This bill would add a new Medicare benefit called "cancer care planning and coordination services." It defines those services as a written or electronic treatment plan developed by a physician, physician assistant, or nurse practitioner. The plan must include each part of the Institute of Medicine Care Management Plan and be provided at the visit or soon after. The plan should, as much as practical, be accessible for cultural and language needs. The Secretary of Health and Human Services must set how often these services can be provided. The bill says services may be furnished at diagnosis, when the patient’s condition or treatment preferences change, at the end of active treatment when survivorship care begins, and if the cancer recurs. The bill also adds these services to the physician fee schedule and sets the initial payment rate equal to the payment for transitional care management services (CPT code 99496), unless the Secretary changes that. The changes would apply to services furnished on or after the first day of the first calendar year that begins after enactment.
If you are a Medicare beneficiary diagnosed with cancer, this bill would aim to make a written or electronic cancer care plan and coordination services covered by Medicare. A qualifying plan would be made by a doctor, physician assistant, or nurse practitioner and given to you at the visit or shortly after. You could get a plan when you are first diagnosed, if your condition or treatment wishes change, when active treatment ends and survivorship care begins, or if the cancer comes back. The bill requires the plan to try to meet cultural and language needs so it is easier to use.
The bill adds cancer care planning and coordination as a payable service under the physician fee schedule. It directs that, unless the Secretary decides otherwise, the initial payment rate be the same as the rate for transitional care management services (CPT code 99496). The bill text does not provide a total cost estimate or budgetary scoring. Services would be covered for dates on or after the first day of the first calendar year after the bill becomes law.
The bill’s findings state proponents believe cancer care is often complex and not equally accessible. They say many patients lack shared decision making, care coordination, and access to survivorship planning. The bill’s sponsors argue that requiring Medicare coverage and payment for cancer care planning will support shared decision making, better coordination of care, access to psychosocial services, and follow-up care for survivors. The bill also notes that some Medicare demonstrations (like the Oncology Care Model) already include care planning and that this bill would expand access to more beneficiaries.
No publicly available information.