,,ii #aafth ,,congress #ast ,session ,s4 #hbi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ad1 #bjai,mr4 ,whitehouse introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xi of the ,social ,security ,act to award cooperative agreements to improve care for individuals with advanced illnesses1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,removing ,barriers to ,person- and ,family-,centered ,care ,act of #bjai4 #b4 ,cooperative agreements to improve care for individuals 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 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 ,cooperative agreements ,to improve care for individuals with advanced illnesses 7#a7 ,in general ,the ,secretary shall1 acting through the ,centers for ,medicare ,medicaid ,services1 award up to #ae cooperative agreements to eligible entities with the goals of-- 7,a7 addressing gaps in community capacity to provide high-quality1 person- and family-centered care2 7,b7 improving the integration and coordination of clinical and nonclinical services2 7,c7 expanding access to a comprehensive care planning process and services2 and 7,d7 developing and implementing alternative payment models that provide accountability for health care costs and quality outcomes4 7#b7 ,eligible entity ,in this subsection1 the term eligible entity means the following3 7,a7 ,a ,state ,medicaid agency4 7,b7 ,a ,state1 local1 or tribal health agency4 7,c7 ,an accountable care organization under section #ahii or an accountable care organization model tested under title ,,xviii or with respect to such title under this section4 7,d7 ,a ,lead ,organization 7as defined in paragraph 7#i774 7,e7 ,a quality improvement organization1 such as a ,quality ,innovation ,network-,quality ,improvement ,organization with a contract pursuant to part ,b of this title4 7#c7 ,application 7,a7 ,in general ,eligible entities seeking a cooperative agreement under this subsection shall submit to the ,secretary an application1 at such time1 and in such manner as the ,secretary may require4 ,an application must include-- 7i7 a list of participating practitioners1 providers of services1 community-based organizations1 and other individuals and entities2 7ii7 a description of the target population or populations and geographic service area2 7iii7 a description of the intended uses of amounts awarded under paragraph 7#d71 and a plan for leveraging existing funding sources to deliver services to the target population or populations2 7iv7 a description of the intended care delivery model and how the model supports high-quality1 person- and family-centered care2 7v7 a plan for-- 7,i7 working with community-based organizations1 including faith-based organizations and aging and disability organizations2 7,,ii7 improving community-based supports for family caregivers2 and 7,,iii7 increasing the number of individuals within the target population or populations who-- 7aa7 have communicated their wishes regarding medical treatment using ,state or locally recognized forms1 such as advance directives or portable medical orders2 7bb7 have comprehensive care plans that are concrete and actionable2 and 7cc7 have access to community-based palliative care services2 and 7vi7 other information as determined appropriate by the ,secretary4 7#d7 ,award amounts 7,a7 ,in general ,the ,secretary may award up to #e1jjj1jjj under each cooperative agreement under this subsection4 7,b7 ,use of funds ,funds awarded under a cooperative agreement may be used for the following purposes3 7i7 ,to develop and implement a care delivery model as described in paragraph 7#e77;,b77i7 and an alternative payment model as described in paragraph 7#e77;,b77ii74 7ii7 ,to conduct education and training for health care professionals1 beneficiaries and family caregivers1 or community-based organizations in methods for documenting and sharing an individual's care goals1 preferences1 and values under such model4 7iii7 ,to hire staff to conduct care management and coordination activities as part of an interdisciplinary care team under such model4 7iv7 ,to support the development of community-based palliative care teams and the delivery of related services4 7v7 ,to modify1 upgrade1 or purchase health information technology1 including technologies that support data aggregation and analytics1 electronic exchange of health information1 accessibility of an individual's comprehensive care plan1 or remote monitoring under such model4 7vi7 ,to conduct other activities determined appropriate by the ,secretary4 7#e7 ,implementation 7,a7 ,duration ,each cooperative agreement under this subsection shall be awarded for a period of #g years4 7,b7 ,pre-implementation period ,during the first #b years of a cooperative agreement1 an awardee shall work with the ,secretary to-- 7i7 develop a care delivery model using one or more of the waivers and expanded services described in paragraphs 7#g7 and 7#h72 7ii7 develop an alternative payment model2 and 7iii7 identify a set of quality measures that will be reported on annually by participants in such model4 7,c7 ,model implementation ,beginning with the third year of a cooperative agreement1 an awardee-- 7i7 shall implement the care delivery model developed under subparagraph 7,b77i7 and the alternative payment model developed under subparagraph 7,b77ii72 7ii7 shall annually report data on quality measures identified under subparagraph 7,b77iii7 to the ,secretary2 and 7iii7 may1 in accordance with paragraphs 7#g7 and 7#h71 receive waivers and provide expanded services as described in such paragraphs1 respectively1 as part of a care delivery model that provides high-quality1 person- and family-centered care to the target population or populations4 7#f7 ,notification ,the ,secretary shall provide guidance on notification and continuity-of-care plan requirements in the event a participating provider leaves a model pursuant to a cooperative agreement under this subsection4 7#g7 ,waiver of certain requirements ,in addition to any waivers pursuant to subsection 7d77#a71 the ,secretary shall include the following waivers of requirements and1 where applicable1 permit ,medicare ,advantage organizations flexibility to waive such requirements1 with respect to coverage of1 and payment for1 items and services furnished to individuals pursuant to a cooperative agreement under this subsection3 7,a7 ,coverage of services related to an individual's terminal illness ,a waiver of 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 ,alternatives in furnishing of home care ,with respect to home health services furnished to an individual by a home health agency1 a waiver of the requirements described in sections #ahad7;a77#b7 and #ahce7;a77#b77;,a71 that-- 7i7 a physician makes the certification 7and recertification1 where such services are provided over a period of time7 as described in such sections2 7ii7 a plan for furnishing such services to such individual is established and periodically reviewed by a physician2 7iii7 such services are or were furnished while the individual was under the care of a physician2 and 7iv7 the physician documents that the individual has had a face-to-face encounter as described in such sections1 provided that a nurse practitioner1 clinical nurse specialist1 or physician assistant 7as those terms are defined in section #ahfa7;aa77#e771 in accordance with ,state law1 makes such certification and recertification1 establishes and periodically reviews such plan1 has the individual under their care when such services are or were furnished1 and documents such face-to-face encounter4 7,c7 ,alternative certification for hospice care ,a waiver of 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;dd77#b77;,b77 of the 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 practitioner1 clinical nurse specialist1 or physician assistant 7as those terms are defined in section #ahfa7;aa77#e77 in accordance with ,state law4 7,d7 ,coverage of skilled nursing services without inpatient stay ,with respect to extended care services furnished to an individual by a skilled nursing facility1 a waiver of 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 home health agency 7as defined in section #ahfa7o771 a waiver of the requirements described in sections #ahad7;a77#b77;,c7 and #ahce7;a77#b77;,a7 that the individual is or was confined to his or her home4 7#h7 ,availability of expanded services ,a hospice program that participates in an alternative payment model pursuant to a cooperative agreement under this subsection may receive an add-on payment1 as determined by the ,secretary1 for furnishing the following services to the target population or populations under such model3 7,a7 ,inpatient alternative to routine hospice care 7i7 ,in general ,notwithstanding regulations in effect prior to the enactment of this subsection1 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 unsuitable for the provision of such care1 such individual may receive such care in an inpatient setting1 including a hospice program 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 an individual has elected to receive hospice care4 ,the assessment described in the preceding sentence may be conducted by the individual's attending physician1 a nurse practitioner1 clinical nurse specialist1 or physician assistant 7as those terms are defined in section #ahfa7;aa77#e771 or the medical director 7or physician member of the interdisciplinary group described in section #ahfa7;dd77#b77;,b77 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 subparagraph 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 ,definitions ,in this subsection3 7,a7 ,lead ,organization ,the term ,lead ,organization means a covered entity for purposes of compliance with the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note7 that will convene community partners to coordinate1 manage1 and expand services for the target population or populations and be accountable for costs and quality outcomes under the cooperative agreement4 7,b7 ,cooperative agreement ,the term cooperative agreement means an agreement between the ,secretary and an eligible entity under this subsection4 7,c7 ,physician ,the term physician has the meaning given such term in section #ahfa7r77#a74 7,d7 ,practitioner ,the term practitioner has the meaning given such term in section #ahdb7;b77#ah77;,c74 7,e7 ,provider of services ,the term provider of services has the meaning given such term in section #ahfa7u74 7,f7 ,target population ,the term target population means individuals who-- 7i7 are enrolled for benefits under parts ,a and ,b of title ,,xviii1 enrolled in a ,medicare ,advantage plan under part ,c of such title1 enrolled under a ,state ,medicaid plan1 or dually eligible for benefits under titles ,,xviii and ,,xix2 7ii7 have one or more advanced chronic conditions1 as determined by the ,secretary1 such as late-stage cancer1 congestive heart failure1 chronic kidney disease1 chronic obstructive pulmonary disease1 geriatric frailty1 ,alzheimer's disease1 or other forms of progressive dementia2 and 7iii7 have demonstrated-- 7,i7 evidence of recent and progressive cognitive impairment2 or 7,,ii7 a functional limitation requiring the assistance of another person 7such as an inability to perform two or more activities of daily living74 4 7b7 ,availability of funding ,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,c7 of paragraph 7#a71 #ge1jjj1jjj shall be made available for the purpose of awarding funds under subsection 7h77#d71 which shall remain available for such purpose until expended4 4 #c4 ,identification and development of quality measures relating to advanced illness care ,section #ahij;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa-#a7 is amended by adding at the end the following new subsection3 7h7 ,advanced illness care quality measures 7#a7 ,in general ,the ,secretary1 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,administrator of the ,administration for ,community ,living1 and the entity with a contract under section #ahij7;a71 shall establish a core set of evidence-based quality measures relating to advanced illness care4 ,such quality measures may include outcome1 structural1 and process measures in the following domains3 7,a7 ,person and family experience of care4 7,b7 ,access to needed services 7medical and supportive71 such as home care1 palliative care1 and timely referral to hospice4 7,c7 ,alignment of care with an individual's preferences1 goals1 and values4 7,d7 ,screening and treatment for physical symptoms1 such as dyspnea1 nausea1 and constipation4 7,e7 ,utilization of health care and support services4 7,f7 ,shared decision making and informed consent4 7#b7 ,process for identifying and developing quality measures ,in identifying and developing the quality measures for the core set described in paragraph 7#a71 the ,secretary shall take the following actions3 7,a7 ,identify existing measures ,identify existing quality measures relating to advanced illness care 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 relating to advanced illness care that1 to the extent practicable1 allow for the use of health information technologies in collecting data relating to such quality measures4 7,c7 ,stakeholder feedback ,solicit feedback from a wide array of stakeholders on quality measures to include in the core set4 7#c7 ,publication and updates 7,a7 ,publication ,not later than ,january #a1 #bjbb1 the ,secretary shall publish a core set of quality measures for advanced illness care4 7,b7 ,updates ,beginning ,january #a1 #bjbd 7and every #b years thereafter71 the ,secretary1 in coordination with the entity with a contract under section #ahij7;a71 shall solicit stakeholder feedback and publish an updated set of quality measures1 prioritizing measures that address gap areas related to advanced illness care4 7#d7 ,funding ,there are authorized to be appropriated such sums as may be necessary to carry out this subsection4 4