[Congressional Record Volume 165, Number 170 (Monday, October 28, 2019)]
[House]
[Pages H8521-H8526]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING ACT

  Ms. SCHAKOWSKY. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 647) 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, social work schools, 
and other programs, including physician assistant education programs, 
to promote education and research in palliative care and hospice, and 
to support the development of faculty careers in academic palliative 
medicine, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 647

       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 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 interprofessional team-based training of 
     health professionals in palliative care, including 
     residencies, traineeships, or fellowships;
       ``(B) develops and disseminates interprofessional team-
     based 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 interprofessional team-based 
     palliative care;
       ``(D) supports interprofessional team-based 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 interprofessional team-
     based palliative care in appropriate health settings, 
     including hospitals, hospices, home care, long-term care 
     facilities, and ambulatory care centers;
       ``(F) establishes traineeships for individuals who are 
     preparing for advanced education nursing degrees, social work 
     degrees, or advanced degrees in physician assistant studies, 
     with a focus in interprofessional team-based palliative care 
     in appropriate health settings, including hospitals, 
     hospices, home care, long-term care facilities, and 
     ambulatory care centers;
       ``(G) supports collaboration between multiple specialty 
     training programs (such as medicine, nursing, social work, 
     physician assistant, chaplaincy, and pharmacy) and clinical 
     training sites to provide training in interprofessional team-
     based palliative care; and
       ``(H) 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 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).

[[Page H8522]]

       ``(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 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 education in 
     interprofessional team-based 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, 
     including 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 
     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 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 interprofessional team-based 
     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, physician assistant education, 
     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 and interprofessional 
     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, physician 
     assistant education programs, or other health professions 
     schools approved by the Secretary with which the Centers are 
     affiliated.
       ``(C) Continuing education 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 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 in the amount of $150,000. Not more than 24 
     Palliative Care and Hospice Education Centers may receive an 
     award under such paragraph.
       ``(7) Maintenance of effort.--A Palliative Care and Hospice 
     Education Center that receives an award under paragraph (1) 
     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 social worker, 
     physician assistant, pharmacist, chaplain, or student of 
     psychology who is pursuing a doctorate, masters, or other 
     advanced degree with a focus in interprofessional team-based 
     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 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 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 or 
     program (such as a physician assistant education program) 
     that is 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 2020 through 
     2024.''.
       (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 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.

[[Page H8523]]

       ``(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 fiscal years 2020 through 2024.''.

     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 decisionmaking, 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 decisionmaking, 
     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 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. Such populations shall include 
     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 agencies and 
     departments, 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.

       None of the funds authorized 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).

     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, acting through the Director of the 
     National Institutes of Health, 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, 2020, for 
     conducting or supporting research with respect to palliative 
     care'' after ``or national centers''.

  The SPEAKER pro tempore (Mr. Stanton). Pursuant to the rule, the 
gentlewoman from Illinois (Ms. Schakowsky) and the gentleman from Texas 
(Mr. Burgess) each will control 20 minutes.
  The Chair recognizes the gentlewoman from Illinois.


                             General Leave

  Ms. SCHAKOWSKY. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous materials on H.R. 647.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Illinois?
  There was no objection.
  Ms. SCHAKOWSKY. Mr. Speaker, I yield 2 minutes to the gentleman from 
New York (Mr. Engel), the author of this important legislation.
  Mr. ENGEL. Mr. Speaker, I thank my colleague for yielding to me.
  Mr. Speaker, I am proud to sponsor H.R. 647, the Palliative Care and 
Hospice Education and Training Act, which has 296 bipartisan cosponsors 
and endorsements from 54 national organizations, including the American 
Cancer Society and the American Academy of Hospice and Palliative 
Medicine.
  The goal of palliative care is to provide patients relief from the 
symptoms of a serious illness. This form of medical care can accompany 
treatments and even cures. Often, an interdisciplinary team of 
healthcare providers consisting of doctors, nurses, social workers, and 
chaplains provide palliative care. In this capacity, these 
professionals often help patients with medical decisionmaking and care 
coordination.
  Palliative and hospice care has been shown to improve health outcomes 
for patients, but not many people are aware of the benefits. 
Furthermore, our Nation has a shortage of qualified palliative and 
hospice care professionals.
  The Palliative Care and Hospice Education and Training Act will help 
remedy these issues. This bill will create programs to train the next 
generation of providers of palliative and hospice care. It will also 
better educate patients, families, and health professionals about 
palliative care's benefits, and it encourages the National Institutes 
of Health to expand research in this field.
  Nearly every one of us has felt the pain and stress of a serious 
illness, either personally or standing beside a loved one. By passing 
this bill, we will take an important step forward in bringing relief to 
patients suffering from serious illnesses.
  Mr. Speaker, I want to thank Chairman Pallone and Ranking Member 
Walden for their leadership on this issue and Congressman Reed and 
Congressman Carter, who coauthored this bill with me.
  Mr. Speaker, I include in the Record a letter of support from 54 
national organizations and 35 State organizations.


[[Page H8524]]


                                                      May 6, 2019.
     Hon. Eliot Engel,
     House of Representatives,
     Washington, DC.
     Hon. Frank Pallone, Jr.,
     Chair, Energy & Commerce Committee,
     House of Representatives,
     Washington, DC.
     Hon. Yvette D. Clarke,
     House of Representatives,
     Washington, DC.
     Hon. Tom Reed
     House of Representatives,
     Washington, DC.
     Hon. Greg Walden,
     Ranking Member, Energy & Commerce Committee, House of 
         Representatives,
     Washington, DC.
     Hon. Buddy Carter,
     House of Representatives, Washington, DC.
     Re: Support for the Palliative Care and Hospice Education and 
         Training Act (PCHETA)
       Dear Representatives Engel, Reed, and Carter, Chairman 
     Pallone, Ranking Member Walden, and Vice Chair Clarke: The 
     undersigned organizations write to express our support for 
     H.R. 647, the Palliative Care and Hospice Education and 
     Training Act (PCHETA). This bipartisan legislation will make 
     a difference in the lives of millions of patients living with 
     serious or life-threatening illness and their caregivers.
       Despite a high intensity of medical treatment, many 
     seriously ill individuals still experience troubling 
     symptoms, unmet psychological and personal care needs, 
     fragmented care, poor communication with their health care 
     providers, and enormous strains on their family caregivers. 
     However, numerous studies have shown that adding palliative 
     care can improve pain and symptom control, quality of life, 
     and patient and family satisfaction.
       Palliative care is an interdisciplinary model of care 
     focused on relief of the pain, stress and other debilitating 
     symptoms of serious illness, such as cancer, cardiac disease, 
     respiratory disease, kidney failure, Alzheimer's, AIDS, ALS, 
     and MS. Its goal is to relieve suffering and provide the best 
     possible quality of life for patients and their families. 
     Palliative care can be offered simultaneously with life-
     prolonging and curative therapies for persons living with 
     serious, complex, and eventually terminal illness and 
     includes hospice care. By its very nature, palliative care is 
     patient-centered care--translating patient goals to 
     appropriate treatments.
       We appreciate your leadership in recognizing the 
     significant role palliative care and hospice can play in 
     creating lasting change across the health care system. With 
     PCHETA's focus on expanding the interdisciplinary palliative 
     care workforce, promoting awareness of the benefits of 
     palliative care among patient and providers, and improving 
     the evidence base for this care, you have demonstrated a 
     strong commitment to addressing key barriers to palliative 
     care access for the growing number of Americans with serious 
     or life-threatening illness.
       Delivery of high-quality palliative care cannot take place 
     without sufficient numbers of health care professionals with 
     appropriate training and skills. Students graduating from 
     medical, nursing or health care professional schools today 
     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 or life-threatening illness. Further, there is a 
     large gap between the number of health care professionals 
     with palliative care training and the number required to meet 
     the needs of the expanding population of seriously ill 
     patients. PCHETA would go a long way towards bridging this 
     gap by establishing education centers and career incentive 
     awards to improve the training of doctors, nurses, physician 
     assistants, social workers and other health professionals in 
     palliative care.
       PCHETA also aims to strengthen clinical practice and 
     improve health care delivery for patients living with serious 
     or life-threatening illness, as well as their families, by 
     directing funding toward palliative care research. Research 
     funding for palliative care and pain and symptom management 
     comprises less than 0.1 percent of the National Institutes of 
     Health annual budget. PCHETA would direct an expansion and 
     intensification of research in these important areas.
       At the same time, more must be done to ensure patients and 
     providers are aware of the benefits of palliative care. 
     According to the Institute of Medicine, there is a ``need for 
     better understanding of the role of palliative care among 
     both the public and professionals across the continuum of 
     care.'' PCHETA would direct the implementation of a national 
     education and awareness campaign so that patients, families, 
     and health professionals understand the essential role of 
     palliative care in ensuring high-quality care for individuals 
     facing serious or life-threatening illness.
       Through your leadership last Congress, PCHETA passed the 
     House of Representatives with overwhelming bi-partisan 
     support. We appreciate your continued support and dedication 
     to this important issue. We look forward to working with you 
     toward quick passage of this legislation in the 116th 
     Congress.
           Sincerely,
       Alzheimer's Association, Alzheimer's Impact Movement, 
     American Academy of Hospice and Palliative Medicine, American 
     Academy of Physician Assistants, American Cancer Society 
     Cancer Action Network, American College of Surgeons 
     Commission on Cancer, American Geriatrics Society, American 
     Heart Association ? American Stroke Association, 
     American Psychological Association, American Psychosocial 
     Oncology Society, American Society of Clinical Oncology, 
     Association of Oncology Social Work, Association of Pediatric 
     Hematology/Oncology Nurses, Association of Professional 
     Chaplains, The California State University Institute for 
     Palliative Care.
       Cambia Health Solutions, Cancer Support Community, Catholic 
     Health Association of the United States, Center to Advance 
     Palliative Care, Children's National Health System, Coalition 
     for Compassionate Care of California, Colorectal Cancer 
     Alliance, Compassus, Courageous Parents Network, 
     ElevatingHOME ? Visiting Nurses Associations of 
     America, The Gary and Mary West Health Institute, The George 
     Washington Institute for Spirituality and Health, HealthCare 
     Chaplaincy Network, Hospice and Palliative Nurses 
     Association, Leukemia & Lymphoma Society.
       Lung Cancer Alliance, Motion Picture & Television Fund, 
     National Alliance for Caregiving, National Association for 
     Home Care & Hospice, National Association of Social Workers, 
     National Brain Tumor Society, National Coalition for Cancer 
     Survivorship, National Coalition for Hospice and Palliative 
     Care, National Hospice and Palliative Care Organization, 
     National Palliative Care Research Center, National Patient 
     Advocate Foundation, National POLST Paradigm, Oncology 
     Nursing Society, Pediatric Palliative Care Coalition, 
     Physician Assistants in Hospice and Palliative Medicine.
       Prevent Cancer Foundation, Resolution-Care Network, Social 
     Work Hospice & Palliative Care Network, Society of Palliative 
     Care Pharmacists, St. Baldrick's Foundation, Supportive Care 
     Matters, Susan G. Komen, Supportive Care Coalition, Trinity 
     Health.
                                  ____


                  State Associations Supporting PCHETA

       Arizona Hospice and Palliative Care Organization, Home Care 
     Association of Arkansas, California Association for Health 
     Services at Home (CAHSAH), Home Care Association of Colorado, 
     Connecticut Association for Health Care at Home, Home Care 
     Association of Florida, Georgia Association for Home Health 
     Agencies, Illinois HomeCare & Hospice Council, Indiana 
     Association for Home Care and Hospice, Healthcare Association 
     of Hawaii, Kansas Home Care & Hospice Association, Kentucky 
     Home Care Association.
       HomeCare Association of Louisiana, Home Care & Hospice 
     Alliance of Maine, Home Care Alliance of Massachusetts, 
     Michigan HomeCare and Hospice Association, Minnesota HomeCare 
     Association, Nebraska Home Care Association, Home Care, 
     Hospice and Palliative Care Alliance of New Hampshire, Home 
     Care Association of New York State (HCA), New York State 
     Association of Healthcare Providers, Association for Home & 
     Hospice Care of North Carolina, LeadingAge Ohio, Ohio Council 
     for Home Care & Hospice.
       Oklahoma Association for Home Care & Hospice, Oregon 
     Association for Home Care, Pennsylvania HomeCare Association, 
     Rhode Island Partnership for Home Care, South Carolina Home 
     Care and Hospice Association, Tennessee Association for Home 
     Care, Texas Association for Home Care & Hospice, VNAs of 
     Vermont, Virginia Association for Home Care & Hospice, Home 
     Care Association of Washington, West Virginia Council of Home 
     Care Agencies.

  Mr. ENGEL. Mr. Speaker, I urge my colleagues to support this 
important legislation.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 647, the Palliative Care and 
Hospice Education and Training Act, by Representatives Engel and Tom 
Reed and cosponsored by many Members of the House. This helps build our 
palliative and hospice care workforce by establishing and supporting 
palliative care and hospice education centers through Federal grants, 
while enhancing research in palliative care at the National Institutes 
of Health.
  1.5 million Medicare beneficiaries were enrolled in hospice care for 
some time during 2017. With the American population aging, we need to 
be sure that our workforce is prepared to handle the influx of patients 
transitioning into palliative and hospice care.
  The bill's sponsors and advocates have worked hard for the past few 
years to get this legislation to the President's desk. As the chairman 
of the Energy and Commerce Health Subcommittee last year, I made it a 
priority to move this bill.
  I also think that this bill complements the House of Representatives' 
work on the opioid crisis. It is appropriate that we are passing this 
bill now as we come to the 1-year anniversary of passage of the SUPPORT 
Act.
  The bill before us today could address the issue from a different 
angle. With the growing scrutiny on doctors prescribing opioids in the 
midst of the

[[Page H8525]]

opioid crisis, we must remember that there are patients with legitimate 
chronic pain. While the use of opioids can lead to substance use 
disorder, these patients still need access to their pain medications, 
particularly if they have been successfully maintained and managed on 
opioids in close consultation with their doctors.
  This bill will ensure that we have a palliative and hospice care 
workforce that is adequately trained to manage patients with serious 
illness, which frequently includes some aspect of chronic pain or the 
need for pain relief.
  I am disappointed that we did not include a provision that 
stakeholders believe is necessary in order for this bill to become law. 
Senate language included this small but necessary change, and I expect 
that this issue will be resolved prior to the bill's arrival at the 
President's desk.
  Mr. Speaker, with a commitment to including this legislative 
language, I urge Members to support H.R. 647, and I reserve the balance 
of my time.
  Ms. SCHAKOWSKY. Mr. Speaker, I rise in support of H.R. 647, the 
Palliative Care and Hospice Education and Training Act.
  This bill, introduced by Representatives Engel, Reed, Clarke, and 
Carter, would establish palliative care and hospice education centers 
to improve training of interdisciplinary professionals and faculty 
members in palliative care.
  The bill would promote career development of physicians who practice 
hospice and palliative medicine. It also helps train the next 
generation of practitioners by authorizing funds to train and retain 
nurses, social workers, pharmacists, and others who are pursuing 
advanced degrees in palliative care and related fields.
  H.R. 647 will help patients facing serious conditions at the end of 
their lives and improve hospice care availability and treatment.
  I just want to say this bill is personal to me. My father, who lived 
with me at the end of his life, we were the beneficiaries of hospice, 
and it made all the difference in the final days of his life.
  This bill has the support of 294 bipartisan cosponsors, as well as 89 
different organizations. I would certainly urge all of my colleagues to 
endorse, support, and vote for this important piece of legislation.
  Mr. Speaker, I reserve the balance of my time.

                              {time}  1930

  Mr. BURGESS. Mr. Speaker, I am pleased to yield 3 minutes to the 
gentleman from New York (Mr. Reed), the co-author of the bill.
  Mr. REED. Mr. Speaker, first, I thank my colleagues, Mr. Engel and 
the members of the Energy and Commerce Committee, for their leadership 
on this bill, as well as, in particular, my colleague, Mr. Carter, for 
helping push this bill through, and Dr. Burgess for his assistance in 
leading the floor debate.
  Mr. Speaker, I rise in strong support of the bill before us, because 
as we all know, when loved ones become deathly ill, we are often left 
feeling helpless, wanting to step in and somehow ease the burden, but 
not sure how.
  When my own mother became sick, there was nothing I wouldn't have 
done, Mr. Speaker, to cure her. The woman who taught me how to live, 
taught me how to die. She taught me that what truly mattered to her in 
those times at the end of her life was the comfort of her home, the 
comfort of her family, and that quality time spent with her loved ones 
and her friends. Surrounded by a wonderful team of family, friends, 
but, in particular, hospice care providers, we watched as her wishes 
were met.
  Physicians, nurses, social workers, and aides made sure her symptoms 
were managed and that she was physically comfortable. But just as 
important, if not more so, were the hospice volunteers who stepped in 
to give mom companionship, normalcy at the end of her illness, and a 
much-needed break by the loved ones who were caring for her, such as 
myself and my brothers and sisters.
  The experience changed my perspective on death and dying. Even now, I 
am enormously thankful to the hospice staff and volunteers who stepped 
in to give my mom, and countless others in the community and folks 
across the country, quality of life when their days and her days were 
limited.
  We must ensure that there is a properly trained workforce to care for 
those closest to us as they increase in age and become chronically and 
terminally ill. Estimates show that there will be no more than 1 
percent growth in the palliative care and hospice physician workforce 
in the next 20 years, while the number of people eligible for 
palliative care will increase by over 20 percent, Mr. Speaker.
  Without a boost for palliative care education and training, there 
will only be one palliative physician for every 26,000 seriously ill 
patients by 2030. This bill promotes a strong American workforce when 
it comes to our palliative and hospice volunteers and caregivers and 
advanced training for those healthcare providers providing those 
services amongst us.
  Mr. Speaker, I thank my colleagues, and I urge all of my colleagues 
to support this legislation and vote ``yes'' this evening.
  Ms. SCHAKOWSKY. Mr. Speaker, I think what you heard from Mr. Reed and 
myself, and those people who have experienced the use of hospice care, 
what a great and wonderful blessing it can be to our families.
  Mr. Speaker, I support the legislation, and I reserve the balance of 
my time.
  Mr. BURGESS. Mr. Speaker, I am pleased to yield 3 minutes to the 
gentleman from Georgia (Mr. Carter), a valuable member of the Health 
Subcommittee of the Committee on Energy and Commerce.
  Mr. CARTER of Georgia. Mr. Speaker, I thank the gentleman for 
yielding.
  Mr. Speaker, I rise today in support of H.R. 647, the Palliative Care 
and Hospice Education and Training Act. I am proud to be a co-lead on 
this much-needed piece of legislation.
  In my years as a pharmacist working in long-term care, I saw how 
patients with all types of illnesses face the challenges of end-of-life 
care. Whether you are talking about patients with cancer, Alzheimer's, 
or some other ailment, critical to our healthcare system is valuing a 
patient's quality of life. That is why palliative and hospice care are 
an important piece of our healthcare system.
  As our population ages, the need for quality, well-trained hospice 
and palliative providers is only growing. The George Washington 
University Health Workforce Institute projects the number of patients 
who could benefit from palliative care could increase by 20 percent 
over the next 20 years. By establishing palliative care and hospice 
education centers to train and educate new providers, this bill is a 
critical step in meeting the needs of future patients.
  Additionally, this bill enhances the NIH's research into palliative 
care, improving our capability to care for patients in even more 
effective ways.
  Finally, PCHETA also establishes a nationwide campaign to better 
inform patients, their families, and their healthcare providers about 
palliative care services. This is critical to ensuring patients have a 
clear picture of all of their options so they and their families can 
make informed decisions of the care that they want.
  This bill is an important investment towards a patient-centered 
healthcare system that values and improves a patient's quality of life.
  I applaud Representatives Engel, Reed, Clarke, Pallone, and Walden 
for their leadership on this bill, and I urge my fellow Members to 
support H.R. 647.
  Ms. SCHAKOWSKY. Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I urge support of the bill, and I yield back the balance 
of my time.
  Ms. SCHAKOWSKY. Mr. Speaker, I think you could hear from the factual 
and the heartfelt testimony you have heard about this bill that will 
make hospice and palliative care more available that we all here urge 
passage of this legislation.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from Illinois (Ms. Schakowsky) that the House suspend the 
rules and pass the bill, H.R. 647, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.

[[Page H8526]]

  A motion to reconsider was laid on the table.

                          ____________________