,,ii #aaith ,,congress #ast ,session ,s4 #bbhg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #ae1 #bjbe,ms4 ,baldwin 7for herself1 ,mrs4 ,capito1 ,mr4 ,merkley1 ,mr4 ,marshall1 ,ms4 ,cantwell1 ,mr4 ,barrasso1 ,mr4 ,welch1 ,mrs4 ,hyde-,smith1 ,mr4 ,reed1 ,mr4 ,rounds1 ,ms4 ,rosen1 ,ms4 ,murkowski1 ,mr4 ,king1 ,mrs4 ,blackburn1 ,mrs4 ,gillibrand1 ,ms4 ,collins1 ,mr4 ,whitehouse1 and ,mr4 ,boozman7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,public ,health ,service ,act to increase the number of permanent faculty in palliative care at accredited allopathic and osteopathic medical schools1 nursing schools and other programs1 including social work1 physician assistant1 and chaplaincy education programs1 to promote education and research in palliative care and hospice1 and to support the development of faculty careers in academic palliative and hospice care4 #a4 ,short title ,this ,act may be cited as the ,palliative ,care and ,hospice ,education and ,training ,act4 #b4 ,palliative care and hospice education and training 7a7 ,in general ,part ,d of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bid et seq47 is amended by inserting after section #gei the following3 #gei;,a4 ,palliative care and hospice education and training 7a7 ,palliative care and hospice education programs 7#a7 ,in general ,the ,secretary shall award grants or contracts under this section to entities described in paragraph 7#a71 7#c71 or 7#d7 of section #gii;,b1 and section #hja7b71 for the establishment or operation of ,palliative ,care and ,hospice ,education ,programs that meet the requirements of paragraph 7#b74 7#b7 ,requirements 7,a7 ,in general ,a ,palliative ,care and ,hospice ,education ,program receiving an award under this section shall support the training of health professionals in palliative and hospice care1 including traineeships or fellowships4 ,such programs shall emphasize1 as appropriate1 patient and family engagement1 integration of palliative and hospice care with primary and specialty care1 and collaboration with community partners to address gaps in health care for individuals with serious or life-threatening illnesses4 7,b7 ,activities ,activities conducted by a program under this section may include the following3 7i7 ,clinical training on providing integrated palliative and hospice care services4 7ii7 ,interprofessional training to practitioners from multiple disciplines and specialties1 including training on the provision of care to individuals with serious or life-threatening illnesses4 7iii7 ,establishing or maintaining training-related community-based programs for individuals with serious or life-threatening illnesses and caregivers to improve quality of life1 and where appropriate1 health outcomes for individuals who have serious or life-threatening illnesses4 7,c7 ,nonduplication ,a ,palliative ,care and ,hospice ,education ,program under this section shall not duplicate the activities of existing education centers funded under this section or under section #gec or #hfe4 7#c7 ,priorities in making awards ,in awarding grants and contracts under paragraph 7#a71 the ,secretary-- 7,a7 shall give priority to programs that demonstrate coordination with another ,federal or ,state program1 or another public or private entity2 7,b7 shall give priority to applicants with programs or activities that are expected to substantially benefit-- 7i7 individuals in rural or medically underserved areas1 frontier health professional shortage areas 7as defined in section #gii;,b71 or ,indian ,tribes or ,tribal organizations2 7ii7 pediatric populations2 or 7iii7 racial and ethnic minority populations2 and 7,c7 may give priority to any program that-- 7i7 integrates palliative and hospice care into primary care practice2 7ii7 provides training to integrate palliative and hospice care into other specialties across care settings1 including practicing clinical specialists1 health care administrators1 faculty without backgrounds in palliative or hospice care1 and students from all health professions2 7iii7 emphasizes integration of palliative and hospice care into existing service delivery locations and care across settings1 including primary care clinics1 medical homes1 ,federally qualified health centers1 ambulatory care clinics1 hospitals1 including critical access hospitals1 emergency care settings1 assisted living and nursing facilities1 and home- and community-based settings2 7iv7 supports the training and retraining of faculty1 primary and specialty care providers1 other direct care providers1 and other appropriate professionals on palliative or hospice care2 7v7 emphasizes education and engagement of family or caregivers on palliative and hospice care management within the context of chronic disease management and strategies to meet the needs of such family or caregivers2 or 7vi7 proposes to conduct outreach to communities that have a shortage of palliative and hospice workforce professionals4 7#d7 ,expansion of existing programs ,nothing in this section shall be construed to-- 7,a7 prevent the ,secretary from providing grants or contracts to expand existing education programs1 including geriatric education programs established under section #gec or #hfe1 to provide for education and training focused specifically on palliative care1 including for non-geriatric populations2 or 7,b7 limit the number of education programs that may be funded in a community4 7b7 ,palliative medicine physician training 7#a7 ,in general ,the ,secretary may make grants to1 and enter into contracts with1 schools of medicine1 schools of osteopathic medicine1 teaching hospitals1 and graduate medical education programs for the purpose of providing support for projects that fund the training of physicians who plan to teach or practice palliative medicine4 7#b7 ,requirements ,each project for which a grant or contract is made under this subsection shall-- 7,a7 be staffed by full-time teaching physicians who have experience or training in interprofessional team-based palliative medicine2 7,b7 be based in a hospice and palliative medicine fellowship program accredited by the ,accreditation ,council for ,graduate ,medical ,education2 7,c7 provide training in interprofessional team-based palliative medicine through a variety of service rotations1 such as consultation services1 acute care services1 extended care facilities1 ambulatory care and comprehensive evaluation units1 hospices1 home care1 and community care programs2 7,d7 develop specific performance-based measures to evaluate the competency of trainees2 and 7,e7 provide training in interprofessional team-based palliative medicine through one or both of the training options described in paragraph 7#c74 7#c7 ,training options ,the training options referred to in subparagraph 7,e7 of paragraph 7#b7 are as follows3 7,a7 #a-year retraining programs in hospice and palliative medicine for physicians who are faculty at schools of medicine and osteopathic medicine1 or others determined appropriate by the ,secretary4 7,b7 #a- or #b-year training programs that are designed to provide training in interprofessional team-based hospice and palliative medicine for physicians who have completed graduate medical education programs in any medical specialty leading to board eligibility in hospice and palliative medicine pursuant to the ,american ,board of ,medical ,specialties4 7#d7 ,definitions ,for purposes of this subsection1 the term graduate medical education means a program sponsored by a school of medicine1 a school of osteopathic medicine1 a hospital1 or a public or private institution that-- 7,a7 offers postgraduate medical training in the specialties and subspecialties of medicine2 and 7,b7 has been accredited by the ,accreditation ,council for ,graduate ,medical ,education or the ,american ,osteopathic ,association through its ,committee on ,postdoctoral ,training4 7c7 ,palliative care and hospice academic career awards 7#a7 ,establishment of program ,the ,secretary shall establish a program to provide awards1 to be known as the ,palliative ,care and ,hospice ,academic ,career ,awards1 to allopathic and osteopathic medical schools1 nursing schools1 and other programs1 including social work1 physician assistant1 and chaplaincy education programs1 or other schools or programs identified by the ,secretary applying on behalf of eligible individuals to promote the career development of such individuals as academic hospice and palliative care specialists4 7#b7 ,eligible individuals ,for purposes of this subsection1 the term eligible individual means an individual who-- 7,a7 is board certified or board eligible in hospice and palliative medicine or has completed required specialty training in palliative and hospice care in the disciplines of nursing1 social work1 physician assistant1 chaplaincy1 or other discipline identified by the ,secretary2 and 7,b7 has a junior 7nontenured7 faculty appointment at an accredited 7as determined by the ,secretary7 allopathic or osteopathic medical school1 nursing school1 or other programs1 including social work1 physician assistant1 chaplaincy1 or other education programs identified by the ,secretary4 7#c7 ,limitations ,no award under paragraph 7#a7 may be made to an eligible individual unless the entity on behalf of the eligible individual-- 7,a7 has submitted to the ,secretary an application1 at such time1 in such manner1 and containing such information as the ,secretary may require1 and the ,secretary has approved such application2 7,b7 provides1 in such form and manner as the ,secretary may require1 assurances that the individual will meet the service requirement described in paragraph 7#f72 and 7,c7 provides1 in such form and manner as the ,secretary may require1 assurances that the individual has a full-time faculty appointment in a health professions institution and documented commitment from such institution to spend a majority of the total funded time of such individual on teaching and developing skills in education in interprofessional team-based palliative care4 7#d7 ,maintenance of effort ,an entity which receives an award under paragraph 7#a7 shall provide assurances to the ,secretary that funds provided to the eligible individual under this subsection will be used only to supplement1 not to supplant1 the amount of ,federal1 ,state1 and local funds otherwise expended by the eligible individual4 7#e7 ,amount and term 7,a7 ,amount ,the amount of an award under this subsection shall be equal to the award amount provided for under section #gec7;b77#e77;,a7 for the fiscal year involved4 7,b7 ,term ,the term of an award made under this subsection shall not exceed #e years4 7,c7 ,payment to institution ,the ,secretary shall make payments for awards under this subsection to institutions1 including allopathic and osteopathic medical schools1 nursing schools1 and other programs1 including social work1 physician assistant1 or chaplaincy education programs4 7#f7 ,service requirement ,an individual who receives an award under this subsection shall provide training in palliative care and hospice1 including the training of interprofessional teams of health care professionals4 ,the provision of such training shall constitute a majority of the total funded obligations of such individual under the award4 7d7 ,palliative care workforce development 7#a7 ,in general ,the ,secretary shall award grants or contracts under this subsection to entities that operate a ,palliative ,care and ,hospice ,education ,program pursuant to subsection 7a77#a74 7#b7 ,application ,to be eligible for an award under paragraph 7#a71 an entity described in such paragraph shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#c7 ,use of funds ,amounts awarded under a grant or contract under paragraph 7#a7 shall be used to carry out the fellowship program described in paragraph 7#d74 7#d7 ,fellowship program 7,a7 ,in general ,pursuant to paragraph 7#c71 a ,palliative ,care and ,hospice ,education ,program that receives an award under this subsection shall use such funds to offer short-term intensive courses 7referred to in this subsection as a fellowship7 that focus on interprofessional team-based palliative care that provide supplemental training for faculty members in allopathic and osteopathic medical schools1 nursing schools1 and other programs1 including psychology1 pharmacy1 social work1 physician assistant1 and chaplaincy education programs1 or other health disciplines1 as approved by the ,secretary4 ,such a fellowship shall be open to current faculty1 and appropriately credentialed volunteer faculty and practitioners1 who do not have formal training in palliative care1 to upgrade their knowledge and clinical skills for the care of individuals with serious or life-threatening illness and to enhance their interdisciplinary and interprofessional teaching skills4 7,b7 ,location ,a fellowship under this paragraph shall be offered either at the ,palliative ,care and ,hospice ,education ,program that is sponsoring the course1 in collaboration with other ,palliative ,care and ,hospice ,education ,programs1 or at allopathic and osteopathic medical schools1 nursing schools1 or other programs1 including pharmacy1 social work1 physician assistant1 chaplaincy1 and psychology education programs1 or other health professions schools and programs approved by the ,secretary4 7#e7 ,targets ,a ,palliative ,care and ,hospice ,education ,program that receives an award under paragraph 7#a7 shall meet targets approved by the ,secretary for providing training in interprofessional team-based palliative care to a certain number of faculty or practitioners during the term of the award1 as well as other parameters established by the ,secretary4 7#f7 ,amount of award ,each award under paragraph 7#a7 shall be not more than #aej1jjj4 ,not more than #bd ,palliative ,care and ,hospice ,education ,programs may receive an award under such paragraph4 7#g7 ,maintenance of effort ,a ,palliative ,care and ,hospice ,education ,program that receives an award under paragraph 7#a7 shall provide assurances to the ,secretary that funds provided to the ,program under the award will be used only to supplement1 not to supplant1 the amount of ,federal1 ,state1 and local funds otherwise expended by such ,program4 7e7 ,palliative care and hospice career incentive awards 7#a7 ,in general ,the ,secretary shall award grants or contracts under this subsection to institutions1 including allopathic and osteopathic medical schools1 nursing schools1 and other programs1 including social work1 physician assistant1 psychology1 chaplaincy1 and pharmacy education programs1 or other programs approved by the ,secretary1 applying on behalf of individuals described in paragraph 7#b7 to foster greater interest among a variety of health professionals in entering the field of palliative care4 7#b7 ,eligible individuals ,to be eligible to receive an award under paragraph 7#a71 an individual shall-- 7,a7 be an advanced practice nurse1 a social worker1 physician assistant1 pharmacist1 chaplain1 psychologist1 or other health care professional pursuing a doctorate1 masters1 or other advanced degree with a focus in interprofessional team-based palliative care or related fields in an accredited school or education program2 and 7,b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#c7 ,conditions of award ,as a condition of receiving an award under paragraph 7#a71 an individual shall agree that1 following completion of the award period1 the individual will teach or practice palliative care in health-related educational1 home1 hospice1 or long-term care settings for a minimum of #e years under guidelines established by the ,secretary4 7#d7 ,payment to institution ,the ,secretary shall make payments for awards under paragraph 7#a7 to institutions that include allopathic and osteopathic medical schools1 nursing schools1 and other programs1 including social work1 physician assistant1 psychology1 chaplaincy1 and pharmacy education programs or other programs approved by the ,secretary4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 #ae1jjj1jjj for each of the fiscal years #bjbf through #bjcj4 4 7b7 ,effective date ,the amendment made by this section shall be effective beginning on the date that is #ij days after the date of enactment of this ,act4 #c4 ,hospice and palliative nursing 7a7 ,nurse education1 practice1 and quality grants ,section #hca7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bifp7b77#c77 is amended by inserting hospice and palliative nursing1 after coordinated care14 7b7 ,palliative care and hospice education and training programs ,part ,d of title ,,viii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bifp et seq47 is amended by adding at the end the following3 #hcb4 ,palliative care and hospice education and training 7a7 ,program authorized ,the ,secretary shall award grants to1 or enter into contracts with1 eligible entities to develop and implement1 in coordination with programs under section #gei;,a1 programs and initiatives to train and educate individuals in providing interprofessional team-based palliative care in health-related educational1 hospital1 hospice1 home1 or long-term care settings4 7b7 ,use of funds ,an eligible entity that receives a grant under subsection 7a7 shall use funds under such grant to-- 7#a7 provide training to individuals who will provide palliative care in health-related educational1 hospital1 home1 hospice1 or long-term care settings2 7#b7 develop and disseminate curricula relating to palliative care in health-related educational1 hospital1 home1 hospice1 or long-term care settings2 7#c7 train faculty members in palliative care in health-related educational1 hospital1 home1 hospice1 or long-term care settings2 or 7#d7 provide continuing education to individuals who provide palliative care in health-related educational1 home1 hospice1 or long-term care settings4 7c7 ,application ,an eligible entity desiring a grant under subsection 7a7 shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may reasonably require4 7d7 ,eligible entity ,for purposes of this section1 the term eligible entity shall include a school of nursing1 a health care facility1 a program leading to certification as a certified nurse assistant1 a partnership of such a school and facility1 or a partnership of such a program and facility4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #e1jjj1jjj for each of the fiscal years #bjbf through #bjcj4 4 #d4 ,dissemination of palliative care information ,part ,a of title ,,ix of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bii et seq47 is amended by adding at the end the following new section3 #ijd4 ,dissemination of palliative care information 7a7 ,in general ,under the authority under section #ijb7;a7 to disseminate information on health care and on systems for the delivery of such care1 the ,director may disseminate information to inform patients1 families1 and health professionals about the benefits of palliative care throughout the continuum of care for patients with serious or life-threatening illness4 7b7 ,information disseminated 7#a7 ,mandatory information ,if the ,director elects to disseminate information under subsection 7a71 such dissemination shall include the following3 7,a7 ,palliative care ,information1 resources1 and communication materials about palliative care as an essential part of the continuum of quality care for patients and families facing serious or life-threatening illness 7including cancer1 heart1 kidney1 liver1 lung1 and infectious diseases2 as well as neurodegenerative disease such as dementia1 ,parkinson's disease1 or amyotrophic lateral sclerosis74 7,b7 ,palliative care services ,specific information regarding the services provided to patients by professionals trained in hospice and palliative care1 including pain and symptom management1 support for shared decision making1 care coordination1 psychosocial care1 and spiritual care1 explaining that such services may be provided starting at the point of diagnosis and alongside curative treatment and are intended to-- 7i7 provide patient-centered and family-centered support throughout the continuum of care for serious and life-threatening illness2 7ii7 anticipate1 prevent1 and treat physical1 emotional1 social1 and spiritual suffering2 7iii7 optimize quality of life2 and 7iv7 facilitate and support the goals and values of patients and families4 7,c7 ,palliative care professionals ,specific materials that explain the role of professionals trained in hospice and palliative care in providing team-based care 7including pain and symptom management1 support for shared decision making1 care coordination1 psychosocial care1 and spiritual care7 for patients and families throughout the continuum of care for serious or life-threatening illness4 7,d7 ,research ,evidence-based research demonstrating the benefits of patient access to palliative care throughout the continuum of care for serious or life-threatening illness4 7,e7 ,population-specific materials ,materials targeting specific populations1 including beneficiaries of ,medicare1 ,medicaid1 and the ,veterans ,health ,administration1 and patients with serious or life-threatening illness who are among medically underserved populations 7as defined in section #ccj7;b77#c77 and families of such patients or health professionals serving medically underserved populations1 including pediatric patients1 young adult and adolescent patients1 racial and ethnic minority populations1 and other priority populations specified by the ,director4 7#b7 ,required publication ,information and materials disseminated under paragraph 7#a7 shall be posted on the internet websites of relevant ,federal departments and agencies1 including the ,department of ,veterans ,affairs1 the ,centers for ,medicare ,medicaid ,services1 and the ,administration on ,aging4 7c7 ,consultation ,the ,director shall consult with appropriate professional societies1 hospice and palliative care stakeholders1 and relevant patient advocate organizations with respect to palliative care1 psychosocial care1 and complex chronic illness with respect to the following3 7#a7 ,the planning and implementation of the dissemination of palliative care information under this section4 7#b7 ,the development of information to be disseminated under this section4 7#c7 ,a definition of the term serious or life-threatening illness for purposes of this section4 4 #e4 ,clarification 7a7 ,restriction on the use of ,federal funds ,none of the funds made available under this ,act 7or an amendment made by this ,act7 may be used to provide1 promote1 or provide training with regard to any item or service for which ,federal funding is unavailable under section #c of ,public ,law #aje-ab 7#db ,u4,s4,c4 #addjb74 7b7 ,additional clarification ,as used in this ,act 7or an amendment made by this ,act71 palliative care and hospice shall not be furnished for the purpose of causing1 or the purpose of assisting in causing1 a patient's death1 for any reason4 #f4 ,enhancing ,,nih research in palliative care 7a7 ,in general ,part ,b of title ,,iv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhd et seq47 is amended by adding at the end the following new section3 #dji,k4 ,enhancing research in palliative care ,the ,secretary1 or his or her designee1 shall develop and implement a strategy to be applied across the institutes and centers of the ,national ,institutes of ,health to expand and intensify national research programs in palliative care in order to address the quality of care and quality of life for the rapidly growing population of patients in the ,united ,states with serious or life-threatening illnesses1 including cancer2 heart1 kidney1 liver1 lung1 and infectious diseases2 as well as neurodegenerative diseases such as dementia1 ,parkinson's disease1 or amyotrophic lateral sclerosis4 4 7b7 ,expanding ,,nih research reporting ,to include palliative care research ,section #djb;,a7c77#b77;,b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhb;a7c77#b77;,b77 is amended by inserting and1 beginning ,january #a1 #bjbf1 for conducting or supporting research with respect to palliative care after or national centers4