Cancer survivorship care program

Summary#

This bill would create new federal rules and programs to improve care for people who have had cancer. It requires Medicare to cover written or electronic cancer survivorship care plans and planning visits, asks HHS to develop a new payment model for survivorship care, and expands Medicaid and CHIP coverage for certain survivorship services. It also funds grants, a survivor employment help program, a GAO study of survivorship progress, and a new Office of Cancer Survivorship inside the National Cancer Institute.

• Requires a “cancer care planning and coordination” service (a written or electronic treatment and follow-up plan) that Medicare must cover and that providers must give at diagnosis, at the end of active treatment, on major changes, and at recurrence.
• Directs Medicare to set a payment code for these planning services, initially at the same rate as an existing transitional care management code.
• Orders HHS to convene stakeholders and publish resources on survivorship care plans and the privacy/security of electronic tools.
• Requires HHS to design an alternative payment model for survivorship care and report its details to Congress.
• Creates grant programs for supportive survivorship services and a Department of Labor program to help cancer survivors with employment, training, and benefits navigation.
• Makes Medicaid and CHIP cover fertility preservation and long-term storage for cancer patients, and requires Medicaid to cover transition services for childhood and adolescent cancer survivors.
• Establishes an Office of Cancer Survivorship at the National Cancer Institute and a GAO study on survivorship progress since 1971.

What it means for you#

• Cancer survivors and patients

  • You could receive a written or electronic survivorship care plan at diagnosis, when treatment ends, if your care changes, and at recurrence.
  • Medicare beneficiaries with cancer may have a covered visit specifically for care planning and coordination.
  • Children and adolescents on Medicaid would have transition services to move from oncology to primary care, including at least two survivorship transition visits per year.
  • Medicaid and CHIP enrollees who need fertility preservation because of cancer treatment would be covered for preservation procedures and for specified periods of long-term storage. Cost-sharing for those fertility services would be prohibited under Medicaid and CHIP.

• Medicare and Medicaid beneficiaries

  • Medicare will get a new covered service for survivorship planning and later an alternative payment model may change how survivorship care is paid.
  • States will be required to cover cancer fertility services and transition services for certain groups under Medicaid and CHIP, with an exception that U.S. territories may opt out of the fertility requirement.

• Health care providers and health systems

  • Physicians, physician assistants, and nurse practitioners will need to provide survivorship care plans and may bill Medicare for those services.
  • The bill asks HHS to specify which provider types (including genetic counselors and mental health professionals) can furnish services under the alternative payment model.
  • Providers and electronic health record vendors may be involved in the stakeholder meeting and in implementing survivorship care tools.

• Employers, workers, and families

  • The Department of Labor grant program would fund services that help cancer survivors stay in or return to work, pay for supportive needs (transportation, childcare, temporary financial help), and help apply for disability or other benefits.

• Community organizations and researchers

  • Eligible community organizations, state cancer programs, and NCI centers could get grants to run quality-of-life and survivorship programs.
  • NCI will host an Office of Cancer Survivorship to manage survivorship research, education, and grants.

Expenses#

No publicly available information.

• The bill would likely increase federal and state spending for several items, including Medicare payments for care-planning visits, HHS administrative costs to run stakeholder meetings and develop an alternative payment model, grant funding for survivorship programs, and new mandatory Medicaid/CHIP benefits (fertility services and transition care).
• Eliminating Medicaid cost-sharing for cancer fertility services and requiring CHIP coverage may raise program costs for states and the federal government.
• The bill sets some timelines (for example, the alternative payment model within one year; grants to start within 18 months), but it does not include a fiscal note in the supplied text specifying dollar amounts or funding sources.

Proponents' View#

• The bill appears intended to reduce fragmented care by requiring written survivorship care plans and by promoting coordinated transitions from cancer specialists to primary care.
• It seeks to improve survivors’ quality of life by increasing access to psychosocial support, physical activity programs, nutrition, and screening for recurrence.
• The legislation aims to address disparities by requiring culturally competent approaches, outreach to underserved communities, and by funding community organizations.
• Making fertility preservation and transition services mandatory in Medicaid and CHIP is intended to prevent long-term harm from treatment-related infertility and to ensure follow-up care for childhood and adolescent survivors.
• Creating an Office of Cancer Survivorship and a GAO study is intended to strengthen research, data collection, and federal leadership on survivorship issues.

Opponents' View#

• One concern is cost: the bill requires new covered benefits, grants, and administrative work but does not provide a funding estimate or specify how much money will be appropriated. This may raise questions about fiscal impact on Medicare, Medicaid, CHIP, and state budgets.
• The bill does not fully specify key operational details for the alternative payment model (for example, exact triggers, episode length, or payment amounts), so how the model will work in practice is unclear.
• Setting the initial Medicare payment rate equal to an existing transitional care management code may not match the time or resources needed for comprehensive survivorship planning; adequacy of payment is not fully explained.
• Implementation could create administrative burdens for providers and states, especially for integrating survivorship plans into electronic health records and for meeting reporting requirements.
• The bill allows U.S. territories to opt out of the Medicaid fertility requirement, which may leave residents of territories without the new benefit.