HR 5585
110th CONGRESS
2d Session
H. R. 5585
To amend title XVIII of the Social Security Act to provide comprehensive
cancer patient treatment education under the Medicare Program and to provide
for research to improve cancer symptom management.
IN THE HOUSE OF REPRESENTATIVES
March 11, 2008
Mr. ISRAEL introduced the following bill; which was referred to the Committee
on Energy and Commerce, and in addition to the Committee on Ways and Means,
for a period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the committee
concerned
A BILL
To amend title XVIII of the Social Security Act to provide comprehensive
cancer patient treatment education under the Medicare Program and to provide
for research to improve cancer symptom management.
Be it enacted by the Senate and House of 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 `Assuring and Improving Cancer
Treatment Education and Cancer Symptom Management Act of 2008'.
(b) Table of Contents- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I--COMPREHENSIVE CANCER PATIENT TREATMENT EDUCATION UNDER THE MEDICARE
PROGRAM
Sec. 101. Medicare coverage of comprehensive cancer patient treatment education
services.
TITLE II--RESEARCH ON CANCER SYMPTOM MANAGEMENT IMPROVEMENT
Sec. 201. Expansion of research.
Sec. 202. Nursing intervention research grants.
Sec. 203. Institute of Medicine study on the provision of symptom management
and supportive care in people with cancer.
SEC. 2. FINDINGS.
The Congress makes the following findings:
(1) Many people with cancer experience side effects, symptoms, and late
complications associated with their disease and their treatment, which can
have a serious adverse impact on their health, well-being, and quality of
life.
(2) Many side effects and symptoms associated with cancer and its treatment
can be reduced or controlled by the provision of timely symptom management
and services and also by educating people with cancer and their caregivers
about the potential effects before treatment begins.
(3) Studies have found that individualized educational intervention for
cancer pain management from a registered nurse was effective for patients
with cancer being treated in outpatient and home-based settings. Similarly,
the number of caregivers who said they were well informed and confident
about caregiving after attending a family caregiver cancer education program
which increased after program attendance.
(4) People with cancer benefit from having an educational session with oncology
nurses in advance of the initiation of treatment to learn how to reduce
the risk of and manage adverse effects and maximize well-being. Helping
patients to manage their side effects reduces adverse events and the need
for urgent or inpatient care.
(5) The Oncology Nursing Society has received reports from its members that,
because the Medicare program and other payers do not cover the provision
of patient treatment education, patients and their caregivers often do not
receive adequate education before the onset of such patients' treatment
for cancer regarding the course of such treatment and the possible side
effects and symptoms such patients may experience. The Oncology Nursing
Society recommends that all patients being treated for cancer have a one-on-one
educational session with a nurse in advance of the onset of such treatment
so that such patients and their caregivers receive the information they
need to help minimize adverse events related to such treatment and maximize
the well-being of such patients.
(6) Insufficient or non-existent Medicare payments coupled with poor investment
in symptom management research contribute to the inadequate education of
patients, poor management and monitoring of cancer symptoms, and inadequate
handling of late effects of cancer and its treatment.
(7) People with cancer often do not have the symptoms associated with their
disease and the associated treatment managed in a comprehensive or appropriate
manner.
(8) People with cancer deserve to have access to comprehensive care that
includes appropriate treatment and symptom management.
(9) Patients who receive infused chemotherapy likely obtain some treatment
education during the course of the administration of their treatment; yet,
many do not, and individuals who may receive a different type of cancer
care, such as radiation or surgical interventions or oral chemotherapy taken
at home, likely do not receive treatment education during their treatment.
(10) Comprehensive cancer care must include access to services and management
associated with nausea, vomiting, fatigue, depression, pain, and other symptoms.
(11) The Institute of Medicine report, `Ensuring Quality Cancer Care' asserts
that `much can be done to relieve the symptoms, ease distress, provide comfort,
and in other ways improve the quality of life of someone with cancer. For
a person with cancer, maintenance of quality of life requires, at a minimum,
relief from pain and other distressing symptoms, relief from anxiety and
depressions, including the fear of pain, and a sense of security that assistance
with be readily available if needed.'.
(12) The Institute of Medicine report, `Cancer Care for the Whole Patient:
Meeting Psychosocial Health Needs' recognizes that cancer patients' psychosocial
needs include information about their therapies and the potential side effects.
(13) As more than half of all cancer diagnoses occur among individuals age
65 and older, the challenges of managing cancer symptoms are growing for
patients enrolled in the Medicare program.
(14) Provision of Medicare payment for comprehensive cancer patient treatment
education, coupled with expanded cancer symptom management research, will
help improve care and quality of life for people with cancer from the time
of diagnosis through survivorship or end of life.
TITLE I--COMPREHENSIVE CANCER PATIENT TREATMENT EDUCATION UNDER THE MEDICARE
PROGRAM
SEC. 101. MEDICARE COVERAGE OF COMPREHENSIVE CANCER PATIENT TREATMENT EDUCATION
SERVICES.
(a) In General- Section 1861 of the Social Security Act (42 U.S.C. 1395x),
as amended by section 114(a) of the Medicare, Medicaid, and SCHIP Extension
Act of 2007, is amended--
(1) in subsection (s)(2)--
(A) by striking `and' at the end of subparagraph (Z);
(B) by adding `and' at the end of subparagraph (AA); and
(C) by adding at the end the following new subparagraph:
`(BB) comprehensive cancer patient treatment education services (as defined
in subsection (ddd)(1));'; and
(2) by adding at the end the following new subsection:
`Comprehensive Cancer Patient Treatment Education Services
`(ddd)(1) The term `comprehensive cancer patient treatment education services'
means--
`(A) in the case of an individual who is diagnosed with cancer, the provision
of a one-hour patient treatment education session delivered by a registered
nurse that--
`(i) is furnished to the individual and the caregiver (or caregivers)
of the individual in advance of the onset of treatment and to the extent
practicable, is not furnished on the day of diagnosis or on the first
day of treatment;
`(ii) educates the individual and such caregiver (or caregivers) to
the greatest extent practicable, about all aspects of the care to be
furnished to the individual, informs the individual regarding any potential
symptoms, side-effects, or adverse events, and explains ways in which
side effects and adverse events can be minimized and health and well-being
maximized, and provides guidance regarding those side effects to be
reported and to which health care provider the side effects should be
reported;
`(iii) includes the provision, in written form, of information about
the course of treatment, any responsibilities of the individual with
respect to self-dosing, and ways in which to address symptoms and side-effects;
and
`(iv) is furnished, to the greatest extent practicable, in an oral,
written, or electronic form that appropriately takes into account cultural
and linguistic needs of the individual in order to make the information
comprehensible to the individual and such caregiver (or caregivers);
and
`(B) with respect to an individual for whom a course of cancer treatment
or therapy is materially modified, a one-hour patient treatment education
session described in subparagraph (A), including updated information on
the matters described in such subparagraph should the individual's oncologic
health care professional deem it appropriate and necessary.
`(2) In establishing standards to carry out paragraph (1), the Secretary
shall consult with appropriate organizations representing providers of oncology
patient treatment education services and organizations representing people
with cancer.'.
(b) Payment- Section 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) is amended--
(1) by striking `and' before `(V)'; and
(2) by inserting before the semicolon at the end the following: `, and (W)
with respect to comprehensive cancer patient treatment education service
(as defined in section 1861(ddd)(1)), 150 percent of the payment rate established
under section 1848 for diabetes outpatient self-management training services
(as defined in section 1861(qq)), determined and applied without regard
to any coinsurance'.
(c) Coverage- Section 1862(a)(1) of such Act (42 U.S.C. 1395y(a)(1)) is amended--
(1) in subparagraph (M), by striking `or' at the end;
(2) in subparagraph (N), by striking the semicolon at the end and inserting
`, and'; and
(3) by adding at the end the following new subparagraph:
`(O) in the case of comprehensive cancer patient treatment education services
(as defined in subsection (ddd)(1)) which are performed more frequently
than is covered under such section;'.
(d) No Impact on Payment for Other Services- Nothing in this section shall
be construed to affect or otherwise authorize any reduction or modification,
in the Medicare payment amounts otherwise established for chemotherapy infusion
or injection codes with respect to the calculation and payment of minutes
for chemotherapy teaching or related services.
(e) Effective Date- The amendments made by this section shall apply to services
furnished on or after the first day of the first calendar year that begins
after the date of the enactment of this Act.
TITLE II--RESEARCH ON CANCER SYMPTOM MANAGEMENT IMPROVEMENT
SEC. 201. EXPANSION OF RESEARCH.
Subpart 1 of part C of title IV of the Public Health Service Act (42 U.S.C.
285 et seq.) is amended by adding at the end the following:
`SEC. 417E. RESEARCH ON CANCER SYMPTOM MANAGEMENT IMPROVEMENT.
`(a) In General- The Director of NIH shall expand, intensify, and coordinate
programs for the conduct and support of research with respect to--
`(1) improving the treatment and management of symptoms and side effects
associated with cancer and cancer treatment; and
`(2) evaluating the role of nursing interventions in the amelioration of
such symptoms and side effects.
`(b) Administration- The Director of NIH shall carry out this section--
`(1) through the Director of the Institute; and
`(2) in collaboration with the directors of the National Institute of Nursing
Research, the National Institute of Mental Health, the National Center on
Minority Health and Health Disparities, the National Center for Complementary
and Alternative Medicine, and the Agency for Healthcare Research and Quality.'.
SEC. 202. NURSING INTERVENTION RESEARCH GRANTS.
Subpart 1 of part C of title IV of the Public Health Service Act (42 U.S.C.
285 et seq.), as amended by section 201, is amended by adding at the end the
following:
`SEC. 417F. NURSING INTERVENTION RESEARCH GRANTS.
`(a) In General- The Director of NIH shall make grants for research to be
conducted--
`(1) with a registered nurse as the principal investigator; and
`(2) for the purpose of studying cancer symptom management care and services
delivered by registered nurses to cancer patients.
`(b) Inclusion of National Research Institutes- In carrying out this section,
the Director of NIH shall provide for the participation of the National Cancer
Institute, the National Institute of Nursing Research, and any other national
research institute that has been engaged in research described subsection
(a)(2).
`(c) Authorization of Appropriations- There are authorized to be appropriated
to carry out this section such sums as may be necessary for fiscal years 2009
through 2013.'.
SEC. 203. INSTITUTE OF MEDICINE STUDY ON THE PROVISION OF SYMPTOM MANAGEMENT
AND SUPPORTIVE CARE IN PEOPLE WITH CANCER.
(1) IN GENERAL- Not later than 2 months after the date of enactment of this
Act, the Secretary of Health and Human Services (in this section referred
to as the `Secretary') shall enter into an arrangement under which the Institute
of Medicine of the National Academy of Sciences (in this section referred
to as the `Institute') shall conduct a study and evaluation, including a
report, on the current state of symptom management, patient treatment education,
and supportive care given to people with cancer.
(2) SPECIFIC MATTERS EVALUATED- In conducting the study and evaluation under
paragraph (1), the Institute shall--
(A) analyze any barriers to access to, and delivery of, symptom management,
patient treatment education, and supportive care to people with cancer;
(B) catalogue and evaluate the incentives and disincentives in the current
reimbursement system that influence whether individuals receive comprehensive
symptom management, patient treatment education, and supportive care,
including adequate and ongoing patient treatment education;
(C) evaluate the importance of nursing interventions in the management
of symptoms and side effects of cancer and the associated treatment;
(D) consider such other matters as the Institute determines appropriate;
and
(E) make recommendations to address any barriers, challenges, or other
issues identified through the study and evaluation.
(3) SCOPE OF REVIEW- In conducting such study and evaluation, the Institute
shall consider a variety of perspectives, including the perspectives of
patients and their family caregivers, registered nurses, including nurses
certified in oncology, physicians, social workers, psychologists, other
health care professionals, and other experts and stakeholders.
(b) Report- Not later than 18 months after the date of enactment of this Act,
the arrangement under subsection (a) shall provide for the Institute to submit
to the Secretary and to Congress a report on the study evaluation conducted
under such subsection. Such report shall contain a detailed description of
the findings of such study and evaluation and recommendations for improving
the provision of symptom management, patient treatment education, and supportive
care to people with cancer.
(c) Authorization of Appropriations- There are authorized to be appropriated
such sums as may be necessary for the purposes of conducting the study and
evaluation, and preparing the report, required by this section.
END
