[Congressional Record (Bound Edition), Volume 155 (2009), Part 11]
[Senate]
[Pages 15040-15042]
[From the U.S. Government Publishing Office, www.gpo.gov]




               SENIOR NAVIGATION AND PLANNING ACT OF 2009

  Mr. WARNER. Mr. President, I rise today to talk about legislation to 
help seniors navigate through a complicated and often overwhelming 
health care delivery system. Because of the fragmented nature of our 
health care system, we often fail to provide patients, their families, 
and caregivers with the necessary tools, information, and support to 
both age well and with dignity in the setting of their preference, 
oftentimes their homes.
  I believe if we provide patients with better information about 
advanced care planning in noncrisis situations, they will make 
decisions for themselves and their families that result in better care 
and a better quality of life.
  Today I am introducing the Senior Navigation and Planning Act of 2009 
to help seniors and their families navigate through a complex system 
and to help them make informed medical decisions. My legislation would 
provide access to an advanced illness care management benefit, a 
benefit that does not exist currently in our health care delivery 
system.
  My legislation, as well, would increase the awareness of advanced 
care planning through a national education campaign and clearinghouse. 
It would also reduce legal hurdles to the enforcement of advanced 
directives. It would create incentives for hospitals and physicians to 
get accredited and certified in palliative care. It would increase 
compliance with medical orders and discharge instructions. Too often a 
patient may leave a hospital, not do the appropriate actions 
afterwards, and not follow the discharge information, which can result 
in the patient being readmitted to the hospital or ending up with their 
health care provider not having the appropriate followup. We have to 
make sure we put an end to that.
  My legislation would also educate entities, including faith-based 
organizations, on advanced care planning issues. Oftentimes an 
individual or

[[Page 15041]]

family, when dealing with end-of-life issues, will turn not only to 
their medical provider but oftentimes to their priest or rabbi or 
minister. We want to make sure folks in the faith-based community 
understand the challenges and opportunities people have with advanced 
care planning.
  My legislation, as well, would increase coordination and integration 
between the Medicare and Medicaid Programs. Too often these programs 
that both deal with seniors, their health care issues, and aging issues 
do not cooperate or collaborate.
  Collectively, these initiatives will create a more accessible 
environment for seniors to receive the care they need when they need 
it, and in the setting they prefer.
  Let me be clear, this legislation does not deny or withhold services. 
However, it does recognize that overall health reform should include a 
thoughtful process that informs patients, their families, and 
caregivers on how to navigate and think through difficult decisions 
about when and how to pursue treatments at the end of life.
  By enacting these reforms, we will begin to develop a culture in 
which all of us will have the ability to age well, with dignity, and, 
again, in the setting of our choosing.
  I ask unanimous consent to have printed in the Record letters of 
support from the following organizations: the AARP, the Alzheimer's 
Foundation, the Duke University Divinity School, the Institute on Care 
at the End of Life, the National Hospice and Palliative Care 
Organization, UnitedHealth Group, and Aetna.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                  National Hospice


                             and Palliative Care Organization,

                                                    June 12, 2009.
     Senator Mark Warner,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Warner: On behalf of hospice programs across 
     the nation, their professionals, volunteers and most 
     importantly, the patients and families they serve, the 
     National Hospice and Palliative Care Organization is writing 
     to express our support for your Senior Navigation and 
     Planning Act of 2009. This health reform legislation will 
     strengthen the quality of end-of-life care, and make it more 
     cost-efficient through enhanced resources to allow more 
     informed choices and prevent unnecessary and costly medical 
     procedures.
       Research has shown that individuals who have discussions 
     about end-of-life care have less invasive medical treatments, 
     and a higher quality of life. We are pleased that your bill 
     enhances access to additional resources for end-of-life care 
     planning, including: a new transitional benefit delivered by 
     hospice teams for patients with advanced illnesses, an 
     expanded use of advance directives, and increased public 
     awareness of the importance of end-of-life planning. These 
     tools implemented nationwide could help reduce Medicare 
     spending by $15 billion over 10 years.
       Your legislation will ensure that patients and families are 
     able to navigate the journey at the end of life with the 
     necessary information and support that will bring dignity, 
     quality care, and hope when they are most needed. For more 
     than 30 years, hospices have been providing high-quality care 
     to people at one of life's most challenging times--and 
     research has shown hospice saves Medicare more than $2 
     billion every year. This legislation uses the knowledge and 
     expertise of the hospice and palliative care community in a 
     valuable way.
       The Senior Navigation and Planning Act of 2009 will give 
     patients and their families coping with life-limiting 
     illnesses the kind of information and services they need. The 
     National Hospice and Palliative Care Organization strongly 
     endorses your bill, and appreciates your support of 
     strengthening high-quality and compassionate end-of-life care 
     for the 1.4 million Americans who choose hospice each year.
           Sincerely,
                                       J. Donald Schumacher, PsyD,
     President/CEO.
                                  ____

                                                 Duke Institute on


                                      Care at the End of Life,

                                                    June 11, 2009.
     Senator Mark R. Warner,
     Rusell Senate Office Building,
     Washington, DC.
     Re The Senitor Navigation and Planning Act of 2009.
       Dear Senator Warner: In my career as a pain and palliative 
     care physician, I have become convinced that innovative 
     models of care that can leverage both community desire and 
     community assets for engagement in the care of the ill and 
     dying--including the involvement and assets of faith 
     communities--are urgently needed.
       Almost all patients and families experience illness within 
     their community and receive episodic acute care in the 
     hospital. Meeting the needs of patients requires an approach 
     that raises public awareness, provides training and resources 
     to family members and loved ones, and connects the resources 
     of the hospital environment with care resources in the 
     community. Faith communities are logically and historically 
     positioned to be a locus of effective care for the ill and 
     the dying and are a relatively untapped resource to meet the 
     health care needs in the community.
       The Senior Navigation and Planning Act of 2009 provides the 
     groundwork that can spark such innovative models and has 
     tremendous potential to improve care for the rapidly growing 
     numbers of individuals with advanced illness or who are at 
     the near end of life. I applaud this effort and offer you my 
     wholehearted support for its passage.
           Sincerely,
                                              Richard Payne, M.D.,
     Professor of Medicine and Divinity.
                                  ____



                            Alzheimer's Foundation of America,

                                                     June 9, 2009.
     Hon. Mark R. Warner,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Warner: The Alzheimer's Foundation of America 
     (AFA) is pleased to endorse the Senior Navigation and 
     Planning Act of 2009. On behalf of AFA and its members, thank 
     you for your leadership in introducing this important 
     legislation.
       AFA was formed in February 2002 ``to provide optimal care 
     and services to individuals confronting dementia, and to 
     their caregivers and families--through member organizations 
     dedicated to improving quality of life.'' Today, the 
     Alzheimer's Foundation of America's membership consists of 
     more than 1,200 member organizations that provide hands-on 
     programs and services from coast to coast, including 
     grassroots nonprofit organizations, healthcare facilities, 
     government agencies, public safety departments, and long-term 
     care communities.
       Dignity, respect, and quality of life are the treatment 
     goals for individuals in the end stage of Alzheimer's disease 
     and related dementias; as well as support, training and 
     respite for family caregivers. The Senior Navigation and 
     Planning Act would greatly help those with dementia and their 
     families by establishing a new transitional care benefit 
     through hospice for Medicare and/or Medicaid beneficiaries 
     with a life expectancy of 18 months or less. Valuable 
     services provided under this new benefit would include: 
     palliative care consultation services; care planning 
     services; counseling of individual and family members; 
     discussions regarding the availability of supportive services 
     including information on advanced directives and other end-
     of-life planning tools; encouragement of patient-centered 
     care; family conference services; respite services up to 16 
     hours per month; and caregiver training provided at the 
     caregivers' home focused on providing effective personal and 
     technical care.
       For the millions of Americans with Alzheimer's disease or a 
     related dementia, advance directive planning services are 
     essential. To address this challenge, the Senior Navigation 
     and Planning Act would create a national awareness campaign 
     of advance directive planning. It would also establish a 
     toll-free telephone line and clearinghouse that the public 
     and health care professionals may access to find out about 
     state-specific information regarding advance directives and 
     end-of-life planning decisions.
       This legislation will allow eligible beneficiaries and 
     their family caregivers to receive the information they need 
     about advance directive and other end-of-life planning tools 
     directly from their physicians. In addition, hospitals, 
     skilled nursing facilities, home health agencies, and hospice 
     programs will be required to provide the opportunity to 
     discuss the general course of treatment expected, the likely 
     impact on the length of life and function, and the procedures 
     they should use to secure help if an unexpected situation 
     arises. Such services will not only help improve quality of 
     life, but will also help to reduce the stigma and fear of 
     facing end-of-life issues in general.
       The Senior Navigation and Planning Act would further 
     protect the rights of individuals by requiring providers to 
     honor written medical orders as a condition of payment. The 
     bill would also provide incentives for hospice and palliative 
     care accreditation and certification by providing bonus 
     payments for those facilities with programs in place and a 
     payment cut for facilities that do not have an accredited 
     palliative program in place by 2020.
       Beneficiaries with Alzheimer's disease and related 
     dementias place heavy demands on the health care system. 
     Because of the unique nature of their disease, individuals 
     with cognitive impairment must rely on family caregivers and 
     others to identify and obtain the right mix of services and 
     supports to maintain their health and to live in the 
     community as long as possible. This legislation would take 
     the much-needed step of creating an Office of Medicare/
     Medicaid Integration to align program policies. The Office 
     would simplify dual eligible access to Medicare and Medicaid 
     program benefits and

[[Page 15042]]

     services; improve care continuity and ensure safe and 
     effective care transitions; eliminate cost shifting between 
     programs and among related care providers; eliminate 
     regulatory conflicts; and improve total cost and quality.
       Faith-based organizations often play a key role in end-of-
     life decision-making and planning for those with terminal 
     illnesses. The Senior Navigation and Planning Act would 
     empower the Secretary to create web-based materials as well 
     as to establish end-of-life home-based service, training and 
     education grants specifically for faith-based organizations. 
     For individuals with end stage Alzheimer's disease and 
     related dementias and their family caregivers in particular, 
     faith-based services, training and support can make a world 
     of difference in an otherwise isolating situation.
       AFA is the face of care for individuals and their families 
     who are affected by Alzheimer's disease and related 
     dementias. We are proud to support the Senior Navigation and 
     Planning Act and we look forward to working with you to 
     advance this important legislation. If you have any further 
     questions, please feel free to contact me, or have your staff 
     contact Sue Peschin, AFA vice president of public policy.
           Sincerely,
                                                     Eric J. Hall,
     President and Chief Executive Officer.
                                  ____

                                               UnitedHealth Group,


                                     Pennsylvania Avenue, NW.,

                                     Washington DC, June 11, 2009.
     Hon. Mark Warner,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Warner: I am writing to express UnitedHealth 
     Group's strong support for your legislation, the Senior 
     Navigation and Planning Act of 2009, which better equips 
     seniors with the necessary tools, information and support 
     needed to make informed medical decisions and ensure they 
     receive the highest quality care.
       Your legislation will fundamentally transform the way 
     terminally ill patients and their families navigate the 
     difficult decisions encountered at the end-of-life. We 
     understand that when the elderly and their families are 
     provided with relevant information and resources about care 
     options such as hospice, palliative care, and the use of 
     advanced directives, they are able to make more informed and 
     personally appropriate decisions. By combining the best 
     practices found in the public and private sectors, this 
     legislation will go a long way in ensuring that patients 
     facing the end-of-life are provided--through shared decision 
     making with their physicians and caregivers--the most 
     appropriate and sensitive care. UnitedHealth Group strongly 
     supports patient-centered care, support services and planning 
     tools for those with advanced illnesses. We applaud your 
     focus on this important issue within the health reform 
     debate.
       UnitedHealth Group has a strong commitment to patient-
     centered end-of-life care, as demonstrated by the following 
     programs and options that we offer to both Medicare 
     beneficiaries and commercially-insured people:
       Evercare Hospice and Palliative Care which operates in ten 
     states and serves more than 1,200 people a day for their end-
     of-life needs.
       The Advanced Illness Care Model which is offered through 
     our Medicare Advantage and Special Needs Plans. This model 
     provides coordinated care for patients with advanced 
     illnesses and supports education for patients and their 
     families regarding their clinical condition and the 
     management of quality of life treatment issues in the last 
     twelve months of life.
       The Evercare Institutional Special Needs Plans (SNPs), 
     which are specialized health plans that deploy nurse 
     practitioners in nursing homes to assist in coordination of 
     care and other planning services.
       The UnitedHealth Care Hospice benefit which is an industry 
     leader in the comprehensiveness of its plan offerings.
       As a result of this accumulated experience, we understand 
     that providing access to early and comprehensive hospice and 
     palliative care services results in an increase in the 
     quality of life for patients and reduction in futile and 
     duplicative clinical interventions.
       In conclusion, we are especially encouraged that your bill:
       Creates a transitional care benefit to increase access to 
     palliative care;
       Establishes a national education campaign and clearinghouse 
     providing advanced care planning resources;
       Assures portability of advanced directives across states;
       Creates incentives for hospitals and physicians to get 
     accredited and certified in hospice and palliative care; and
       Increases integration and coordination between the Medicare 
     and Medicaid programs.
       Thank you for your strong leadership in the U.S. Senate on 
     this issue of critical importance to the entire health care 
     system. We look forward to working with you to advance the 
     Senior Navigation and Planning Act of 2009 and on other areas 
     to strengthen our health care system.
           Sincerely,

                                          Reed V. Tuckson, MD,

                                      Executive Vice President and
     Chief of Medical Affairs.
                                  ____

                                                            Aetna,


                                            Farmington Avenue,

                                      Hartford, CT, June 15, 2009.
     Hon. Mark R. Warner,
     U.S. Senate,
     Washington, DC.
       Dear Senator Warner: Aetna is pleased to support the Senior 
     Navigation and Planning Act of 2009. This legislation will 
     strengthen the quality of counseling, support services, and 
     care management for patients and families coping with life-
     limiting illnesses. We commend you for your leadership on 
     these critical issues.
       Aetna, itself, has been a leader in advocating for 
     compassionate care in the face of life-threatening illness. 
     In April 2004, Aetna announced a comprehensive program of 
     case management support and expanded benefits to help Aetna 
     members and their families cope more effectively with the 
     complex medical and emotional issues associated with the end 
     of life. In an innovative move, Aetna provided coverage for 
     hospice benefits while allowing members to continue with 
     curative care, and to do so with a life expectancy of twelve 
     months instead of the six months Medicare allows. Aetna also 
     pioneered a comprehensive program of case management provided 
     by nurses trained in advance illness and in coordinating care 
     in a manner that respects ethnic and cultural traditions.
       Member reaction to Aetna's Compassionate Care Program has 
     been gratifying. Ninety-six percent of participants' 
     caregivers said they believed the member's needs for pain 
     management and symptom relief were met in the final months of 
     life. Sixty-three percent of program members accessed 
     hospice, a significant increase over traditional Medicare.
       In the pursuit of curative care, we too often fail to 
     engage patients and loved ones in discussions of additional 
     options for dealing with advanced illness and to support them 
     in their choices. This legislation will help change that by 
     facilitating the ability of patients and families to make 
     informed decisions at times of stress and vulnerability. 
     Aetna supports this legislation, and hopes to collaborate in 
     the realization of its goals. We look forward to working with 
     you and your Congressional colleagues to advance the quality 
     of health care for all Americans.
           Sincerely,
     Lonny Reisman, MD,
       Chief Medical Officer.
     Randall Krakauer, MD,
       Head of Medicare Medical Management.

  Mr. WARNER. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

                          ____________________