Cancer Care Planning and Communications Act
- Sponsor
- Rep. DeSaulnier, Mark [D-CA-10]
- Committees
- Ways and Means Committee (primary)
- Last action
- Aug 13, 2026
Bottom line
This bill expands Medicare coverage to explicitly include and pay for comprehensive cancer care planning and coordination services, aiming to improve patient outcomes and shared decision-making for beneficiaries with cancer.
What it actually does
This bill amends title XVIII of the Social Security Act to establish coverage for cancer care planning and coordination services under the Medicare program. It defines these services as the development of a comprehensive, culturally and linguistically appropriate treatment plan by a physician, physician assistant, or nurse practitioner, incorporating Institute of Medicine (IOM) guidelines. The bill also specifies the key junctures at which these services can be furnished and sets the initial Medicare payment rate for these services to be equivalent to transitional care management services.
Proponents argue
Proponents argue that this bill addresses critical gaps in cancer care by ensuring Medicare beneficiaries have access to structured care planning and coordination, as consistently recommended by the Institute of Medicine. They highlight that this will lead to better patient participation in treatment decisions, improved management of symptoms and side effects, and more effective follow-up care for survivors, ultimately enhancing the quality of life and potentially survival rates for millions of Americans. They also contend that current Medicare payment inadequacies hinder such planning, and this bill rectifies that by providing a dedicated reimbursement mechanism.
Opponents contend
Opponents might raise concerns about the potential increase in Medicare expenditures, especially given the broad definition of services and the multiple frequencies at which they can be furnished. They could argue that existing alternative payment models, such as the Oncology Care Model, are already testing these services, and a broad mandate could prematurely scale an unproven or costly approach. Concerns might also be raised regarding the administrative burden on providers to develop and document these comprehensive plans, and whether the proposed payment rate is appropriately aligned with the actual costs and benefits of these services.
The bill text is very short and clearly written, making it highly accessible for any reader to understand its provisions quickly.
Section 2(a)(1) and (2) (amending Section 1861(s)(2) and adding new subsection (ooo) to the Social Security Act)
Establishes Medicare Coverage for Cancer Care Planning and Coordination Services
This provision adds "cancer care planning and coordination services" as a new covered benefit under Medicare Part B. It defines these services as the development of a treatment plan by a physician, physician assistant, or nurse practitioner for individuals diagnosed with cancer. The plan must incorporate each component of the Institute of Medicine Care Management Plan, be provided in written or electronic form, and be furnished in a culturally and linguistically appropriate manner to make it accessible to the individual.
Supporters argue
Supporters argue this is a crucial step to formalize and incentivize comprehensive, patient-centered cancer care, directly addressing long-standing recommendations from the Institute of Medicine. It ensures that all Medicare beneficiaries, not just those in specific pilot programs, receive coordinated care that is tailored to their needs.
Critics contend
Critics might argue that this provision could lead to an increase in healthcare utilization and costs without clear evidence of improved outcomes that justify the expense, especially if the services duplicate existing care components or are not implemented effectively across diverse practices.
Tradeoffs
This provision balances the desire for improved patient care and coordination against potential increases in Medicare spending and the administrative burden on healthcare providers.
Section 2(a)(2) (new subsection (ooo)(2) of the Social Security Act)
Defines Permissible Frequencies for Cancer Care Planning Services
This section specifies the circumstances under which cancer care planning and coordination services may be furnished. These include: at the time of cancer diagnosis for treatment planning, if there is a change in the individual's condition or treatment preferences, at the end of active treatment (to initiate survivorship care), and if there is a recurrence of cancer. The Secretary is directed to establish the specific frequencies for these services.
Section 2(b)(1) and (2) (amending Section 1848(j)(3) of the Social Security Act)
Establishes Payment Under Physician Fee Schedule and Sets Initial Rate
This provision integrates cancer care planning and coordination services into the Medicare physician fee schedule, making them eligible for reimbursement. Crucially, it mandates that the initial payment rate for these new services will be the same as the payment rate provided for transitional care management services (as defined in CPT code 99496), unless the Secretary of Health and Human Services specifies a different rate.