,,ii #aadth ,,congress #b;d ,session ,s4 #bifa ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ai1 #bjaf ,mr4 ,blumenthal 7for himself and ,mrs4 ,capito7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to improve end-of-life care4 #a4 ,short title 7a7 ,short title ,this ,act may be cited as the ,compassionate ,care ,act4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title4 ,sec4 #b4 ,definitions4 ,,title ,i--,advance care planning ,subtitle ,a--,consumer education ,sec4 #aja4 ,advance care planning guidelines4 ,sec4 #ajb4 ,national public education campaign4 ,subtitle ,b--,provider education ,sec4 #aaa4 ,public provider advance care planning website4 ,sec4 #aab4 ,advance care curricula pilot program4 ,sec4 #aac4 ,development of core end-of-life care quality measures across each relevant provider setting4 ,sec4 #aad4 ,continuing education for qualified health care providers4 ,,title ,,ii--,reports1 research1 and evaluations ,sec4 #bja4 ,demonstration projects for use of telemedicine services in advance care planning4 ,sec4 #bjb4 ,study and report by the ,secretary regarding the establishment and implementation of a national uniform policy on advance directives4 ,sec4 #bjc4 ,gao study and report on establishment of national advance directive registry2 other studies4 #b4 ,definitions ,in this ,act3 7#a7 ,advance care planning ,the term advance care planning means the process of discussion of end-of-life care1 clarification of related values and goals1 and embodiment of preferences through written documents and medical orders4 7#b7 ,advance directive ,the term advance directive means a written or otherwise recorded instruction1 such as a living will or durable power of attorney for health care1 recognized under the law of the ,state in which it was executed 7whether statutory or as recognized by the courts of the ,state7 and relating to the provision of such care when the individual is incapacitated4 7#c7 ,,chip ,the term ,,chip means the ,state ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq47 7#d7 ,end-of-life-care ,the term end-of-life care means all aspects of care of a patient with a potentially fatal condition1 and includes care that is focused on preparations for an impending death4 7#e7 ,health care agent ,the term health care agent means the person1 designated in a health care power of attorney1 who is selected to make medical decisions on behalf of the person who executed such power of attorney1 in the case of incapacity of such person who executed the power of attorney4 7#f7 ,health care power of attorney ,the term health care power of attorney means a legal document that identifies the health care agent of the person executing such document4 7#g7 ,living will ,the term living will means a written document or a video statement about the kinds of medical care or other care a person does or does not want under certain specific conditions1 in the event that such person no longer is able to express those wishes4 7#h7 ,medicaid ,the term ,medicaid means the program established under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#i7 ,medicare ,the term ,medicare means the program established under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7#aj7 ,orders for life-sustaining treatment ,the term orders for life-sustaining treatment means a set of portable medical orders 7such as physician orders for life-sustaining treatment or similar portable medical orders7 that address key medical decisions consistent with the patient's goals of care and results from a clinical process designed to facilitate shared1 informed medical decisionmaking and communication between qualified health care professionals and patients with serious1 progressive illness or frailty4 7#aa7 ,qualified health care provider ,the term qualified health care provider means a medical doctor1 doctor of osteopathy1 nurse1 physician assistant1 nurse practitioner1 social worker1 home health aide1 palliative care professional1 or individual in a similar position1 as designated by the ,secretary4 7#ab7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 ,i ,advance care planning ,a ,consumer education #aja4 ,advance care planning guidelines ,it is the sense of the ,senate that1 to the extent practicable1 advance care planning should-- 7#a7 occur with an individual and such individual's health care agent1 primary clinician1 other authorized decisionmaker1 or members of the entire interdisciplinary health care team2 7#b7 be recorded and updated as needed2 and 7#c7 allow for flexible decisionmaking in the context of the patient's medical situation1 in accordance with guidelines provided by the ,secretary4 #ajb4 ,national public education campaign 7a7 ,national public education campaign 7#a7 ,in general ,not later than ,january #a1 #bjag1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention and in consultation with public and private entities1 as the ,secretary determines appropriate1 shall1 directly or through grants1 contracts1 or interagency agreements1 develop and implement a national campaign to inform the public of the importance of advance care planning and of an individual's right to direct and participate in health care decisions affecting such individual4 7#b7 ,content of educational campaign ,the national public education campaign established under paragraph 7#a7 may-- 7,a7 employ the use of various media1 including regularly televised public service announcements2 7,b7 provide culturally and linguistically appropriate information2 7,c7 be conducted continuously over a period of not less than #e years2 7,d7 identify and promote the advance care planning information available on the ,internet ,websites of the ,department of ,health and ,human ,service's ,national ,clearinghouse for ,long-,term ,care ,information1 the ,administration for ,children and ,families1 the ,administration for ,community ,living1 and the ,centers for ,medicare ,medicaid ,services2 7,e7 address the importance of individuals speaking to family members1 health care proxies1 and qualified health care providers as part of an ongoing dialogue regarding health care choices2 7,f7 address the need for individuals to communicate their health care goals and wishes through a variety of means1 including the use of readily available legal and medical documents that express their health care decisions in the form of advance directives 7including living wills1 orders for life-sustaining treatment1 and durable powers of attorney for health care72 7,g7 raise public awareness regarding the availability of hospice and palliative care and the quality of life benefits of early use of such services2 and 7,h7 encourage individuals to speak with qualified health care professionals about their options and intentions for end-of-life care4 7#c7 ,evaluation ,not later than ,july #a #bjai1 the ,secretary shall report to the appropriate committees of ,congress on the effectiveness of the public education campaign under this section1 and include in such report any recommendations that the ,secretary determines appropriate regarding the need for continuation of legislative or administrative changes to facilitate changing public awareness1 attitudes1 and behaviors regarding advance care planning4 7b7 ,repeal ,section #dgea7;d7 of the ,omnibus ,budget ,reconciliation ,act of #aiij 7#db ,u4,s4,c4 #acif;a note2 ,public ,law #aja-ejh7 is repealed4 ,b ,provider education #aaa4 ,public provider advance care planning website 7a7 ,development ,not later than ,january #a1 #bjah1 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services and the ,director of the ,agency for ,healthcare ,research and ,quality1 shall establish an1 or expand upon an existing1 ,internet ,website for providers under ,medicare1 ,medicaid1 ,,chip1 the ,indian ,health ,service 7including contract providers71 and other qualified health care providers on each individual's right to make decisions concerning medical care1 including the right to accept or refuse medical or surgical treatment1 and engage in advance care planning4 7b7 ,maintenance ,the ,internet ,website described in subsection 7a7 shall be maintained and publicized by the ,secretary on an ongoing basis4 7c7 ,content ,the ,internet ,website may include content1 tools1 and resources necessary to do the following3 7#a7 ,inform qualified health care providers about the advance directive requirements under the health care programs described in subsection 7a7 and other ,state and ,federal laws and regulations related to advance care planning4 7#b7 ,educate providers about advance care planning quality improvement activities4 7#c7 ,provide assistance to qualified health care providers to-- 7,a7 integrate advance care planning documents into electronic health records1 including oral directives2 and 7,b7 develop and disseminate advance care planning informational materials for patients4 7#d7 ,inform qualified health care providers about advance care planning continuing education requirements and opportunities4 7#e7 ,encourage qualified health care providers to discuss advance care planning with patients of all ages4 7#f7 ,assist qualified health care providers' understanding of the continuum of end-of-life care services and supports available to patients1 including palliative care and hospice4 7#g7 ,inform qualified health care providers of best practices for discussing end-of-life care with dying patients and their loved ones4 #aab4 ,advance care curricula pilot program 7a7 ,in general ,the ,secretary1 in consultation with appropriate professional associations1 shall establish a pilot program by which the ,secretary awards grants to eligible entities that require a minimum amount of end-of-life training as a requirement for obtaining a degree from such entity4 7b7 ,eligibility ,to be eligible to participate in the pilot program under this section1 an entity shall-- 7#a7 be a school of medicine1 school of osteopathic medicine1 a physician assistant education program 7as defined in section #gii;,b7#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep7#c7771 a school of allied health 7as defined in section #gii;,b7#d7 of the ,public ,health ,service ,act7#db ,u4,s4,c4 #biep7#d7771 a school of nursing1 a school of social work1 a graduate medical education program accredited by the ,accreditation ,council for ,graduate ,medical ,education or the ,american ,osteopathic ,association1 or other school1 as the ,secretary determines appropriate2 7#b7 be staffed by teaching health professionals who have experience or training in palliative medicine2 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 ensure that by not later than the end of the #b-year period beginning on the date of enactment of this ,act1 professionals who are applicable faculty at the entity1 or others as determined appropriate by the ,secretary1 shall be offered retraining in hospice and palliative medicine4 7c7 ,training ,eligible entities participating in the pilot program under this section shall require minimum training for trainees that includes-- 7#a7 training in how to discuss and help patients and their loved ones with advance care planning2 7#b7 with respect to trainees who will work with children1 specialized pediatric training2 7#c7 training in the continuum of end-of-life services and supports1 including palliative care and hospice2 7#d7 training in how to discuss end-of-life care with dying patients and their loved ones2 7#e7 medical and legal issues training associated with end of life care2 7#f7 training in cultural competency2 and 7#g7 in the case of a graduate medical education program accredited by the ,accreditation ,council for ,graduate ,medical ,education or the ,american ,osteopathic ,association1 a longitudinal component of at least #f months4 7d7 ,reports ,each recipient of a grant under this section shall report to the ,secretary on the outcomes of the program within #ah months of receipt of the final allotment of grant funds4 ,not later than #a year after receipt of all such reports1 the ,secretary shall submit to ,congress a report compiling such results from all grant recipients4 #aac4 ,development of core end-of-life care quality measures across each relevant provider setting 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,agency for ,healthcare ,research and ,quality 7in this section referred to as the ,administrator7 and in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall require the development of specific end-of-life quality measures for each relevant qualified health care provider setting1 as identified by the ,administrator1 in accordance with the requirements of subsection 7b74 7b7 ,requirements ,for purposes of subsection 7a71 the requirements specified in this subsection are the following3 7#a7 ,selection of the specific measure or measures for an identified provider setting shall be based on an assessment of what is likely to have the greatest positive impact on quality of end-of-life care in that setting1 and made in consultation with affected providers1 patients1 and private organizations1 that have developed such measures4 7#b7 ,the measures may be structure-oriented1 process-oriented1 or outcome-oriented1 as determined appropriate by the ,administrator1 and shall be patient-oriented4 7#c7 ,the ,administrator shall ensure that reporting requirements related to such measures are imposed consistently with other applicable laws and regulations1 and in a manner that takes into account existing measures1 the needs of patient populations1 the specific services provided1 and the potential administrative burden to providers4 7#d7 ,not later than-- 7,a7 ,april #a1 #bjag1 the ,secretary shall disseminate the reporting requirements to all affected providers and provide for a #fj-;day period for public comment2 and 7,b7 ,april #a1 #bjah1 initial reporting by health care providers relating to the measures shall begin4 #aad4 ,continuing education for qualified health care providers 7a7 ,in general ,not later than ,january #a1 #bjah1 the ,secretary1 acting through the ,director of ,health ,resources and ,services ,administration1 shall approve existing and develop1 in consultation with qualified health care providers1 other professionals as the ,secretary determines appropriate1 and ,state boards of medicine and nursing1 new curricula on advance care planning and end-of-life care for continuing education that ,states may adopt for qualified health care providers4 7b7 ,content ,the continuing education curriculum developed under subsection 7a7 shall1 at a minimum1 include-- 7#a7 a description of the meaning and importance of advance care planning2 7#b7 a description of advance care planning documents1 including living wills and durable powers of attorney1 and the use of such directives2 7#c7 the appropriate use of orders for scope of treatment2 7#d7 counseling skills for when and how to introduce and engage in advance care planning with patients and their loved ones2 7#e7 palliative care principles and approaches to care2 7#f7 the continuum of end-of-life services and supports1 including palliative care and hospice2 and 7#g7 the importance of introducing palliative care and hospice early in illness in order to improve quality of life4 ,,ii ,reports1 research1 and evaluations #bja4 ,demonstration projects for use of telemedicine services in advance care planning 7a7 ,in general ,not later than ,july #a1 #bjai1 the ,secretary shall establish a demonstration program to reimburse eligible entities for costs associated with the use of telemedicine services 7including equipment and connection costs7 to provide advance care planning through telemedicine consultations with geographically distant providers and their patients4 7b7 ,duration ,the demonstration project under this section shall be conducted for at least a #c-year period4 7c7 ,report ,not later than ,march #ae1 #bjag1 the ,secretary shall1 using quantitative and qualitative research methods1 submit a report to ,congress on the status of telemedicine programs1 including information that identifies-- 7#a7 the telehealth services for which payment can be made1 as of the date of the enactment of this ,act1 under the fee-for-service program under parts ,a and ,b of title ,,xviii of the ,social ,security ,act2 7#b7 the telehealth services for which payment can be made1 as of such date1 under private health insurance plans2 7#c7 with respect to services identified under paragraph 7#b7 but not under paragraph 7#a71 ways in which payment for such services might be incorporated into such fee-for-service program 7including any recommendations for ways to accomplish this incorporation72 and 7#d7 any legal or regulatory challenges to expanding telehealth services1 and any promising solutions to such challenges4 7d7 ,definitions ,for purposes of this section3 7#a7 ,the term eligible entity means an academic medical center1 a medical school1 a ,state health department1 a ,state medical association1 a multi-,state taskforce1 a hospital1 a home health agency1 or a health system or coalition of stakeholders capable of administering a program for orders regarding life-sustaining treatment for a ,state or locality4 7#b7 ,the term geographically distant has the meaning given that term by the ,secretary for purposes of conducting the demonstration program established under this section4 7#c7 ,the term telemedicine services means a service or consultation provided via telecommunication equipment that allows an eligible entity to exchange or discuss medical information with a patient 7including the family caregiver of the patient if the patient agrees7 or a qualified health care provider at a separate location through real-time videoconferencing1 or a similar format1 for the purpose of providing health care diagnosis and treatment4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to the ,secretary such sums as may be necessary to carry out this section4 ,any funds made available under this section shall be used to supplement1 not supplant1 other ,federal1 ,state1 and local funding provided for telemedicine services4 #bjb4 ,study and report by the ,secretary regarding the establishment and implementation of a national uniform policy on advance directives 7a7 ,study 7#a7 ,in general ,the ,secretary1 acting through the ,office of the ,assistant ,secretary for ,planning and ,evaluation1 shall conduct a study to evaluate the barriers to establishing and implementing a national uniform policy on advance directives and what needs to be done to overcome those barriers4 7#b7 ,matters studied ,the matters studied by the ,secretary under paragraph 7#a7 may include issues concerning-- 7,a7 family satisfaction that a patient's wishes1 as stated in the patient's advance directive1 were carried out2 7,b7 the portability of advance directives1 including cases involving the transfer of an individual from one health care setting to another2 7,c7 the feasibility of establishing an optional1 national advance directive form deemed valid by any health care entity or qualified health care provider participating in ,medicare1 ,medicaid1 or ,,chip1 regardless of ,state law2 and 7,d7 ,state variations in advance directive laws that are relevant to the establishment and implementation of a national uniform policy of advance directives4 7b7 ,report to congress ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative actions as the ,secretary considers appropriate4 7c7 ,consultation ,in conducting the study and developing the report under this section1 the ,secretary shall consult with the ,uniform ,law ,commissioners1 and other interested parties4 #bjc4 ,gao study and report on establishment of national advance directive registry2 other studies 7a7 ,study and report on establishment of national advance directive registry 7#a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on the feasibility of a national registry for advance directives1 taking into consideration the constraints created by the privacy provisions enacted as a result of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7,public ,law #ajd-aia74 7#b7 ,report ,not later than #ah months after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on the study conducted under subsection 7a7 together with recommendations for such legislation and administrative action as the ,comptroller ,general of the ,united ,states determines to be appropriate4 7b7 ,,onc ,study ,the ,national ,coordinator of the ,office of the ,national ,coordinator for ,health ,information ,technology shall conduct a study on the feasibility and impact on advance care planning of requiring that electronic health record vendors seeking certification have a prominent and easily visible field for storing and sharing advance care planning documents and related clinical notes4 7c7 ,additional study ,the ,comptroller ,general of the ,united ,states shall conduct a study and submit a report to ,congress on the incidence of health care1 tests1 surgeries1 drugs1 and other services paid provided by qualified health care providers and paid for by the ,federal ,government or the patient and that were unwanted by the patient or family of the patient4