead to such infertility.''.
            (2) Mandatory benefit.--Section 1902(a)(10)(A) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by 
        striking ``and (30)'' and inserting ``(30), and (31)''.
    (b) CHIP.--
            (1) In general.--Section 2103(c) of the Social Security Act 
        (42 U.S.C. 1397cc(c)) is amended by adding at the end the 
        following new paragraph:
            ``(12) Required coverage of fertility preservation services 
        for cancer patients.--Regardless of the type of coverage 
        elected by a State under subsection (a), the child health 
        assistance provided for a targeted low-income child, and, in 
        the case of a State that elects to provide pregnancy-related 
        assistance pursuant to section 2112, the pregnancy-related 
        assistance provided for a targeted low-income pregnant woman 
        (as such terms are defined for purposes of such section), shall 
        include coverage of standard fertility preservation services 
        (as described in section 1905(a)(31)) for individuals described 
        in such section.''.
            (2) Conforming amendment.--
                    (A) In general.--Section 2103(c) of the Social 
                Security Act (42 U.S.C. 1397cc(c)) is amended by 
                redesignating the paragraph (12) added by section 
                11405(b)(1) of Public Law 117-169 as paragraph (13).
                    (B) Effective date.--The amendment made by 
                subparagraph (A) shall take effect on October 1, 2023.
    (c) Effective Date.--The amendments made by this section (other 
than the amendment made by subsection (b)(2)) shall apply with respect 
to medical assistance, child health assistance, and pregnancy-related 
assistance furnished on or after the date that is 18 months after the 
date of the enactment of this Act.
                                 <all>