1.Short
title; table of contents
(a)This Act may be cited
as the Senior Navigation and Planning
Act of 2009
.
(b)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.
2.Medicare and
Medicaid coverage of advanced illness care management services
(a)Medicare
coverage of advanced illness care management services
(1)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)Section
1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the
end the following new subsection:
(hhh)Advanced illness care management
services(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 scheduleSection 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)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)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)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)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)
(A)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 amendmentIn 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 servicesThe 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.
3.Increasing awareness of the importance of
end-of-life planningTitle 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:
SPROGRAMS TO INCREASE AWARENESS OF ADVANCE
CARE PLANNING ISSUES
399GG.Advance care planning education campaigns
and information phone line and clearinghouse
(a)Advance care planning education
campaignThe 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
clearinghouseThe 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)
(1)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)Any grant awarded under paragraph (1) shall
be for a period of 3 years.
(d)Authorization of
appropriationsThere 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.
.
4.Inclusion of
end-of-life planning materials in the Medicare & You handbook
(a)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)The amendments made by this section shall apply to notices
distributed on or after January 1, 2011.
5.Senior
Navigation Advisory Board
(a)The
Secretary of Health and Human Services shall establish the Senior Navigation
Advisory Board (in this section referred to as the Advisory
Board).
(b)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)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)The Federal Advisory Committee Act (5 U.S.C. App.) shall
apply to the Advisory Board.
(e)
(1)No compensation
for members of Advisory BoardExcept 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)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)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)The
Advisory Board shall terminate 30 days after submitting the report under
subsection (f).
(h)Authorization
of appropriationsThere are authorized to be appropriated such
sums as may be necessary to carry out this section.
6.Requirement for
physicians and nurse practitioners to provide certain Medicare beneficiaries
with information on advance directives and other end-of-life planning
toolsSection 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)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)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.
.
7.Improvement of policies related to the use
and portability of advance directives
(a)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)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)
(1)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
amendmentIn 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.
8.Additional
requirements for facilities
(a)
(1)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)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)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)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.
9.Requirement for
Medicare providers To honor written orders for medical careSection 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 careNo 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.
.
10.Incentives for
accreditation and certification in hospice and palliative care
(a)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)
(A)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 definedThe term applicable percent
means—
(i)for fiscal years
2011 through 2016, 2 percent; and
(ii)for fiscal years
2017 through 2020, 1 percent.
(C)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 adjustmentSubject 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)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)In
this subsection:
(A)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)The term payment year means fiscal years 2011
through 2020.
(5)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
facilitiesSection 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)
(A)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)In
this subsection:
(i)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)The term payment year means fiscal years 2011
through 2020.
(C)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 adjustmentSubject 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)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)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)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)
(A)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)In
this subsection:
(i)The term applicable percent
means—
(I)for 2011 through
2016, 2 percent; and
(II)for 2017 through
2020, 1 percent.
(ii)The term payment year means 2011 through
2020.
(C)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)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.
.
11.Discharge
checklist pilot program
(a)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)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)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)There
are authorized to be appropriated such sums as may be necessary for purposes of
conducting the pilot program under this section.
12.Office of
Medicare/Medicaid Integration
(a)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)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)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)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)There
are authorized to be appropriated such sums as may be necessary to carry out
the provisions of this section.
13.Web-based
materials and grants
(a)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)
(1)Hospice Care
Grant Program
(A)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)
(i)The
grant program shall be conducted for a 5-year period, beginning not later than
January 1, 2011.
(ii)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)The Secretary shall award grants under this paragraph to
not more than 100 entities.
(C)Additional
Medicaid FundsA 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)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)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 AppropriationsFor 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)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)
(i)The
grant program shall be conducted for a 5-year period, beginning not later than
January 1, 2011.
(ii)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)The Secretary shall award grants under this paragraph to
not more than 100 entities.
(C)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)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 AppropriationsFor 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.
14.HHS study and report on the storage of
advance directives
(a)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)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.
15.GAO study and
report on the provisions of, and amendments made by, this Act
(a)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)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.