[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2748 Introduced in Senate (IS)]
<DOC>
114th CONGRESS
2d Session
S. 2748
To amend the Public Health Service Act to increase the number of
permanent faculty in palliative care at accredited allopathic and
osteopathic medical schools, nursing schools, social work schools, and
other programs, including physician assistant education programs, to
promote education and research in palliative care and hospice, and to
support the development of faculty careers in academic palliative
medicine.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 5, 2016
Ms. Baldwin introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, 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 schools, nursing schools, social work schools, and
other programs, including physician assistant education programs, to
promote education and research in palliative care and hospice, and to
support the development of faculty careers in academic palliative
medicine.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Palliative Care and Hospice
Education and Training Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Health care providers need better education about pain
management and palliative care. Students graduating from
medical school have very little, if any, training in the core
precepts of pain and symptom management, advance care planning,
communication skills, and care coordination for patients with
serious, life-threatening, or terminal illness.
(2) Palliative care is interdisciplinary, patient- and
family-centered health care for people with serious illnesses.
This type of care is focused on providing patients with relief
from the symptoms, pain, and stress of a serious illness,
whatever the diagnosis. The goal of palliative care is to
relieve suffering and improve quality of life for both patients
and their families. Palliative care is provided by a team of
doctors, nurses, social workers, physician assistants,
chaplains, and other specialists who work with a patient's
other health care providers to provide an extra layer of
support, including assistance with difficult medical
decisionmaking and coordination of care among specialists.
Palliative care is appropriate at any age and at any stage in a
serious illness, and can be provided together with curative
treatment. Palliative care is not dependent on a life-limiting
prognosis and may actually help an individual recover from
illness by relieving symptoms, such as pain, anxiety, or loss
of appetite, while undergoing sometimes difficult medical
treatments or procedures, such as surgery or chemotherapy. In
2013, 1,744 United States hospitals with 50 or more beds had a
palliative care program.
(3) Hospice is palliative care for patients in their last
year of life. Considered the model for quality compassionate
care for individuals facing a life-limiting illness, hospice
provides expert medical care, pain management, and emotional
and spiritual support expressly tailored to the patient's needs
and wishes. In most cases, care is provided in the patient's
home but may also be provided in freestanding hospice centers,
hospitals, nursing homes, and other long-term care facilities.
In 2012, an estimated 1,500,000 to 1,600,000 patients received
services from hospice, including non-Medicare beneficiaries.
Nearly 45 percent of all deaths in the United States in 2011
occurred under the care of a hospice program. Hospice is a
covered benefit under the Medicare program. There were 3,782
Medicare-certified hospices serving more than 1,200,000
Medicare beneficiaries in 2012.
(4) Despite a high intensity of medical treatment, many
seriously ill patients experience troubling symptoms, unmet
psychological and personal care needs, and high caregiver
burden. Numerous studies have shown that adding palliative care
can improve pain and symptom control, quality of life, and
family satisfaction with care.
(5) A 2005 study at Michigan State University found that
the formal training of United States doctors in palliative care
is ``grossly inadequate''. When the American Society of
Clinical Oncology surveyed their members, 65 percent said they
had received inadequate education in controlling symptoms
associated with cancer, and 81 percent felt they had inadequate
mentoring in discussing a poor prognosis with their patients
and families. Training in pediatric palliative care is also
seriously lacking according to physicians, residents, and
medical students responding to a survey presented at a meeting
of American Federation for Medical Research.
(6) The American Board of Medical Specialties and the
Accreditation Council for Graduate Medical Education provided
formal subspecialty status for hospice and palliative medicine
in 2006, and the Centers for Medicare & Medicaid Services
recognized hospice and palliative medicine as a medical
subspecialty in October of 2008.
(7) As of April 2015, there were a total of 106 hospice and
palliative medicine training programs accredited by the
Accreditation Council for Graduate Medical Education. For the
2014-2015 academic year, these programs were training 265
physicians in hospice and palliative medicine. Some programs
include an additional track in research, geriatrics,
pediatrics, or public health.
(8) There is a large gap between the number of physicians
practicing in the palliative medicine field and the number of
physicians needed in the field. A mid-range estimate by the
Workforce Task Force of the American Academy of Hospice and
Palliative Medicine calls for 6,000 or more full-time
equivalents to serve current needs in hospice and palliative
care programs. At maximum capacity, the current system would
produce roughly 5,300 new hospice and palliative medicine
certified physicians over the next 20 years, during which time
some 70,000,000 new Medicare beneficiaries will enter the
Medicare program. At the same time, there is expected to be
increasing acceptance of the hospice and palliative approach to
care among the general population and health care providers.
(9) According to the Institute of Medicine, there is a
``need for better understanding of the role of palliative care
among both the public and professionals across the continuum of
care so that hospice and palliative care can achieve their full
potential for patients and their families''.
SEC. 3. PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING.
(a) In General.--Part D of title VII of the Public Health Service
Act (42 U.S.C. 294 et seq.) is amended by adding at the end the
following:
``SEC. 759A. PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING.
``(a) Palliative Care and Hospice Education Centers.--
``(1) In general.--The Secretary shall award grants or
contracts under this section to entities described in paragraph
(1), (3), or (4) of section 799B, and section 801(2), for the
establishment or operation of Palliative Care and Hospice
Education Centers that meet the requirements of paragraph (2).
``(2) Requirements.--A Palliative Care and Hospice
Education Center meets the requirements of this paragraph if
such Center--
``(A) improves the training of health professionals
in palliative care, including residencies,
traineeships, or fellowships;
``(B) develops and disseminates curricula relating
to the palliative treatment of the complex health
problems of individuals with serious or life-
threatening illnesses;
``(C) supports the training and retraining of
faculty to provide instruction in palliative care;
``(D) supports continuing education of health
professionals who provide palliative care to patients
with serious or life-threatening illness;
``(E) provides students (including residents,
trainees, and fellows) with clinical training in
palliative care in long-term care facilities, home
care, hospices, chronic and acute disease hospitals,
and ambulatory care centers;
``(F) establishes traineeships for individuals who
are preparing for advanced education nursing degrees,
social work degrees, or advanced degrees in physician
assistant studies, with a focus in palliative care in
long-term care facilities, home care, hospices, chronic
and acute disease hospitals, and ambulatory care
centers; and
``(G) does not duplicate the activities of existing
education centers funded under this section or under
section 753 or 865.
``(3) Expansion of existing centers.--Nothing in this
section shall be construed to--
``(A) prevent the Secretary from providing grants
to expand existing education centers, including
geriatric education centers established under section
753 or 865, to provide for education and training
focused specifically on palliative care, including for
non-geriatric populations; or
``(B) limit the number of education centers that
may be funded in a community.
``(b) Palliative Medicine Physician Training.--
``(1) In general.--The Secretary may make grants to, and
enter into contracts with, schools of medicine, schools of
osteopathic medicine, teaching hospitals, and graduate medical
education programs, for the purpose of providing support for
projects that fund the training of physicians (including
residents, trainees, and fellows) who plan to teach palliative
medicine.
``(2) Requirements.--Each project for which a grant or
contract is made under this subsection shall--
``(A) be staffed by full-time teaching physicians
who have experience or training in palliative medicine;
``(B) be based in a hospice and palliative medicine
fellowship program accredited by the Accreditation
Council for Graduate Medical Education;
``(C) provide training in palliative medicine
through a variety of service rotations, such as
consultation services, acute care services, extended
care facilities, ambulatory care and comprehensive
evaluation units, hospice, home health, and community
care programs;
``(D) develop specific performance-based measures
to evaluate the competency of trainees; and
``(E) provide training in palliative medicine
through one or both of the training options described
in subparagraphs (A) and (B) of paragraph (3).
``(3) Training options.--The training options referred to
in subparagraph (E) of paragraph (2) are as follows:
``(A) 1-year retraining programs in hospice and
palliative medicine for physicians who are faculty at
schools of medicine and osteopathic medicine, or others
determined appropriate by the Secretary.
``(B) 1- or 2-year training programs that are
designed to provide training in 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
Specialties.
``(4) Definitions.--For purposes of this subsection the
term `graduate medical education' means a program sponsored by
a school of medicine, a school of osteopathic medicine, a
hospital, or a public or private institution that--
``(A) offers postgraduate medical training in the
specialties and subspecialties of medicine; and
``(B) has been accredited by the Accreditation
Council for Graduate Medical Education or the American
Osteopathic Association through its Committee on
Postdoctoral Training.
``(c) Palliative Medicine and Hospice Academic Career Awards.--
``(1) Establishment of program.--The Secretary shall
establish a program to provide awards, to be known as the
`Palliative Medicine and Hospice Academic Career Awards', to
eligible individuals to promote the career development of such
individuals as academic hospice and palliative care physicians.
``(2) Eligible individuals.--To be eligible to receive an
award under paragraph (1), an individual shall--
``(A) be board certified or board eligible in
hospice and palliative medicine; and
``(B) have a junior (non-tenured) faculty
appointment at an accredited (as determined by the
Secretary) school of medicine or osteopathic medicine.
``(3) Limitations.--No award under paragraph (1) may be
made to an eligible individual unless the individual--
``(A) has submitted to the Secretary an
application, at such time, in such manner, and
containing such information as the Secretary may
require, and the Secretary has approved such
application;
``(B) provides, in such form and manner as the
Secretary may require, assurances that the individual
will meet the service requirement described in
paragraph (6); and
``(C) provides, in such form and manner as the
Secretary may require, 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 interdisciplinary education in
palliative care.
``(4) Maintenance of effort.--An eligible individual who
receives an award under paragraph (1) shall provide assurances
to the Secretary that funds provided to the eligible individual
under this subsection will be used only to supplement, not to
supplant, the amount of Federal, State, and local funds
otherwise expended by the eligible individual.
``(5) Amount and term.--
``(A) Amount.--The amount of an award under this
subsection shall be equal to the award amount provided
for under section 753(c)(5)(A) for the fiscal year
involved.
``(B) Term.--The term of an award made under this
subsection shall not exceed 5 years.
``(C) Payment to institution.--The Secretary shall
make payments for awards under this subsection to
institutions, including schools of medicine and
osteopathic medicine.
``(6) Service requirement.--An individual who receives an
award under this subsection shall provide training in
palliative care and hospice, including the training of
interdisciplinary teams of health care professionals. The
provision of such training shall constitute a majority of the
total funded obligations of such individual under the award.
``(d) Palliative Care Workforce Development.--
``(1) In general.--The Secretary shall award grants or
contracts under this subsection to entities that operate a
Palliative Care and Hospice Education Center pursuant to
subsection (a)(1).
``(2) Application.--To be eligible for an award under
paragraph (1), an entity described in such paragraph shall
submit to the Secretary an application at such time, in such
manner, and containing such information as the Secretary may
require.
``(3) Use of funds.--Amounts awarded under a grant or
contract under paragraph (1) shall be used to carry out the
fellowship program described in paragraph (4).
``(4) Fellowship program.--
``(A) In general.--Pursuant to paragraph (3), a
Palliative Care and Hospice Education Center that
receives an award under this subsection shall use such
funds to offer short-term intensive courses (referred
to in this subsection as a `fellowship') that focus on
palliative care that provide supplemental training for
faculty members in medical schools and other health
professions schools with programs in psychology,
pharmacy, nursing, social work, physician assistant
education, chaplaincy, or other health disciplines, as
approved by the Secretary. Such a fellowship shall be
open to current faculty, and appropriately credentialed
volunteer faculty and practitioners, who do not have
formal training in palliative care, 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 skills.
``(B) Location.--A fellowship under this paragraph
shall be offered either at the Palliative Care and
Hospice Education Center that is sponsoring the course,
in collaboration with other Palliative Care and Hospice
Education Centers, or at medical schools, schools of
nursing, schools of pharmacy, schools of social work,
schools of chaplaincy or pastoral care education,
graduate programs in psychology, physician assistant
education programs, or other health professions schools
approved by the Secretary with which the Centers are
affiliated.
``(C) Continuing education credit.--Participation
in a fellowship under this paragraph shall be accepted
with respect to complying with continuing health
profession education requirements. As a condition of
such acceptance, the recipient shall subsequently
provide a minimum of 18 hours of voluntary instruction
in palliative care content (that has been approved by a
palliative care and hospice education center) to
students or trainees in health-related educational,
home, hospice, or long-term care settings.
``(5) Targets.--A Palliative Care and Hospice Education
Center that receives an award under this subsection shall meet
targets approved by the Secretary for providing palliative care
training to a certain number of faculty or practitioners during
the term of the award, as well as other parameters established
by the Secretary.
``(6) Amount of award.--Each award under this subsection
shall be in the amount of $150,000. Not more than 24 Palliative
Care and Hospice Education Centers may receive an award under
this subsection.
``(7) Maintenance of effort.--A Palliative Care and Hospice
Education Center that receives an award under this subsection
shall provide assurances to the Secretary that funds provided
to the Center under the award will be used only to supplement,
not to supplant, the amount of Federal, State, and local funds
otherwise expended by such Center.
``(e) Palliative Care and Hospice Career Incentive Awards.--
``(1) In general.--The Secretary shall award grants or
contracts under this subsection to individuals described in
paragraph (2) to foster greater interest among a variety of
health professionals in entering the field of palliative care.
``(2) Eligible individuals.--To be eligible to receive an
award under paragraph (1), an individual shall--
``(A) be an advanced practice nurse, a social
worker, physician assistant, pharmacist, chaplain, or
student of psychology who is pursuing a doctorate,
masters, or other advanced degree with a focus in
palliative care or related fields in an accredited
health professions school; and
``(B) submit to the Secretary an application at
such time, in such manner, and containing such
information as the Secretary may require.
``(3) Conditions of award.--As a condition of receiving an
award under this subsection, an individual shall agree that,
following completion of the award period, the individual will
teach or practice palliative care in health-related
educational, home, hospice, or long-term care settings for a
minimum of 5 years under guidelines established by the
Secretary.
``(4) Payment to institution.--The Secretary shall make
payments for awards under this subsection to institutions which
include schools of medicine, osteopathic medicine, nursing,
social work, psychology, chaplaincy or pastoral care education,
dentistry, and pharmacy, or other allied health discipline in
an accredited health professions school or program (such as a
physician assistant education program) that is approved by the
Secretary.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $44,100,000 for each of the
fiscal years 2016 through 2020.''.
(b) Effective Date.--The amendment made by this section shall be
effective beginning on the date that is 90 days after the date of
enactment of this Act.
SEC. 4. HOSPICE AND PALLIATIVE NURSING.
(a) Preference for Grants or Awards for Nursing Workforce
Development Projects.--Section 805 of the Public Health Service Act (42
U.S.C. 296d) is amended--
(1) by striking ``or help'' and inserting ``help''; and
(2) by inserting the following before the period at the
end: ``, or for education and training in hospice and
palliative nursing''.
(b) Advanced Education Nursing Grants.--Section 811 of the Public
Health Service Act (42 U.S.C. 296j) is amended--
(1) in subsection (a)--
(A) in paragraph (1), by striking ``and'' at the
end;
(B) by redesignating paragraph (2) as paragraph
(3); and
(C) by inserting after paragraph (1), the following
new paragraph:
``(2) palliative care and hospice career incentive awards
under section 759A(e); and''; and
(2) in subsection (g)(2), by inserting ``or for education
and training in hospice and palliative nursing'' after
``section 332''.
(c) Nurse Education, Practice, and Quality Grants.--Section 831 of
the Public Health Service Act (42 U.S.C. 296p) is amended--
(1) in subsection (a)--
(A) by striking ``or'' at the end of paragraph (1);
(B) by striking the period at the end of paragraph
(2) and inserting ``; or''; and
(C) by adding at the end the following new
paragraph:
``(3) education and training in hospice and palliative
nursing.''; and
(2) in subsection (b)(3), by inserting ``hospice and
palliative nursing,'' after ``coordinated care,''.
(d) Nurse Retention Grants.--Section 831A of the Public Health
Service Act (42 U.S.C. 296p-1) is amended--
(1) in subsection (c)(2), by inserting ``, and to
applicants with programs that include initiatives to train
nurses in hospice and palliative nursing'' before the period;
and
(2) in subsection (d), by inserting ``, and to train nurses
in hospice and palliative nursing'' before the period.
(e) Additional Palliative Care and Hospice Education and Training
Programs.--Part D of title VIII of the Public Health Service Act (42
U.S.C. 296p et seq.) is amended by adding at the end the following:
``SEC. 832. PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING.
``(a) Program Authorized.--The Secretary shall award grants to
eligible entities to develop and implement, in coordination with
programs under section 759A, programs and initiatives to train and
educate individuals in providing palliative care in health-related
educational, hospice, home, or long-term care settings.
``(b) Use of Funds.--An eligible entity that receives a grant under
subsection (a) shall use funds under such grant to--
``(1) provide training to individuals who will provide
palliative care in health-related educational, home, hospice,
or long-term care settings;
``(2) develop and disseminate curricula relating to
palliative care in health-related educational, home, hospice,
or long-term care settings;
``(3) train faculty members in palliative care in health-
related educational, home, hospice, or long-term care settings;
or
``(4) provide continuing education to individuals who
provide palliative care in health-related educational, home,
hospice, or long-term care settings.
``(c) Application.--An eligible entity desiring a grant under
subsection (a) shall submit an application to the Secretary at such
time, in such manner, and containing such information as the Secretary
may reasonably require.
``(d) Eligible Entity.--For purposes of this section, the term
`eligible entity' shall include a school of nursing, a health care
facility, a program leading to certification as a certified nurse
assistant, a partnership of such a school and facility, or a
partnership of such a program and facility.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $5,000,000 for each of fiscal
years 2016 through 2020.''.
SEC. 5. NATIONAL PALLIATIVE CARE EDUCATION AND AWARENESS CAMPAIGN.
Part A of title IX of the Public Health Service Act (42 U.S.C. 299
et seq.) is amended by adding at the end the following new section:
``SEC. 904. NATIONAL PALLIATIVE CARE EDUCATION AND AWARENESS CAMPAIGN.
``(a) In General.--Under the authority under section 902(a) to
disseminate information on health care and on systems for the delivery
of such care, the Director shall provide for the planning and
implementation of a national education and awareness campaign to inform
patients, families, and health professionals about the benefits of
palliative care throughout the continuum of care for patients with
serious or life-threatening illness.
``(b) Information Disseminated.--
``(1) Mandatory information.--The campaign under subsection
(a) shall include dissemination of the following:
``(A) Palliative care.--Information, resources, 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 (including cancer; heart, kidney,
liver, lung, and infectious diseases; as well as
neurodegenerative disease such as dementia, Parkinson's
disease, or amyotrophic lateral sclerosis).
``(B) Palliative care services.--Specific
information regarding the services provided to patients
by professionals trained in hospice and palliative
care, including pain and symptom management, support
for shared decisionmaking, care coordination,
psychosocial care, and spiritual care, explaining that
such services may be provided starting at the point of
diagnosis and alongside curative treatment and are
intended to--
``(i) provide patient-centered and family-
centered support throughout the continuum of
care for serious and life-threatening illness;
``(ii) anticipate, prevent, and treat
physical, emotional, social, and spiritual
suffering;
``(iii) optimize quality of life; and
``(iv) facilitate and support the goals and
values of patients and families.
``(C) Palliative care professionals.--Specific
materials that explain the role of professionals
trained in hospice and palliative care in providing
team-based care (including pain and symptom management,
support for shared decisionmaking, care coordination,
psychosocial care, and spiritual care) for patients and
families throughout the continuum of care for serious
or life-threatening illness.
``(D) Research.--Evidence-based research
demonstrating the benefits of patient access to
palliative care throughout the continuum of care for
serious or life-threatening illness.
``(E) Population-specific materials.--Materials
shall be developed that target specific populations,
including patients with serious or life-threatening
illness who are among medically underserved populations
(as defined in section 330(b)(3)) and families of such
patients or health professionals serving medically
underserved populations. Such populations shall include
pediatric patients, young adult and adolescent
patients, racial and ethnic minority populations, and
other priority populations specified by the Director.
``(2) Other information.--In addition to the information
described in paragraph (1), such campaign may include
dissemination of such other information as the Director
determines to be relevant.
``(3) Information format.--The information and materials
required to be disseminated under paragraph (1) and any
information disseminated under paragraph (2) shall be presented
in a variety of formats (such as posted online, in print, and
through public service announcements).
``(4) Required publication.--The information and materials
required to be disseminated under paragraph (1) and any
information disseminated under paragraph (2) shall be posted on
the Internet Web sites of relevant Federal agencies and
Departments, including the Agency for Healthcare Research and
Quality, the Centers for Medicare & Medicaid Services, the
Administration on Aging, the Centers for Disease Control and
Prevention, and the Department of Veterans Affairs.
``(c) Consultation.--The Director shall consult with appropriate
professional societies, hospice and palliative care stakeholders, and
relevant patient advocate organizations with respect to palliative
care, psychosocial care, and complex chronic illness with respect to
the following:
``(1) The planning and implementation of the national
palliative care education and awareness campaign under this
section.
``(2) The development of information to be disseminated
under this section.
``(3) A definition of the term `serious or life-threatening
illness' for purposes of this section.''.
SEC. 6. ENHANCING NIH RESEARCH IN PALLIATIVE CARE.
(a) In General.--Part B of title IV of the Public Health Service
Act (42 U.S.C. 284 et seq.) is amended by adding at the end the
following new section:
``SEC. 409K. ENHANCING RESEARCH IN PALLIATIVE CARE.
``(a) In General.--The Secretary, acting through the Director of
the National Institutes of Health, shall develop and implement a
strategy to be applied across the institutes and centers of the
National Institutes of Health to expand national research programs in
palliative care.
``(b) Research Programs.--The Director of the National Institutes
of Health shall expand and intensify research programs in palliative
care 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 illnesses, including cancer; heart, kidney, liver,
lung, and infectious diseases; as well as neurodegenerative disease
such as dementia, Parkinson's disease, or amyotrophic lateral
sclerosis.''.
(b) Expanding Trans-NIH Research Reporting To Include Palliative
Care Research.--Section 402A(c)(2)(B)(i) of the Public Health Service
Act (42 U.S.C. 282a(c)(2)(B)(i)) is amended by inserting ``and,
beginning January 1, 2017, for conducting or supporting research with
respect to palliative care'' after ``or national centers''.
<all>