Sec. 6. Alternative payment model
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Not later than 18 months after the date of the enactment of this Act, the Secretary shall submit to Congress a report containing a description of an alternative payment model for payment under title XVIII and title XIX of the Social Security Act ( 42 U.S.C. 1395 et seq. , 1396 et seq.) for items and services relating to cancer survivorship care. The report shall include the following: A description of what event would trigger an individual’s entry into such a model (such as the end of the individual’s active cancer treatment, the beginning of the individual’s need for supportive care during active treatment, or another event).
The length of the individual’s participation under such model, including a description of any ability to extend such participation. In the case that such model is based on an episode of care, the appropriate length of the survivorship episode of care and whether additional episodes may be triggered, if necessary. Strategies to ensure that any episode of care under such a model begins with the development and dissemination of a survivorship care plan for the transition from active cancer treatment to follow-up care to the individual and all relevant health care providers.
A description of any bundled payment packages that will be used under such model. A specification of any follow up or new screening under such model for unmet needs of individuals participating in such model. How consistent, shared decisionmaking will be promoted under such model so that individuals are given the knowledge needed for self-management between episodes of care. A specification of which types of health care providers may furnish items and services under such model, including genetic counselors and mental health professionals.
Strategies for applying evidence-based risk stratification principles to direct survivors to personalized care pathways that match the level of care needed to the relative risks and needs of the survivor. Strategies for coordination of care between such providers, such as between specialists and primary care providers, and how principal responsibility will be assigned for an episode of care. Strategies for addressing social determinants of health through such model. A description of how such model will promote— prevention, early detection surveillance, and treatment for individuals continuing to receive systemic therapy after the end of active cancer treatment; such individuals’ understanding of, and access to, treatment; survivorship research; and the continuing health of cancer survivors.
An analysis of how different forms and stages of cancer may require the development of different survivorship plans and alternative payment models based on varying episodes of care. A plan for testing any alternative payment model described in the report, including the timing of such testing, an analysis of the impact of such testing, any barriers to implementing such testing, and any other recommendations determined appropriate by the Secretary.
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Sec. 6
Alternative payment model
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