,,ii #aadth ,,congress #b;d ,session ,s4 #cjif ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #bc1 #bjaf ,mr4 ,whitehouse 7for himself and ,ms4 ,warren7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to establish a pilot program promoting an alternative payment model for person-centered care for ,medicare beneficiaries with advanced illnesses4 #a4 ,short title ,this ,act may be cited as the ,removing ,barriers to ,person-,centered ,care ,act of #bjaf4 #b4 ,identification and development of advance care quality measures 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this ,act as the ,secretary71 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,agency for ,healthcare ,research and ,quality ,services1 and the entity with a contract under section #ahij7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7a771 shall identify and develop a recommended set of not more than #bj advance care quality measures for ,medicare beneficiaries that may be tested in1 and allow for the assessment of1 the pilot program established under subparagraph 7,d7 of section #aaae;,a7b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b771 as added by section #c4 ,such set of quality measures shall include outcome1 structural1 and process measures in the following categories3 7#a7 ,patient and family experience of care4 7#b7 ,access to needed services 7medical and supportive71 such as timely referral to hospice4 7#c7 ,completion of care planning documentation1 such as health care proxies1 advance directives1 and portable treatment orders4 7#d7 ,consistency of care with documented care preferences4 7#e7 ,screening for physical symptoms1 such as dyspnea1 nausea1 and constipation4 7#f7 ,utilization of health care and support services4 7b7 ,process for identifying and developing quality measures ,in identifying and developing the quality measures described in subsection 7a71 the ,secretary shall take the following actions3 7#a7 ,identify existing measures ,identify existing quality measures that are in use under public and privately sponsored health care arrangements4 7#b7 ,development of measures ,enter into grants1 contracts1 or intergovernmental agreements with eligible entities for the purposes of developing quality measures 7which may include improving existing quality measures7 that1 to the extent practicable1 allow for the use of health information technologies in collecting data relating to such quality measures4 7c7 ,publication and report ,not later than ,january #a1 #bjah1 the ,secretary shall-- 7#a7 publish an initial core set of quality measures2 and 7#b7 submit a report to ,congress that-- 7,a7 evaluates the set of quality measures published under paragraph 7#a72 and 7,b7 includes a strategy for designating a core set of quality measures on advance illness care that may be used across public and private payers and eliminating redundant measures that are not part of the core set4 7d7 ,funding ,there are authorized to be appropriated such sums as may be necessary for fiscal year #bjag to carry out this section4 #c4 ,pilot program for ,medicare beneficiaries with advanced illnesses 7a7 ,in general ,section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 is amended-- 7#a7 in the last sentence of subparagraph 7,a7 of subsection 7b77#b71 by inserting 1 and shall include the model described in subsection 7h7 before the period at the end2 and 7#b7 by adding at the end the following new subsection3 7h7 ,pilot program ,to promote person-,centered care for medicare beneficiaries with advanced illnesses 7#a7 ,in general ,the model described in this subsection is a pilot program under which the ,secretary shall enter into demonstration project agreements with advance care collaboratives to provide services and supplies under parts ,a and ,b of title ,,xviii in a manner that promotes accountability for target ,medicare beneficiaries1 coordinates the provision of items and services under parts ,a and ,b of such title1 and encourages investment in infrastructure and redesigned care processes for coordinated1 person- and family-centered1 and high-quality service delivery4 7#b7 ,eligibility ,an advance care collaborative shall be eligible to enter into a demonstration project agreement under this subsection if the collaborative-- 7,a7 submits a timely application under paragraph 7#c72 and 7,b7 meets such other requirements and satisfies such conditions as the ,secretary shall determine4 7#c7 ,application 7,a7 ,in general ,not later than ,october #a1 #bjah1 each advance care collaborative that wishes to enter into a demonstration project agreement with the ,secretary shall submit to the ,secretary an application that includes-- 7i7 information about each provider of services1 physician1 and practitioner in the collaborative2 7ii7 a description of1 and an implementation plan for1 the demonstration project that the collaborative intends to carry out under paragraph 7#f71 including intended uses of grant amounts under paragraph 7#e71 and a strategy for the continued participation of community-based social services organizations1 including faith-based organizations1 in the care of the target ,medicare beneficiary population2 7iii7 a description of how the collaborative intends to use the waivers and expanded services described in paragraphs 7#g7 and 7#h7 to conduct the demonstration project2 7iv7 with respect to the collection and reporting of data relating to the results of the demonstration project-- 7,i7 subject to the availability of such measures1 a description of how the collaborative will collect and report on data pertaining to the recommended set of quality measures established by the ,secretary under section #b of the ,removing ,barriers to ,person-,centered ,care ,act of #bjaf2 and 7,,ii7 a description of additional quality measures the collaborative proposes to use to measure any characteristics of its demonstration project that are not captured in the quality measures described in subclause 7,i71 and how the collaborative will collect and report on data pertaining to such measures2 and 7v7 a description of how the collaborative will identify its target ,medicare beneficiary population for the demonstration project4 7,b7 ,priority ,in selecting advance care collaboratives to participate in the pilot program1 the ,secretary may give priority to collaboratives that are located in ,states that use1 or are in the process of developing1 a uniform1 portable medical order for life-sustaining treatment4 7,c7 ,geographic diversity ,in selecting advance care collaboratives to participate in the pilot program1 the ,secretary shall make efforts to select collaboratives from geographically diverse areas4 7#d7 ,demonstration project agreement 7,a7 ,in general ,not later than ,january #a1 #bjai1 the ,secretary shall enter into agreements with up to #bj advance care collaboratives to participate in the pilot program4 7,b7 ,required terms ,as part of any agreement between the ,secretary and an advance care collaborative under this paragraph3 7i7 ,pre-implementation grant ,the advance care collaborative shall receive a grant described in paragraph 7#e74 7ii7 ,demonstration project ,the advance care collaborative shall conduct a demonstration project described in paragraph 7#f74 7,c7 ,termination ,the ,secretary may terminate an agreement with an advance care collaborative if the collaborative's expenditures under the demonstration project for services and supplies under parts ,a and ,b of title ,,xviii substantially exceed the benchmark established for the collaborative by the ,secretary under paragraph 7#f77;,b77ii74 7#e7 ,grants for pre-implementation activities 7,a7 ,in general ,beginning in fiscal year #bjai1 from the amount made available under subsection 7f77#b77;,b71 the ,secretary shall award grants to advance care collaboratives that have entered into demonstration project agreements with the ,secretary to facilitate the implementation of demonstration projects4 7,b7 ,use of grant amounts ,a grant awarded under this paragraph may be used by an advance care collaborative for the following purposes3 7i7 ,to conduct a needs assessment in collaboration with community-based social service organizations1 such as faith-based organizations1 beneficiary groups1 and providers of long-term services and supports to identify gaps in services and supports for the target ,medicare beneficiary population identified by the collaborative4 7ii7 ,to modify1 upgrade1 or purchase health information technology to facilitate the exchange of information between members of the collaborative1 including technologies that support data aggregation and analytics1 increase interoperability across medical and supportive services1 or improve accessibility of beneficiary care plans4 7iii7 ,to conduct education and training for health care professionals1 beneficiaries and family caregivers1 or community-based social service organizations1 including faith-based organizations1 in methods for learning1 documenting1 and communicating treatment preferences and goals1 on best practices for pain and symptom management1 and to improve understanding of palliative care and hospice services1 among other topics4 7iv7 ,to hire staff to conduct care management and coordination activities4 7v7 ,to conduct other activities determined appropriate by the ,secretary4 7#f7 ,demonstration project 7,a7 ,in general ,not later than ,january #a1 #bjbj1 each advance care collaborative that has a demonstration project agreement with the ,secretary shall begin to conduct a demonstration project to provide coordinated1 person- and family-centered1 and high-quality service delivery to target ,medicare beneficiaries by utilizing the waivers and expanded services described in paragraphs 7#g7 and 7#h74 7,b7 ,shared savings payments 7i7 ,in general ,beginning in fiscal year #bjba1 in addition to reimbursement that would otherwise be due under title ,,xviii for services provided by the advance care collaborative in conducting the demonstration project1 a collaborative shall be eligible for shared savings payments if the ,secretary determines that expenditures under the demonstration project for services and supplies under parts ,a and ,b of title ,,xviii are below the expenditures benchmark established by the ,secretary for the collaborative under clause 7ii74 7ii7 ,benchmark ,the ,secretary shall establish an appropriate expenditures benchmark for each advance care collaborative conducting a demonstration project under this subsection4 7,c7 ,duration ,subject to paragraph 7#d77;,c71 any demonstration project under this paragraph shall be conducted for not less than #c years4 7#g7 ,waiver of certain requirements ,as part of a demonstration project under the pilot program1 the ,secretary shall waive the following requirements with respect to coverage of1 and payment for1 services under title ,,xviii provided to a target ,medicare beneficiary by an advance care collaborative under such demonstration project3 7,a7 ,coverage of curative care during election period ,the requirement described in section #ahab7;d77#b77;,a7 that an individual electing to receive hospice care shall be deemed to have waived all rights to have payment made under title ,,xviii with respect to services described in clause 7ii77,i7 of such section4 7,b7 ,alternative certification for home care ,with respect to home health services furnished to an individual by a ,medicare-certified home health agency1 the requirements described in section #ahad7;a77#b7 and subparagraph 7,c7 of such section that-- 7i7 a physician make the certification 7and recertification1 where such services are provided over a period of time7 described in such subparagraph 7,c72 7ii7 a plan for furnishing such services to such individual is periodically reviewed by a physician2 and 7iii7 the physician 7or another practitioner who is collaborating with or supervised by the physician7 has a face-to-face encounter with the individual1 provided that such certification and recertification1 and review of such plan1 is conducted by a nurse practitioner 7as defined in section #ahfa7;aa77#e77 who is authorized to conduct such certification1 recertification1 and review under ,state law4 7,c7 ,alternative certification for hospice care ,the requirements described in subparagraphs 7,a7 and 7,b7 of section #ahad7;a77#g7 that an individual's attending physician and the medical director 7or physician member of the interdisciplinary group described in section #ahfa7;gg77 of the ,medicare-certified hospice program providing 7or arranging for7 the individual's hospice care certify that the individual is terminally ill and periodically review the written plan for hospice care1 provided that such certification and review is conducted by a nurse practitioner 7as defined in section #ahfa7;aa77#e77 who is authorized to conduct such certification and review under ,state law4 7,d7 ,coverage of skilled nursing services without inpatient stay ,with respect to extended care services furnished to an individual by a ,medicare-certified skilled nursing facility1 the requirement described in section #ahfa7;i7 that an individual must have been an inpatient in a hospital for not less than #c consecutive days before his discharge and transfer to the skilled nursing facility before such extended care services may be deemed post-hospital extended care services4 7,e7 ,coverage of home health care without homebound status requirement ,with respect to home health services furnished to an individual by a ,medicare-certified home health agency 7as defined in section #ahfa7o771 the requirement described in section #ahad7;a77#b77;,c7 that the individual is or was confined to his or her home4 7#h7 ,availability of expanded services ,as part of a demonstration project under the pilot program1 an advance care collaborative may receive payment for the furnishing the following services to target ,medicare beneficiaries in the same manner1 and subject to the same limitations1 that a hospice program is paid for hospice care under section #ahad7;i73 7,a7 ,inpatient alternative to routine hospice care 7i7 ,in general ,notwithstanding regulations in effect prior to the enactment of this subparagraph1 if an assessment meeting such requirements as the ,secretary determines appropriate has been made that the home of an individual who is certified for hospice care and has elected to receive hospice care is unsafe or otherwise unsuitable for the provision of such care1 such individual may receive such care in an inpatient setting1 including a ,medicare-certified hospice that meets the conditions of participation specified in section #dah4aaj of title #db1 ,code of ,federal ,regulations 7as in effect on the date of enactment of this subparagraph71 or a skilled nursing facility that meets the standards specified in subsections 7b7 and 7e7 of such section1 for the duration of the election period4 ,the assessment described in the preceding sentence may be conducted by the individual's attending physician1 a nurse practitioner1 or the medical director 7or physician member of the interdisciplinary group described in section #ahfa7;gg77 of the hospice program providing 7or arranging for7 the individual's hospice care4 7ii7 ,application of limitation on inpatient care days ,for purposes of any limitation on the number of total inpatient care days for which a hospice may receive payment1 hospice care that is provided in an inpatient setting under this subclause 7but would otherwise be provided in an outpatient setting7 shall not count towards such limitation4 7,b7 ,home-based alternative to inpatient respite care 7i7 ,in general ,notwithstanding section #ahfa7;dd77#a77;,g71 an individual who is certified for hospice care and has elected to receive hospice care may receive short-term1 home-based respite care as an alternative to inpatient respite care4 7ii7 ,limitations ,the home-based respite care described in clause 7i7 is subject to the same limitations that apply to inpatient respite care under section #ahfa7;dd77#a77;,g71 including the limitation that respite care may be provided only on an intermittent1 non-routine1 and occasional basis and may not be provided consecutively over longer than #e days4 7#i7 ,participation by beneficiaries1 providers1 and suppliers voluntary ,participation in a demonstration project conducted under the pilot program with respect to target ,medicare beneficiaries1 providers of services1 physicians1 and practitioners shall be voluntary4 7#aj7 ,definitions ,in this subparagraph3 7,a7 ,advance care collaborative ,the term advance care collaborative means an affiliated group of providers of services1 physicians1 or practitioners that-- 7i7 has a mechanism for shared governance between participating providers of services1 physicians1 and practitioners2 and 7ii7 has a formal legal structure that would allow for the receipt and distribution of shared savings payments under paragraph 7#f77;,b7 to the providers of services1 physicians1 and practitioners that belong to the group4 7,b7 ,demonstration project agreement ,the term demonstration project agreement means an agreement between the ,secretary and an advance care collaborative under paragraph 7#d74 7,c7 ,pilot program ,the term pilot program means the pilot program described in this subsection4 7,d7 ,physician ,the term physician has the meaning given such term in section #ahfa7r77#a74 7,e7 ,practitioner ,the term practitioner has the meaning given such term in section #ahdb7;b77#ah77;,c74 7,f7 ,provider of services ,the term provider of services has the meaning given such term in section #ahfa7u74 7,g7 ,supplier ,the term supplier has the meaning given such term in #ahfa7;d74 7,h7 ,target ,medicare beneficiary ,the term target ,medicare beneficiary means an individual who-- 7i7 is enrolled for benefits under parts ,a and ,b of title ,,xviii1 but who is not enrolled in a ,medicare ,advantage plan under part ,c of such title1 an eligible organization under section #ahgf1 or a ,,pace program under section #ahid2 and 7ii7 demonstrates two or more of the following characteristics3 7,i7 ,has one or more advanced chronic conditions1 such as late-stage cancer1 congestive heart failure1 chronic kidney disease1 chronic obstructive pulmonary disease1 geriatric frailty1 ,alzheimer's disease1 or another form of progressive dementia4 7,,ii7 ,has evidence of recent and progressive cognitive impairment or functional limitations 7such as an inability to perform one or more activities of daily living74 7,,iii7 ,has1 during the previous #ab months1 experienced an increase in health care utilization1 such as two or more nonelective hospital admissions4 7,,iv7 ,other characteristics identified by the ,secretary4 4 7b7 ,availability of funds for pre-,implementation grants ,section #aaae;,a7f77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7f77#b77 is amended-- 7#a7 by striking ,out of amounts appropriated and inserting 7,a7 ,out of amounts appropriated2 and 7#b7 by adding at the end the following new subparagraph3 7,b7 ,out of the amount appropriated under subparagraph 7,b7 of paragraph 7#a71 #aj1jjj1jjj shall be made available for fiscal year #bjai for the purpose of awarding grants under subsection 7h77#f71 and shall remain available for such purpose until expended4 4