[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1251 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1251

To amend title XVIII of the Social Security Act to provide for advanced 
 illness care management services for Medicare beneficiaries, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 11, 2009

  Mr. Warner introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for advanced 
 illness care management services for Medicare beneficiaries, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Senior Navigation 
and Planning Act of 2009''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Medicare and Medicaid coverage of advanced illness care 
                            management services.
Sec. 3. Increasing awareness of the importance of end-of-life planning.
Sec. 4. Inclusion of end-of-life planning materials in the Medicare & 
                            You handbook.
Sec. 5. Senior Navigation Advisory Board.
Sec. 6. Requirement for physicians and nurse practitioners to provide 
                            certain Medicare beneficiaries with 
                            information on advance directives and other 
                            end-of-life planning tools.
Sec. 7. Improvement of policies related to the use and portability of 
                            advance directives.
Sec. 8. Additional requirements for facilities.
Sec. 9. Requirement for Medicare providers to honor written orders for 
                            medical care.
Sec. 10. Incentives for accreditation and certification in hospice and 
                            palliative care.
Sec. 11. Discharge checklist pilot program.
Sec. 12. Office of Medicare/Medicaid Integration.
Sec. 13. Web-based materials and grants.
Sec. 14. HHS study and report on the storage of advance directives.
Sec. 15. GAO study and report on the provisions of, and amendments made 
                            by, this Act.

SEC. 2. MEDICARE AND MEDICAID COVERAGE OF ADVANCED ILLNESS CARE 
              MANAGEMENT SERVICES.

    (a) Medicare Coverage of Advanced Illness Care Management 
Services.--
            (1) Coverage.--Section 1812(a)(5) of the Social Security 
        Act (42 U.S.C. 1395d(a)(5)) is amended to read as follows:
            ``(5) for individuals who have a life expectancy of 18 
        months or less and who have not made an election under 
        subsection (d)(1) to receive hospice care under this part, 
        advanced illness care management services (as defined in 
        section 1861(hhh)).''.
            (2) Definition.--Section 1861 of the Social Security Act 
        (42 U.S.C. 1395x) is amended by adding at the end the following 
        new subsection:

              ``Advanced Illness Care Management Services

    ``(hhh)(1) The term `advanced illness care management services' 
means the following services furnished to an individual by a hospice 
program, as defined in subsection (dd)(2):
            ``(A) Palliative care consultation services.
            ``(B) Care planning services.
            ``(C) Counseling of individual and family members.
            ``(D) Discussions regarding the availability of supportive 
        services (including information on advance care planning).
            ``(E) Patient-centered care.
            ``(F) Family conference services.
            ``(G) Respite services.
            ``(H) Onsite caregiver training.
            ``(I) Such other services as may be appropriate under a 
        hospice model of care.
    ``(2) For purposes of paragraph (1)(F), the term `family conference 
services' means a family conference held by a hospice program (as so 
defined) for the individual and the family members of the individual, 
including services for the facilitation and provision of adequate 
follow-up to such family conference, which includes additional 
collaboration and coordination with the hospice physician or other 
hospice personnel to clarify and put into action the goals of care as 
outlined by the individual and the family members of the individual.
    ``(3)(A) For purposes of paragraph (1)(G), the term `respite 
services' means the provision of additional hours of care to 
individuals who are unable to perform 2 or more activities of daily 
living. Such services shall be targeted toward furnishing services to 
the individual and providing the caregivers of the individual a needed 
break outside of the home of the individual.
    ``(B) For purposes of subparagraph (A), the Secretary shall 
establish, on an annual basis, a minimum and maximum number of hours 
(not to exceed 16 hours each month) for which respite services may be 
provided to individuals eligible to receive such services.
    ``(C) In subparagraph (A), the term `activities of daily living' 
means bathing, transferring, toileting, and feeding.
    ``(4) For purposes of paragraph (1)(H), the term `onsite caregiver 
training' means training provided to the caregivers of an individual, 
which is focused on training such caregivers to provide effective 
personal and technical care to individuals, with an emphasis on what 
the caregiver can expect with the disease process of the individual or 
the needs of the individual at the end of life. Such training shall be 
pragmatic and easily understood by non-health professionals as well as 
culturally and educationally appropriate.
    ``(5) In the case of a hospice program that is furnishing advanced 
illness care management services to an individual who becomes eligible 
for hospice care under this title, the hospice program shall notify the 
individual of such eligibility.''.
            (3) Payment based on the physician fee schedule.--Section 
        1814(i)(4) of the Social Security Act (42 U.S.C. 1395f(i)(4)) 
        is amended to read as follows:
    ``(4) The amount paid to a hospice program with respect to the 
advanced illness care management services (as defined in section 
1861(hhh)) for which payment may be made under this part shall be--
            ``(A) with respect to such services, other than respite 
        services, furnished by a hospice physician, an amount equal to 
        the amount that would be paid for an equivalent physician 
        consultation under the fee schedule established under section 
        1848(b);
            ``(B) with respect to such services, other than respite 
        services, furnished by other hospice personnel, an amount equal 
        to 85 percent of such fee schedule amount; and
            ``(C) with respect to respite services, payment shall be at 
        an appropriate rate to be determined by the Secretary''.
            (4) Conforming amendments.--Section 1862(a) of the Social 
        Security Act (42 U.S.C. 1395y(a)) is amended--
                    (A) in paragraph (1)--
                            (i) by striking ``and'' at the end of 
                        subparagraph (N);
                            (ii) by striking the semicolon at the end 
                        of subparagraph (O) and inserting ``, and''; 
                        and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(P) in the case of advanced illness care 
                management services which are respite services (as 
                defined in section 1861(hhh)(3)), which are performed 
                more frequently than is provided under clause (ii) of 
                such section;''; and
                    (B) in paragraph (7), by striking ``or (K)'' and 
                inserting ``(K), or (P)''.
            (5) Effective date.--The amendments made by this subsection 
        shall apply to services furnished on or after January 1, 2011.
    (b) Medicaid Coverage of Advanced Illness Care Management 
Services.--
            (1) In general.--Section 1905(a) of the Social Security Act 
        (42 U.S.C. 1396d(a)) is amended--
                    (A) by redesignating paragraph (28) as paragraph 
                (29);
                    (B) in paragraph (27), by striking at the end 
                ``and''; and
                    (C) by inserting after paragraph (27) the following 
                new paragraph:
            ``(28) advanced illness care management services (as 
        defined in section 1861(hhh)) for individuals described in 
        section 1812(a)(5); and''.
            (2) Conforming amendment.--Section 1902(a)(10)(A) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by 
        striking ``and (21)'' and inserting ``, (21), and (28)''.
            (3) Effective date.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the amendments made by paragraphs (1) and (2) take 
                effect on January 1, 2011.
                    (B) Extension of effective date for state law 
                amendment.--In the case of a State plan under title XIX 
                of the Social Security Act (42 U.S.C. 1396 et seq.) 
                which the Secretary determines requires State 
                legislation in order for the plan to meet the 
                additional requirements imposed by the amendments made 
                by paragraph (1), the State plan shall not be regarded 
                as failing to comply with the requirements of such 
                title solely on the basis of its failure to meet these 
                additional requirements before the first day of the 
                first calendar quarter beginning after the close of the 
                first regular session of the State legislature that 
                begins after the date of enactment of this Act. For 
                purposes of the previous sentence, in the case of a 
                State that has a 2-year legislative session, each year 
                of the session is considered to be a separate regular 
                session of the State legislature.
    (c) Education on Advanced Illness Care Management Services.--The 
Secretary of Health and Human Services (in this section referred to as 
the ``Secretary'') shall establish a program under which physicians (as 
defined in subsection (r) of section 1861 of the Social Security Act 
(42 U.S.C. 1395x)) are educated on the coverage of advanced illness 
care management services (as defined in subsection (hhh) of such 
section) under the Medicare and Medicaid programs under titles XVIII 
and XIX, respectively, of the Social Security Act (42 U.S.C. 1395 et 
seq.; 1396 et seq.), including the importance of early intervention in 
providing such care to individuals.

SEC. 3. INCREASING AWARENESS OF THE IMPORTANCE OF END-OF-LIFE PLANNING.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following new part:

   ``PART S--PROGRAMS TO INCREASE AWARENESS OF ADVANCE CARE PLANNING 
                                 ISSUES

``SEC. 399GG. ADVANCE CARE PLANNING EDUCATION CAMPAIGNS AND INFORMATION 
              PHONE LINE AND CLEARINGHOUSE.

    ``(a) Advance Care Planning Education Campaign.--The Secretary 
shall, directly or through grants awarded under subsection (c), conduct 
a national public education campaign--
            ``(1) to raise public awareness of the importance of 
        planning for care near the end of life;
            ``(2) to improve the public's understanding of the various 
        situations in which individuals may find themselves if they 
        become unable to express their health care wishes;
            ``(3) to explain the need for readily available legal 
        documents that express an individual's wishes through--
                    ``(A) advance directives (including living wills, 
                comfort care orders, and durable powers of attorney for 
                health care); and
                    ``(B) other planning tools, such as a physician's 
                orders for life-sustaining treatment (POLST); and
            ``(4) to educate the public about the availability of 
        hospice care and palliative care.
    ``(b) Information Phone Line and Clearinghouse.--The Secretary, 
directly or through grants awarded under subsection (c), shall provide 
for the establishment of a national, toll-free, information telephone 
line and a clearinghouse that the public and health care professionals 
may access to find out about State-specific and other information 
regarding advance directive and end-of-life decisions.
    ``(c) Grants.--
            ``(1) In general.--The Secretary shall use funds 
        appropriated under subsection (d) for the purpose of awarding 
        grants to public or nonprofit private entities (including 
        States or political subdivisions of a State), or a consortium 
        of any of such entities, for the purpose of conducting 
        education campaigns under subsection (a).
            ``(2) Period.--Any grant awarded under paragraph (1) shall 
        be for a period of 3 years.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated--
            ``(1) for purposes of carrying out subsection (b), 
        $5,000,000 for fiscal year 2010 and each subsequent year; and
            ``(2) for purposes of making grants under subsection (c), 
        $10,000,000 for fiscal year 2010, to remain available until 
        expended.''.

SEC. 4. INCLUSION OF END-OF-LIFE PLANNING MATERIALS IN THE MEDICARE & 
              YOU HANDBOOK.

    (a) In General.--Section 1804(a) of the Social Security Act (42 
U.S.C. 1395b-2(a)) is amended--
            (1) in paragraph (2), by striking ``and'' at the end;
            (2) in paragraph (3), by striking the period at the end and 
        inserting ``; and''; and
            (3) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) information on advance directives, other end-of-life 
        planning tools, and the hospice care benefit under this 
        title.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to notices distributed on or after January 1, 2011.

SEC. 5. SENIOR NAVIGATION ADVISORY BOARD.

    (a) Establishment.--The Secretary of Health and Human Services 
shall establish the Senior Navigation Advisory Board (in this section 
referred to as the ``Advisory Board'').
    (b) Membership.--The Board shall be comprised of advocates, 
researchers, government officials, health care providers, ethicists, 
caregivers, and other individuals with expertise in issues related to 
end-of-life care.
    (c) Duties.--The Advisory Board shall advise the Secretary on 
issues related to end-of-life care and advance care planning, including 
how to--
            (1) increase patients' quality of life;
            (2) reduce current legal hurdles to the enforcement of 
        advance directives;
            (3) encourage provider participation in educational and 
        training activities surrounding advanced illnesses and end-of-
        life care planning;
            (4) develop quality and outcome measures that hospice 
        programs should report for advanced illness care management 
        services (as defined in section 1861(hhh) of the Social 
        Security Act, as added by section 2);
            (5) determine what information should be discussed in 
        discharge planning; and
            (6) enhance advance care planning.
    (d) Application of FACA.--The Federal Advisory Committee Act (5 
U.S.C. App.) shall apply to the Advisory Board.
    (e) Pay and Reimbursement.--
            (1) No compensation for members of advisory board.--Except 
        as provided in paragraph (2), a member of the Advisory Board 
        may not receive pay, allowances, or benefits by reason of their 
        service on the Board.
            (2) Travel expenses.--Each member shall receive travel 
        expenses, including per diem in lieu of subsistence under 
        subchapter I of chapter 57 of title 5, United States Code.
    (f) Report.--Not later than 3 years after the establishment of the 
Advisory Board, the Advisory Board shall submit to Congress a final 
report containing the findings and conclusions of the Advisory Board, 
together with recommendations for such legislation and administrative 
actions as the Advisory Board considers appropriate.
    (g) Termination.--The Advisory Board shall terminate 30 days after 
submitting the report under subsection (f).
    (h) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 6. REQUIREMENT FOR PHYSICIANS AND NURSE PRACTITIONERS TO PROVIDE 
              CERTAIN MEDICARE BENEFICIARIES WITH INFORMATION ON 
              ADVANCE DIRECTIVES AND OTHER END-OF-LIFE PLANNING TOOLS.

    Section 1834 of the Social Security Act (42 U.S.C. 1395m) is 
amended by adding at the end the following new subsection:
    ``(n) Requirement for Physicians and Nurse Practitioners To Provide 
Certain Individuals With Information on Advance Directives and Other 
End-of-Life Planning Tools.--
            ``(1) In general.--No payment may be made under this title 
        to a physician (as defined in section 1861(r)) or a nurse 
        practitioner (as defined in section 1861(aa)(5)(A)) for items 
        and services furnished on or after January 1, 2014, unless the 
        physician or nurse practitioner agrees (under a process 
        established by the Secretary) to provide individuals described 
        in paragraph (2) with information on advance directives and 
        other end-of-life planning tools. Such information shall be 
        provided in a form and manner, and at a time, determined 
        appropriate by the Secretary.
            ``(2) Individual described.--An individual described in 
        this paragraph is an individual entitled to, or enrolled for, 
        benefits under part A or enrolled for benefits under this part 
        with--
                    ``(A) metastatic solid organ cancer;
                    ``(B) congestive heart failure;
                    ``(C) end stage renal disease;
                    ``(D) a progressive neurodegenerative disorder;
                    ``(E) oxygen dependent chronic pulmonary disease; 
                or
                    ``(F) any other condition with a similar level of 
                medical necessity determined appropriate by the 
                Secretary.''.

SEC. 7. IMPROVEMENT OF POLICIES RELATED TO THE USE AND PORTABILITY OF 
              ADVANCE DIRECTIVES.

    (a) Medicare.--Section 1866(f) of the Social Security Act (42 
U.S.C. 1395cc(f)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (B), by inserting ``and if 
                presented by the individual (or on behalf of the 
                individual), to include the content of such advance 
                directive in a prominent part of such record'' before 
                the semicolon at the end;
                    (B) in subparagraph (D), by striking ``and'' after 
                the semicolon at the end;
                    (C) in subparagraph (E), by striking the period at 
                the end and inserting ``; and''; and
                    (D) by inserting after subparagraph (E) the 
                following new subparagraph:
            ``(F) to provide each individual with the opportunity to 
        discuss issues relating to the information provided to that 
        individual pursuant to subparagraph (A) with an appropriately 
        trained professional.'';
            (2) in paragraph (3), by striking ``a written'' and 
        inserting ``an''; and
            (3) by adding at the end the following new paragraph:
    ``(5)(A) In addition to the requirements of paragraph (1), a 
provider of services, Medicare Advantage organization, or prepaid or 
eligible organization (as the case may be) shall give effect to an 
advance directive executed outside the State in which such directive is 
presented, even one that does not appear to meet the formalities of 
execution, form, or language required by the State in which it is 
presented to the same extent as such provider or organization would 
give effect to an advance directive that meets such requirements, 
except that a provider or organization may decline to honor such a 
directive if the provider or organization can reasonably demonstrate 
that it is not an authentic expression of the individual's wishes 
concerning his or her health care. Nothing in this paragraph shall be 
construed to authorize the administration of medical treatment 
otherwise prohibited by the laws of the State in which the directive is 
presented.
    ``(B) The provisions of this paragraph shall preempt any State law 
to the extent such law is inconsistent with such provisions. The 
provisions of this paragraph shall not preempt any State law that 
provides for greater portability, more deference to a patient's wishes, 
or more latitude in determining a patient's wishes.''.
    (b) Medicaid.--Section 1902(w) of the Social Security Act (42 
U.S.C. 1396a(w)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (B)--
                            (i) by striking ``in the individual's 
                        medical record'' and inserting ``in a prominent 
                        part of the individual's current medical 
                        record''; and
                            (ii) by inserting ``and if presented by the 
                        individual (or on behalf of the individual), to 
                        include the content of such advance directive 
                        in a prominent part of such record'' before the 
                        semicolon at the end;
                    (B) in subparagraph (D), by striking ``and'' after 
                the semicolon at the end;
                    (C) in subparagraph (E), by striking the period at 
                the end and inserting ``; and''; and
                    (D) by inserting after subparagraph (E) the 
                following new subparagraph:
            ``(F) to provide each individual with the opportunity to 
        discuss issues relating to the information provided to that 
        individual pursuant to subparagraph (A) with an appropriately 
        trained professional.'';
            (2) in paragraph (4), by striking ``a written'' and 
        inserting ``an''; and
            (3) by adding at the end the following paragraph:
    ``(6)(A) In addition to the requirements of paragraph (1), a 
provider or organization (as the case may be) shall give effect to an 
advance directive executed outside the State in which such directive is 
presented, even one that does not appear to meet the formalities of 
execution, form, or language required by the State in which it is 
presented to the same extent as such provider or organization would 
give effect to an advance directive that meets such requirements, 
except that a provider or organization may decline to honor such a 
directive if the provider or organization can reasonably demonstrate 
that it is not an authentic expression of the individual's wishes 
concerning his or her health care. Nothing in this paragraph shall be 
construed to authorize the administration of medical treatment 
otherwise prohibited by the laws of the State in which the directive is 
presented.
    ``(B) The provisions of this paragraph shall preempt any State law 
to the extent such law is inconsistent with such provisions. The 
provisions of this paragraph shall not preempt any State law that 
provides for greater portability, more deference to a patient's wishes, 
or more latitude in determining a patient's wishes.''.
    (c) Effective Dates.--
            (1) In general.--Subject to paragraph (2), the amendments 
        made by subsections (a) and (b) shall apply to provider 
        agreements and contracts entered into, renewed, or extended 
        under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
        seq.), and to State plans under title XIX of such Act (42 
        U.S.C. 1396 et seq.), on or after such date as the Secretary of 
        Health and Human Services specifies, but in no case may such 
        date be later than 1 year after the date of enactment of this 
        Act.
            (2) Extension of effective date for state law amendment.--
        In the case of a State plan under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
        Health and Human Services determines requires State legislation 
        in order for the plan to meet the additional requirements 
        imposed by the amendments made by subsection (b), the State 
        plan shall not be regarded as failing to comply with the 
        requirements of such title solely on the basis of its failure 
        to meet these additional requirements before the first day of 
        the first calendar quarter beginning after the close of the 
        first regular session of the State legislature that begins 
        after the date of enactment of this Act. For purposes of the 
        previous sentence, in the case of a State that has a 2-year 
        legislative session, each year of the session is considered to 
        be a separate regular session of the State legislature.

SEC. 8. ADDITIONAL REQUIREMENTS FOR FACILITIES.

    (a) Requirements.--
            (1) In general.--Section 1866(a)(1) of the Social Security 
        Act (42 U.S.C. 1395cc(a)(1)) is amended--
                    (A) in subsection (a)(1)--
                            (i) in subparagraph (U), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (V), by striking the 
                        period at the end and inserting a comma; and
                            (iii) by inserting after subparagraph (V) 
                        the following new subparagraphs:
            ``(W) in the case of hospitals, skilled nursing facilities, 
        home health agencies, and hospice programs, to provide 
        individuals receiving care by or through the provider (and 
        their caregivers and families, with the patient's consent, or 
        their surrogate decision-makers) with the opportunity to 
        discuss the general course of treatment expected, the likely 
        impact on length of life and function, and the procedures they 
        should use to secure help if an unexpected situation arises, 
        and
            ``(X) in the case of hospitals, skilled nursing facilities, 
        and hospice programs, to--
                    ``(i) provide for an assessment of each individual 
                (at the time of discharge from the provider) using an 
                assessment instrument that is at least as informative 
                as the continuity assessment record and evaluation 
                (CARE) instrument developed by the Centers for Medicare 
                & Medicaid Services; and
                    ``(ii) include the results of such assessment in 
                the individual's medical record.''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to agreements entered into or renewed on or after 
        January 1, 2012.
    (b) HHS Study and Report on Appropriate Assessments at Discharge.--
            (1) Study.--The Secretary of Health and Human Services 
        shall conduct a study on the extent to which the assessment of 
        individual by hospitals, skilled nursing facilities, and 
        hospice programs under section 1886(a)(1)(X) of the Social 
        Security Act, as added by subsection (a), accurately reflects 
        the actual diagnosis and care plan of the individual involved 
        at the time of discharge.
            (2) Report.--Not later than January 1, 2014, the Secretary 
        of Health and Human Services shall submit to Congress a report 
        on the study conducted under paragraph (1) together with 
        recommendations for such legislation and administrative action 
        as the Secretary determines to be appropriate.

SEC. 9. REQUIREMENT FOR MEDICARE PROVIDERS TO HONOR WRITTEN ORDERS FOR 
              MEDICAL CARE.

    Section 1834 of the Social Security Act (42 U.S.C. 1395m), as 
amended by section 6, is amended by adding at the end the following new 
subsection:
    ``(o) Requirement To Honor Written Orders for Medical Care.--No 
payment may be made under this title to a provider of services or a 
supplier for items and services furnished on or after January 1, 2013, 
unless the provider or supplier agrees (under a process established by 
the Secretary) to, in the case of an individual with a written order 
for medical care (such as a physician's orders for life-sustaining 
treatment (POLST)), follow such order when furnishing items and 
services to the individual.''.

SEC. 10. INCENTIVES FOR ACCREDITATION AND CERTIFICATION IN HOSPICE AND 
              PALLIATIVE CARE.

    (a) Hospitals.--Section 1886 of the Social Security Act (42 U.S.C. 
1395ww) is amended by adding at the end the following new subsection:
    ``(o) Incentives for Accreditation in Palliative Care.--
            ``(1) Incentive payment.--
                    ``(A) In general.--Subject to subparagraph (3), 
                with respect to inpatient hospital services and 
                inpatient critical access hospital services furnished 
                by an eligible hospital during a payment year, if the 
                eligible hospital has in place an accredited palliative 
                care program (as determined by the Secretary) with 
                respect to such year and meets utilization criteria for 
                such program (as established by the Secretary) with 
                respect to such year, in addition to the amount 
                otherwise paid under this section or section 1814, 
                there shall also be paid to the eligible hospital, from 
                the Federal Hospital Insurance Trust Fund established 
                under section 1817, an amount equal to the applicable 
                percent of the amount that would otherwise be paid 
                under this section or section 1814 for such services 
                for the hospital for such year.
                    ``(B) Applicable percent defined.--The term 
                `applicable percent' means--
                            ``(i) for fiscal years 2011 through 2016, 2 
                        percent; and
                            ``(ii) for fiscal years 2017 through 2020, 
                        1 percent.
                    ``(C) Form of payment.--The payment under this 
                paragraph for a payment year may be in the form of a 
                single consolidated payment or in the form of such 
                periodic installments as the Secretary may specify.
            ``(2) Incentive payment adjustment.--Subject to paragraph 
        (3), with respect to inpatient hospital services and inpatient 
        critical access hospital services furnished by an eligible 
        hospital during a fiscal year after fiscal year 2020, if the 
        eligible hospital does not have in place an accredited 
        palliative care program (as determined by the Secretary) with 
        respect to such fiscal year, the amount otherwise paid under 
        this section or section 1814 for such services for the hospital 
        for the year shall be reduced by 1 percent.
            ``(3) Exception.--In the case of an eligible hospital with 
        fewer than 50 beds, such hospital shall be deemed to meet the 
        requirement in paragraphs (1)(A) and (2) if, in lieu of having 
        in place an accredited palliative care program, the hospital 
        provides patients and family members with access to a local or 
        regional accredited palliative care team or program.
            ``(4) Definitions.--In this subsection:
                    ``(A) Eligible hospital.--The term `eligible 
                hospital' means--
                            ``(i) a hospital (as defined in section 
                        1861(e)); and
                            ``(ii) a critical access hospital (as 
                        defined in section 1861(mm)(1)).
                    ``(B) Payment year.--The term `payment year' means 
                fiscal years 2011 through 2020.
            ``(5) Limitations on review.--There shall be no 
        administrative or judicial review under section 1869, section 
        1878, or otherwise, of--
                    ``(A) the methodology and standards for determining 
                payment amounts under paragraph (1) and payment 
                adjustments under paragraph (2);
                    ``(B) the methodology and standards for determining 
                whether the eligible hospital has in place an 
                accredited palliative care program; and
                    ``(C) the application of the exception under 
                paragraph (3).''.
    (b) Skilled Nursing Facilities.--Section 1888 of the Social 
Security Act (42 U.S.C. 1395yy) is amended by adding at the end the 
following new subsection:
    ``(f) Incentives for Accreditation in Palliative Care.--
            ``(1) Incentive payment.--
                    ``(A) In general.--Subject to subparagraph (3), 
                with respect to covered skilled nursing facility 
                services (as defined in subsection (e)(2)(A)) furnished 
                by a skilled nursing facility during a payment year, if 
                the facility has in place an accredited palliative care 
                program (as determined by the Secretary) with respect 
                to such year and meets utilization criteria for such 
                program (as established by the Secretary) with respect 
                to such year, in addition to the amount otherwise paid 
                under this subsection (e), there shall also be paid to 
                the facility, from the Federal Hospital Insurance Trust 
                Fund established under section 1817, an amount equal to 
                the applicable percent of the amount that would 
                otherwise be paid under subsection (e) for such 
                services for the facility for such year.
                    ``(B) Definitions.--In this subsection:
                            ``(i) Applicable percent.--The term 
                        `applicable percent' means--
                                    ``(I) for fiscal years 2011 through 
                                2016, 2 percent; and
                                    ``(II) for fiscal years 2017 
                                through 2020, 1 percent.
                            ``(ii) Payment year.--The term `payment 
                        year' means fiscal years 2011 through 2020.
                    ``(C) Form of payment.--The payment under this 
                paragraph for a payment year may be in the form of a 
                single consolidated payment or in the form of such 
                periodic installments as the Secretary may specify.
            ``(2) Incentive payment adjustment.--Subject to paragraph 
        (3), with respect to covered skilled nursing facility services 
        (as defined in subsection (e)(2)(A)) furnished by a skilled 
        nursing facility during a fiscal year after fiscal year 2020, 
        if the facility does not have in place an accredited palliative 
        care program (as determined by the Secretary) with respect to 
        such fiscal year, the amount otherwise paid under subsection 
        (e) for such services for the facility for the year shall be 
        reduced by 1 percent.
            ``(3) Exception.--In the case of a skilled nursing facility 
        with fewer than 60 beds, such facility shall be deemed to meet 
        the requirement in paragraphs (1)(A) and (2) if, in lieu of 
        having in place an accredited palliative care program, the 
        facility provides patients and family members with access to a 
        local or regional accredited palliative care team or program.
            ``(4) Limitations on review.--There shall be no 
        administrative or judicial review under section 1869, section 
        1878, or otherwise, of--
                    ``(A) the methodology and standards for determining 
                payment amounts under paragraph (1) and payment 
                adjustments under paragraph (2);
                    ``(B) the methodology and standards for determining 
                whether the skilled nursing facility has in place an 
                accredited palliative care program; and
                    ``(C) the application of the exception under 
                paragraph (3).''.
    (c) Physicians.--Section 1848 of the Social Security Act (42 U.S.C. 
1395w-4) is amended by adding at the end the following new subsection:
    ``(p) Incentives for Certification in Hospice and Palliative 
Care.--
            ``(1) Incentive payment.--
                    ``(A) In general.--With respect to physicians' 
                services furnished by a physician during a payment 
                year, if the physician is certified in hospice and 
                palliative care (as determined by the Secretary) with 
                respect to such year, in addition to the amount 
                otherwise paid under this part, there shall also be 
                paid to the physician, from the Federal Supplementary 
                Medical Insurance Trust Fund established under section 
                1841, an amount equal to the applicable percent of the 
                Secretary's estimate (based on claims submitted not 
                later than 2 months after the end of the payment year) 
                of the allowed charges under this part for all covered 
                professional services (as defined in subsection (k)(3)) 
                furnished by the physician during such year.
                    ``(B) Definitions.--In this subsection:
                            ``(i) Applicable percent.--The term 
                        `applicable percent' means--
                                    ``(I) for 2011 through 2016, 2 
                                percent; and
                                    ``(II) for 2017 through 2020, 1 
                                percent.
                            ``(ii) Payment year.--The term `payment 
                        year' means 2011 through 2020.
                    ``(C) Form of payment.--The payment under this 
                subsection for a payment year may be in the form of a 
                single consolidated payment or in the form of such 
                periodic installments as the Secretary may specify.
            ``(2) Limitations on review.--There shall be no 
        administrative or judicial review under section 1869, section 
        1878, or otherwise, of--
                    ``(A) the methodology and standards for determining 
                payment amounts under paragraph (1); and
                    ``(B) the methodology and standards for determining 
                whether the physician is certified in hospice and 
                palliative care.''.

SEC. 11. DISCHARGE CHECKLIST PILOT PROGRAM.

    (a) Establishment.--Not later than July 1, 2010, the Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary'') shall conduct a pilot program under title XVIII of the 
Social Security Act to test the use of the Centers for Medicare and 
Medicaid Services' discharge checklist included in the publication 
entitled ``Planning for Your Discharge: A checklist for patients and 
caregivers preparing to leave a hospital, nursing home, or other health 
care setting''.
    (b) Waiver Authority.--The Secretary may waive compliance of such 
requirements of titles XI and XVIII of the Social Security Act as the 
Secretary determines necessary to conduct the pilot program under this 
section.
    (c) Report.--Not later than 6 months after the completion of the 
pilot program under this section, the Secretary shall submit to 
Congress a final report on the pilot program, together with 
recommendations for such legislation and administrative action as the 
Secretary determines appropriate.
    (d) Funding.--There are authorized to be appropriated such sums as 
may be necessary for purposes of conducting the pilot program under 
this section.

SEC. 12. OFFICE OF MEDICARE/MEDICAID INTEGRATION.

    (a) Establishment.--The Secretary shall establish or designate an 
Office on Medicare/Medicaid Integration (in this subsection referred to 
as the ``Office'') for the purpose of aligning Medicare and Medicaid 
program policies and procedures and developing tools to support State 
integration efforts in order to--
            (1) simplify dual eligible access to Medicare and Medicaid 
        program benefits and services;
            (2) improve care continuity and ensure safe and effective 
        care transitions;
            (3) eliminate cost shifting between the Medicare and 
        Medicaid programs and among related care providers;
            (4) eliminate regulatory conflicts between Medicare and 
        Medicaid program rules; and
            (5) improve total cost and quality performance.
    (b) Responsibilities.--The responsibilities of the Office are to 
develop policies and procedures to--
            (1) identify incentives for States to advance the 
        integration of the Medicare and Medicaid programs to improve 
        total cost and quality performance, including shared cost 
        savings among consumers, plans, and Federal and State 
        governments with respect to State initiatives for advancing 
        Medicare and Medicaid program integration;
            (2) provide support for coordination of Federal and State 
        contracting and oversight for dual integration programs 
        supportive of the goals described in subsection (a);
            (3) serve as a liaison between Centers for Medicare & 
        Medicaid Services central and regional offices to ensure 
        consistent application of Centers for Medicare & Medicaid 
        Services rules, policies, and auditing practices as such rules, 
        policies, and auditing practices pertain to dual eligibles;
            (4) monitor total combined Medicare and Medicaid program 
        costs in serving dual eligibles and make recommendations for 
        optimizing total quality and cost performance across both 
        programs; and
            (5) identify legislative and administrative changes that 
        are needed to facilitate the integration of benefits and 
        oversight functions of the Medicare and Medicaid programs with 
        respect to dual eligibles.
    (c) Dual Eligible Defined.--In this section, the term ``dual 
eligible'' means an individual who is--
            (1) entitled to, or enrolled for, benefits under part A of 
        title XVIII of the Social Security Act or enrolled for benefits 
        under part B of such title; and
            (2) entitled to medical assistance under a State plan under 
        title XIX of such Act.
    (d) Study.--Not later than January 1, 2011, the Secretary of Health 
and Human Services, in consultation with private health information 
technology stakeholders and in coordination with other Federal health 
information technology efforts, shall conduct a study to determine the 
data that the Office should collect and analyze in order to improve 
health care outcomes, create efficiencies in care delivery, and impact 
Federal health care spending.
    (e) Funding.--There are authorized to be appropriated such sums as 
may be necessary to carry out the provisions of this section.

SEC. 13. WEB-BASED MATERIALS AND GRANTS.

    (a) Web-Based Materials.--The Secretary of Health and Human 
Services (in this section referred to as the ``Secretary'') shall 
establish and maintain a website that provides information, online 
training, and instructional materials for entities, including faith-
based organizations, on end-of-life issues, which shall include content 
addressing--
            (1) advance care planning, including common issues and 
        questions regarding advance directives and their uses;
            (2) hospice benefits under Medicare, Medicaid, and the 
        State Children's Health Insurance Program established under the 
        Social Security Act, including information on how hospice care 
        is administered and provided to terminally ill individuals;
            (3) palliative care, including information on services that 
        palliative care units provide for terminally ill patients; and
            (4) any additional information related to end-of-life care 
        and associated issues, as determined by the Secretary.
    (b) Grants.--
            (1) Hospice care grant program.--
                    (A) Grants authorized.--The Secretary is authorized 
                to award grants to entities, including faith-based 
                organizations, to develop and provide services for 
                terminally ill individuals who are receiving hospice 
                care in their own homes.
                    (B) Requirements.--
                            (i) Duration.--The grant program shall be 
                        conducted for a 5-year period, beginning not 
                        later than January 1, 2011.
                            (ii) Amount of grants.--An entity may be 
                        awarded a grant under this paragraph for a 
                        fiscal year that is not less than $5,000 and 
                        not more than $250,000.
                            (iii) Number of grants.--The Secretary 
                        shall award grants under this paragraph to not 
                        more than 100 entities.
                    (C) Additional medicaid funds.--A State may elect 
                to provide additional funds to recipients of a grant 
                under this section, with such funds to be considered as 
                amounts expended for the proper and efficient 
                administration of the State plan under title XIX of the 
                Social Security Act for purposes of the State receiving 
                payments under section 1903(a)(7) of that Act.
                    (D) Use of funds.--Grants awarded pursuant to this 
                paragraph shall be used by entities to develop and 
                provide end-of-life support services for terminally ill 
                individuals who are receiving care in their own homes, 
                including--
                            (i) support for caregivers;
                            (ii) if the entity is a hospice program 
                        under the Medicare program, any additional 
                        hospice care determined appropriate by the 
                        Secretary; and
                            (iii) any additional end-of-life 
                        information or materials relating to support 
                        services determined appropriate by the 
                        Secretary.
                    (E) Application.--Each entity desiring a grant 
                under this paragraph shall submit an application to the 
                Secretary at such time, in such manner, and accompanied 
                by such information as the Secretary may reasonably 
                require.
                    (F) Authorization of appropriations.--For the 
                purpose of carrying out the grant program established 
                under this paragraph, there is authorized to be 
                appropriated $15,000,000 for the period of fiscal years 
                2011 through 2015.
            (2) End-of-life educational grant program.--
                    (A) Grants authorized.--The Secretary is authorized 
                to award grants to entities, including faith-based 
                organizations and religious educational institutions, 
                to develop and provide appropriate training and 
                educational programs addressing end-of-life care 
                issues.
                    (B) Requirements.--
                            (i) Duration.--The grant program shall be 
                        conducted for a 5-year period, beginning not 
                        later than January 1, 2011.
                            (ii) Amount of grants.--An entity may be 
                        awarded a grant under this paragraph for a 
                        fiscal year that is not less than $5,000, and 
                        not more than $50,000.
                            (iii) Number of grants.--The Secretary 
                        shall award grants under this paragraph to not 
                        more than 100 entities.
                    (C) Use of funds.--Grants awarded pursuant to this 
                paragraph shall be used by entities to develop 
                appropriate training and education programs addressing 
                end-of-life care issues and include such programs as 
                part of their educational curriculum, continuing 
                education programs, or vocational training.
                    (D) Application.--Each entity desiring a grant 
                under this paragraph shall submit an application to the 
                Secretary at such time, in such manner, and accompanied 
                by such information as the Secretary may reasonably 
                require.
                    (E) Authorization of appropriations.--For the 
                purpose of carrying out the grant program established 
                under this paragraph, there is authorized to be 
                appropriated $10,000,000 for the period of fiscal years 
                2011 through 2015.

SEC. 14. HHS STUDY AND REPORT ON THE STORAGE OF ADVANCE DIRECTIVES.

    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study on the best methods of storing completed advance 
directives. Such study shall include an analysis of the feasibility of 
establishing a national registry for completed advance directives, 
taking into consideration the constraints created by the privacy 
provisions enacted as a result of the Health Insurance Portability and 
Accountability Act of 1996 (Public Law 104-191).
    (b) Report.--Not later than January 1, 2012, the Secretary of 
Health and Human Services shall submit to Congress a report on the 
study conducted under subsection (a) together with recommendations for 
such legislation and administrative action as the Secretary determines 
to be appropriate.

SEC. 15. GAO STUDY AND REPORT ON THE PROVISIONS OF, AND AMENDMENTS MADE 
              BY, THIS ACT.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall conduct a 
study on the provisions of, and amendments made by, this Act, including 
the quality and costs (such as patient and family experience, patient 
understanding of treatment choices, and any decrease in avoidable 
hospital admissions) associated with such provisions and such 
amendments.
    (b) Report.--Not later than January 1, 2012, the Comptroller 
General shall submit to Congress a report containing the results of the 
study conducted under subsection (a), together with recommendations for 
such legislation and administrative action as the Comptroller General 
determines appropriate.
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