[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2966 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 2966

 To improve the understanding and coordination of critical care health 
                               services.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 20, 2014

  Ms. Baldwin (for herself and Mr. Portman) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To improve the understanding and coordination of critical care health 
                               services.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Critical Care Assessment and 
Improvement Act of 2014''.

SEC. 2. FINDINGS; PURPOSES.

    (a) Findings.--Congress finds the following:
            (1) Critical care medicine is the care for patients whose 
        illnesses or injuries present a significant danger to life, 
        limb, or organ function and require comprehensive care and 
        constant monitoring, usually in intensive care units (ICUs).
            (2) Each year, approximately 5,000,000 people in the United 
        States are admitted into adult medical, surgical, pediatric, or 
        neonatal ICUs.
            (3) Critical care medicine encompasses a wide array of 
        diseases and health issues. The care provided in the ICU is 
        highly specialized and complex due to the extreme severity of 
        illness of its patient population, often involving multiple 
        disease processes in different organ systems at the same time.
            (4) Critical care medicine consumes a significant amount of 
        financial resources, accounting for more than 17 percent of all 
        hospital costs.
            (5) According to a 2006 report by the Health Resources and 
        Services Administration (referred to in this section as 
        ``HRSA''), demand in the United States for critical care 
        medical services is on the rise, due in part to the growing 
        elderly population, as individuals over the age of 65 consume a 
        large percentage of critical care services.
            (6) The HRSA report also found that the growing aging 
        population will further exacerbate an existing shortage of 
        intensivists, the physicians certified in critical care who 
        primarily deliver care in intensive care units, potentially 
        compromising the quality and availability of care. Today, 
        intensivist-led teams treat only one-third of critically ill 
        patients despite substantial evidence that these teams lead to 
        improved outcomes.
            (7) Ensuring the strength of our critical care medical 
        delivery infrastructure is integral to the improvement of the 
        quality and delivery of health care in the United States.
    (b) Purpose.--The purpose of this Act is to assess the current 
state of the United States critical care medical delivery system and 
implement policies to improve the quality and effectiveness of care 
delivered to the critically ill and injured.

SEC. 3. STUDIES ON CRITICAL CARE.

    (a) Institute of Medicine Study.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this Act referred to as the ``Secretary'') shall enter into 
        an agreement with the Institute of Medicine under which, not 
        later than 1 year after the date of the enactment of this Act, 
        the Institute will--
                    (A) conduct an analysis of the current state of 
                critical care health services in the United States;
                    (B) develop recommendations to bolster critical 
                care capabilities to meet future demand; and
                    (C) submit to Congress a report including the 
                analysis and recommendations under subparagraphs (A) 
                and (B).
            (2) Issues to be studied.--The agreement under paragraph 
        (1) shall, at a minimum, provide for the following:
                    (A) Analysis of the current critical care system in 
                the United States, including--
                            (i) the system's capacity and resources, 
                        including the size of the critical care 
                        workforce and the availability of health 
                        information technology and medical equipment;
                            (ii) the system's strengths, limitations, 
                        and future challenges; and
                            (iii) the system's ability to provide 
                        adequate care for the critically ill or injured 
                        in response to a national health emergency, 
                        including a pandemic or natural disaster.
                    (B) Analysis and recommendations regarding 
                regionalizing critical care systems.
                    (C) Analysis regarding the status of critical care 
                research in the United States and recommendations for 
                future research priorities.
    (b) Health Resources and Services Administration Study.--
            (1) In general.--The Secretary shall review and update the 
        Health Resources and Services Administration's 2006 study 
        entitled ``The Critical Care Workforce: A Study of the Supply 
        and Demand for Critical Care Physicians''.
            (2) Scope.--In carrying out paragraph (1), the Secretary 
        shall expand the scope of the study to address the supply and 
        demand of other providers within the spectrum of critical care 
        delivery, such as critical care nurses, mid-level providers 
        (such as physician assistants and nurse practitioners), 
        intensive care unit pharmacists, and intensive care unit 
        respiratory care practitioners.

SEC. 4. NIH CRITICAL CARE COORDINATING WORKING GROUP.

    (a) Establishment.--The Secretary shall establish a working group 
within the National Institutes of Health to be known as the Critical 
Care Coordinating Working Group (in this section referred to as the 
``Working Group'').
    (b) Membership.--The Secretary shall ensure that the membership of 
the Working Group includes representatives throughout the National 
Institutes of Health and any other component of the Department of 
Health and Human Services, as the Secretary determines appropriate to 
increase agency coordination on critical care, and based on existing 
resources, such as--
            (1) the National Heart, Lung, and Blood Institute;
            (2) the National Institute of Nursing Research;
            (3) the Eunice Kennedy Shriver National Institute of Child 
        Health and Human Development;
            (4) the National Institute of General Medical Sciences;
            (5) the National Institute on Aging; and
            (6) the National Institute of Minority Health.
    (c) Duties.--The Working Group shall--
            (1) serve as the focal point and catalyst across the 
        National Institutes of Health and any other component of the 
        Department of Health and Human Services, as the Secretary 
        determines appropriate for advancing research and research 
        training in the critical care setting;
            (2) coordinate funding opportunities that involve multiple 
        components of the Department of Health and Human Services;
            (3) catalyze the development of new funding opportunities;
            (4) inform investigators about funding opportunities in 
        their areas of interest;
            (5) represent the National Institutes of Health in 
        government-wide efforts to improve the Nation's critical care 
        system;
            (6) coordinate the collection and analysis of information 
        on current research of the National Institutes of Health 
        relating to the care of the critically ill and injured and 
        identify gaps in such research;
            (7) provide an annual report to the Director of the 
        National Institutes of Health regarding research efforts of the 
        Institutes relating to the care of the critically ill and 
        injured; and
            (8) make recommendations in each such report on how to 
        strengthen partnerships within the National Institutes of 
        Health and between the Department of Health and Human Services 
        and public and private entities to expand collaborative, cross-
        cutting research.

SEC. 5. CENTERS FOR MEDICARE AND MEDICAID INNOVATION CRITICAL CARE 
              DEMONSTRATION PROJECT.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall carry out a demonstration 
project under Section 1115A of the Social Security Act (42 U.S.C. 
1315a), designed to improve the quality and efficiency of care provided 
to critically ill and injured patients receiving critical care in 
intensive care units or other areas of acute care hospitals.
    (b) Activities Under Demonstration Project.--The activities 
conducted under the demonstration project under subsection (a) may, in 
addition to any other activity specified by the Center for Medicare and 
Medicaid Innovation, include activities that seek to--
            (1) improve the coordination and transitions of care to and 
        from an intensive care unit and the next point of care;
            (2) incorporate value-based purchasing methodologies or 
        novel informatics, monitoring, or other methodologies to 
        eliminate error, improve outcomes, and reduce waste from the 
        delivery of critical care;
            (3) improve prediction models that help health care 
        providers and hospitals identify patients at high risk for 
        requiring critical care services and streamline care delivery 
        to prevent unexpected hospital readmissions for critical 
        illnesses; and
            (4) utilize bundled payment approaches and incentive care 
        redesign, such as efforts to facilitate and support 
        comprehensive team delivered care.
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