Sponsor
Mark James Desaulnier
Representative · D-CA
Representative · D-CA
The bill improves cancer care coordination and equity for Medicare patients by funding standardized, culturally appropriate care plans, but it increases Medicare spending and provider administrative burden, and its impact will depend on adequate payment rates and broad program adoption.
Medicare beneficiaries with cancer will receive standardized, clinician-developed written or electronic cancer care plans at diagnosis and key care transitions, improving continuity of care and ensuring documented guidance for follow-up.
Clinicians will be reimbursed under Medicare for delivering cancer care planning, which should improve provider compensation and make coordinated planning services more available across communities, reducing access disparities for many beneficiaries.
Patients with cancer will be more likely to receive coordinated symptom management (pain, nausea, fatigue, depression), improving quality of life and potentially survival.
Expanding Medicare-covered cancer care planning and increasing Medicare payments will raise federal spending and put additional pressure on Medicare outlays and the trust fund, with costs borne by taxpayers or requiring offsets.
Mandating written/electronic survivorship and care plans and documenting cultural/linguistic accommodations will increase administrative workload for clinicians, hospitals, and health systems, potentially diverting time from direct patient care.
If payment rates are set at or near transitional care management levels, reimbursement may be insufficient for time-intensive planning, limiting provider uptake and the policy's effectiveness.
Based on analysis of 2 sections of legislative text.
Creates a new Medicare-covered benefit for cancer care planning and coordination and sets initial payment under the physician fee schedule.
Official title: To amend title XVIII of the Social Security Act to provide for coverage of cancer care planning and coordination under the Medicare program.
Introduced August 13, 2026 by Mark James Desaulnier · Last progress August 13, 2026
Creates a new Medicare-covered service called "cancer care planning and coordination services" that requires clinicians to provide written or electronic cancer care plans at defined points in a patient’s treatment. It directs the HHS Secretary to set allowable frequencies (e.g., at diagnosis, treatment transitions, end of active treatment, recurrence) and requires payment under the Medicare physician fee schedule using the initial rate equal to CPT code 99496 unless otherwise set by the Secretary. The benefit must be culturally and linguistically appropriate and furnished promptly at or after the clinician visit. The provision applies to services furnished on or after the first day of the first calendar year beginning after enactment.