,,ii  #aae? ,,congress  #a/ ,session    
,s4 #fic  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #bb1 #bjag,ms4    
,baldw9 7= h]self & ,mrs4 ,capito7      
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to am5d ! ,public ,heal?    
,s]vice ,act to increase ! numb] (      
p]man5t faculty 9 palliative c>e at     
accr$it$ allopa?ic & o/eopa?ic m$ical   
s*ools1 nurs+ s*ools1 social "w s*ools1 
& o!r programs1 includ+ physician       
assi/ant education programs1 to promote 
education & rese>* 9 palliative c>e &   
hospice1 & to support ! developm5t (    
faculty c>e]s 9 academic palliative     
m$ic9e4  #a4 ,%ort title ,?is ,act may  
be cit$ z ! ,palliative ,c>e & ,hospice 
,education & ,tra9+ ,act4  #b4 ,f9d+s   
,congress makes ! foll[+ f9d+s3  7#a7   
,palliative c>e is int]discipl9>y1      
pati5t- & family-c5t]$ heal? c>e = p )  
s]i\s illnesses4 ,?is type ( c>e is     
focus$ on provid+ pati5ts ) relief f !  

symptoms1 pa91 & /ress ( a s]i\s        
illness1 :atev] ! diagnosis4 ,! goal (  
palliative c>e is to relieve suff]+ &   
improve quality ( life = bo? pati5ts &  
_! families4 ,palliative c>e is provid$ 
by a team ( doctors1 nurses1 social     
work]s1 physician assi/ants1 *apla9s1 & 
o!r speciali/s :o "w ) a pati5t's o!r   
heal? c>e provid]s to provide an extra  
lay] ( support1 includ+ assi/ance )     
difficult m$ical decisionmak+ &         
coord9ation ( c>e among speciali/s4     
,palliative c>e is appropriate at any   
age & at any /age 9 a s]i\s illness1 & c
 be provid$ toge!r ) curative treatm5t4 
,palliative c>e is n dep5d5t on a       
life-limit+ prognosis & may actually    
help an individual recov] f illness by  
reliev+ symptoms1 su* z pa91 anxiety1 or
 loss ( appetite1 :ile und]go+ sometimes
 difficult m$ical treatm5ts or          
proc$ures1 su* z surg]y or *emo!rapy4   
7#b7 ,hospice is palliative c>e =       
pati5ts 9 _! la/ ye> ( life4 ,consid]$ !
 model = quality compassionate c>e =    

individuals fac+ a life-limit+ illness1 
hospice provides exp]t m$ical c>e1 pa9  
managem5t1 & emotional & spiritual      
support expressly tailor$ to ! pati5t's 
ne$s & wi%es4 ,9 mo/ cases1 c>e is      
provid$ 9 ! pati5t's home b may also be 
provid$ 9 free/&+ hospice c5t]s1        
hospitals1 nurs+ homes1 & o!r long-t]m  
c>e facilities4 ,9 #bjad1 an e/imat$    
#a1fjj1jjj to #a1gjj1jjj pati5ts receiv$
 s]vices f hospice1 includ+ non-,m$ic>e 
b5efici>ies4 ,ne>ly #dh p]c5t ( all     
,m$ic>e dec$5ts 9 #bjad receiv$ c>e f a 
hospice program4 ,hospice is a cov]$    
b5efit "u ! ,m$ic>e program4 ,!re 7     
#d1jbe ,m$ic>e-c]tifi$ hospices s]v+ m  
?an #a1cjj1jjj ,m$ic>e b5efici>ies 9    
#bjad4  7#c7 ,despite a high int5sity ( 
m$ical treatm5t1 _m s]i\sly ill pati5ts 
exp]i5ce tr\bl+ symptoms1 unmet         
psy*ological & p]sonal c>e ne$s1 & high 
c>egiv] burd54 ,num]\s /udies h %[n t   
add+ palliative c>e c improve pa9 &     
symptom control1 quality ( life1 &      
family satisfaction ) c>e4  7#d7 ,heal? 

c>e provid]s ne$ bett] education ab\t   
pa9 managem5t & palliative c>e4 ,/ud5ts 
graduat+ f m$ical1 nurs+ & o!r heal?    
pr(essional s*ools today h v little1 if 
any1 tra9+ 9 ! core precepts ( pa9 &    
symptom managem5t1 advance c>e plann+1  
communication skills1 & c>e coord9ation 
= pati5ts ) s]i\s or life-?reat5+       
illness4 ,ev5 = speciali/s1 tra9+ is    
lack+4 ,= example1 ! ,accr$itation      
,c\ncil = ,graduate ,m$ical ,education  
requires oncology fell[%ip programs to  
integrate compet5ce 9 palliative c>e    
into _! curriculum & ! ,am]ican ,society
 ( ,cl9ical ,oncology has recomm5d$ !   
integration ( palliative c>e s]vices    
into /&>d oncology practice at ! "t a   
p]son is diagnos$ ) meta/atic or advanc$
 canc]4 ,yet a #bjae national survey    
f\nd t hematology_/oncology fell[s 7    
inadequately prep>$ to provide          
palliative c>e to _! pati5ts4 ,less ?an 
half _h a rotation 9 palliative c>e &   
#be p]c5t ( fell[s report$ no explicit  
tea*+ on key skills su* z assess+       

prognosis1 conduct+ a family meet+ to   
discuss treatm5t options1 & ref]ral to  
palliative c>e4  7#e7 ,! ,am]ican ,bo>d 
( ,m$ical ,specialties & ! ,accr$itation
 ,c\ncil = ,graduate ,m$ical ,education 
provid$ =mal subspecialty /atus =       
hospice & palliative m$ic9e 9 #bjjf1 & !
 ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices    
recogniz$ hospice & palliative m$ic9e z 
a m$ical subspecialty 9 ,octob] ( #bjjh4
  7#f7 ,z ( ,febru>y #bjag1 !re 7 a     
total ( #abg hospice & palliative m$ic9e
 tra9+ programs accr$it$ by !           
,accr$itation ,c\ncil = ,graduate       
,m$ical ,education4 ,= ! #bjaf-bjag     
academic ye>1 ^! programs 7 tra9+ #cbg  
physicians 9 hospice & palliative       
m$ic9e4 ,"s programs include an         
additional track 9 p$iatrics1 g]iatrics1
 rese>*1 or public heal?4 ,few] ?an a   
doz5 ( ^! ,,acgme-accr$it$ tra9+        
programs focus solely on p$iatric       
palliative m$ic9e ?\gh data %[ an       
increas+ preval5ce ( *ildr5 ) complex   
*ronic conditions :o c\ld b5efit f su*  

specializ$ c>e4  7#g7 ,!re is a l>ge gap
 betwe5 ! numb] ( heal?c>e pr(essionals 
) palliative c>e tra9+ & ! numb] requir$
 to meet ! ne$s ( ! gr[+ population (   
individuals ) s]i\s or life-?reat5+     
illness4 ,9 #bjae1 #ge p]c5t ( ,unit$   
,/ates hospitals ) #ej or m b$s _h a    
palliative c>e program ?\gh n all ^!    
programs h 9 place ! int]discipl9>y team
 necess>y to provide compreh5sive1      
high-quality palliative c>e4 ,hospital  
data report$ to ! ,national ,palliative 
,c>e ,regi/ry %[ t 9 #bjae only #dd     
p]c5t ( programs met national /aff+     
/&>ds set by ! ,jo9t ,commission1 ev5 :5
 includ+ unfund$ positions4 ,among ! #ef
 p]c5t ( programs )\t complete          
int]discipl9>y teams1 #cj p]c5t h no    
physician1 #aj p]c5t h no advanc$       
practice regi/]$ nurse or ,,rn1 #ed     
p]c5t h no social work]1 & #gj p]c5t h  
no *apla94 ,look+ at j physician        
speciali/s1 #bjag projections by !      
,george ,wa%+ton ,univ]sity ,heal?      
,work=ce ,in/itute %[ t curr5t tra9+    

capacity = hospice & palliative m$ic9e  
is n suffici5t to provide hospital-bas$ 
c>e & keep pace ) gr[? 9 ! population ( 
adults ov] #fe ye>s old4 ,! %ortages are
 exac]bat$ :5 consid]+ ! curr5t rapid   
expansion ( community-bas$ palliative   
c>e1 su* z 9 outpati5t & home-bas$      
sett+s4 ,a sep>ate survey ( physicians 9
 ! field f\nd t1 if ! rate ( ^? ent]+ & 
leav+ hospice & palliative m$ic9e       
ma9ta9s1 !re w be no m ?an #a p]c5t     
absolute gr[? 9 ?is physician work=ce 9 
#bj ye>s1 dur+ :i* "t ! numb] ( p]sons  
eligible = palliative c>e w gr[ by ov]  
#bj p]c5t4 ,! /udy's au?ors project ?is 
w result 9 a ratio ( "o palliative      
m$ic9e physician = e #bf1jjj s]i\sly ill
 pati5ts by #bjcj4  7#h7 ,accord+ to !  
,national ,academy ( ,m$ic9e1 !re is a  
ne$ = bett] und]/&+ ( ! role (          
palliative c>e among bo? ! public &     
pr(essionals across ! cont9uum ( c>e s t
 hospice & palliative c>e c a*ieve _!   
full pot5tial = pati5ts & _! families4  
#c4 ,palliative c>e & hospice education 

& tra9+  7a7 ,9 g5]al ,"p ,d ( title    
,,vii ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #bid et seq47 is am5d$ by
 ins]t+ aft] section #gei ! foll[+3     
#gei;,a4 ,palliative c>e & hospice      
education & tra9+  7a7 ,palliative c>e &
 hospice education c5t]s  7#a7 ,9 g5]al 
,! ,secret>y %all aw>d grants or        
contracts "u ?is section to entities    
describ$ 9 p>agraph 7#a71 7#c71 or 7#d7 
( section #gii;,b1 & section #hja7b71 = 
! e/abli%m5t or op]ation ( ,palliative  
,c>e & ,hospice ,education ,c5t]s t meet
 ! requirem5ts ( p>agraph 7#b74  7#b7   
,requirem5ts ,a ,palliative ,c>e &      
,hospice ,education ,c5t] meets !       
requirem5ts ( ?is p>agraph if su*       
,c5t]--  7,a7 improves ! tra9+ ( heal?  
pr(essionals 9 palliative c>e1 includ+  
resid5cies1 tra9ee%ips1 or fell[%ips2   
7,b7 develops & dissem9ates curricula   
relat+ to ! palliative treatm5t ( !     
complex heal? problems ( individuals )  
s]i\s or life-?reat5+ illnesses2  7,c7  
supports ! tra9+ & retra9+ ( faculty to 

provide in/ruction 9 palliative c>e2    
7,d7 supports cont9u+ education ( heal? 
pr(essionals :o provide palliative c>e  
to pati5ts ) s]i\s or life-?reat5+      
illness2  7,e7 provides /ud5ts 7includ+ 
resid5ts1 tra9ees1 & fell[s7 ) cl9ical  
tra9+ 9 palliative c>e 9 long-t]m c>e   
facilities1 home c>e1 hospices1 *ronic &
 acute disease hospitals1 & ambulatory  
c>e c5t]s2  7,f7 e/abli%es tra9ee%ips = 
individuals :o are prep>+ = advanc$     
education nurs+ degrees1 social "w      
degrees1 or advanc$ degrees 9 physician 
assi/ant /udies1 ) a focus 9 palliative 
c>e 9 long-t]m c>e facilities1 home c>e1
 hospices1 *ronic & acute disease       
hospitals1 & ambulatory c>e c5t]s2 &    
7,g7 does n duplicate ! activities (    
exi/+ education c5t]s fund$ "u ?is      
section or "u section #gec or #hfe4     
7#c7 ,expansion ( exi/+ c5t]s ,no?+ 9   
?is section %all be con/ru$ to-- 7,a7   
prev5t ! ,secret>y f provid+ grants to  
exp& exi/+ education c5t]s1 includ+     
g]iatric education c5t]s e/abli%$ "u    

section #gec or #hfe1 to provide =      
education & tra9+ focus$ specifically on
 palliative c>e1 includ+ = non-g]iatric 
populations2 or  7,b7 limit ! numb] (   
education c5t]s t may be fund$ 9 a      
community4  7b7 ,palliative m$ic9e      
physician tra9+  7#a7 ,9 g5]al ,!       
,secret>y may make grants to1 & ent]    
into contracts )1 s*ools ( m$ic9e1      
s*ools ( o/eopa?ic m$ic9e1 tea*+        
hospitals1 & graduate m$ical education  
programs1 = ! purpose ( provid+ support 
= projects t fund ! tra9+ ( physicians  
7includ+ resid5ts1 tra9ees1 & fell[s7 :o
 plan to tea* palliative m$ic9e4  7#b7  
,requirem5ts ,ea* project = :i* a grant 
or contract is made "u ?is subsection   
%all-- 7,a7 be /aff$ by full-"t tea*+   
physicians :o h exp]i5ce or tra9+ 9     
palliative m$ic9e2  7,b7 be bas$ 9 a    
hospice & palliative m$ic9e fell[%ip    
program accr$it$ by ! ,accr$itation     
,c\ncil = ,graduate ,m$ical ,education2 
7,c7 provide tra9+ 9 palliative m$ic9e  
?r\gh a v>iety ( s]vice rotations1 su* z

 consultation s]vices1 acute c>e        
s]vices1 ext5d$ c>e facilities1         
ambulatory c>e & compreh5sive evaluation
 units1 hospice1 home heal?1 & community
 c>e programs2  7,d7 develop specific   
p]=mance-bas$ measures to evaluate !    
compet5cy ( tra9ees2 &  7,e7 provide    
tra9+ 9 palliative m$ic9e ?r\gh "o or   
bo? ( ! tra9+ options describ$ 9        
subp>agraphs 7,a7 & 7,b7 ( p>agraph     
7#c74  7#c7 ,tra9+ options ,! tra9+     
options ref]r$ to 9 subp>agraph 7,e7 (  
p>agraph 7#b7 are z foll[s3 7,a7 #a-ye> 
retra9+ programs 9 hospice & palliative 
m$ic9e = physicians :o are faculty at   
s*ools ( m$ic9e & o/eopa?ic m$ic9e1 or  
o!rs det]m9$ appropriate by ! ,secret>y4
  7,b7 #a- or #b-ye> tra9+ programs t   
are design$ to provide tra9+ 9 hospice &
 palliative m$ic9e = physicians :o h    
complet$ graduate m$ical education      
programs 9 any m$ical specialty lead+ to
 bo>d eligibility 9 hospice & palliative
 m$ic9e pursuant to ! ,am]ican ,bo>d (  
,m$ical ,specialties4  7#d7 ,def9itions 

,= purposes ( ?is subsection ! t]m      
graduate m$ical education means a       
program sponsor$ by a s*ool ( m$ic9e1 a 
s*ool ( o/eopa?ic m$ic9e1 a hospital1 or
 a public or private in/itution t--     
7,a7 (f]s po/graduate m$ical tra9+ 9 !  
specialties & subspecialties ( m$ic9e2 &
  7,b7 has be5 accr$it$ by !            
,accr$itation ,c\ncil = ,graduate       
,m$ical ,education or ! ,am]ican        
,o/eopa?ic ,association ?r\gh its       
,committee on ,po/doctoral ,tra9+4  7c7 
,palliative m$ic9e & hospice academic   
c>e] aw>ds  7#a7 ,e/abli%m5t ( program  
,! ,secret>y %all e/abli% a program to  
provide aw>ds1 to be kn[n z !           
,palliative ,m$ic9e & ,hospice ,academic
 ,c>e] ,aw>ds1 to eligible individuals  
to promote ! c>e] developm5t ( su*      
individuals z academic hospice &        
palliative c>e physicians4  7#b7        
,eligible individuals ,to be eligible to
 receive an aw>d "u p>agraph 7#a71 an   
individual %all-- 7,a7 be bo>d c]tifi$  
or bo>d eligible 9 hospice & palliative 

m$ic9e2 &  7,b7 h a junior 7non-t5ur$7  
faculty appo9tm5t at an accr$it$ 7z     
det]m9$ by ! ,secret>y7 s*ool ( m$ic9e  
or o/eopa?ic m$ic9e4  7#c7 ,limitations 
,no aw>d "u p>agraph 7#a7 may be made to
 an eligible individual unless !        
individual-- 7,a7 has submitt$ to !     
,secret>y an application1 at su* "t1 9  
su* mann]1 & conta9+ su* in=mation z !  
,secret>y may require1 & ! ,secret>y has
 approv$ su* application2  7,b7         
provides1 9 su* =m & mann] z ! ,secret>y
 may require1 assurances t ! individual 
w meet ! s]vice requirem5t describ$ 9   
p>agraph 7#f72 &  7,c7 provides1 9 su*  
=m & mann] z ! ,secret>y may require1   
assurances t ! individual has a full-"t 
faculty appo9tm5t 9 a heal? pr(essions  
in/itution & docum5t$ commitm5t f su*   
in/itution to sp5d a majority ( ! total 
fund$ "t ( su* individual on tea*+ &    
develop+ skills 9 int]discipl9>y        
education 9 palliative c>e4  7#d7       
,ma9t5ance ( ef=t ,an eligible          
individual :o receives an aw>d "u       

p>agraph 7#a7 %all provide assurances to
 ! ,secret>y t funds provid$ to !       
eligible individual "u ?is subsection w 
be us$ only to supplem5t1 n to supplant1
 ! am\nt ( ,f$]al1 ,/ate1 & local funds 
o!rwise exp5d$ by ! eligible individual4
  7#e7 ,am\nt & t]m  7,a7 ,am\nt ,!     
am\nt ( an aw>d "u ?is subsection %all  
be equal to ! aw>d am\nt provid$ = "u   
section #gec7;c77#e77;,a7 = ! fiscal ye>
 involv$4  7,b7 ,t]m ,! t]m ( an aw>d   
made "u ?is subsection %all n exce$ #e  
ye>s4  7,c7 ,paym5t to in/itution ,!    
,secret>y %all make paym5ts = aw>ds "u  
?is subsection to in/itutions1 includ+  
s*ools ( m$ic9e & o/eopa?ic m$ic9e4     
7#f7 ,s]vice requirem5t ,an individual  
:o receives an aw>d "u ?is subsection   
%all provide tra9+ 9 palliative c>e &   
hospice1 includ+ ! tra9+ (              
int]discipl9>y teams ( heal? c>e        
pr(essionals4 ,! provision ( su* tra9+  
%all con/itute a majority ( ! total     
fund$ obligations ( su* individual "u ! 
aw>d4  7d7 ,palliative c>e work=ce      

developm5t  7#a7 ,9 g5]al ,! ,secret>y  
%all aw>d grants or contracts "u ?is    
subsection to entities t op]ate a       
,palliative ,c>e & ,hospice ,education  
,c5t] pursuant to subsection 7a77#a74   
7#b7 ,application ,to be eligible = an  
aw>d "u p>agraph 7#a71 an entity        
describ$ 9 su* p>agraph %all submit to !
 ,secret>y an application at su* "t1 9  
su* mann]1 & conta9+ su* in=mation z !  
,secret>y may require4  7#c7 ,use (     
funds ,am\nts aw>d$ "u a grant or       
contract "u p>agraph 7#a7 %all be us$ to
 c>ry out ! fell[%ip program describ$ 9 
p>agraph 7#d74  7#d7 ,fell[%ip program  
7,a7 ,9 g5]al ,pursuant to p>agraph     
7#c71 a ,palliative ,c>e & ,hospice     
,education ,c5t] t receives an aw>d "u  
?is subsection %all use su* funds to (f]
 %ort-t]m int5sive c\rses 7ref]r$ to 9  
?is subsection z a fell[%ip7 t focus on 
palliative c>e t provide supplem5tal    
tra9+ = faculty memb]s 9 m$ical s*ools &
 o!r heal? pr(essions s*ools ) programs 
9 psy*ology1 ph>macy1 nurs+1 social "w1 

physician assi/ant education1 *apla9cy1 
or o!r heal? discipl9es1 z approv$ by ! 
,secret>y4 ,su* a fell[%ip %all be op5  
to curr5t faculty1 & appropriately      
cr$5tial$ volunte] faculty &            
practition]s1 :o d n h =mal tra9+ 9     
palliative c>e1 to upgrade _! k &       
cl9ical skills = ! c>e ( individuals )  
s]i\s or life-?reat5+ illness & to      
enhance _! int]discipl9>y &             
int]pr(essional tea*+ skills4  7,b7     
,location ,a fell[%ip "u ?is p>agraph   
%all be (f]$ ei!r at ! ,palliative ,c>e 
& ,hospice ,education ,c5t] t is        
sponsor+ ! c\rse1 9 collaboration ) o!r 
,palliative ,c>e & ,hospice ,education  
,c5t]s1 or at m$ical s*ools1 s*ools (   
nurs+1 s*ools ( ph>macy1 s*ools ( social
 "w1 s*ools ( *apla9cy or pa/oral c>e   
education1 graduate programs 9          
psy*ology1 physician assi/ant education 
programs1 or o!r heal? pr(essions s*ools
 approv$ by ! ,secret>y ) :i* ! ,c5t]s  
are affiliat$4  7,c7 ,cont9u+ education 
cr$it ,p>ticipation 9 a fell[%ip "u ?is 

p>agraph %all be accept$ ) respect to   
comply+ ) cont9u+ heal? pr(ession       
education requirem5ts4 ,z a condition ( 
su* acceptance1 ! recipi5t %all         
subsequ5tly provide a m9imum ( #ah h\rs 
( volunt>y in/ruction 9 palliative c>e  
cont5t 7t has be5 approv$ by a          
palliative c>e & hospice education c5t]7
 to /ud5ts or tra9ees 9 heal?-relat$    
educational1 home1 hospice1 or long-t]m 
c>e sett+s4  7#e7 ,t>gets ,a ,palliative
 ,c>e & ,hospice ,education ,c5t] t     
receives an aw>d "u ?is subsection %all 
meet t>gets approv$ by ! ,secret>y =    
provid+ palliative c>e tra9+ to a c]ta9 
numb] ( faculty or practition]s dur+ !  
t]m ( ! aw>d1 z well z o!r p>amet]s     
e/abli%$ by ! ,secret>y4  7#f7 ,am\nt ( 
aw>d ,ea* aw>d "u ?is subsection %all be
 9 ! am\nt ( #aej1jjj4 ,n m ?an #bd     
,palliative ,c>e & ,hospice ,education  
,c5t]s may receive an aw>d "u ?is       
subsection4  7#g7 ,ma9t5ance ( ef=t ,a  
,palliative ,c>e & ,hospice ,education  
,c5t] t receives an aw>d "u ?is         

subsection %all provide assurances to ! 
,secret>y t funds provid$ to ! ,c5t] "u 
! aw>d w be us$ only to supplem5t1 n to 
supplant1 ! am\nt ( ,f$]al1 ,/ate1 &    
local funds o!rwise exp5d$ by su* ,c5t]4
  7e7 ,palliative c>e & hospice c>e]    
inc5tive aw>ds  7#a7 ,9 g5]al ,!        
,secret>y %all aw>d grants or contracts 
"u ?is subsection to individuals        
describ$ 9 p>agraph 7#b7 to fo/] great] 
int]e/ among a v>iety ( heal?           
pr(essionals 9 ent]+ ! field (          
palliative c>e4  7#b7 ,eligible         
individuals ,to be eligible to receive  
an aw>d "u p>agraph 7#a71 an individual 
%all-- 7,a7 be an advanc$ practice      
nurse1 a social work]1 physician        
assi/ant1 ph>maci/1 *apla91 or /ud5t (  
psy*ology :o is pursu+ a doctorate1     
ma/]s1 or o!r advanc$ degree ) a focus 9
 palliative c>e or relat$ fields 9 an   
accr$it$ heal? pr(essions s*ool2 &  7,b7
 submit to ! ,secret>y an application at
 su* "t1 9 su* mann]1 & conta9+ su*     
in=mation z ! ,secret>y may require4    

7#c7 ,conditions ( aw>d ,z a condition (
 receiv+ an aw>d "u ?is subsection1 an  
individual %all agree t1 foll[+         
completion ( ! aw>d p]iod1 ! individual 
w tea* or practice palliative c>e 9     
heal?-relat$ educational1 home1 hospice1
 or long-t]m c>e sett+s = a m9imum ( #e 
ye>s "u guidel9es e/abli%$ by !         
,secret>y4  7#d7 ,paym5t to in/itution  
,! ,secret>y %all make paym5ts = aw>ds  
"u ?is subsection to in/itutions :i*    
include s*ools ( m$ic9e1 o/eopa?ic      
m$ic9e1 nurs+1 social "w1 psy*ology1    
*apla9cy or pa/oral c>e education1      
d5ti/ry1 & ph>macy1 or o!r alli$ heal?  
discipl9e 9 an accr$it$ heal? pr(essions
 s*ool or program 7su* z a physician    
assi/ant education program7 t is approv$
 by ! ,secret>y4  7f7 ,au?orization (   
appropriations ,!re are au?oriz$ to be  
appropriat$ to c>ry out ?is section1    
#dd1ajj1jjj = ea* ( ! fiscal ye>s #bjah 
?r\gh #bjbb4  4  7b7 ,effective date ,! 
am5dm5t made by ?is section %all be     
effective beg9n+ on ! date t is #ij days

 aft] ! date ( enactm5t ( ?is ,act4  #d4
 ,hospice & palliative nurs+  7a7       
,pref]5ce = grants or aw>ds = nurs+     
work=ce developm5t projects ,section    
#hje ( ! ,public ,heal? ,s]vice ,act    
7#db ,u4,s4,c4 #bif;d7 is am5d$-- 7#a7  
by /rik+ or help & ins]t+ help2 &  7#b7 
by ins]t+ ! foll[+ be=e ! p]iod at !    
end3 1 or = education & tra9+ 9 hospice 
& palliative nurs+4  7b7 ,advanc$       
education nurs+ grants ,section #haa ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #bif;j7 is am5d$--  7#a7 9    
subsection 7a7-- 7,a7 9 p>agraph 7#a71  
by /rik+ & at ! end2  7,b7 by r$esignat+
 p>agraph 7#b7 z p>agraph 7#c72 &  7,c7 
by ins]t+ aft] p>agraph 7#a71 ! foll[+  
new p>agraph3  7#b7 palliative c>e &    
hospice c>e] inc5tive aw>ds "u section  
#gei;,a7e72 &  2 &  7#b7 9 subsection   
7g77#b71 by ins]t+ or = education &     
tra9+ 9 hospice & palliative nurs+ aft] 
section #ccb4  7c7 ,nurse education1    
practice1 & quality grants ,section #hca
 ( ! ,public ,heal? ,s]vice ,act 7#db   

,u4,s4,c4 #bifp7 is am5d$-- 7#a7 9      
subsection 7a7--  7,a7 by /rik+ or at ! 
end ( p>agraph 7#a72  7,b7 by /rik+ !   
p]iod at ! end ( p>agraph 7#b7 & ins]t+ 
2 or2 &  7,c7 by add+ at ! end ! foll[+ 
new p>agraph3  7#c7 education & tra9+ 9 
hospice & palliative nurs+4  2 &  7#b7 9
 subsection 7b77#c71 by ins]t+ hospice &
 palliative nurs+1 aft] coord9at$ c>e14 
7d7 ,nurse ret5tion grants ,section     
#hca;,a ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #bifp-#a7 is am5d$--     
7#a7 9 subsection 7c77#b71 by ins]t+ 1 &
 to applicants ) programs t include     
initiatives to tra9 nurses 9 hospice &  
palliative nurs+ be=e ! p]iod2 &  7#b7 9
 subsection 7d71 by ins]t+ 1 & to tra9  
nurses 9 hospice & palliative nurs+ be=e
 ! p]iod4  7e7 ,additional palliative   
c>e & hospice education & tra9+ programs
 ,"p ,d ( title ,,viii ( ! ,public      
,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bifp
 et seq47 is am5d$ by add+ at ! end !   
foll[+3  #hcb4 ,palliative c>e & hospice
 education & tra9+  7a7 ,program        

au?oriz$ ,! ,secret>y %all aw>d grants  
to eligible entities to develop &       
implem5t1 9 coord9ation ) programs "u   
section #gei;,a1 programs & initiatives 
to tra9 & educate individuals 9 provid+ 
palliative c>e 9 heal?-relat$           
educational1 hospice1 home1 or long-t]m 
c>e sett+s4  7b7 ,use ( funds ,an       
eligible entity t receives a grant "u   
subsection 7a7 %all use funds "u su*    
grant to-- 7#a7 provide tra9+ to        
individuals :o w provide palliative c>e 
9 heal?-relat$ educational1 home1       
hospice1 or long-t]m c>e sett+s2  7#b7  
develop & dissem9ate curricula relat+ to
 palliative c>e 9 heal?-relat$          
educational1 home1 hospice1 or long-t]m 
c>e sett+s2  7#c7 tra9 faculty memb]s 9 
palliative c>e 9 heal?-relat$           
educational1 home1 hospice1 or long-t]m 
c>e sett+s2 or  7#d7 provide cont9u+    
education to individuals :o provide     
palliative c>e 9 heal?-relat$           
educational1 home1 hospice1 or long-t]m 
c>e sett+s4  7c7 ,application ,an       

eligible entity desir+ a grant "u       
subsection 7a7 %all submit an           
application to ! ,secret>y at su* "t1 9 
su* mann]1 & conta9+ su* in=mation z !  
,secret>y may reasonably require4  7d7  
,eligible entity ,= purposes ( ?is      
section1 ! t]m eligible entity %all     
include a s*ool ( nurs+1 a heal? c>e    
facility1 a program lead+ to            
c]tification z a c]tifi$ nurse assi/ant1
 a p>tn]%ip ( su* a s*ool & facility1 or
 a p>tn]%ip ( su* a program & facility4 
7e7 ,au?orization ( appropriations ,!re 
are au?oriz$ to be appropriat$ to c>ry  
out ?is section #e1jjj1jjj = ea* (      
fiscal ye>s #bjah ?r\gh #bjbb4  4  #e4  
,national palliative c>e education &    
aw>5ess campaign ,"p ,a ( title ,,ix ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #bii et seq47 is am5d$ by add+
 at ! end ! foll[+ new section3  #ijd4  
,national palliative c>e education &    
aw>5ess campaign  7a7 ,9 g5]al ,"u !    
au?ority "u section #ijb7;a7 to         
dissem9ate in=mation on heal? c>e & on  

sy/ems = ! deliv]y ( su* c>e1 !         
,director %all provide = ! plann+ &     
implem5tation ( a national education &  
aw>5ess campaign to in=m pati5ts1       
families1 & heal? pr(essionals ab\t !   
b5efits ( palliative c>e ?r\gh\t !      
cont9uum ( c>e = pati5ts ) s]i\s or     
life-?reat5+ illness4  7b7 ,in=mation   
dissem9at$  7#a7 ,m&atory in=mation ,!  
campaign "u subsection 7a7 %all include 
dissem9ation ( ! foll[+3 7,a7           
,palliative c>e ,in=mation1 res\rces1 & 
communication mat]ials ab\t palliative  
c>e z an ess5tial "p ( ! cont9uum (     
quality c>e = pati5ts & families fac+   
s]i\s or life-?reat5+ illness 7includ+  
canc]2 he>t1 kidney1 liv]1 lung1 &      
infecti\s diseases2 z well z            
neurodeg5]ative disease su* z dem5tia1  
,p>k9son's disease1 or amyotrophic      
lat]al scl]osis74  7,b7 ,palliative c>e 
s]vices ,specific in=mation reg>d+ !    
s]vices provid$ to pati5ts by           
pr(essionals tra9$ 9 hospice &          
palliative c>e1 includ+ pa9 & symptom   

managem5t1 support = %>$ decisionmak+1  
c>e coord9ation1 psy*osocial c>e1 &     
spiritual c>e1 expla9+ t su* s]vices may
 be provid$ />t+ at ! po9t ( diagnosis &
 alongside curative treatm5t & are      
int5d$ to--  7i7 provide pati5t-c5t]$ & 
family-c5t]$ support ?r\gh\t ! cont9uum 
( c>e = s]i\s & life-?reat5+ illness2   
7ii7 anticipate1 prev5t1 & treat        
physical1 emotional1 social1 & spiritual
 suff]+2  7iii7 optimize quality ( life2
 &  7iv7 facilitate & support ! goals & 
values ( pati5ts & families4  7,c7      
,palliative c>e pr(essionals ,specific  
mat]ials t expla9 ! role ( pr(essionals 
tra9$ 9 hospice & palliative c>e 9      
provid+ team-bas$ c>e 7includ+ pa9 &    
symptom managem5t1 support = %>$        
decisionmak+1 c>e coord9ation1          
psy*osocial c>e1 & spiritual c>e7 =     
pati5ts & families ?r\gh\t ! cont9uum ( 
c>e = s]i\s or life-?reat5+ illness4    
7,d7 ,rese>* ,evid5ce-bas$ rese>*       
demon/rat+ ! b5efits ( pati5t access to 
palliative c>e ?r\gh\t ! cont9uum ( c>e 

= s]i\s or life-?reat5+ illness4  7,e7  
,population-specific mat]ials ,mat]ials 
%all be develop$ t t>get specific       
populations1 includ+ pati5ts ) s]i\s or 
life-?reat5+ illness :o are among       
m$ically und]s]v$ populations 7z def9$ 9
 section #ccj7;b77#c77 & families ( su* 
pati5ts or heal? pr(essionals s]v+      
m$ically und]s]v$ populations4 ,su*     
populations %all include p$iatric       
pati5ts1 "y adult & adolesc5t pati5ts1  
racial & e?nic m9ority populations1 &   
o!r priority populations specifi$ by !  
,director4  7#b7 ,o!r in=mation ,9      
addition to ! in=mation describ$ 9      
p>agraph 7#a71 su* campaign may include 
dissem9ation ( su* o!r in=mation z !    
,director det]m9es to be relevant4  7#c7
 ,in=mation =mat ,! in=mation & mat]ials
 requir$ to be dissem9at$ "u p>agraph   
7#a7 & any in=mation dissem9at$ "u      
p>agraph 7#b7 %all be pres5t$ 9 a v>iety
 ( =mats 7su* z po/$ onl9e1 9 pr9t1 &   
?r\gh public s]vice ann\ncem5ts74  7#d7 
,requir$ publication ,! in=mation &     

mat]ials requir$ to be dissem9at$ "u    
p>agraph 7#a7 & any in=mation dissem9at$
 "u p>agraph 7#b7 %all be po/$ on !     
,int]net websites ( relevant ,f$]al     
ag5cies & ,dep>tm5ts1 includ+ ! ,ag5cy =
 ,heal?c>e ,rese>* & ,quality1 ! ,c5t]s 
= ,m$ic>e  ,m$icaid ,s]vices1 !         
,adm9i/ration on ,ag+1 ! ,c5t]s =       
,disease ,control & ,prev5tion1 & !     
,dep>tm5t ( ,vet]ans ,affairs4  7c7     
,consultation ,! ,director %all consult 
) appropriate pr(essional societies1    
hospice & palliative c>e /akehold]s1 &  
relevant pati5t advocate organizations )
 respect to palliative c>e1 psy*osocial 
c>e1 & complex *ronic illness ) respect 
to ! foll[+3  7#a7 ,! plann+ &          
implem5tation ( ! national palliative   
c>e education & aw>5ess campaign "u ?is 
section4  7#b7 ,! developm5t ( in=mation
 to be dissem9at$ "u ?is section4  7#c7 
,a def9ition ( ! t]m s]i\s or           
life-?reat5+ illness = purposes ( ?is   
section4  4  #f4 ,cl>ification ,none ( !
 funds made available "u ?is ,act 7or an

 am5dm5t made by ?is ,act7 may be us$ to
 provide1 promote1 or provide tra9+ )   
reg>d to any item or s]vice = :i* ,f$]al
 fund+ is unavailable "u section #c (   
,public ,law #aje-ab 7#db ,u4,s4,c4     
#addjb74  #g4 ,enhanc+ ,,nih rese>* 9   
palliative c>e  7a7 ,9 g5]al ,"p ,b (   
title ,,iv ( ! ,public ,heal? ,s]vice   
,act 7#db ,u4,s4,c4 #bhd et seq47 is    
am5d$ by add+ at ! end ! foll[+ new     
section3  #dji,k4 ,enhanc+ rese>* 9     
palliative c>e  7a7 ,9 g5]al ,!         
,secret>y1 act+ ?r\gh ! ,director ( !   
,national ,in/itutes ( ,heal?1 %all     
develop & implem5t a /rategy to be      
appli$ across ! in/itutes & c5t]s ( !   
,national ,in/itutes ( ,heal? to exp&   
national rese>* programs 9 palliative   
c>e4  7b7 ,rese>* programs ,! ,director 
( ! ,national ,in/itutes ( ,heal? %all  
exp& & int5sify rese>* programs 9       
palliative c>e to address ! quality (   
c>e & quality ( life = ! rapidly gr[+   
population ( pati5ts 9 ! ,unit$ ,/ates )
 s]i\s or life-?reat5+ illnesses1       

includ+ canc]2 he>t1 kidney1 liv]1 lung1
 & infecti\s diseases2 z well z         
neurodeg5]ative disease su* z dem5tia1  
,p>k9son's disease1 or amyotrophic      
lat]al scl]osis4  4  7b7 ,exp&+         
trans-,,nih rese>* report+ ,to include  
palliative c>e rese>* ,section          
#djb;,a7c77#b77;,b7 ( ! ,public ,heal?  
,s]vice ,act 7#db ,u4,s4,c4             
#bhb;a7c77#b77;,b77 is am5d$ by ins]t+  
&1 beg9n+ ,janu>y #a1 #bjah1 = conduct+ 
or support+ rese>* ) respect to         
palliative c>e aft] or national c5t]s4