Expands the national program of State cancer registries funded under the Act. Directs the Secretary to establish a Cancer Surveillance System to monitor such registries, and reauthorizes the national program through 2008.
Modifies provision dealing with matching funds to require States pay at least one dollar for every five (currently, three) Federal dollars spent on a cancer registry.
Requires the Secretary to develop partnerships to speed the pace of improvements in the quality of cancer care.
Directs the Secretary to establish a National Comprehensive Cancer Control Program to improve the quality of cancer care.
Requires the Secretary to award grants to entities to develop, implement, and evaluate: (1) cancer case management programs; (2) model programs for the delivery of palliative care for cancer sufferers; and (3) end-of-life care programs.
Directs the Secretary to conduct and support research regarding cancer survivorship.
Requires the Secretary to make grants to support cancer curriculum development for health care provider training.
Requires National Cancer Institute cancer control programs to include a plan to assist health professionals in professions facing the most severe shortages. Requires the Director of the National Cancer Institute to cooperate with, and make grants to, public or nonprofit entities to conduct multidisciplinary translational cancer research.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 2965 Introduced in Senate (IS)]
107th CONGRESS
2d Session
S. 2965
To amend the Public Health Service Act to improve the quality of care
for cancer, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 18, 2002
Mr. Kennedy (for himself, Mr. Frist, Mrs. Feinstein, Mrs. Hutchison,
Mr. Harkin, Ms. Collins, Mr. Biden, Mr. Bond, Ms. Landrieu, Mr. Reid,
Mr. Bingaman, Mr. Dodd, Mrs. Clinton, Mr. Hollings, and Mr. Edwards)
introduced the following bill; which was read twice and referred to the
Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to improve the quality of care
for cancer, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Quality of Care for Individuals With
Cancer Act''.
SEC. 2. TABLE OF CONTENTS.
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--MEASURING THE QUALITY OF CANCER CARE
Sec. 101. Development of core sets of quality of cancer care measures.
TITLE II--ENHANCING DATA COLLECTION
Sec. 201. Expansion of national program of cancer registries.
Sec. 202. Reauthorization of national program of cancer registries.
Sec. 203. Relationship to certification.
TITLE III--MONITORING AND EVALUATING QUALITY OF CANCER CARE AND
OUTCOMES
Sec. 301. Partnerships to develop model systems for monitoring and
evaluating quality of cancer care and
outcomes.
TITLE IV--STRENGTHENING COMPREHENSIVE CANCER CONTROL
Sec. 401. Comprehensive cancer control program.
TITLE V--IMPROVING NAVIGATION AND SYSTEM COORDINATION
Sec. 501. Enhancing cancer care through improved navigation.
Sec. 502. Cancer care coordination.
TITLE VI--ESTABLISHING PROGRAMS IN PALLIATIVE CARE
Sec. 601. Programs to improve palliative care.
TITLE VII--ESTABLISHING SURVIVORSHIP PROGRAMS
Sec. 701. Programs for survivorship.
Sec. 702. Cancer control programs.
TITLE VIII--PROGRAMS FOR END-OF-LIFE CARE
Sec. 801. Programs for end-of-life care.
TITLE IX--DEVELOPING TRAINING CURRICULA
Sec. 901. Curriculum development.
Sec. 902. Cancer care workforce and translational research.
TITLE X--CONDUCTING REPORTS
Sec. 1001. Studies and reports by the Institute of Medicine.
TITLE I--MEASURING THE QUALITY OF CANCER CARE
SEC. 101. DEVELOPMENT OF CORE SETS OF QUALITY OF CANCER CARE MEASURES.
(a) Development of Core Sets of Quality of Cancer Care Measures.--
Subpart 1 of part C of title IV of the Public Health Service Act (42
U.S.C. 285 et seq.) is amended by adding at the end the following:
``SEC. 417E. DEVELOPMENT OF CORE SETS OF QUALITY OF CANCER CARE
MEASURES.
``(a) In General.--The Secretary shall award a contract to a
national voluntary consensus organization to identify core sets of
quality of cancer care measures.
``(b) Quality of Cancer Care Measures.--An entity that receives a
contract under this section shall identify core sets of quality of
cancer care measures in consultation with a panel or advisory group of
interested parties, including significant participation from consumer
representatives (which shall include survivors of cancer and their
families and members of organizations representing such survivors and
their families), health care providers, cancer researchers, payers and
purchasers of cancer care services and insurance, and public and
private organizations that monitor, accredit, or seek to improve the
quality of cancer care.
``(c) Report by Entity.--Not later than 24 months after the date of
enactment of this section, an eligible entity that receives a contract
under this section shall submit to the Secretary a report that--
``(1) lists existing measures used to assess and improve
the quality of cancer care;
``(2) identifies those measures that have been
scientifically validated, those measures that still require
validation, and those aspects of cancer care for which
additional measures need to be developed or validated;
``(3) recommends a core set of validated quality of cancer
care measures, reflecting a voluntary consensus of interested
parties, for measuring and improving the quality of cancer
care;
``(4) summarizes the process used to develop the consensus
recommendations in paragraph (3), including a statement of any
minority views; and
``(5) develops a process for updating the core sets of
validated quality of cancer care measures as new scientific
evidence becomes available.
``(d) Recommendations by Secretary.--Not later than 6 months after
the date the Secretary receives the report described in subsection (c),
the Secretary shall issue recommendations on the areas described in
paragraphs (1) through (5) of such subsection and shall transmit such
recommendations to the President.
``(e) Report by President.--Not later than 6 months after receipt
of the report described in subsection (d), the President shall, in
consultation with the Quality Interagency Coordination Task Force
(established by a Presidential Directive in 1998)--
``(1) provide to the appropriate committees of Congress a
report that describes a plan to use the core sets of quality of
cancer care measures in programs administered by the Federal
Government, including outlining activities to support the
widespread dissemination of the report, and provide any other
recommendations the President determines to be appropriate; and
``(2) provide updated reports, in accordance with
subsection (c)(5), if new quality measures or scientific
evidence on quality of cancer care develops.
``(f) Technical Support.--The Secretary may provide scientific and
technical support to ensure that the scientific evaluation requirements
in this section are met.
``(g) AHRQ.--
``(1) Annual report.--The Agency for Healthcare Research
and Quality shall include in the annual report required under
section 913(b)(2) the core set of quality of cancer care
measures developed under this section that are suitable for
quality monitoring.
``(2) Requirement.--The Secretary shall ensure that all
agencies within the Department of Health and Human Services
shall provide the information necessary for the report
described in paragraph (1) regarding quality of cancer care
measures.
``(h) Support.--The Director of the Agency for Healthcare Research
and Quality, acting in collaboration with the Director of the National
Cancer Institute and the Director of the Centers for Disease Control
and Prevention, shall support the development and validation of
measures identified by the report in subsection (d).
``(i) Definitions of Hospice Care; Palliative Care; Quality of
Cancer Care.--In this section the terms `hospice care', `palliative
care' and `quality of cancer care' have the meanings given such terms
in section 399AA.
``(j) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $3,000,000 for fiscal year
2003, and such sums as may be necessary for each of fiscal years 2004
through 2007.''.
(b) Monitoring.--Not later than 4 years after the date of the
transmission of the report required under section 417E(e) of the Public
Health Service Act, the Comptroller of the General Accounting Office
shall submit to the appropriate committees of Congress a report that
evaluates the extent to which Federal and private sector health care
delivery programs, States, and State cancer plans are utilizing the
core sets of quality of cancer care measures (developed under section
417E of the Public Health Service Act) and the extent to which its
adoption is affecting the quality of cancer care.
TITLE II--ENHANCING DATA COLLECTION
SEC. 201. EXPANSION OF NATIONAL PROGRAM OF CANCER REGISTRIES.
Part M of title III of the Public Health Service Act (42 U.S.C.
280e et seq.) is amended by inserting after section 399E, the
following:
``SEC. 399E-1. MONITORING AND EVALUATING THE QUALITY OF CANCER CARE.
``(a) Demonstration Projects.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, and in
coordination with the Director of the National Cancer Institute, shall
award competitive grants to State cancer registries that receive funds
under this part to enable such registries to expand their ability to
monitor and evaluate the quality of cancer care, to develop information
concerning the quality of cancer care, and to monitor cancer
survivorship.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), a State cancer registry shall be certified by the North
American Association of Central Cancer Registries or other similar
certification organization.
``(c) Application.--A State cancer registry desiring a grant under
this section shall submit an application to the Secretary at such time,
in such manner, and containing such information as the Secretary may
require.
``(d) Contracting Authority.--A State cancer registry receiving a
grant under this section may enter into contracts with academic
institutions, cancer centers, and other entities determined to be
appropriate by the Secretary, to carry out the activities authorized
under this section.
``(e) Use of Funds.--A State cancer registry receiving a grant
under this section shall use amounts received under such grant to--
``(1) collect information for public health surveillance
and quality improvement activities using the quality of cancer
care measures developed under section 417E (where appropriate),
including data concerning traditionally underserved populations
and populations within the State that may have a disparity in
incidence or survival from cancer;
``(2) develop linkages between State cancer registry data
and other databases, including those that collect outpatient
data, to gather information concerning the quality of cancer
care;
``(3) identify, develop, and disseminate evidence-based
best practices relating to cancer care regarding how States use
registry data and how to better link and coordinate the sharing
of such data;
``(4) identify geographic areas and populations within the
State that have an increased need for awareness regarding
cancer risk reduction, screening, prevention, and treatment
activities;
``(5) increase coordination between State cancer registries
and other entities, including academic institutions, hospitals,
health centers, researchers, health care providers, cancer
centers, or nonprofit organizations;
``(6) incorporate the collection of data on cancer
survivors for the purpose of improving the quality of cancer
care;
``(7) identify the impact of co-morbidity of other diseases
on survival from cancer; or
``(8) develop methods of determining whether cancer
survivors are at an increased risk for other chronic or
disabling conditions.
``(f) Privacy.--A State cancer registry receiving a grant or an
entity receiving a contract under this section shall comply with
appropriate security and privacy protocols (including protocols
required under the regulations promulgated under section 264(c) of the
Health Insurance Portability and Accountability Act of 1996 (42 U.S.C.
1320d-2 note)), if applicable, with respect to information collected
under this title. Nothing in this section shall be construed to
supersede applicable Federal or State privacy laws.
``(g) Databases.--
``(1) In general.--In carrying out this section, a State
cancer registry may utilize appropriate databases, including--
``(A) the National Death Index;
``(B) databases related to claims under the
medicare and medicaid programs under titles XVIII and
XIX of the Social Security Act; and
``(C) other databases maintained by the Department
of Health and Human Services (including those
maintained at the Agency for Healthcare Research and
Quality, the Centers for Disease Control and
Prevention, the Centers for Medicare & Medicaid
Services, and the National Institutes of Health).
``(2) Additional data.--A State cancer registry may utilize
data in addition to the databases described in paragraph (1),
including data maintained by private insurance plans and health
care delivery organizations.
``(h) Rule of Construction.--Nothing in this section shall be
construed to require an individual or entity to submit information to a
State cancer registry under this section.
``(i) Definitions.--In this section:
``(1) Health center.--The term `health center' has the
meaning given the term `federally qualified health center' in
section 1861(aa)(4) of the Social Security Act (12 U.S.C.
1395x(aa)(4)).
``(2) Quality of cancer care.--The term `quality of cancer
care' has the meaning given such term in section 399AA.
``(j) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $3,000,000 for fiscal year 2003
and such sums as may be necessary for each of fiscal years 2004 through
2007.
``SEC. 399E-2. CANCER SURVEILLANCE SYSTEM.
``(a) In General.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, and in coordination
with the Director of the National Cancer Institute, shall--
``(1) establish the Cancer Surveillance System (referred to
in this section as the `System') to monitor State cancer
registries funded under section 399B; and
``(2) provide for the development, expansion, and
evaluation of such registries.
``(b) Duties.--The System shall--
``(1) facilitate timely access to and exchange of accurate
quality of cancer care information among State cancer
registries including the use of the quality of cancer care
measures developed under section 417E, where appropriate;
``(2) develop guidelines permitting State cancer registries
to access the national registry clearinghouse established under
paragraph (3);
``(3) establish and maintain a registry information
clearinghouse to collect, synthesize, and disseminate
information concerning evidence-based best practices for the
creative use of State cancer registries, including maintaining
an Internet website where such information may be accessed;
``(4) determine the feasibility of monitoring the quality
of palliative care by State cancer registries;
``(5) identify and develop evidence-based best practices
for coordination between cancer registries and other entities;
and
``(6) update information collected or made available under
this section as determined to be necessary by the Secretary.
``(c) Privacy.--The System shall comply with appropriate security
and privacy protocols (including protocols required under the
regulations promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note)),
if applicable, with respect to information collected by the System.
Nothing in this section shall be construed to supersede applicable
Federal or State privacy laws.
``(d) Definitions.--In this section, the terms `palliative care'
and `quality of cancer care' have the meanings given such terms in
section 399AA.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $6,000,000 for fiscal year 2003
and such sums as may be necessary for each of fiscal years 2004 through
2007.''.
SEC. 202. REAUTHORIZATION OF NATIONAL PROGRAM OF CANCER REGISTRIES.
Section 399F(a) of the Public Health Service Act (42 U.S.C. 280e-
4(a)) is amended--
(1) by striking ``this part,'' and inserting ``this part,
other than sections 399E-1 and 399E-2),''; and
(2) by striking ``2003'' and inserting ``2008''.
SEC. 203. MATCHING FUNDS; RELATIONSHIP TO CERTIFICATION.
(a) Matching Funds.--Section 399B(b)(1) of the Public Health
Service Act (42 U.S.C. 280e(B)(1)) is amended by striking ``$3'' and
inserting ``$5''.
(b) Relationship to Certification.--Section 399E of the Public
Health Service Act (42 U.S.C. 280e-3) is amended--
(1) by redesignating subsections (d) and (e) as subsections
(e) and (f), respectively; and
(2) by inserting after subsection (c) the following:
``(d) Relationship to Certification.--The Centers for Disease
Control and Prevention is encouraged to work with eligible entities
through the provision of technical assistance and funding authority
under the National Program of Cancer Registries to assist such entities
in complying with the certification process of the North American
Association of Central Cancer Registries or similar certification
organization.''.
TITLE III--MONITORING AND EVALUATING QUALITY OF CANCER CARE AND
OUTCOMES
SEC. 301. PARTNERSHIPS TO DEVELOP MODEL SYSTEMS FOR MONITORING AND
EVALUATING QUALITY OF CANCER CARE AND OUTCOMES.
(a) Quality of Cancer Care.--Part A of title IX of the Public
Health Service Act (42 U.S.C. 299 et seq.) is amended by adding at the
end the following:
``SEC. 904. AREAS OF SPECIAL EMPHASIS.
``(a) Quality of Cancer Care.--The Secretary, acting through the
Director and in collaboration with the Director of the Centers for
Disease Control and Prevention and the Director of the National Cancer
Institute, shall conduct and support research pertaining to the
measurement, evaluation, and improvement of the quality of cancer care,
take steps to enhance the usefulness of such research to improve
patient care, and appropriately disseminate such information by--
``(1) expanding the evidence base concerning effective
interventions for improving the quality of cancer care;
``(2) ensuring effective analysis of data collected by
State cancer registries funded under section 399B by developing
evidence-based best practices for--
``(A) the real-time recording of and automated
transfer of cancer care data to State cancer care
registries; and
``(B) the linkage of registry data with private
sector claims data and other existing data systems for
purposes of analytic academic research;
``(3) developing and validating quality of cancer care
indicators and evaluate their use and usefulness; and
``(4) developing volume-based quality indicators, as
appropriate, and evaluate ongoing efforts to integrate volume-
based measures into cancer quality improvement programs and
their impact on patient decisionmaking.
``(b) Partnerships To Speed the Pace of Improvements in the Quality
of Cancer Care.--
``(1) In general.--The Secretary, acting through the
Director and in collaboration with the Director of the Centers
for Disease Control and Prevention and the Director of the
National Cancer Institute, shall award competitive grants,
contracts, or enter into cooperative agreements with eligible
entities to--
``(A) foster the development or adoption of model
systems of cancer care;
``(B) speed the pace of improvement in the quality
of cancer care; or
``(C) when appropriate, carry out the other
requirements of this section.
``(2) Eligibility.--In accordance with the limitations of
section 926(c), an applicant eligible to receive a grant,
contract, or cooperative agreement under this subsection shall
be a consortium consisting of public- and private-sector
entities. Each consortium shall include an institution of
higher learning or other research entity and 1 or more of the
following:
``(A) An entity that delivers or purchases cancer
care.
``(B) A professional society or societies that
represent health care providers and other cancer
caregivers, including hospice programs.
``(C) A consumer or patient organization.
``(D) An entity involved in the monitoring of
quality of cancer care or efforts to improve cancer
care (including a State or local health department).
``(d) Collaboration.--In carrying out this section, the Secretary,
acting through the Director, shall ensure coordination with appropriate
Federal and State agencies, private quality improvement entities, and
accreditation or licensure organizations with an interest in improving
the quality of cancer care.
``(e) Definitions.--In this section, the term `quality of cancer
care' has the meaning given such term in section 399AA.''.
(b) Authorization of Appropriations.--Section 927 of the Public
Health Service Act (42 U.S.C. 299c-6) is amended by adding at the end
the following:
``(e) Quality of Cancer Care.--For the purpose of carrying out the
activities under section 904, there is authorized to be appropriated
$5,000,000 for fiscal year 2003, and such sums as may be necessary for
each of fiscal years 2004 through 2007.''.
TITLE IV--STRENGTHENING COMPREHENSIVE CANCER CONTROL
SEC. 401. COMPREHENSIVE CANCER CONTROL PROGRAM.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by adding at the end the following:
``SEC. 320B. COMPREHENSIVE CANCER CONTROL PROGRAM.
``(a) Establishment.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention and in consultation with
the Director of the Agency for Healthcare Research and Quality and the
Director of the National Cancer Institute, shall establish a National
Comprehensive Cancer Control Program (referred to in this section as
the `Program') to improve the quality of cancer care.
``(b) Program.--In carrying out the Program the Secretary shall--
``(1) establish guidelines regarding the design and
implementation of comprehensive cancer control plans; and
``(2) award competitive grants to eligible entities to
develop, update, implement, and evaluate comprehensive cancer
control plans.
``(c) Eligibility.--An entity is eligible to receive assistance
under the Program if such entity is a State health department,
territory, Indian tribe, or tribal organization or its designee.
``(d) Application.--An eligible entity desiring a grant under this
section shall submit an application to the Secretary at such time, in
such manner, and containing such information as the Secretary may
require, including--
``(1) a description of how assistance under such grant will
be used to develop and implement comprehensive cancer control
programs, including programs to monitor the quality of cancer
care (which may include the use of quality of cancer care
measures developed under section 417E);
``(2) a description of how the applicant will integrate its
activities with academic institutions, nonprofit organizations,
or other appropriate entities in planning and implementing
comprehensive cancer control plans; and
``(3) a description of how activities carried out by the
applicant will be evaluated.
``(e) Use of Funds.--An entity shall use assistance received under
this section to--
``(1) convene stakeholders, including stakeholders from the
public, private, and nonprofit sectors, to determine priorities
for the State, territory, or tribe involved;
``(2) develop, update, implement, or evaluate comprehensive
cancer control plans;
``(3) assess disparities in cancer risk reduction,
prevention, diagnosis, or quality of cancer care; and
``(4) develop and disseminate best practices, where
appropriate, and evaluate the application of such practices as
necessary.
``(f) Definitions.--In this section:
``(1) Comprehensive cancer control plan.--The term
`comprehensive cancer control plan' means a plan developed with
assistance provided under this section that provides for an
integrated and coordinated approach to reducing the incidence,
morbidity, and mortality of cancer, with a particular emphasis
on preventing and controlling cancer among populations most at
risk and reducing cancer disparities among underserved
populations.
``(2) Comprehensive cancer control program.--The term
`comprehensive cancer control program' means a program to
fulfill the comprehensive control plan.
``(3) Quality of cancer care.--The term `quality of cancer
care' has the meaning given such term in section 399AA.
``(4) Indian tribe; tribal organization.--The terms `Indian
tribe' and `tribal organization' have the meanings given such
terms in subsections (b) and (c) of section 4 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C.
450b).
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $15,000,000 for fiscal year
2003 and such sums as may be necessary for each of fiscal years 2004
through 2007.''.
TITLE V--IMPROVING NAVIGATION AND SYSTEM COORDINATION
SEC. 501. ENHANCING CANCER CARE THROUGH IMPROVED NAVIGATION AND CANCER
CARE COORDINATION.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by adding at the end the following:
``Part R--Cancer Prevention and Treatment
``SEC. 399AA. DEFINITIONS; AUTHORIZATION OF APPROPRIATIONS.
(a) Definitions.--In this part:
``(1) Health center.--The term `health center' has the
meaning given such term in section 399E-1.
``(2) Hospice care.--The term `hospice care' has the
meaning given such term in section 1861(dd)(1) of the Social
Security Act (42 U.S.C. 1395x(dd)(1)).
``(3) Hospice program.--The term `hospice program' has the
meaning given such term in section 1861(dd)(2) of the Social
Security Act (42 U.S.C. 1395x(dd)(2)).
``(4) Palliative care.--The term `palliative care' means
comprehensive, interdisciplinary, coordinated, and appropriate
care and services provided throughout all stages of disease,
from the time of diagnosis to the end of life, relating to pain
and other symptom management, including psychosocial needs,
that seeks to improve quality of life and prevent and alleviate
suffering for an individual and, if appropriate, that
individual's family or caregivers.
``(5) Quality of cancer care.--The term `quality of cancer
care' means the provision of cancer-related, timely, evidence-
based (whenever there is scientific evidence on the
effectiveness of interventions), patient-centered care and
services of individuals in a technically and culturally
competent and appropriate manner, using effective communication
and shared decisionmaking to improve clinical outcomes,
survival, or quality of life which encompasses--
``(A) the various stages of care, including care
and services provided to individuals with a family
history of cancer, with an abnormal cancer screening
test, or who are clinically diagnosed with cancer,
beginning with risk reduction, prevention, and early
detection through survivorship, remission, and end-of-
life care, and including risk counseling, screening,
diagnosis, treatment, followup care, monitoring,
rehabilitation, and hospice care; and
``(B) appropriate care and services which should be
provided throughout the continuum of care including
palliative care and information on treatment options
including information regarding clinical trials.
``(b) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this part, other than section 399FF, such
sums as may be necessary for each of fiscal years 2003 through 2007.
``SEC. 399BB. ENHANCING CANCER CARE THROUGH IMPROVED NAVIGATION.
``(a) Demonstration Projects.--The Secretary shall award
competitive grants to eligible entities to develop, implement, and
evaluate cancer case management programs to enhance the quality of
cancer care through improved access and navigation.
``(b) Eligibility.--An entity is eligible to receive a grant under
this section if such entity is a hospital; health center; an academic
institution; a hospice program; a palliative care program, or a program
offering a continuum of hospice care, palliative care, and other
appropriate care to children and their families; a State health agency;
an Indian Health Service hospital or clinic, Indian tribal health
facility, or urban Indian facility; a nonprofit organization; a health
plan; a primary care practice-based research network as defined by the
Agency for Healthcare Research and Quality; a cancer center; or any
other entity determined to be appropriate by the Secretary.
``(c) Application.--An eligible entity seeking a grant under this
section shall submit an application to the Secretary at such time, in
such manner, and containing such information as the Secretary may
require, including assurances that the eligible entity will--
``(1) target patient populations with an unequal burden of
cancer through specific outreach activities;
``(2) coordinate culturally competent and appropriate care
specified in observance of existing, relevant departmental
guidelines, including a special emphasis on underserved
populations and how their values and priorities influence
screening and treatment decisions;
``(3) coordinate with relevant ombudsman programs and other
existing coordination and navigation efforts and services,
where possible; and
``(4) evaluate activities and disseminate findings
including findings related to repeated difficulties in
accessing navigation.
``(d) Use of Funds.--An eligible entity shall use amounts received
under a grant under this section to carry out programs in which--
``(1) trained individuals (such as representatives from the
community, nurses, social workers, cancer survivors,
physicians, or patient advocates) are assigned to act as
contacts--
``(A) within the community; or
``(B) within the health care system,
to facilitate access to quality cancer care and cancer
preventive services;
``(2) partnerships are created with community organizations
(which may include cancer centers, hospitals, health centers,
hospice programs, palliative care programs, health care
providers, home care, nonprofit organizations, health plans, or
other entities determined appropriate by the Secretary) to help
facilitate access or to improve the quality of cancer care;
``(3) activities are conducted to coordinate cancer care
and preventive services and referrals, including referrals to
hospice programs, and palliative care programs; or
``(4) the grantee negotiates, mediates, or arbitrates on
behalf of the patient with relevant entities to resolve issues
that impede access to care.
``(e) Models.--Not later than 3 years after the date of enactment
of this section, the Secretary shall develop or modify models to
improve the navigation of cancer care for grantees under this section.
The Secretary shall update such models as may be necessary to ensure
that the best cancer case management practices are being utilized.
``SEC. 399CC. CANCER CARE COORDINATION.
``(a) Demonstration Projects.--The Secretary shall award
competitive grants to eligible entities to facilitate the development
of a coordinated system to improve the quality of cancer care.
``(b) Eligibility.--An entity is eligible to receive a grant under
this section if such entity is a hospital; a health center; an academic
institution; a hospice program; a palliative care program; a program
offering a continuum of hospice care, palliative care, and other
appropriate care to children and their families; a State health agency;
a nonprofit organization; a health plan; a primary care practice-based
research network as defined by the Agency for Healthcare Research and
Quality; a cancer center; or any other entity determined to be
appropriate by the Secretary.
``(c) Application.--An eligible entity desiring a grant under this
section shall prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as the
Secretary may require.
``(d) Use of Funds.--An eligible entity shall use amounts received
under a grant under this section to improve coordination of the quality
of cancer care, by--
``(1) creating partnerships and enhancing collaboration
with health care providers (which may include cancer centers,
hospitals, health centers, hospice programs, health care
providers, experts in palliative care, preventive service
providers) to improve the provision of quality of cancer care;
``(2) developing best practices for the quality of cancer
care coordination (with special emphasis provided to those
cancers that have low survival rates or individuals with
advanced disease), including the development of model systems;
and
``(3) evaluating overall activities to identify optimal
designs and essential components for cancer practices and
models to improve the coordination of cancer care services and
activities.
``(e) Dissemination.--The Secretary shall disseminate findings made
as a result of activities conducted under this section to the public in
coordination with the Agency for Healthcare Research and Quality, the
Centers for Medicare & Medicaid Services, or other appropriate Federal
agencies.''.
TITLE VI--ESTABLISHING PROGRAMS IN PALLIATIVE CARE
SEC. 601. PROGRAMS TO IMPROVE PALLIATIVE CARE.
Part R of title III of the Public Health Service Act (as added by
section 501), is further amended by adding at the end the following:
``SEC. 399DD. PROGRAMS TO IMPROVE PALLIATIVE CARE.
``(a) Demonstration Projects.--The Secretary shall award
competitive grants to eligible entities to develop, implement, and
evaluate model programs for the delivery of palliative care throughout
all stages of disease for individuals with cancer (with a special
emphasis on children) and their families.
``(b) Eligibility.--An entity is eligible to receive a grant under
this section if such entity is a hospital; an academic institution; a
hospice program; a palliative care program; a program offering a
continuum of hospice care, palliative care, and other appropriate care
to children and their families; a nonprofit organization; a State
health agency; a health center; a cancer center; or any other entity
determined to be appropriate by the Secretary.
``(c) Application.--An eligible entity desiring a grant under this
section shall prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as the
Secretary may require.
``(d) Use of Funds.--An entity shall use amounts received under a
grant under this section to--
``(1) integrate palliative care with such entities as
academic institutions, community organizations, hospice
programs, hospitals, cancer patient and survivorship
organizations, health care providers, cancer centers, or other
entities determined appropriate by the Secretary;
``(2) conduct outreach and education activities to
encourage the dissemination of evidence-based clinical best
practices relating to palliative care;
``(3) increase public awareness, including outreach
campaigns, particularly to underserved populations;
``(4) disseminate evidence-based information to health care
providers and individuals with cancer and their families
regarding available palliative care programs and services;
``(5) provide and evaluate education and training programs
in palliative care for health care providers, including--
``(A) establishing pilot training programs
(including faculty training programs) in medicine,
including oncology (including pediatric oncology),
family medicine, psychiatry, psychology, pain, nursing,
pharmacology, physical therapy, occupational therapy,
social work, and other relevant disciplines; or
``(B) developing, implementing, and evaluating
pilot training programs for the staff of hospices,
nursing homes, hospitals, home health agencies,
outpatient care clinics, and other entities determined
appropriate by the Secretary;
``(6) design or implement model palliative care programs
for individuals with cancer and their families including
improving access to clinical trials, where appropriate;
``(7) develop and evaluate pilot programs to address the
special needs of children or other underserved populations and
their families in palliative care programs;
``(8) conduct demonstration projects to enhance or develop
online support networks for individuals with cancer and their
families, including those networks for individuals who are
homebound, and develop other methods to reach underserved
cancer patients; or
``(9) determine whether strategies developed for palliative
care for individuals with cancer and their families would be
applicable to individuals with other diseases.
``(e) Dissemination.--The Secretary shall disseminate findings made
as a result of activities conducted under this section to the public in
coordination with the Director of the Agency for Healthcare Research
and Quality, the Administrator of the Centers for Medicare & Medicaid
Services, and the heads other appropriate Federal agencies.''.
TITLE VII--ESTABLISHING SURVIVORSHIP PROGRAMS
SEC. 701. PROGRAMS FOR SURVIVORSHIP.
Subpart 1 of Part C of title IV of the Public Health Service Act
(42 U.S.C. 285 et seq.) (as amended by section 101), is further amended
by adding at the end the following:
``SEC. 417F. PROGRAMS FOR SURVIVORSHIP.
``(a) Demonstration Projects.--The Secretary shall conduct and
support research regarding the unique health challenges associated with
cancer survivorship and carry out demonstration projects to develop and
implement post-treatment public health programs and services including
followup care and monitoring to support and improve the long-term
quality of life for cancer survivors, including children.
``(b) Eligibility.--An entity is eligible to receive a competitive
grant under this section if such entity is an academic institution,
nonprofit organization, State health agency, cancer center, health
center, or other entity determined to be appropriate by the Secretary.
``(c) Application.--An entity desiring a grant under this section
shall prepare and submit to the Secretary an application at such time,
in such manner, and containing such information as the Secretary may
require.
``(d) Use of Funds.--An entity shall use amounts received under a
grant under this section to plan, implement, and evaluate demonstration
projects that--
``(1) design protocols for followup care, monitoring, and
other survivorship programs (including peer support and mentor
programs);
``(2) increase public awareness about appropriate followup
care, monitoring and other survivorship programs (including
peer support and mentor programs) by disseminating information
to health care providers and survivors and their families; and
``(3) support programs to improve the quality of life among
cancer survivors, referenced by the quality of cancer care
measures developed under section 417E (where appropriate), with
particular emphasis on underserved populations, including
children.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2003 through 2007.''.
SEC. 702. CANCER CONTROL PROGRAMS.
Section 412 of the Public Health Service Act (42 U.S.C. 285a-1) is
amended--
(1) in the matter preceding paragraph (1), by striking
``cancer and for rehabilitation and counseling respecting
cancer.'' and inserting ``cancer and for survivorship,
rehabilitation, and counseling respecting cancer.'';
(2) in paragraph (1)(B), by striking ``and the families of
cancer patients'' and inserting ``the families of cancer
patients, and cancer survivors''; and
(3) in paragraph (3), by striking ``diagnosis, and
treatment and control of cancer'' and inserting ``diagnosis,
treatment, survivorship programs, and control of cancer.''.
TITLE VIII--PROGRAMS FOR END-OF-LIFE CARE
SEC. 801. PROGRAMS FOR END-OF-LIFE CARE.
Part R of title III of the Public Health Service Act (as amended by
section 601), is further amended by adding the following:
``SEC. 399EE. PROGRAMS FOR END-OF-LIFE CARE.
``(a) Demonstration Projects.--The Secretary shall award
competitive grants to eligible entities to develop, implement, and
evaluate evidence-based programs for the delivery of quality of cancer
care during the end-of-life to individuals with cancer (with a special
emphasis on children) and their families.
``(b) Eligibility.--An entity is eligible to receive a grant under
this section if such entity is a hospital; an academic institution; a
hospice program; a palliative care program; a program offering a
continuum of hospice care, palliative care, and other appropriate care
to children and their families; a nonprofit organization; a State
health agency; a health center; a cancer center; or any other entity
determined to be appropriate by the Secretary.
``(c) Application.--An entity desiring a grant under this section
shall prepare and submit to the Secretary an application at such time,
in such manner, and containing such information as the Secretary may
require.
``(d) Use of Funds.--An entity shall use amounts received under a
grant under this section to--
``(1) integrate palliative care or end-of-life care
programs with entities including academic institutions,
community organizations, hospice programs, hospitals, cancer
patient and survivorship organizations, health care providers,
cancer centers, or other entities determined appropriate by the
Secretary;
``(2) conduct outreach and education activities to
encourage the dissemination of evidence-based clinical best
practices relating to end-of-life care;
``(3) increase public awareness, including outreach
campaigns, particularly to underserved populations;
``(4) disseminate information to health care providers and
individuals with cancer and their families regarding available
end-of-life programs, including hospice programs;
``(5) provide and evaluate education and training in end-
of-life care for health care providers, including--
``(A) establishing pilot training programs
(including faculty training programs) in medicine
including oncology (including pediatric oncology),
family medicine, psychiatry, psychology, pain, nursing,
pharmacology and social work, and other disciplines; or
``(B) developing, implementing, and evaluating
pilot training programs for the staff of hospices,
nursing homes, hospitals, home health agencies,
outpatient care clinics, and other entities determined
appropriate by the Secretary;
``(6) design or implement model end-of-life care programs
for individuals with cancer and their families including
improving access to clinical trials where appropriate;
``(7) develop and evaluate pilot programs to address the
special needs of children or other underserved populations and
their families in end-of-life programs;
``(8) integrate palliative care and hospice care activities
in the delivery of end-of-life care; or
``(9) determine whether strategies developed for end-of-
life care for individuals with cancer and their families would
be applicable to individuals with other diseases.
``(e) Dissemination.--The Secretary shall disseminate findings made
as a result of activities conducted under this section to the public in
coordination with the Director of the Agency for Healthcare Research
and Quality, the Administrator of the Centers for Medicare & Medicaid
Services, and the heads of other appropriate Federal agencies.''.
TITLE IX--DEVELOPING TRAINING CURRICULA
SEC. 901. CURRICULUM DEVELOPMENT.
Part R of title III of the Public Health Service Act (as amended by
section 801), is further amended by adding at the end the following:
``SEC. 399FF. CURRICULUM DEVELOPMENT.
``(a) In General.--The Secretary shall award competitive grants for
the development of curricula for health care provider training
regarding the assessment, monitoring, improvement, and delivery of
quality of cancer care.
``(b) Eligibility.--To be eligible to receive a grant under this
section, an entity shall be an academic institution, nonprofit
organization, cancer center, health center, medical school, or other
entity determined appropriate by the Secretary.
``(c) Application.--An entity desiring a grant under this section
shall prepare and submit to the Secretary an application at such time,
in such manner, and containing such information as the Secretary may
require.
``(d) Use of Funds.--An entity shall use amounts received under a
grant under this subsection to--
``(1) evaluate methods of delivery of the quality of cancer
care, including palliative care, hospice care, end-of-life
care, or cancer survivorship by health care providers;
``(2) develop curricula concerning the delivery of quality
of cancer care including palliative care, hospice care, end-of-
life care, or cancer survivorship; and
``(3) provide recommendations for training protocols for
medical and nursing education, fellowships, and continuing
education in quality of cancer care including palliative care,
hospice care, survivorship, or end-of-life care for health care
providers.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $3,000,000 for fiscal year 2003
and such sums as may be necessary for each of fiscal years 2004 through
2007.''.
SEC. 902. CANCER CARE WORKFORCE AND TRANSLATIONAL RESEARCH.
(a) Cancer Control Programs.--Section 412 of the Public Health
Service Act (42 U.S.C. 285a-1) is amended--
(1) by striking ``The Director of the Institute'' and
inserting the following:
``(a) In General.--The Director of the Institute'';
(2) by striking paragraph (2) and inserting the following:
``(2) annual and long-term training goals to assure an
adequate and diverse cancer care workforce including--
``(A) preparing and implementing a plan to provide
assistance to health professionals in health
professions experiencing the most severe shortages
including the provision of grants, scholarships,
fellowships, post-doctoral stipends, or loans to
eligible individuals to increase the cancer care
workforce; and
``(B) educating students of health professions and
health professionals in--
``(i) effective methods for the prevention
and early detection of cancer;
``(ii) the identification of individuals
with a high risk of developing cancer;
``(iii) improved methods of patient
referral to appropriate centers for early
diagnosis and treatment of cancer;
``(iv) methods to deliver culturally
competent care; and
``(v) other appropriate methods for
providing quality of cancer care; and''; and
(3) by adding at the end the following:
``(b) Coordination With Existing Programs.--In carrying out the
activities under subsection (a)(2), the Director of the Institute shall
coordinate with existing programs, including programs at the Health
Resources and Services Administration, to prevent duplication.''.
(b) National Cancer Research and Demonstration Centers.--Section
414(b) of the Public Health Service Act (42 U.S.C. 285a-3(b)) is
amended by striking paragraph (3) and inserting the following:
``(3) clinical training (including training for allied
health professionals), loan forgiveness or post-doctoral
stipends for bench researchers, continuing education for health
professionals and allied health professionals, and information
programs for the public regarding cancer; and''.
(c) Translational Cancer Research.--Subpart 1 of part C of title IV
of the Public Health Service Act (42 U.S.C. 285 et seq.) is amended by
inserting after section 414 the following:
``SEC. 414A. TRANSLATIONAL CANCER RESEARCH.
``(a) In General.--The Director of the Institute shall enter into
cooperative agreements with, and make grants to, public or nonprofit
entities to conduct multidisciplinary, translational cancer research.
``(b) Use of Funds.--
``(1) In general.--The Director of the Institute may use
funds provided under this section to establish networks and
partnerships to link community cancer providers to programs
funded under this section.
``(2) Construction of New Facilities.--Funds provided under
this section shall not be used for the construction of new
facilities.
``(c) Strategic Plan.--Not later than October 1, 2004, the Director
of the Institute shall develop and implement a strategic plan, in
collaboration with entities performing translational research, for
identifying, expanding, and disseminating the results of translational
cancer research to health care providers.
``(d) Duties.--An entity receiving a grant under this section
shall--
``(1) conduct research with the potential to improve the
prevention, diagnosis, and treatment of cancer and to improve
the quality of cancer care, including palliation;
``(2) conduct clinical research studies on promising cancer
treatments including clinical trials; and
``(3) evaluate tests, techniques, or technologies in
individuals being evaluated for the presence of cancer.
``(e) Definition of Translational Cancer Research.--As used in this
section, the term `translational cancer research' means scientific
laboratory and clinical research and testing necessary to transform
scientific or medical discoveries into new approaches, products, or
processes that can assist in preventing, diagnosing, or controlling
cancer.''
(d) Authorization of Appropriations.--Section 417B(a) of the Public
Health Service Act (42 U.S.C. 285a-8(a)) is amended by striking
``1996'' and inserting ``2007''.
TITLE X--CONDUCTING REPORTS
SEC. 1001. STUDIES AND REPORTS BY THE INSTITUTE OF MEDICINE.
(a) Contract.--The Secretary shall enter into a contract with the
Institute of Medicine to--
(1) evaluate Federal and State activities relating to
comprehensive cancer control programs and activities;
(2) evaluate the quality of cancer care (including
palliative care, end-of-life care, and survivorship) that
medicare and medicaid beneficiaries receive and the extent to
which medicare and medicaid coverage and reimbursement policies
affect access to quality cancer care;
(3) evaluate data from the Centers for Medicare & Medicaid
Services and other agencies on volume-outcome relationships;
(4) evaluate access to clinical trials and the relationship
of such access to the quality of cancer care, especially with
respect to medically underserved populations; and
(5) assess existing gaps in and impediments to the quality
of cancer care, including gaps in data, research and
translation, seamless patient care and navigation, palliative
care, and care provided to underserved populations.
(b) Reports.--
(1) In general.--Not later than 4 years after the date of
enactment of this Act, the Institute of Medicine shall submit
to the Secretary of Health and Human Services a report
containing information on the evaluation conducted under
paragraphs (1) through (5) of subsection (a), including data
collected at the State level through contracts with appropriate
organizations as designated by the Institute of Medicine.
(2) 8 years.--Not later than 8 years after the date of
enactment of this Act, the Institute of Medicine shall submit
to the Secretary of Health and Human Services a report
containing information and recommendations on the areas
described in subsection (a), including data collected from
relevant demonstration projects.
(3) Reports.--The Secretary of Health and Human Services
shall submit the reports described in paragraphs (1) and (2) to
the relevant committees of Congress.
(c) Definitions.--
(1) Palliative care; quality of cancer care.--The terms
`palliative care' and `quality of cancer care' have the
meanings given such term in section 399AA of the Public Health
Service Act.
(2) Comprehensive cancer control program.--The term
`comprehensive cancer control program' has the meaning given
such term in section 320B of the Public Health Service Act.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $2,500,000 for fiscal year
2003, and such sums as may be necessary for each of fiscal years 2004
through 2007.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S8761-8762)
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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