Planning Actively for Cancer Treatment (PACT) Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act to provide for coverage of cancer care planning and coordination services.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2477 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 2477
To amend title XVIII of the Social Security Act to provide for coverage
of cancer care planning and coordination under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 25, 2013
Mrs. Capps (for herself and Mr. Boustany) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committee on Ways and Means, for a period to be
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 for coverage
of cancer care planning and coordination under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
(a) Short Title.--This Act may be cited as the ``Planning Actively
for Cancer Treatment (PACT) Act of 2013''.
(b) Findings.--Congress makes the following findings:
(1) Individuals with cancer often do not have access to a
cancer care system that incorporates shared decision-making and
the coordination of all elements of care.
(2) The cancer care system has not traditionally offered
individuals with cancer a shared decision-making process, a
prospective and comprehensive plan for treatment, symptom
management and supportive care, 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 may become more severe with
disease progression and at the end of life. The failure to
treat the symptoms, side effects, and late effects of cancer
and cancer treatment may have a serious adverse impact on the
health, survival, well-being, and quality of life of cancer
survivors.
(4) The 1999 Institute of Medicine report entitled ``The
Unequal Burden of Cancer'' found that low-income people often
lack access to adequate cancer care and that ethnic minorities
have not benefitted fully from cancer treatment advances.
(5) Individuals with cancer often do not participate in a
shared decision-making process that considers all treatment
options and do not benefit from coordination of all elements of
active treatment and palliative care.
(6) Quality cancer care should incorporate access to
psychosocial services and management of the symptoms of cancer
and the symptoms of cancer treatment, including pain, nausea,
vomiting, fatigue, and depression.
(7) Quality cancer care should include a means for engaging
cancer survivors in a shared decision-making process that
produces a comprehensive care summary and a plan for follow-up
care after primary treatment to ensure that cancer survivors
have access to follow-up monitoring and treatment of possible
late effects of cancer and cancer treatment, including
appropriate psychosocial services.
(8) The Institute of Medicine report entitled ``Ensuring
Quality Cancer Care'' described the elements of quality care
for an individual with cancer to include--
(A) the development of initial treatment
recommendations by an experienced health care provider;
(B) the development of a plan for the course of
treatment of the individual and communication of the
plan to the individual;
(C) access to the resources necessary to implement
the course of treatment;
(D) access to high-quality clinical trials;
(E) a mechanism to coordinate services for the
treatment of the individual; and
(F) psychosocial support services and compassionate
care for the individual.
(9) In its report ``From Cancer Patient to Cancer Survivor:
Lost in Transition'', the Institute of Medicine recommended
that individuals with cancer completing primary treatment be
provided a comprehensive summary of their care along with a
follow-up survivorship plan of treatment.
(10) In ``Cancer Care for the Whole Patient'', the
Institute of Medicine stated that the development of a plan
that includes biomedical and psychosocial care should be a
standard for quality cancer care in any quality measurement
system.
(11) Because more than half of all cancer diagnoses occur
among elderly Medicare beneficiaries, cancer care inadequacies
should be addressed through the Medicare program.
(12) Shortcomings in providing cancer care, resulting in a
lack of shared decision-making, inadequate management of cancer
symptoms, and insufficient monitoring and treatment of late
effects of cancer and its treatment, relate in part to the
inadequacy of Medicare payments for such planning and
coordination services.
(13) Changes in Medicare payment for cancer care planning
and coordination will support shared decision-making that
reviews all treatment options and will contribute to improved
care for individuals with cancer from the time of diagnosis
through the end of the life.
SEC. 2. COVERAGE OF CANCER CARE PLANNING AND 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
(EE);
(B) by adding ``and'' at the end of subparagraph
(FF); and
(C) by adding at the end the following new
subparagraph:
``(GG) cancer care planning and coordination services (as
defined in subsection (iii))''; and
(2) by adding at the end the following new subsection:
``Cancer Care Planning and Coordination Services
``(iii)(1) The term `cancer care planning and coordination
services' means--
``(A) with respect to an individual who is diagnosed with
cancer, the development of a treatment plan by a physician,
nurse practitioner, or physician assistant that--
``(i) includes an assessment of the individual's
diagnosis, health status, treatment needs, functional
status, pain control, and psychosocial needs;
``(ii) engages the individual in a shared decision-
making process that reviews all treatment options;
``(iii) details, to the greatest extent practicable
all aspects of the care to be provided to the
individual with respect to the treatment of such
cancer, including any curative treatment, comprehensive
symptom management, and palliative care;
``(iv) is furnished in person, in written form, to
the individual within a period specified by the
Secretary that is as soon as practicable after the date
on which the individual is so diagnosed;
``(v) is furnished, to the greatest extent
practicable, in a form that appropriately takes into
account cultural and linguistic needs of the individual
in order to make the plan accessible to the individual;
and
``(vi) is in accordance with standards determined
by the Secretary to be appropriate;
``(B) with respect to an individual for whom a treatment
plan has been developed under subparagraph (A), the revision of
such treatment plan as necessary to account for any substantial
change in the condition of the individual, recurrence of
disease, changes in the individual's treatment preferences, or
significant revision of the elements of curative care or
symptom management for the individual, if such revision--
``(i) is in accordance with clauses (i), (ii), (iv)
and (v) of such subparagraph; and
``(ii) is furnished in written form to the
individual within a period specified by the Secretary
that is as soon as practicable after the date of such
revision;
``(C) with respect to an individual who has completed the
primary treatment for cancer, as defined by the Secretary, the
development of a follow-up survivorship care plan that--
``(i) includes an assessment of the individual's
diagnosis, health status, treatment needs, functional
status, pain control, and psychosocial needs;
``(ii) engages the individual in a shared decision-
making process that reviews all survivorship care
options;
``(iii) describes the elements of the primary
treatment, including symptom management and palliative
care, furnished to such individual;
``(iv) provides recommendations for the subsequent
care of the individual with respect to the cancer
involved;
``(v) is furnished, in person, in written form, to
the individual within a period specified by the
Secretary that is as soon as practicable after the
completion of such primary treatment;
``(vi) is furnished, to the greatest extent
practicable, in a form that appropriately takes into
account cultural and linguistic needs of the individual
in order to make the plan accessible to the individual;
and
``(vii) is in accordance with standards determined
by the Secretary to be appropriate; and
``(D) with respect to an individual for whom a follow-up
cancer care plan has been developed under subparagraph (C), the
revision of such plan as necessary to account for any
substantial change in the condition of the individual,
diagnosis of a second cancer, change in the individual's
preference for survivorship care, or significant revision of
the plan for follow-up care, if such revision--
``(i) is in accordance with clauses (i), (ii),
(iii), (v), and (vi) of such subparagraph; and
``(ii) is furnished in written form to the
individual within a period specified by the Secretary
that is as soon as practicable after the date of such
revision.
``(2) The Secretary shall establish standards to carry out
paragraph (1) in consultation with appropriate organizations
representing suppliers and providers of services related to cancer
treatment and organizations representing survivors of cancer. Such
standards shall include standards for determining the need and
frequency for revisions of the treatment plans and follow-up
survivorship care plans based on changes in the condition of the
individual or elements and intent of treatment and standards for the
communication of the plan to the individual.
``(3) In this subsection, the term `shared decision-making process'
means, with respect to an individual, a process in which the individual
and the individual's health care providers consider the individual's
diagnosis, treatment options, the medical evidence related to treatment
options, the risks and benefits of all treatment options, and the
individual's preferences regarding treatment, and then jointly develop
and implement a treatment plan.''.
(b) Payment Under Physician Fee Schedule.--
(1) In general.--Section 1848(j)(3) of the Social Security
Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting ``(GG),''
after ``health risk assessment),''.
(2) Initial rates.--Unless the Secretary of Health and
Human Services otherwise provides, the payment rate specified
under the physician fee schedule under the amendment made by
paragraph (1) for cancer care planning and coordination
services shall be the same payment rate as provided for
transitional care management services (as defined in CPT code
99496).
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the first day of the first
calendar year that begins after the date of the enactment of this Act.
<all>
Introduced in House
Introduced in House
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.
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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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