1.Short
title; table of contents
(a)This Act may be cited
as the Senior Navigation and Planning
Act of 2012
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of
contents.
Sec. 2. Findings.
Sec. 3. Medicare and Medicaid coverage of advanced illness care
coordination services.
Sec. 4. Increasing awareness of the importance of advance care
planning.
Sec. 5. Inclusion of advance care planning materials in the
Medicare & You handbook.
Sec. 6. Senior Navigation Advisory Board.
Sec. 7. Improvement of policies related to the use and
portability of advanced directives.
Sec. 8. Additional requirements for facilities.
Sec. 9. Incentives for accreditation and certification in
hospice and palliative care.
Sec. 10. Discharge checklist pilot program.
Sec. 11. Web-based materials and grants.
Sec. 12. HHS study and report on the storage of advanced
directives.
Sec. 13. GAO study and report on the provisions of, and
amendments made by, this Act.
2.Congress makes the following
findings:
(1)Whereas the
population of the United States is estimated to age rapidly, with the number of
people over the age of 65 set to double to more than 72,000,000, or 1 in 5
Americans, over the next two decades.
(2)Whereas Americans
today are living longer and healthier lives than ever before in the history of
the United States yet are also facing increased incidence of multiple chronic
conditions as aging progresses. Advanced illness occurs when one or more
conditions become serious enough that general health and functioning decline
and quality of life increasingly becomes the primary focus of care.
(3)Whereas older
Americans with advanced illness face an increasingly complicated and fragmented
system of care delivery and are at greater risk for repeat hospitalizations,
adverse drug reactions, and conflicting medical advice that may be overwhelming
to individuals and families.
(4)Whereas the
progression of advanced illness over time leads to more intense needs that
require greater time and assistance from that individual's caregiver, be it a
family member or a direct care worker and significantly increased medical
needs, including the need to see multiple specialists across the health care
system, which often results in uncoordinated care, making individuals more
prone to adverse health outcomes, increased frustration, and decreased
satisfaction.
(5)Whereas advanced
illness imposes financial and emotional burdens on families, friends, and
co-workers, in addition to leading to billions per year in lost productivity
due to caregivers having to take time off of work to care for frail and elderly
loved ones.
(6)Whereas numerous
private sector leaders, including hospitals, health systems, home health
agencies, hospice programs, long-term care providers, employers, and other
entities, have put in place innovative solutions to providing more
comprehensive and coordinated care for Americans living with advanced
illness.
(7)Whereas hospice
programs, as one of the longest standing Medicare care coordination benefits
that entails administering a comprehensive set of services via an
interdisciplinary team working to provide person-centered care to the frailest
and most vulnerable individuals in our communities, can help serve as a model
for advanced illness care delivery.
(8)Whereas the
Government of the United States, as the Nation’s largest purchaser of health
care services, must learn from these innovators and encourage health care
providers to furnish more supportive and comprehensive advanced illness care
coordination services to improve individual's experiences and ensure a more
sustainable system of care delivery for generations of Americans to
come.
3.Medicare and
Medicaid coverage of advanced illness care coordination services
(a)Medicare
coverage of advanced illness care coordination 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
with advanced illness (as determined under section 1861(iii)(2)) who have not
made an election under subsection (d)(1) to receive hospice care under this
part, advanced illness care coordination services (as defined in section
1861(iii)(1)).
.
(2)Section
1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the
end the following new subsection:
(iii)Advanced illness care coordination
services(1)The term advanced
illness care coordination services means the following services
furnished to an individual with advanced illness by an applicable
provider:
(A)Palliative care consultation
services.
(B)Person and family centered care
planning services, including information on advance care planning.
(C)Medication management.
(D)Individual and family counseling
services, including assistance with the identification of care options and the
goals of care.
(E)Culturally and educationally
appropriate family caregiver training and support services, including respite
services.
(F)Such other services the Secretary may
specify.
(2)(A)An individual is
considered to have advanced illness if the individual has a
medical prognosis that the individual's life expectancy is 18 months or less or
meets other criteria specified by the Secretary in accordance with subparagraph
(B).
(B)In specifying criteria under
subparagraph (A), the Secretary shall consider—
(i)the severity of illness, including the
diagnosis, stage, comorbidities, functional status, hospitalization, and other
objective factors determined appropriate by the Secretary;
(ii)the acuity of illness, as measured by
the progression of illness and disability over the immediately preceding 30-
and 90-day periods; and
(iii)treatment response, such as, in the
case of cancer, resistance to chemotherapy.
(3)For purposes of this subsection, the
term applicable provider means—
(A)a hospice program (as defined in
subsection (dd)(2)); or
(B)other provider of services or supplier
specified by the Secretary.
(4)In the case of an applicable provider
that is furnishing advanced illness care coordination services to an individual
who becomes eligible for hospice care under this title, the applicable provider
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 an applicable
provider with respect to advanced illness care coordination services (as
defined in section 1861(iii)) for which payment may be made under this part
shall be—
(A)with respect to such services
furnished by a physician, an amount equal to the amount that would be paid for
an equivalent physician's service under the fee schedule established under
section 1848(b);
(B)with respect to such services, other
than respite services, furnished by a non-physician practitioner, an amount
equal to the amount that would be paid for an equivalent service under section
1833(a)(1)(O); and
(C)with respect to respite services,
payment shall be at an appropriate rate to be determined by the
Secretary
.
(4)The amendments made by this subsection shall apply to
services furnished on or after January 1, 2013.
(b)Medicaid
coverage of advanced illness care coordination services
(1)Section 1905(a) of
the Social Security Act (42 U.S.C. 1396d(a)) is amended—
(A)by redesignating
paragraph (29) as paragraph (30);
(B)in paragraph (28),
by striking at the end and
; and
(C)by inserting after
paragraph (28) the following new paragraph:
(29)advanced illness care coordination services
(as defined in section 1861(iii)) 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 (28)
and
inserting , (28), and (29)
.
(3)
(A)Except as provided in subparagraph (B), the amendments
made by paragraphs (1) and (2) take effect on January 1, 2013.
(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 paragraphs
(1) and (2), 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 coordination 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 coordination
services (as defined in subsection (iii) 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.
4.Increasing awareness of the importance of
advance care 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:
WPROGRAMS TO INCREASE AWARENESS OF ADVANCE
CARE PLANNING ISSUES
399OO.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 throughout the life cycle and as illness
progresses;
(2)to explain the need for readily available
legal documents and medical orders 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 Physician’s Orders for Life-Sustaining Treatment (POLST) or a
State authorized portable order; and
(3)to educate the public about the
availability of advanced illness care, palliative care, and hospice
care.
(b)The Secretary, directly or through grants
awarded under subsection (c), shall provide for multiple, innovative
communications resources, including a toll-free information telephone line,
that the public and health care professionals may access to find out about
State-specific information regarding advance directives 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 2013 and each subsequent year; and
(2)for purposes of making grants under
subsection (c), $10,000,000 for fiscal year 2013, to remain available until
expended.
.
5.Inclusion of
advance care 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
advanced illness care coordination, palliative care, 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, 2013.
6.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, consumer representatives, researchers,
government officials, health care providers, ethicists, members of the
faith-based community, family caregivers, medical providers, 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)improve the
quality of life for beneficiaries;
(2)reduce current
legal barriers to the enforcement of advance directives;
(3)encourage
provider participation in educational and training activities surrounding
advanced illnesses and personal care planning;
(4)develop quality
and outcome measures that applicable programs should report for advanced
illness care coordination services (as defined in section 1861(iii) of the
Social Security Act, as added by section 3);
(5)determine what
information should be discussed in discharge planning;
(6)enhance advance
care planning; and
(7)develop and
sustain an optimal service array for implementing quality care coordination
services.
(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.
7.Improvement of policies related to the use
and portability of advanced 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)—
(i)by inserting paragraph (5) and
applicable
after requirements of
; and
(ii)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)An advance directive or State authorized
portable order validly executed outside of the State in which the directive or
order is presented shall be given effect by a provider of services or
organization (as the case may be) to the same extent as an advance directive or
order validly executed under the law of the State in which it is
presented.
(B)In the absence of knowledge to the
contrary, a physician or other health care provider or a provider of services
or organization may presume that a written advance health care directive or
similar instrument or a State authorized portable order, regardless of where
executed, is valid.
(C)In the absence of a validly executed
advance directive or State authorized portable order, a provider of services or
organization shall honor any authentic expression of an individual’s wishes
with respect to health care.
(D)The provisions of this paragraph shall
preempt any State law with respect to advance directive portability to the
extent such law is inconsistent with such provisions. Nothing in this paragraph
shall be construed to authorize the administration of health care treatment
otherwise prohibited by the laws of the State in which the directive is
presented.
.
(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)—
(i)by inserting paragraph (6) and
applicable
after requirements of
; and
(ii)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)An advance directive or State authorized
portable order validly executed outside of the State in which the directive is
presented shall be given effect by a provider of services or organization (as
the case may be) to the same extent as an advance directive or order validly
executed under the law of the State in which it is presented.
(B)In the absence of knowledge to the
contrary, a physician or other health care provider or a provider of services
or organization may presume that a written advance health care directive or
similar instrument or a State authorized portable order, regardless of where
executed, is valid.
(C)In the absence of a validly executed
advance directive or State authorized portable order, a provider of services or
organization shall honor any authentic expression of an individual’s wishes
with respect to health care.
(D)The provisions of this paragraph shall
preempt any State law with respect to advance directive portability to the
extent such law is inconsistent with such provisions. Nothing in this paragraph
shall be construed to authorize the administration of health care treatment
otherwise prohibited by the laws of the State in which the directive is
presented.
.
(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 subparagraph
(V), by striking and
at the end;
(B)in subparagraph
(W), as added by section 3005(1)(C) of the Patient Protection and Affordable
Care Act (Public Law 111–148), by redesignating such subparagraph as
subparagraph (X), moving such subparagraph to follow subparagraph (V), moving
such subparagraph 2 ems to the left, and striking the period at the end and
inserting a comma;
(C)in subparagraph
(W), as added by section 6406(b)(3) of the Patient Protection and Affordable
Care Act (Public Law 111–148), by redesignating such subparagraph as
subparagraph (Y), moving such subparagraph to follow subparagraph (X), as added
by subparagraph (B), moving such subparagraph 2 ems to the left, and striking
the period at the end and inserting , and
; and
(D)by inserting
after subparagraph (Y) the following new subparagraphs:
(Z)in the case of hospitals, skilled
nursing facilities, home health agencies, and hospice programs, to provide an
individual (and the caregivers and family of the individual, with the
individual’s consent, and the legal representative of the individual) who is
receiving care by or through the provider 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
(AA)in the case of hospitals, skilled
nursing facilities, home health agencies, hospice programs, and applicable
providers of advanced illness care coordination services (as defined in section
1861(iii)(3)) 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, 2014.
(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 individuals by
hospitals, skilled nursing facilities, hospice programs, home health agencies,
and applicable providers of advanced illness care coordination services under
section 1886(a)(1)(AA) of the Social Security Act, as added by subsection (a),
accurately reflects the actual diagnosis and care plan, including care
coordination, of the individual at the time of discharge. Such study shall
include an analysis of how successful the hospital, skilled nursing facility,
hospice program, home health agency, or applicable provider is in converting
care goals and preferences expressed by the individual into a valid advance
directive.
(2)Not later than January 1, 2016, 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.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:
(t)Incentives for
accreditation in palliative care
(1)
(A)Subject to paragraph (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
2013 through 2018, 2 percent; and
(ii)for fiscal years
2019 through 2022, 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 2022,
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
individuals 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 2013
through 2022.
(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:
(g)Incentives for
accreditation in palliative care
(1)
(A)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 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
2013 through 2018, 2 percent; and
(II)for fiscal years
2019 through 2022, 1 percent.
(ii)The term payment year means fiscal years 2013
through 2022.
(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
2022, 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 individuals 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:
(q)Incentives for
certification in hospice and palliative care
(1)
(A)With respect to physician's 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 2013 through
2018, 2 percent; and
(II)for 2019 through
2022, 1 percent.
(ii)The term payment year means 2013 through
2022.
(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.
.
10.Discharge
checklist pilot program
(a)Not
later than July 1, 2013, 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
individuals and caregivers preparing to leave a hospital, nursing home, or
other health care setting and the continuity assessment record and
evaluation (CARE) instrument development by the Centers for Medicare and
Medicaid Services.
(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.
11.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 Web site that provides information, online training, and instructional
materials for entities, including faith-based organizations, on advance care
planning, which shall include content addressing—
(1)advance care
planning, including common issues and questions regarding advance directives
and their uses;
(2)Physician Orders
for Life-Sustaining Treatment (POLST);
(3)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;
(4)palliative care,
including information on services that palliative care consultation teams and
designated units provide for terminally ill individuals; and
(5)any additional
information related to advanced progressive conditions 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, 2013.
(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 (42 U.S.C. 1396b(a)(7)).
(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
family or other designated caregivers; and
(ii)any additional
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 2013 through
2017.
(2)Advanced
illness care 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 the care of individuals with advanced illness.
(B)
(i)The
grant program shall be conducted for a 5-year period, beginning not later than
January 1, 2013.
(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 care
of individuals with advanced illness 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 2013 through
2017.
12.HHS study and report on the storage of
advanced directives
(a)The Secretary of Health and Human Services
shall conduct a study on State and regional activities with respect to storing
completed advance directives and Physician Orders for Life-Sustaining
Treatment. Such study shall include an analysis of the practicality and
feasibility of establishing a national registry for completed advance
directives and Physician Orders for Life-Sustaining Treatment, 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, 2015, 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.
13.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
individual and family experience, individual understanding of treatment
choices, and any decrease in avoidable hospital admissions) associated with
such provisions and such amendments.
(b)Not
later than January 1, 2015, 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.