Sec. 4. Coverage of cancer care planning and coordination services
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Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended— in subsection (s)(2)— by striking and at the end of subparagraph (GG); by adding and at the end of subparagraph (HH); and by adding at the end the following new subparagraph: cancer care planning and coordination services (as defined in subsection (lll)) ; and by adding at the end the following new subsection: The term cancer care planning and coordination services means, with respect to an individual who is diagnosed with cancer, the development of a treatment plan by a physician, physician assistant, or nurse practitioner that— includes each component of the Institute of Medicine Care Management Plan (as described in the article entitled Delivering High-Quality Cancer Care:
Charting a New Course for a System in Crisis published by the Institute of Medicine); is furnished in written form or electronically, at the visit of such individual with such physician, physician assistant, or nurse practitioner, or as soon after the date of the visit as practicable; and is furnished, to the greatest extent practicable, in a form that appropriate takes into account cultural and linguistic needs of the individual in order to make the plan accessible to the individual.
The Secretary shall establish frequencies at which services described in paragraph
(1)may be furnished, provided that such services may be furnished with respect to an individual— at the time such individual is diagnosed with cancer for purposes of planning treatment; if there is a change in the condition of such individual or such individual’s treatment preferences; at the end of active treatment and beginning of survivorship care; and if there is a recurrence of such cancer. . Section 1848(j)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(j)(3) ) is amended by inserting (2)(II), after health risk assessment), . Unless the Secretary 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). 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.
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- 42 USC 1395w–4(j)(3)
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Sec. 4
Coverage of cancer care planning and coordination services
Cite42 USC 1395w–4(j)(3)
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