S 2790
110th CONGRESS
2d Session
S. 2790
To amend title XVIII of the Social Security Act to provide
for coverage of comprehensive cancer care planning under the Medicare
program and to improve the care furnished to individuals diagnosed with
cancer by establishing a Medicare hospice care demonstration program
and grants programs for cancer palliative care and symptom management
programs, provider education, and related research.
IN THE SENATE OF THE UNITED STATES
March 31 (legislative day, March 13), 2008
Ms. LANDRIEU introduced the following bill; which was read twice and
referred to the Committee on Finance
A BILL
To amend title XVIII of the Social Security Act to provide
for coverage of comprehensive cancer care planning under the Medicare
program and to improve the care furnished to individuals diagnosed with
cancer by establishing a Medicare hospice care demonstration program
and grants programs for cancer palliative care and symptom management
programs, provider education, and related research.
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
Care Improvement 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 CARE UNDER THE MEDICARE PROGRAM
Sec. 101. Coverage of cancer care planning services.
Sec. 102. Demonstration project to provide comprehensive cancer care
symptom management services under Medicare.
TITLE II--COMPREHENSIVE PALLIATIVE CARE AND SYMPTOM MANAGEMENT PROGRAMS
Sec. 201. Grants for comprehensive palliative care and symptom management
programs.
TITLE III--PROVIDER EDUCATION REGARDING PALLIATIVE CARE AND SYMPTOM
MANAGEMENT.
Sec. 301. Grants to improve health professional education.
Sec. 302. Grants to improve continuing professional education.
TITLE IV--RESEARCH ON END-OF-LIFE TOPICS FOR CANCER PATIENTS
Sec. 401. Research program.
SEC. 2. FINDINGS.
The Congress makes the following findings:
(1) Individuals with cancer often do not have access to a cancer care
system that provides comprehensive and coordinated care of high quality.
(2) The cancer care system has not traditionally offered individuals
with cancer a prospective and comprehensive plan for treatment and
symptom management, strategies for updating and evaluating such plan
with the assistance of a health care professional, and a follow-up
plan for monitoring and treating possible late effects of cancer and
its treatment.
(3) Cancer survivors often experience the under-diagnosis and under-treatment
of the symptoms of cancer, a problem that begins at the time of diagnosis
and often becomes more severe at the end of life. The failure to treat
the symptoms, side effects, and late effects of cancer and its treatment
may have a serious adverse impact on the health, well-being, and quality
of life of cancer survivors.
(4) Cancer survivors who are members of racial and ethnic minority
groups may face special obstacles in receiving cancer care that is
coordinated and includes appropriate management of cancer symptoms
and treatment side effects.
(5) Individuals with cancer are sometimes put in the untenable position
of choosing between potentially curative therapies and palliative
care instead of being assured access to comprehensive care that includes
appropriate treatment and symptom management.
(6) Comprehensive cancer care should incorporate access to psychosocial
services and management of the symptoms of cancer (and the symptoms
of its treatment), including pain, nausea and vomiting, fatigue, and
depression.
(7) Comprehensive cancer care should include a means for providing
cancer survivors with 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.
(8) The Institute of Medicine report, `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) Since more than half of all cancer diagnoses occur among elderly
Medicare beneficiaries, the problems of providing cancer care are
problems of the Medicare program.
(11) Shortcomings in providing cancer care, resulting in inadequate
management of cancer symptoms and insufficient monitoring and treatment
of late effects of cancer and its treatment, are related to problems
of Medicare payments for such care, inadequate professional training,
and insufficient investment in research on symptom management.
(12) Changes in Medicare payment for comprehensive cancer care, enhanced
public and professional education regarding symptom management, and
more research related to symptom management and palliative care will
enhance patient decision-making about treatment options and will contribute
to improved care for individuals with cancer from the time of diagnosis
of the individual through the end of the life of the individual.
TITLE I--COMPREHENSIVE CANCER CARE UNDER THE MEDICARE PROGRAM
SEC. 101. COVERAGE OF CANCER CARE PLANNING SERVICES.
(a) In General- Section 1861 of the Social Security Act, as amended
by section 114 of the Medicare, Medicaid, and SCHIP Extension Act of
2007 (Public Law 110-173) 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 care planning services (as defined in subsection
(ddd));'; and
(2) by adding at the end the following new subsection:
`Comprehensive Cancer Care Planning Services
`(ddd)(1) The term `comprehensive cancer care planning services' means--
`(A) with respect to an individual who is diagnosed with cancer,
the development of a plan of care that--
`(i) 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
and comprehensive symptom management (such as palliative care)
involved;
`(ii) is furnished in written form to the individual in person
within a period specified by the Secretary that is as soon as
practicable after the date on which the individual is so diagnosed;
`(iii) 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
`(iv) is in accordance with standards determined by the Secretary
to be appropriate;
`(B) with respect to an individual for whom a plan of care has been
developed under subparagraph (A), the revision of such plan of care
as necessary to account for any substantial change in the condition
of the individual, if such revision--
`(i) is in accordance with clauses (i) and (iii) 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 (such as completion
of chemotherapy or radiation treatment), the development of a follow-up
cancer care plan that--
`(i) describes the elements of the primary treatment, including
symptom management, furnished to such individual;
`(ii) provides recommendations for the subsequent care of the
individual with respect to the cancer involved;
`(iii) is furnished in written form to the individual in person
within a period specified by the Secretary that is as soon as
practicable after the completion of such primary treatment;
`(iv) 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
`(v) 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, if such revision--
`(i) is in accordance with clauses (i), (ii), and (iv) 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 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 plans of care and follow-up
plans based on changes in the condition of the individual and standards
for the communication of the plan to the patient.'.
(b) Payment- Section 1833(a)(1) of the Social Security Act (42 U.S.C.
1395l(a)(1)) is amended by striking `and' before `(V)' and inserting
before the semicolon at the end the following: `, and (W) with respect
to comprehensive cancer care planning services described in any of subparagraphs
(A) through (D) of section 1861(ddd)(1), the amount paid shall be an
amount equal to the sum of (i) the national average amount under the
physician fee schedule established under section 1848 for a new patient
office consultation of the highest level of service in the non-facility
setting, and (ii) the national average amount under such fee schedule
for a physician certification described in section 1814(a)(2) for home
health services furnished to an individual by a home health agency under
a home health plan of care'.
(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. 102. DEMONSTRATION PROJECT TO PROVIDE COMPREHENSIVE CANCER CARE
SYMPTOM MANAGEMENT SERVICES UNDER MEDICARE.
(a) In General- Beginning not later than 180 days 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 conduct a two-year
demonstration project (in this section referred to as the `demonstration
project') under title XVIII of the Social Security Act under which payment
shall be made under such title for comprehensive cancer care symptom
management services, including items and services described in subparagraphs
(A) through (I) of section 1861(dd)(1) of the Social Security Act, furnished
by an eligible entity, in accordance with a plan developed under subparagraph
(A) or (C) of section 1861(ddd)(1) of such Act, as added by section
101(a). Sections 1812(d) and 1814(a)(7) of such Act (42 U.S.C. 1395d(d),
1395f(a)(7)) are not applicable to items and services furnished under
the demonstration project. Participation of Medicare beneficiaries in
the demonstration project shall be voluntary.
(b) Qualifications and Selection of Eligible Entities-
(1) QUALIFICATIONS- For purposes of subsection (a), the term `eligible
entity' means an entity (such as a cancer center, hospital, academic
health center, hospice program, physician practice, school of nursing,
visiting nurse association, or other home health agency) that the
Secretary determines is capable, directly or through an arrangement
with a hospice program (as defined in section 1861(dd)(2) of the Social
Security Act (42 U.S.C. 1395x(dd)(2))), of providing the items and
services described in such subsection.
(2) SELECTION- The Secretary shall select not more than 10 eligible
entities to participate in the demonstration project. Such entities
shall be selected in a manner so that the demonstration project is
conducted in different regions across the United States and in urban
and rural locations.
(c) Evaluation and Report-
(1) EVALUATION- The Secretary shall conduct a comprehensive evaluation
of the demonstration project to determine--
(A) the effectiveness of the project in improving patient outcomes;
(B) the cost of providing comprehensive symptom management, including
palliative care, from the time of diagnosis;
(C) the effect of comprehensive cancer care planning and the provision
of comprehensive symptom management on patient outcomes, cancer
care expenditures, and the utilization of hospitalization and emergent
care services; and
(D) potential savings to the Medicare program demonstrated by the
project.
(2) REPORT- Not later than the date that is one year after the date
on which the demonstration project concludes, the Secretary shall
submit to Congress a report on the evaluation conducted under paragraph
(1).
TITLE II--COMPREHENSIVE PALLIATIVE CARE AND SYMPTOM MANAGEMENT PROGRAMS
SEC. 201. GRANTS FOR COMPREHENSIVE PALLIATIVE CARE AND SYMPTOM MANAGEMENT
PROGRAMS.
(a) In General- The Secretary of Health and Human Services shall make
grants to eligible entities for the purpose of--
(1) establishing a new palliative care and symptom management program
for cancer patients; or
(2) expanding an existing palliative care and symptom management program
for cancer patients.
(b) Authorized Activities- Activities funded through a grant under this
section may include--
(1) securing consultative services and advice from institutions with
extensive experience in developing and managing comprehensive palliative
care and symptom management programs;
(2) expanding an existing program to serve more patients or enhance
the range or quality of services, including cancer treatment patient
education services, that are provided;
(3) developing a program that would ensure the inclusion of cancer
treatment patient education in the coordinated cancer care model;
and
(4) establishing an outreach program to partner with an existing comprehensive
care program and obtain expert consultative services and advice.
(c) Distribution of Funds- In making grants and distributing the funds
under this section, the Secretary shall ensure that--
(1) two-thirds of the funds appropriated to carry out this section
for each fiscal year are used for establishing new palliative care
and symptom management programs, of which not less than half of such
two-thirds shall be for programs in medically underserved communities
to address issues of racial and ethnic disparities in access to cancer
care; and
(2) one-third of the funds appropriated to carry out this section
for each fiscal year are used for expanding existing palliative care
and symptom management programs.
(d) Definitions- In this section:
(1) The term `eligible entity' includes--
(A) an academic medical center, a cancer center, a hospital, a school
of nursing, or a health system capable of administering a palliative
care and symptom management program for cancer patients;
(B) a physician practice with care teams, including nurses and other
professionals trained in palliative care and symptom management;
(C) a visiting nurse association or other home care agency with
experience administering a palliative care and symptom management
program;
(E) any other health care agency or entity, as the Secretary determines
appropriate.
(2) The term `medically underserved community' has the meeting given
to that term in section 799B(6) of the Public Health Service Act (42
U.S.C. 295p(6)).
(3) The term `Secretary' means the Secretary of Health and Human Services.
(e) Authorization of Appropriations- To carry out this section, there
are authorized to be appropriated such sums as may be necessary for
each of the fiscal years 2009 through 2013.
TITLE III--PROVIDER EDUCATION REGARDING PALLIATIVE CARE AND SYMPTOM
MANAGEMENT.
SEC. 301. GRANTS TO IMPROVE HEALTH PROFESSIONAL EDUCATION.
(a) In General- The Secretary of Health and Human Services shall make
grants to eligible entities to enable the entities to improve the quality
of graduate and postgraduate training of physicians, nurses, and other
health care providers in palliative care and symptom management for
cancer patients.
(b) Application- To seek a grant under this section, an eligible entity
shall submit an application at such time, in such manner, and containing
such information as the Secretary may require. At a minimum, the Secretary
shall require that each such application demonstrate--
(1) the ability to incorporate palliative care and symptom management
into training programs; and
(2) the ability to collect and analyze data related to the effectiveness
of educational efforts.
(c) Evaluation- The Secretary shall develop and implement a plan for
evaluating the effects of professional training programs funded through
this section.
(d) Definitions- In this section:
(1) The term `eligible entity' means a cancer center (including an
NCI-designated cancer center), an academic health center, a physician
practice, a school of nursing, or a visiting nurse association or
other home care agency.
(2) The term `NCI-designated cancer center' means a cancer center
receiving funds through a P30 Cancer Center Support Grant of the National
Cancer Institute.
(3) The term `Secretary' means the Secretary of Health and Human Services.
(e) Authorization of Appropriations- To carry out this section, there
are authorized to be appropriated such sums as may be necessary for
each of the fiscal years 2009 through 2013.
SEC. 302. GRANTS TO IMPROVE CONTINUING PROFESSIONAL EDUCATION.
(a) In General- The Secretary of Health and Human Services shall make
grants to eligible entities to improve the quality of continuing professional
education provided to qualified individuals regarding palliative care
and symptom management.
(b) Application- To seek a grant under this section, an eligible entity
shall submit an application at such time, in such manner, and containing
such information as the Secretary may require. At a minimum, the Secretary
shall require that each such application demonstrate--
(1) experience in sponsoring continuing professional education programs;
(2) the ability to reach health care providers and other professionals
who are engaged in cancer care;
(3) the capacity to develop innovative training programs; and
(4) the ability to evaluate the effectiveness of educational efforts.
(c) Evaluation- The Secretary shall develop and implement a plan for
evaluating the effects of continuing professional education programs
funded through this section.
(d) Definitions- In this section:
(1) The term `eligible entity' means a cancer center (including an
NCI-designated cancer center), an academic health center, a school
of nursing, or a professional society that supports continuing professional
education programs.
(2) The term `NCI-designated cancer center' means a cancer center
receiving funds through a P30 Cancer Center Support Grant of the National
Cancer Institute.
(3) The term `qualified individual' means a physician, nurse, social
worker, chaplain, psychologist, or other individual who is involved
in providing palliative care and symptom management services to cancer
patients.
(4) The term `Secretary' means the Secretary of Health and Human Services.
(e) Authorization of Appropriations- To carry out this section, there
are authorized to be appropriated such sums as may be necessary for
each of the fiscal years 2009 through 2013.
TITLE IV--RESEARCH ON END-OF-LIFE TOPICS FOR CANCER PATIENTS
SEC. 401. RESEARCH PROGRAM.
(a) In General- The Director of the National Institutes of Health shall
establish a program of grants for research on palliative care, symptom
management, communication skills, and other end-of-life topics for cancer
patients.
(b) Inclusion of National Research Institutes- In carrying out the program
established under this section, the Director should 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 in subsection (a).
(c) Definitions- In this section:
(1) The term `Director' means the Director of the National Institutes
of Health.
(2) The term `national research institute' has the meaning given to
that term in section 401(g) of the Public Health Service Act (42 U.S.C.
281(g)).
(d) Authorization of Appropriations- To carry out this section, there
are authorized to be appropriated such sums as may be necessary for
each of the fiscal years 2009 through 2013.
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