,,ii #aacth ,,congress #ast ,session ,s4 #fda ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ba1 #bjac ,mr4 ,wyden 7for himself and ,mr4 ,reed7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,public ,health ,service ,act to increase the number of permanent faculty in palliative care at accredited allopathic and osteopathic medical schools1 nursing schools1 and other programs1 to promote education in palliative care and hospice1 and to support the development of faculty careers in academic palliative medicine4 #a4 ,short title ,this ,act may be cited as the ,palliative ,care and ,hospice ,education and ,training ,act4 #b4 ,findings ,congress makes the following findings3 7#a7 ,health care providers need better education about pain management and palliative care4 ,students graduating from medical school have very little1 if any1 training in the core precepts of pain and symptom management1 advance care planning1 communication skills1 and care coordination for patients with serious1 life-threatening1 or terminal illness4 7#b7 ,palliative care is interdisciplinary1 patient- and family-centered health care for people with serious illnesses4 ,this type of care is focused on providing patients with relief from the symptoms1 pain1 and stress of a serious illness1 whatever the diagnosis4 ,the goal of palliative care is to relieve suffering and improve quality of life for both patients and their families4 ,palliative care is provided by a team of doctors1 nurses1 social workers1 chaplains1 and other specialists who work with a patient's other health care providers to provide an extra layer of support1 including assistance with difficult medical decisionmaking and coordination of care among specialists4 ,palliative care is appropriate at any age and at any stage in a serious illness1 and can be provided together with curative treatment4 ,palliative care is not dependent on a life-limiting prognosis and may actually help an individual recover from illness by relieving symptoms1 such as pain1 anxiety1 or loss of appetite1 while undergoing sometimes difficult medical treatments or procedures1 such as surgery or chemotherapy4 ,there were #a1fbc hospitals with palliative care programs in #bjab4 7#c7 ,hospice is palliative care for patients in their last year of life4 ,considered the model for quality compassionate care for individuals facing a life-limiting illness1 hospice provides expert medical care1 pain management1 and emotional and spiritual support expressly tailored to the patient's needs and wishes4 ,in most cases1 care is provided in the patient's home but may also be provided in freestanding hospice centers1 hospitals1 nursing homes1 and other long-term care facilities4 ,in #bjaa1 an estimated #a1fej1jjj patients received services from hospice1 and nearly #de percent of all deaths in the ,united ,states occurred under the care of a hospice program4 ,hospice is a covered benefit under the ,medicare program4 ,there were #c1fcj ,medicare-certified hospices serving more than #a1bjj1jjj beneficiaries in #bjaa4 7#d7 ,a #bjje study at ,michigan ,state ,university found that the formal training of ,united ,states doctors in palliative care is grossly inadequate4 ,when the ,american ,society of ,clinical ,oncology surveyed their members1 #fe percent said they had received inadequate education in controlling symptoms associated with cancer1 and #ha percent felt they had inadequate mentoring in discussing a poor prognosis with their patients and families4 ,training in pediatric palliative care is also seriously lacking according to physicians1 residents1 and medical students responding to a survey presented at a meeting of ,american ,federation for ,medical ,research4 7#e7 ,the ,american ,board of ,medical ,specialties 7,,abms7 and the ,accreditation ,council for ,graduate ,medical ,education 7,,acgme7 provided formal subspecialty status for hospice and palliative medicine 7,,hpm7 in #bjjf1 and the ,centers for ,medicare ,medicaid ,services recognized hospice and palliative medicine as a medical subspecialty in ,october of #bjjh4 7#f7 ,as of ,february #bjac1 there were a total of #hi hospice and palliative medicine training programs accredited by the ,accreditation ,council for ,graduate ,medical ,education4 ,for the #bjab-bjac academic year1 these programs were training #bjf physicians in hospice and palliative medicine4 ,some programs include an additional track in research1 geriatrics1 or public health4 7#g7 ,there is a large gap between those practicing in the palliative medicine field and the number of physicians needed4 ,a mid-range estimate by the ,american ,academy of ,hospice and ,palliative ,medicine's ,workforce ,task ,force calls for #f1jjj or more full time equivalents to serve current needs in hospice and palliative care programs4 ,at maximum capacity1 the current system would produce roughly #d1fjj new hospice and palliative medicine certified physicians over the next #bj years1 during which time some #gj1jjj1jjj new ,medicare beneficiaries will enter the ,medicare program4 ,at the same time1 there is expected to be increasing acceptance of the hospice and palliative approach to care among the general population and health care providers4 #c4 ,palliative care and hospice education and training 7a7 ,in general ,part ,d of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bid et seq47 is amended by adding at the end the following3 #gei;,a4 ,palliative care and hospice education and training 7a7 ,palliative care and hospice education centers 7#a7 ,in general ,the ,secretary shall award grants or contracts under this section to entities described in paragraph 7#a71 7#c71 or 7#d7 of section #gii;,b1 and section #hja7b71 for the establishment or operation of ,palliative ,care and ,hospice ,education ,centers that meet the requirements of paragraph 7#b74 7#b7 ,requirements ,a ,palliative ,care and ,hospice ,education ,center meets the requirements of this paragraph if such ,center-- 7,a7 improves the training of health professionals in palliative care1 including residencies1 traineeships1 or fellowships2 7,b7 develops and disseminates curricula relating to the palliative treatment of the complex health problems of individuals with serious or life-threatening illnesses2 7,c7 supports the training and retraining of faculty to provide instruction in palliative care2 7,d7 supports continuing education of health professionals who provide palliative care to patients with serious or life-threatening illness2 7,e7 provides students 7including residents1 trainees1 and fellows7 with clinical training in palliative care in the home1 long-term care facilities1 home care1 hospices1 chronic and acute disease hospitals1 and ambulatory care centers2 7,f7 establishes traineeships for individuals who are preparing for advanced education nursing degrees in palliative care nursing1 home care1 hospice1 in the home1 long-term care1 or other nursing areas that specialize in palliative care2 and 7,g7 does not duplicate the activities of existing education centers funded under this section or under section #gec or #hfe4 7#c7 ,expansion of existing centers ,nothing in this section shall be construed to-- 7,a7 prevent the ,secretary from providing grants to expand existing education centers1 including geriatric education centers established under section #gec or #hfe1 to provide for education and training focused specifically on palliative care1 including for non-geriatric populations2 or 7,b7 limit the number of education centers that may be funded in a community4 7b7 ,palliative medicine physician training 7#a7 ,in general ,the ,secretary may make grants to1 and enter into contracts with1 schools of medicine1 schools of osteopathic medicine1 teaching hospitals1 and graduate medical education programs1 for the purpose of providing support for projects that fund the training of physicians 7including residents1 trainees1 and fellows7 who plan to teach palliative medicine4 7#b7 ,requirements ,each project for which a grant or contract is made under this subsection shall-- 7,a7 be staffed by full-time teaching physicians who have experience or training in palliative medicine2 7,b7 be based in a hospice and palliative medicine fellowship program accredited by the ,accreditation ,council for ,graduate ,medical ,education2 7,c7 provide training in palliative medicine through a variety of service rotations1 such as consultation services1 acute care services1 extended care facilities1 ambulatory care and comprehensive evaluation units1 hospice1 home health1 and community care programs2 7,d7 develop specific performance-based measures to evaluate the competency of trainees2 and 7,e7 provide training in palliative medicine through one or both of the training options described in subparagraphs 7,a7 and 7,b7 of paragraph 7#c74 7#c7 ,training options ,the training options referred to in subparagraph 7,e7 of paragraph 7#b7 shall be as follows3 7,a7 #a-year retraining programs in hospice and palliative medicine for physicians who are faculty at schools of medicine and osteopathic medicine1 or others determined appropriate by the ,secretary4 7,b7 #a- or #b-year training programs that shall be designed to provide training in hospice and palliative medicine for physicians who have completed graduate medical education programs in any medical specialty leading to board eligibility in hospice and palliative medicine pursuant to the ,american ,board of ,medical ,specialties4 7#d7 ,definitions ,for purposes of this subsection the term graduate medical education means a program sponsored by a school of medicine1 a school of osteopathic medicine1 a hospital1 or a public or private institution that-- 7,a7 offers postgraduate medical training in the specialties and subspecialties of medicine2 and 7,b7 has been accredited by the ,accreditation ,council for ,graduate ,medical ,education or the ,american ,osteopathic ,association through its ,committee on ,postdoctoral ,training4 7c7 ,palliative medicine and hospice academic career awards 7#a7 ,establishment of program ,the ,secretary shall establish a program to provide awards1 to be known as the ,palliative ,medicine and ,hospice ,academic ,career ,awards1 to eligible individuals to promote the career development of such individuals as academic hospice and palliative care physicians4 7#b7 ,eligible individuals ,to be eligible to receive an award under paragraph 7#a71 an individual shall-- 7,a7 be board certified or board eligible in hospice and palliative medicine2 and 7,b7 have a junior 7non-tenured7 faculty appointment at an accredited 7as determined by the ,secretary7 school of medicine or osteopathic medicine4 7#c7 ,limitations ,no award under paragraph 7#a7 may be made to an eligible individual unless the individual-- 7,a7 has submitted to the ,secretary an application1 at such time1 in such manner1 and containing such information as the ,secretary may require1 and the ,secretary has approved such application2 7,b7 provides1 in such form and manner as the ,secretary may require1 assurances that the individual will meet the service requirement described in paragraph 7#f72 and 7,c7 provides1 in such form and manner as the ,secretary may require1 assurances that the individual has a full-time faculty appointment in a health professions institution and documented commitment from such institution to spend a majority of the total funded time of such individual on teaching and developing skills in interdisciplinary education in palliative care4 7#d7 ,maintenance of effort ,an eligible individual who receives an award under paragraph 7#a7 shall provide assurances to the ,secretary that funds provided to the eligible individual under this subsection will be used only to supplement1 not to supplant1 the amount of ,federal1 ,state1 and local funds otherwise expended by the eligible individual4 7#e7 ,amount and term 7,a7 ,amount ,the amount of an award under this subsection shall be equal to the award amount provided for under section #gec7;c77#e77;,a7 for the fiscal year involved4 7,b7 ,term ,the term of an award made under this subsection shall not exceed #e years4 7,c7 ,payment to institution ,the ,secretary shall make payments for awards under this subsection to institutions which include schools of medicine and osteopathic medicine4 7#f7 ,service requirement ,an individual who receives an award under this subsection shall provide training in palliative care and hospice1 including the training of interdisciplinary teams of health care professionals4 ,the provision of such training shall constitute a majority of the total funded obligations of such individual under the award4 7d7 ,palliative care workforce development 7#a7 ,in general ,the ,secretary shall award grants or contracts under this subsection to entities that operate a ,palliative ,care and ,hospice ,education ,center pursuant to subsection 7a77#a74 7#b7 ,application ,to be eligible for an award under paragraph 7#a71 an entity described in such paragraph shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#c7 ,use of funds ,amounts awarded under a grant or contract under paragraph 7#a7 shall be used to carry out the fellowship program described in paragraph 7#d74 7#d7 ,fellowship program 7,a7 ,in general ,pursuant to paragraph 7#c71 a ,palliative ,care and ,hospice ,education ,center that receives an award under this subsection shall use such funds to offer short-term intensive courses 7referred to in this subsection as a fellowship7 that focus on palliative care that provide supplemental training for faculty members in medical schools and other health professions schools with programs in psychology1 pharmacy1 nursing1 social work1 chaplaincy1 or other health disciplines1 as approved by the ,secretary4 ,such a fellowship shall be open to current faculty1 and appropriately credentialed volunteer faculty and practitioners1 who do not have formal training in palliative care1 to upgrade their knowledge and clinical skills for the care of individuals with serious or life-threatening illness and to enhance their interdisciplinary teaching skills4 7,b7 ,location ,a fellowship under this paragraph shall be offered either at the ,palliative ,care and ,hospice ,education ,center that is sponsoring the course1 in collaboration with other ,palliative ,care and ,hospice ,education ,centers1 or at medical schools1 schools of nursing1 schools of pharmacy1 schools of social work1 schools of chaplaincy or pastoral care education1 graduate programs in psychology1 or other health professions schools approved by the ,secretary with which the ,centers are affiliated4 7,c7 ,,cme credit ,participation in a fellowship under this paragraph shall be accepted with respect to complying with continuing health profession education requirements4 ,as a condition of such acceptance1 the recipient shall subsequently provide a minimum of #ah hours of voluntary instruction in palliative care content 7that has been approved by a palliative care and hospice education center7 to students or trainees in health-related educational1 home1 hospice1 or long-term care settings4 7#e7 ,targets ,a ,palliative ,care and ,hospice ,education ,center that receives an award under this subsection shall meet targets approved by the ,secretary for providing palliative care training to a certain number of faculty or practitioners during the term of the award1 as well as other parameters established by the ,secretary4 7#f7 ,amount of award ,an award under this subsection shall be in an amount of #aej1jjj4 ,not more than #bd ,palliative ,care and ,hospice ,education ,centers may receive an award under this subsection4 7#g7 ,maintenance of effort ,a ,palliative ,care and ,hospice ,education ,center that receives an award under this subsection shall provide assurances to the ,secretary that funds provided to the ,center under the award will be used only to supplement1 not to supplant1 the amount of ,federal1 ,state1 and local funds otherwise expended by such ,center4 7e7 ,palliative care and hospice career incentive awards 7#a7 ,in general ,the ,secretary shall award grants or contracts under this subsection to individuals described in paragraph 7#b7 to foster greater interest among a variety of health professionals in entering the field of palliative care4 7#b7 ,eligible individuals ,to be eligible to receive an award under paragraph 7#a71 an individual shall-- 7,a7 be an advanced practice nurse1 a clinical social worker1 a pharmacist1 a chaplain1 or student of psychology who is pursuing a doctorate or other advanced degree in palliative care or related fields in an accredited health professions school2 and 7,b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#c7 ,conditions of award ,as a condition of receiving an award under this subsection1 an individual shall agree that1 following completion of the award period1 the individual will teach or practice palliative care in health-related educational1 home1 hospice or long-term care settings for a minimum of #e years under guidelines established by the ,secretary4 7#d7 ,payment to institution ,the ,secretary shall make payments for awards under this subsection to institutions which include schools of medicine1 osteopathic medicine1 nursing1 social work1 psychology1 chaplaincy or pastoral care education1 dentistry1 and pharmacy1 or other allied health discipline in an accredited health professions school that is approved by the ,secretary4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 #dd1ajj1jjj for each of the fiscal years #bjad through #bjah4 4 7b7 ,effective date ,the amendment made by this section shall be effective beginning on the date that is #ij days after the date of enactment of this ,act4 #d4 ,application to advanced practice nurses 7a7 ,advanced education nursing grants ,section #haa7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bif;j7a77 is amended-- 7#a7 in paragraph 7#a71 by striking and at the end2 7#b7 by redesignating paragraph 7#b7 as paragraph 7#c72 and 7#c7 by inserting after paragraph 7#a71 the following3 7#b7 palliative care and hospice career incentive awards authorized under section #gei;,a7e72 and 4 7b7 ,in general ,part ,d of title ,,viii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bifp et seq47 is amended by adding at the end the following3 #hcb4 ,palliative care and hospice education and training 7a7 ,program authorized ,the ,secretary shall award grants to eligible entities to develop and implement1 in coordination with programs under section #gei;,a1 programs and initiatives to train and educate individuals in providing palliative care in health-related educational1 hospice1 home1 or long-term care settings4 7b7 ,use of funds ,an eligible entity that receives a grant under subsection 7a7 shall use funds under such grant to-- 7#a7 provide training to individuals who will provide palliative care in health-related educational1 home1 hospice1 or long-term care settings2 7#b7 develop and disseminate curricula relating to palliative care in health-related educational1 home1 hospice1 or long-term care settings2 7#c7 train faculty members in palliative care in health-related educational1 home1 hospice1 or long-term care settings2 or 7#d7 provide continuing education to individuals who provide palliative care in health-related educational1 home1 hospice1 or long-term care settings4 7c7 ,application ,an eligible entity desiring a grant under subsection 7a7 shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may reasonably require4 7d7 ,eligible entity ,for purposes of this section1 the term eligible entity shall include a school of nursing1 a health care facility1 a program leading to certification as a certified nurse assistant1 a partnership of such a school and facility1 or a partnership of such a program and facility4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #e1jjj1jjj for each of fiscal years #bjad through #bjah4 4