[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 641 Introduced in Senate (IS)]

113th CONGRESS
  1st Session
                                 S. 641

   To amend the Public Health Service Act to increase the number of 
   permanent faculty in palliative care at accredited allopathic and 
 osteopathic medical schools, nursing schools, and other programs, to 
 promote education in palliative care and hospice, and to support the 
    development of faculty careers in academic palliative medicine.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 21, 2013

  Mr. Wyden (for himself and Mr. Reed) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act to increase the number of 
   permanent faculty in palliative care at accredited allopathic and 
 osteopathic medical schools, nursing schools, and other programs, to 
 promote education in palliative care and hospice, and to support the 
    development of faculty careers in academic palliative medicine.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Palliative Care and Hospice 
Education and Training Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Health care providers need better education about pain 
        management and palliative care. Students graduating from 
        medical school have very little, if any, training in the core 
        precepts of pain and symptom management, advance care planning, 
        communication skills, and care coordination for patients with 
        serious, life-threatening, or terminal illness.
            (2) Palliative care is interdisciplinary, patient- and 
        family-centered health care for people with serious illnesses. 
        This type of care is focused on providing patients with relief 
        from the symptoms, pain, and stress of a serious illness, 
        whatever the diagnosis. The goal of palliative care is to 
        relieve suffering and improve quality of life for both patients 
        and their families. Palliative care is provided by a team of 
        doctors, nurses, social workers, chaplains, and other 
        specialists who work with a patient's other health care 
        providers to provide an extra layer of support, including 
        assistance with difficult medical decisionmaking and 
        coordination of care among specialists. Palliative care is 
        appropriate at any age and at any stage in a serious illness, 
        and can be provided together with curative treatment. 
        Palliative care is not dependent on a life-limiting prognosis 
        and may actually help an individual recover from illness by 
        relieving symptoms, such as pain, anxiety, or loss of appetite, 
        while undergoing sometimes difficult medical treatments or 
        procedures, such as surgery or chemotherapy. There were 1,623 
        hospitals with palliative care programs in 2012.
            (3) Hospice is palliative care for patients in their last 
        year of life. Considered the model for quality compassionate 
        care for individuals facing a life-limiting illness, hospice 
        provides expert medical care, pain management, and emotional 
        and spiritual support expressly tailored to the patient's needs 
        and wishes. In most cases, care is provided in the patient's 
        home but may also be provided in freestanding hospice centers, 
        hospitals, nursing homes, and other long-term care facilities. 
        In 2011, an estimated 1,650,000 patients received services from 
        hospice, and nearly 45 percent of all deaths in the United 
        States occurred under the care of a hospice program. Hospice is 
        a covered benefit under the Medicare program. There were 3,630 
        Medicare-certified hospices serving more than 1,200,000 
        beneficiaries in 2011.
            (4) A 2005 study at Michigan State University found that 
        the formal training of United States doctors in palliative care 
        is ``grossly inadequate''. When the American Society of 
        Clinical Oncology surveyed their members, 65 percent said they 
        had received inadequate education in controlling symptoms 
        associated with cancer, and 81 percent felt they had inadequate 
        mentoring in discussing a poor prognosis with their patients 
        and families. Training in pediatric palliative care is also 
        seriously lacking according to physicians, residents, and 
        medical students responding to a survey presented at a meeting 
        of American Federation for Medical Research.
            (5) The American Board of Medical Specialties (ABMS) and 
        the Accreditation Council for Graduate Medical Education 
        (ACGME) provided formal subspecialty status for hospice and 
        palliative medicine (HPM) in 2006, and the Centers for Medicare 
        & Medicaid Services recognized hospice and palliative medicine 
        as a medical subspecialty in October of 2008.
            (6) As of February 2013, there were a total of 89 hospice 
        and palliative medicine training programs accredited by the 
        Accreditation Council for Graduate Medical Education. For the 
        2012-2013 academic year, these programs were training 206 
        physicians in hospice and palliative medicine. Some programs 
        include an additional track in research, geriatrics, or public 
        health.
            (7) There is a large gap between those practicing in the 
        palliative medicine field and the number of physicians needed. 
        A mid-range estimate by the American Academy of Hospice and 
        Palliative Medicine's Workforce Task Force calls for 6,000 or 
        more full time equivalents to serve current needs in hospice 
        and palliative care programs. At maximum capacity, the current 
        system would produce roughly 4,600 new hospice and palliative 
        medicine certified physicians over the next 20 years, during 
        which time some 70,000,000 new Medicare beneficiaries will 
        enter the Medicare program. At the same time, there is expected 
        to be increasing acceptance of the hospice and palliative 
        approach to care among the general population and health care 
        providers.

SEC. 3. PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING.

    (a) In General.--Part D of title VII of the Public Health Service 
Act (42 U.S.C. 294 et seq.) is amended by adding at the end the 
following:

``SEC. 759A. PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING.

    ``(a) Palliative Care and Hospice Education Centers.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts under this section to entities described in paragraph 
        (1), (3), or (4) of section 799B, and section 801(2), for the 
        establishment or operation of Palliative Care and Hospice 
        Education Centers that meet the requirements of paragraph (2).
            ``(2) Requirements.--A Palliative Care and Hospice 
        Education Center meets the requirements of this paragraph if 
        such Center--
                    ``(A) improves the training of health professionals 
                in palliative care, including residencies, 
                traineeships, or fellowships;
                    ``(B) develops and disseminates curricula relating 
                to the palliative treatment of the complex health 
                problems of individuals with serious or life-
                threatening illnesses;
                    ``(C) supports the training and retraining of 
                faculty to provide instruction in palliative care;
                    ``(D) supports continuing education of health 
                professionals who provide palliative care to patients 
                with serious or life-threatening illness;
                    ``(E) provides students (including residents, 
                trainees, and fellows) with clinical training in 
                palliative care in the home, long-term care facilities, 
                home care, hospices, chronic and acute disease 
                hospitals, and ambulatory care centers;
                    ``(F) establishes traineeships for individuals who 
                are preparing for advanced education nursing degrees in 
                palliative care nursing, home care, hospice, in the 
                home, long-term care, or other nursing areas that 
                specialize in palliative care; and
                    ``(G) does not duplicate the activities of existing 
                education centers funded under this section or under 
                section 753 or 865.
            ``(3) Expansion of existing centers.--Nothing in this 
        section shall be construed to--
                    ``(A) prevent the Secretary from providing grants 
                to expand existing education centers, including 
                geriatric education centers established under section 
                753 or 865, to provide for education and training 
                focused specifically on palliative care, including for 
                non-geriatric populations; or
                    ``(B) limit the number of education centers that 
                may be funded in a community.
    ``(b) Palliative Medicine Physician Training.--
            ``(1) In general.--The Secretary may make grants to, and 
        enter into contracts with, schools of medicine, schools of 
        osteopathic medicine, teaching hospitals, and graduate medical 
        education programs, for the purpose of providing support for 
        projects that fund the training of physicians (including 
        residents, trainees, and fellows) who plan to teach palliative 
        medicine.
            ``(2) Requirements.--Each project for which a grant or 
        contract is made under this subsection shall--
                    ``(A) be staffed by full-time teaching physicians 
                who have experience or training in palliative medicine;
                    ``(B) be based in a hospice and palliative medicine 
                fellowship program accredited by the Accreditation 
                Council for Graduate Medical Education;
                    ``(C) provide training in palliative medicine 
                through a variety of service rotations, such as 
                consultation services, acute care services, extended 
                care facilities, ambulatory care and comprehensive 
                evaluation units, hospice, home health, and community 
                care programs;
                    ``(D) develop specific performance-based measures 
                to evaluate the competency of trainees; and
                    ``(E) provide training in palliative medicine 
                through one or both of the training options described 
                in subparagraphs (A) and (B) of paragraph (3).
            ``(3) Training options.--The training options referred to 
        in subparagraph (E) of paragraph (2) shall be as follows:
                    ``(A) 1-year retraining programs in hospice and 
                palliative medicine for physicians who are faculty at 
                schools of medicine and osteopathic medicine, or others 
                determined appropriate by the Secretary.
                    ``(B) 1- or 2-year training programs that shall be 
                designed to provide training in hospice and palliative 
                medicine for physicians who have completed graduate 
                medical education programs in any medical specialty 
                leading to board eligibility in hospice and palliative 
                medicine pursuant to the American Board of Medical 
                Specialties.
            ``(4) Definitions.--For purposes of this subsection the 
        term `graduate medical education' means a program sponsored by 
        a school of medicine, a school of osteopathic medicine, a 
        hospital, or a public or private institution that--
                    ``(A) offers postgraduate medical training in the 
                specialties and subspecialties of medicine; and
                    ``(B) has been accredited by the Accreditation 
                Council for Graduate Medical Education or the American 
                Osteopathic Association through its Committee on 
                Postdoctoral Training.
    ``(c) Palliative Medicine and Hospice Academic Career Awards.--
            ``(1) Establishment of program.--The Secretary shall 
        establish a program to provide awards, to be known as the 
        `Palliative Medicine and Hospice Academic Career Awards', to 
        eligible individuals to promote the career development of such 
        individuals as academic hospice and palliative care physicians.
            ``(2) Eligible individuals.--To be eligible to receive an 
        award under paragraph (1), an individual shall--
                    ``(A) be board certified or board eligible in 
                hospice and palliative medicine; and
                    ``(B) have a junior (non-tenured) faculty 
                appointment at an accredited (as determined by the 
                Secretary) school of medicine or osteopathic medicine.
            ``(3) Limitations.--No award under paragraph (1) may be 
        made to an eligible individual unless the individual--
                    ``(A) has submitted to the Secretary an 
                application, at such time, in such manner, and 
                containing such information as the Secretary may 
                require, and the Secretary has approved such 
                application;
                    ``(B) provides, in such form and manner as the 
                Secretary may require, assurances that the individual 
                will meet the service requirement described in 
                paragraph (6); and
                    ``(C) provides, in such form and manner as the 
                Secretary may require, assurances that the individual 
                has a full-time faculty appointment in a health 
                professions institution and documented commitment from 
                such institution to spend a majority of the total 
                funded time of such individual on teaching and 
                developing skills in interdisciplinary education in 
                palliative care.
            ``(4) Maintenance of effort.--An eligible individual who 
        receives an award under paragraph (1) shall provide assurances 
        to the Secretary that funds provided to the eligible individual 
        under this subsection will be used only to supplement, not to 
        supplant, the amount of Federal, State, and local funds 
        otherwise expended by the eligible individual.
            ``(5) Amount and term.--
                    ``(A) Amount.--The amount of an award under this 
                subsection shall be equal to the award amount provided 
                for under section 753(c)(5)(A) for the fiscal year 
                involved.
                    ``(B) Term.--The term of an award made under this 
                subsection shall not exceed 5 years.
                    ``(C) Payment to institution.--The Secretary shall 
                make payments for awards under this subsection to 
                institutions which include schools of medicine and 
                osteopathic medicine.
            ``(6) Service requirement.--An individual who receives an 
        award under this subsection shall provide training in 
        palliative care and hospice, including the training of 
        interdisciplinary teams of health care professionals. The 
        provision of such training shall constitute a majority of the 
        total funded obligations of such individual under the award.
    ``(d) Palliative Care Workforce Development.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts under this subsection to entities that operate a 
        Palliative Care and Hospice Education Center pursuant to 
        subsection (a)(1).
            ``(2) Application.--To be eligible for an award under 
        paragraph (1), an entity described in such paragraph shall 
        submit to the Secretary an application at such time, in such 
        manner, and containing such information as the Secretary may 
        require.
            ``(3) Use of funds.--Amounts awarded under a grant or 
        contract under paragraph (1) shall be used to carry out the 
        fellowship program described in paragraph (4).
            ``(4) Fellowship program.--
                    ``(A) In general.--Pursuant to paragraph (3), a 
                Palliative Care and Hospice Education Center that 
                receives an award under this subsection shall use such 
                funds to offer short-term intensive courses (referred 
                to in this subsection as a `fellowship') that focus on 
                palliative care that provide supplemental training for 
                faculty members in medical schools and other health 
                professions schools with programs in psychology, 
                pharmacy, nursing, social work, chaplaincy, or other 
                health disciplines, as approved by the Secretary. Such 
                a fellowship shall be open to current faculty, and 
                appropriately credentialed volunteer faculty and 
                practitioners, who do not have formal training in 
                palliative care, to upgrade their knowledge and 
                clinical skills for the care of individuals with 
                serious or life-threatening illness and to enhance 
                their interdisciplinary teaching skills.
                    ``(B) Location.--A fellowship under this paragraph 
                shall be offered either at the Palliative Care and 
                Hospice Education Center that is sponsoring the course, 
                in collaboration with other Palliative Care and Hospice 
                Education Centers, or at medical schools, schools of 
                nursing, schools of pharmacy, schools of social work, 
                schools of chaplaincy or pastoral care education, 
                graduate programs in psychology, or other health 
                professions schools approved by the Secretary with 
                which the Centers are affiliated.
                    ``(C) CME credit.--Participation in a fellowship 
                under this paragraph shall be accepted with respect to 
                complying with continuing health profession education 
                requirements. As a condition of such acceptance, the 
                recipient shall subsequently provide a minimum of 18 
                hours of voluntary instruction in palliative care 
                content (that has been approved by a palliative care 
                and hospice education center) to students or trainees 
                in health-related educational, home, hospice, or long-
                term care settings.
            ``(5) Targets.--A Palliative Care and Hospice Education 
        Center that receives an award under this subsection shall meet 
        targets approved by the Secretary for providing palliative care 
        training to a certain number of faculty or practitioners during 
        the term of the award, as well as other parameters established 
        by the Secretary.
            ``(6) Amount of award.--An award under this subsection 
        shall be in an amount of $150,000. Not more than 24 Palliative 
        Care and Hospice Education Centers may receive an award under 
        this subsection.
            ``(7) Maintenance of effort.--A Palliative Care and Hospice 
        Education Center that receives an award under this subsection 
        shall provide assurances to the Secretary that funds provided 
        to the Center under the award will be used only to supplement, 
        not to supplant, the amount of Federal, State, and local funds 
        otherwise expended by such Center.
    ``(e) Palliative Care and Hospice Career Incentive Awards.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts under this subsection to individuals described in 
        paragraph (2) to foster greater interest among a variety of 
        health professionals in entering the field of palliative care.
            ``(2) Eligible individuals.--To be eligible to receive an 
        award under paragraph (1), an individual shall--
                    ``(A) be an advanced practice nurse, a clinical 
                social worker, a pharmacist, a chaplain, or student of 
                psychology who is pursuing a doctorate or other 
                advanced degree in palliative care or related fields in 
                an accredited health professions school; and
                    ``(B) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require.
            ``(3) Conditions of award.--As a condition of receiving an 
        award under this subsection, an individual shall agree that, 
        following completion of the award period, the individual will 
        teach or practice palliative care in health-related 
        educational, home, hospice or long-term care settings for a 
        minimum of 5 years under guidelines established by the 
        Secretary.
            ``(4) Payment to institution.--The Secretary shall make 
        payments for awards under this subsection to institutions which 
        include schools of medicine, osteopathic medicine, nursing, 
        social work, psychology, chaplaincy or pastoral care education, 
        dentistry, and pharmacy, or other allied health discipline in 
        an accredited health professions school that is approved by the 
        Secretary.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $44,100,000 for each of the 
fiscal years 2014 through 2018.''.
    (b) Effective Date.--The amendment made by this section shall be 
effective beginning on the date that is 90 days after the date of 
enactment of this Act.

SEC. 4. APPLICATION TO ADVANCED PRACTICE NURSES.

    (a) Advanced Education Nursing Grants.--Section 811(a) of the 
Public Health Service Act (42 U.S.C. 296j(a)) is amended--
            (1) in paragraph (1), by striking ``and'' at the end;
            (2) by redesignating paragraph (2) as paragraph (3); and
            (3) by inserting after paragraph (1), the following:
            ``(2) palliative care and hospice career incentive awards 
        authorized under section 759A(e); and''.
    (b) In General.--Part D of title VIII of the Public Health Service 
Act (42 U.S.C. 296p et seq.) is amended by adding at the end the 
following:

``SEC. 832. PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING.

    ``(a) Program Authorized.--The Secretary shall award grants to 
eligible entities to develop and implement, in coordination with 
programs under section 759A, programs and initiatives to train and 
educate individuals in providing palliative care in health-related 
educational, hospice, home, or long-term care settings.
    ``(b) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use funds under such grant to--
            ``(1) provide training to individuals who will provide 
        palliative care in health-related educational, home, hospice, 
        or long-term care settings;
            ``(2) develop and disseminate curricula relating to 
        palliative care in health-related educational, home, hospice, 
        or long-term care settings;
            ``(3) train faculty members in palliative care in health-
        related educational, home, hospice, or long-term care settings; 
        or
            ``(4) provide continuing education to individuals who 
        provide palliative care in health-related educational, home, 
        hospice, or long-term care settings.
    ``(c) Application.--An eligible entity desiring a grant under 
subsection (a) shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may reasonably require.
    ``(d) Eligible Entity.--For purposes of this section, the term 
`eligible entity' shall include a school of nursing, a health care 
facility, a program leading to certification as a certified nurse 
assistant, a partnership of such a school and facility, or a 
partnership of such a program and facility.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2014 through 2018.''.
                                 <all>