[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2243 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  1st Session
                                S. 2243

   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, 
 including social work, physician assistant, and chaplaincy education 
  programs, to promote education and research in palliative care and 
hospice, and to support the development of faculty careers in academic 
                      palliative and hospice care.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 11, 2023

Ms. Baldwin (for herself, Mrs. Capito, Mr. Merkley, Ms. Murkowski, Mr. 
Reed, Mr. Rounds, Ms. Sinema, Mr. King, Mrs. Hyde-Smith, Mr. Marshall, 
    Mrs. Blackburn, Ms. Cantwell, Mr. Boozman, and Mrs. Gillibrand) 
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, 
 including social work, physician assistant, and chaplaincy education 
  programs, to promote education and research in palliative care and 
hospice, and to support the development of faculty careers in academic 
                      palliative and hospice care.

    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. 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 inserting after section 759 
the following:

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

    ``(a) Palliative Care and Hospice Education Programs.--
            ``(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 Programs that meet the requirements of paragraph (2).
            ``(2) Requirements.--
                    ``(A) In general.--A Palliative Care and Hospice 
                Education Program receiving an award under this section 
                shall support the training of health professionals in 
                palliative and hospice care, including traineeships or 
                fellowships. Such programs shall emphasize, as 
                appropriate, patient and family engagement, integration 
                of palliative and hospice care with primary and 
                specialty care, and collaboration with community 
                partners to address gaps in health care for individuals 
                with serious or life-threatening illnesses.
                    ``(B) Activities.--Activities conducted by a 
                program under this section may include the following:
                            ``(i) Clinical training on providing 
                        integrated palliative and hospice care 
                        services.
                            ``(ii) Interprofessional training to 
                        practitioners from multiple disciplines and 
                        specialties, including training on the 
                        provision of care to individuals with serious 
                        or life-threatening illnesses.
                            ``(iii) Establishing or maintaining 
                        training-related community-based programs for 
                        individuals with serious or life-threatening 
                        illnesses and caregivers to improve quality of 
                        life, and where appropriate, health outcomes 
                        for individuals who have serious or life-
                        threatening illnesses.
                    ``(C) Nonduplication.--A Palliative Care and 
                Hospice Education Program under this section shall not 
                duplicate the activities of existing education centers 
                funded under this section or under section 753 or 865.
            ``(3) Priorities in making awards.--In awarding grants and 
        contracts under paragraph (1), the Secretary--
                    ``(A) shall give priority to programs that 
                demonstrate coordination with another Federal or State 
                program, or another public or private entity;
                    ``(B) shall give priority to applicants with 
                programs or activities that are expected to 
                substantially benefit--
                            ``(i) individuals in rural or medically 
                        underserved areas, frontier health professional 
                        shortage areas (as defined in section 799B), or 
                        Indian Tribes or Tribal organizations;
                            ``(ii) pediatric populations; or
                            ``(iii) racial and ethnic minority 
                        populations; and
                    ``(C) may give priority to any program that--
                            ``(i) integrates palliative and hospice 
                        care into primary care practice;
                            ``(ii) provides training to integrate 
                        palliative and hospice care into other 
                        specialties across care settings, including 
                        practicing clinical specialists, health care 
                        administrators, faculty without backgrounds in 
                        palliative or hospice care, and students from 
                        all health professions;
                            ``(iii) emphasizes integration of 
                        palliative and hospice care into existing 
                        service delivery locations and care across 
                        settings, including primary care clinics, 
                        medical homes, Federally qualified health 
                        centers, ambulatory care clinics, hospitals, 
                        including critical access hospitals, emergency 
                        care settings, assisted living and nursing 
                        facilities, and home- and community-based 
                        settings;
                            ``(iv) supports the training and retraining 
                        of faculty, primary and specialty care 
                        providers, other direct care providers, and 
                        other appropriate professionals on palliative 
                        or hospice care;
                            ``(v) emphasizes education and engagement 
                        of family or caregivers on palliative and 
                        hospice care management within the context of 
                        chronic disease management and strategies to 
                        meet the needs of such family or caregivers; or
                            ``(vi) proposes to conduct outreach to 
                        communities that have a shortage of palliative 
                        and hospice workforce professionals.
            ``(4) Expansion of existing programs.--Nothing in this 
        section shall be construed to--
                    ``(A) prevent the Secretary from providing grants 
                or contracts to expand existing education programs, 
                including geriatric education programs 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 programs 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 who plan to teach 
        or practice 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 interprofessional 
                team-based 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 interprofessional team-
                based palliative medicine through a variety of service 
                rotations, such as consultation services, acute care 
                services, extended care facilities, ambulatory care and 
                comprehensive evaluation units, hospices, home care, 
                and community care programs;
                    ``(D) develop specific performance-based measures 
                to evaluate the competency of trainees; and
                    ``(E) provide training in interprofessional team-
                based palliative medicine through one or both of the 
                training options described in paragraph (3).
            ``(3) Training options.--The training options referred to 
        in subparagraph (E) of paragraph (2) are 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 are 
                designed to provide training in interprofessional team-
                based 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 Care and Hospice Academic Career Awards.--
            ``(1) Establishment of program.--The Secretary shall 
        establish a program to provide awards, to be known as the 
        `Palliative Care and Hospice Academic Career Awards', to 
        allopathic and osteopathic medical schools, nursing schools, 
        and other programs, including social work, physician assistant, 
        and chaplaincy education programs, or other schools or programs 
        identified by the Secretary applying on behalf of eligible 
        individuals to promote the career development of such 
        individuals as academic hospice and palliative care 
        specialists.
            ``(2) Eligible individuals.--For purposes of this 
        subsection, the term `eligible individual' means an individual 
        who--
                    ``(A) is board certified or board eligible in 
                hospice and palliative medicine or has completed 
                required specialty training in palliative and hospice 
                care in the disciplines of nursing, social work, 
                physician assistant, chaplaincy, or other discipline 
                identified by the Secretary; and
                    ``(B) has a junior (nontenured) faculty appointment 
                at an accredited (as determined by the Secretary) 
                allopathic or osteopathic medical school, nursing 
                school, or other programs, including social work, 
                physician assistant, chaplaincy, or other education 
                programs identified by the Secretary.
            ``(3) Limitations.--No award under paragraph (1) may be 
        made to an eligible individual unless the entity on behalf of 
        the eligible 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 education in interprofessional 
                team-based palliative care.
            ``(4) Maintenance of effort.--An entity which 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(b)(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, including allopathic and osteopathic 
                medical schools, nursing schools, and other programs, 
                including social work, physician assistant, or 
                chaplaincy education programs.
            ``(6) Service requirement.--An individual who receives an 
        award under this subsection shall provide training in 
        palliative care and hospice, including the training of 
        interprofessional 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 Program 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 Program 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 
                interprofessional team-based palliative care that 
                provide supplemental training for faculty members in 
                allopathic and osteopathic medical schools, nursing 
                schools, and other programs, including psychology, 
                pharmacy, social work, physician assistant, and 
                chaplaincy education programs, 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 and interprofessional teaching 
                skills.
                    ``(B) Location.--A fellowship under this paragraph 
                shall be offered either at the Palliative Care and 
                Hospice Education Program that is sponsoring the 
                course, in collaboration with other Palliative Care and 
                Hospice Education Programs, or at allopathic and 
                osteopathic medical schools, nursing schools, or other 
                programs, including pharmacy, social work, physician 
                assistant, chaplaincy, and psychology education 
                programs, or other health professions schools and 
                programs approved by the Secretary.
            ``(5) Targets.--A Palliative Care and Hospice Education 
        Program that receives an award under paragraph (1) shall meet 
        targets approved by the Secretary for providing training in 
        interprofessional team-based palliative care 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.--Each award under paragraph (1) 
        shall be not more than $150,000. Not more than 24 Palliative 
        Care and Hospice Education Programs may receive an award under 
        such paragraph.
            ``(7) Maintenance of effort.--A Palliative Care and Hospice 
        Education Program that receives an award under paragraph (1) 
        shall provide assurances to the Secretary that funds provided 
        to the Program under the award will be used only to supplement, 
        not to supplant, the amount of Federal, State, and local funds 
        otherwise expended by such Program.
    ``(e) Palliative Care and Hospice Career Incentive Awards.--
            ``(1) In general.--The Secretary shall award grants or 
        contracts under this subsection to institutions, including 
        allopathic and osteopathic medical schools, nursing schools, 
        and other programs, including social work, physician assistant, 
        psychology, chaplaincy, and pharmacy education programs, or 
        other programs approved by the Secretary, applying on behalf of 
        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 social 
                worker, physician assistant, pharmacist, chaplain, 
                psychologist, or other health care professional 
                pursuing a doctorate, masters, or other advanced degree 
                with a focus in interprofessional team-based palliative 
                care or related fields in an accredited school or 
                education program; 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 paragraph (1), 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 paragraph (1) to institutions that 
        include allopathic and osteopathic medical schools, nursing 
        schools, and other programs, including social work, physician 
        assistant, psychology, chaplaincy, and pharmacy education 
        programs or other programs approved by the Secretary.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $15,000,000 for each of the 
fiscal years 2024 through 2028.''.
    (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. 3. HOSPICE AND PALLIATIVE NURSING.

    (a) Nurse Education, Practice, and Quality Grants.--Section 
831(b)(3) of the Public Health Service Act (42 U.S.C. 296p(b)(3)) is 
amended by inserting ``hospice and palliative nursing,'' after 
``coordinated care,''.
    (b) Palliative Care and Hospice Education and Training Programs.--
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, or 
enter into contracts with, eligible entities to develop and implement, 
in coordination with programs under section 759A, programs and 
initiatives to train and educate individuals in providing 
interprofessional team-based palliative care in health-related 
educational, hospital, 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, hospital, home, 
        hospice, or long-term care settings;
            ``(2) develop and disseminate curricula relating to 
        palliative care in health-related educational, hospital, home, 
        hospice, or long-term care settings;
            ``(3) train faculty members in palliative care in health-
        related educational, hospital, 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 the 
fiscal years 2024 through 2028.''.

SEC. 4. DISSEMINATION OF PALLIATIVE CARE INFORMATION.

    Part A of title IX of the Public Health Service Act (42 U.S.C. 299 
et seq.) is amended by adding at the end the following new section:

``SEC. 904. DISSEMINATION OF PALLIATIVE CARE INFORMATION.

    ``(a) In General.--Under the authority under section 902(a) to 
disseminate information on health care and on systems for the delivery 
of such care, the Director may disseminate information to inform 
patients, families, and health professionals about the benefits of 
palliative care throughout the continuum of care for patients with 
serious or life-threatening illness.
    ``(b) Information Disseminated.--
            ``(1) Mandatory information.--If the Director elects to 
        disseminate information under subsection (a), such 
        dissemination shall include the following:
                    ``(A) Palliative care.--Information, resources, and 
                communication materials about palliative care as an 
                essential part of the continuum of quality care for 
                patients and families facing serious or life-
                threatening illness (including cancer, heart, kidney, 
                liver, lung, and infectious diseases; as well as 
                neurodegenerative disease such as dementia, Parkinson's 
                disease, or amyotrophic lateral sclerosis).
                    ``(B) Palliative care services.--Specific 
                information regarding the services provided to patients 
                by professionals trained in hospice and palliative 
                care, including pain and symptom management, support 
                for shared decision making, care coordination, 
                psychosocial care, and spiritual care, explaining that 
                such services may be provided starting at the point of 
                diagnosis and alongside curative treatment and are 
                intended to--
                            ``(i) provide patient-centered and family-
                        centered support throughout the continuum of 
                        care for serious and life-threatening illness;
                            ``(ii) anticipate, prevent, and treat 
                        physical, emotional, social, and spiritual 
                        suffering;
                            ``(iii) optimize quality of life; and
                            ``(iv) facilitate and support the goals and 
                        values of patients and families.
                    ``(C) Palliative care professionals.--Specific 
                materials that explain the role of professionals 
                trained in hospice and palliative care in providing 
                team-based care (including pain and symptom management, 
                support for shared decision making, care coordination, 
                psychosocial care, and spiritual care) for patients and 
                families throughout the continuum of care for serious 
                or life-threatening illness.
                    ``(D) Research.--Evidence-based research 
                demonstrating the benefits of patient access to 
                palliative care throughout the continuum of care for 
                serious or life-threatening illness.
                    ``(E) Population-specific materials.--Materials 
                targeting specific populations, including beneficiaries 
                of Medicare, Medicaid, and the Veterans Health 
                Administration, and patients with serious or life-
                threatening illness who are among medically underserved 
                populations (as defined in section 330(b)(3)) and 
                families of such patients or health professionals 
                serving medically underserved populations, including 
                pediatric patients, young adult and adolescent 
                patients, racial and ethnic minority populations, and 
                other priority populations specified by the Director.
            ``(2) Required publication.--Information and materials 
        disseminated under paragraph (1) shall be posted on the 
        internet websites of relevant Federal departments and agencies, 
        including the Department of Veterans Affairs, the Centers for 
        Medicare & Medicaid Services, and the Administration on Aging.
    ``(c) Consultation.--The Director shall consult with appropriate 
professional societies, hospice and palliative care stakeholders, and 
relevant patient advocate organizations with respect to palliative 
care, psychosocial care, and complex chronic illness with respect to 
the following:
            ``(1) The planning and implementation of the dissemination 
        of palliative care information under this section.
            ``(2) The development of information to be disseminated 
        under this section.
            ``(3) A definition of the term `serious or life-threatening 
        illness' for purposes of this section.''.

SEC. 5. CLARIFICATION.

    (a) Restriction on the Use of Federal Funds.--None of the funds 
made available under this Act (or an amendment made by this Act) may be 
used to provide, promote, or provide training with regard to any item 
or service for which Federal funding is unavailable under section 3 of 
Public Law 105-12 (42 U.S.C. 14402).
    (b) Additional Clarification.--As used in this Act (or an amendment 
made by this Act), palliative care and hospice shall not be furnished 
for the purpose of causing, or the purpose of assisting in causing, a 
patient's death, for any reason.

SEC. 6. ENHANCING NIH RESEARCH IN PALLIATIVE CARE.

    (a) In General.--Part B of title IV of the Public Health Service 
Act (42 U.S.C. 284 et seq.) is amended by adding at the end the 
following new section:

``SEC. 409K. ENHANCING RESEARCH IN PALLIATIVE CARE.

    ``The Secretary, or his or her designee, shall develop and 
implement a strategy to be applied across the institutes and centers of 
the National Institutes of Health to expand and intensify national 
research programs in palliative care in order to address the quality of 
care and quality of life for the rapidly growing population of patients 
in the United States with serious or life-threatening illnesses, 
including cancer; heart, kidney, liver, lung, and infectious diseases; 
as well as neurodegenerative diseases such as dementia, Parkinson's 
disease, or amyotrophic lateral sclerosis.''.
    (b) Expanding Trans-NIH Research Reporting To Include Palliative 
Care Research.--Section 402A(c)(2)(B) of the Public Health Service Act 
(42 U.S.C. 282a(c)(2)(B)) is amended by inserting ``and, beginning 
January 1, 2024, for conducting or supporting research with respect to 
palliative care'' after ``or national centers''.
                                 <all>