Alternative payment model for quality cancer survivorship care

(a) In general Not later than one year after the date of enactment of this Act, the Secretary of Health and Human Services shall develop an alternative payment model for payments made under titles XVIII and 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 (as defined by the Secretary). (b) Report to Congress Following development of the alternative payment model under subsection (a), the Secretary shall submit to Congress a report containing a description of such model that includes the following information: (1) 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). (2) The length of the individual’s participation under such model, including a description of any ability to extend such participation, or a definition of survivorship care as extending until death. (3) In the case that such model is based on an episode of care, the appropriate length of the survivorship episode of care, whether additional episodes may be triggered, if necessary, and whether the episode should end at the beneficiary’s death but not before. (4) 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. (5) A description of the navigation services that will be provided as part of such model. (6) A description of any bundled payment packages that will be used under such model. (7) A specification of any follow-up or new screening under such model for unmet needs of individuals participating in such model. (8) A description of how consistent, shared decision-making will be promoted under such model so that individuals are given the knowledge needed for self-management between episodes of care. (9) A specification of which types of health care providers may furnish items and services under such model, including genetic counselors and mental health professionals. (10) 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. (11) 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. (12) Strategies for addressing social determinants of health through such model. (13) A description of how such model will promote— (A) prevention, early detection surveillance, and treatment for individuals continuing to receive systemic therapy after the end of active cancer treatment; (B) such individuals’ understanding of, and access to, treatment; (C) survivorship research; and (D) the continuing health of cancer survivors. (14) An analysis of how different forms and stages of cancer may require the development of different survivorship plans and suggest variations in elements of the alternative payment model based on form and stage of cancer. (15) 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.