,,ii  #aaith ,,congress  #ast ,session  
,s4 #aice  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,june #c1 #bjbe
 ,ms4 ,rosen 7for herself1 ,mr4         
,barrasso1 ,ms4 ,baldwin1 and ,mrs4     
,fischer7 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 provide for the       
testing of a community-based palliative 
care model4  #a4  ,short title  ,this   
,act may be cited as the ,expanding     
,access to ,palliative ,care ,act4  #b4 
,community-based palliative care model  
,section #aaae;,a of the ,social        
,security ,act 7#db ,u4,s4,c4 #acae;a7  
is amended--  7#a7 in subsection        
7b77#b77;,a71 by adding at the end the  
following new sentence3 ,the models     
selected under this subparagraph shall  
include the testing of the model        
described in subsection 7h742 and  7#b7 
by adding at the end the following new  
subsection3  7h7  ,community-,based     

palliative care model  7#a7  ,in general
  ,the ,,cmi shall develop and implement
 a model to provide community-based     
palliative care and care coordination   
for high-risk beneficiaries1 in         
co-management with other providers of   
services and suppliers1 aimed at        
improving outcomes and experience of    
care and reducing unnecessary or        
unwanted emergency department visits and
 hospitalizations 7in this subsection   
referred to as the model71 and that is  
intended to replace the ,medicare ,care 
,choices ,model4  7#b7  ,duration  ,the 
model shall be implemented for a #e-year
 period1 beginning not later than one   
year after the date of the enactment of 
this subsection4  7#c7  ,target         
population  7,a7  ,in general  ,the     
target population for the model is an   
individual-- 7i7 entitled to1 or        
enrolled for1 benefits under part ,a of 
title ,,xviii2 and  7ii7 with a         
diagnosis of a serious illness or       
injury1 which may include a diagnosis of

 cancer1 heart and vascular disease1    
pulmonary disease1 human                
immunodeficiency virus_/acquired        
immunodeficiency1 ,alzheimer's and      
dementia1 stroke1 serious injury        
requiring rehabilitation including      
burns1 kidney disease1 liver disease1   
,amyotrophic lateral sclerosis1 any     
neuro degenerative disease1 or any other
 serious illness or injury the          
,secretary determines appropriate4  7,b7
  ,no exclusion for prior use of hospice
 care benefits  ,an individual shall not
 be excluded from participation in the  
model based on prior use of hospice care
 benefits during any period prior to    
such participation1 regardless of the   
source of coverage for such benefits4   
7#d7  ,participating providers          
,providers eligible to participate under
 the model may include palliative care  
teams working as an independent practice
 or associated with a hospice program1  
home health agencies1 hospitals1        
integrated health systems1 and other    

facilities determined appropriate by the
 ,secretary4  7#e7  ,team-based approach
  ,under the model1 at least one member 
of the multi-disciplinary palliative    
care team shall be certified in hospice 
and palliative care4 ,this is a         
co-management model with palliative care
 aligning with primary and specialist   
care for a team-based approach4 ,care   
must be coordinated across providers and
 community services for inclusion of all
 pain1 symptom management1              
disease-modifying and curative          
treatments1 and other palliative care   
services4  7#f7  ,location  ,care may be
 furnished under the model in any       
beneficiary home1 including a           
caregiver's residence1 an extended care 
facility1 or a community setting as     
appropriate based on the individual's   
ability to access services4 ,the model  
shall include access within an          
in-patient stay so long as the patient  
begins receiving palliative care        
services prior to admission4 ,services  

shall not be disrupted solely due to    
change in location from a residence to  
an in-patient setting1 and shall be part
 of care coordination and care planning 
following hospital discharge4  7#g7     
,services  ,the model shall include     
items and services based on specific    
patient needs with respect to pain1     
symptom management1 education1 disease  
modifying treatments1 advance care      
planning and shared decision making1    
goals clarification1 mental health      
services1 family and caregiver support  
services1 spiritual support care1       
personal care assistance1 and stress    
reduction therapies4 ,this includes a   
comprehensive assessment of symptoms and
 stress factors that impact quality of  
life4  7#h7  ,access  ,care shall be    
available under the model #bd hours a   
day1 #g days a week1 and #cfe days a    
year1 including telehealth services4    
,the ,,cmi shall specifically consider  
the needs of rural and underserved areas
 and adjust accordingly to ensure       

equitable access to care4 ,a broad range
 of providers must be included with no  
geographic limitations4  7#i7  ,metrics 
,the ,,cmi shall assess the model by    
comparing participants to other members 
of the target population who are        
receiving care outside of the model1    
including with respect to the following3
  7,a7 ,demographics 7including age1    
diagnosis1 residence type1 medical      
encounters in preceding #ab months      
leading to enrollment1 geographic       
location 7such as urban or rural7 and   
others as determined by the ,,cmi74     
7,b7 ,impact on utilization of items and
 services under title ,,xviii 7such as  
emergency department services1 hospital 
observation services1 inpatient         
admissions1 and intensive care unit     
7,,icu7 stays74  7,c7 ,election of      
hospice care4  7,d7 ,duration of hospice
 care4  7,e7 ,care ,experience          
7beneficiary and caregiver74  4