[Congressional Record (Bound Edition), Volume 158 (2012), Part 9]
[Senate]
[Pages 11735-11740]
[From the U.S. Government Publishing Office, www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. HELLER (for himself and Mr. Burr):
  S. 3405. A bill to amend title 38, United States Code, to treat small 
businesses bequeathed to spouses and dependents by members of the Armed 
Forces killed in line of duty as small business concerns owned and 
controlled by veterans for purposes of Department of Veterans Affairs 
contracting goals and preferences, and for other purposes; to the 
Committee on Veterans' Affairs.
  Mr. HELLER. Mr. President, last month was yet another disappointing 
month of job growth. Over 12 million Americans are unemployed, close to 
6 million have been unemployed for over 27 weeks, and 8 million have 
been forced to work part time because they have been unable to find 
full-time work.
  To put this in context, since this administration came into office, 
the number of Americans who are unemployed has increased by 700,000. 
This is a 5-percent increase in our national unemployment rate. Home 
values and middle-class income have decreased, and America has dropped 
from being the most competitive Nation in the world to the fourth most 
competitive Nation in the world.
  After this administration's failed policies of bailout after bailout, 
Senate Democrats are endorsing the idea of letting America go off the 
so-called fiscal cliff at the end of this year instead of letting 
businesses maintain their existing tax rates. This would effectively 
raise taxes on every American during one of the slowest economic 
recoveries in modern times.
  While I support extending these taxes and giving our Nation's job 
creators certainty, I believe we need tax reform. Our Tax Code is too 
complex. We need to close loopholes, broaden the base, and lower rates.
  As a member of the Committee on Ways and Means in the House, I worked 
on this issue, and I will continue to advocate for comprehensive reform 
while I am in the Senate. While I recognize that sometimes 
comprehensive policies may be difficult to move forward, especially in 
an election year, I believe we can find consensus on commonsense 
solutions.
  Since coming to the Senate, I have advocated for policies that create 
jobs for Nevadans and for all Americans. My State has been one of the 
hardest hit in this current economic climate. Nevada has had the 
distinction of leading the Nation in unemployment for over 2 years, as 
well as in foreclosures and bankruptcies. One part of our population 
has been especially hit hard, and that is our veterans.
  Over 13 percent of the Nation's bravest who put their lives on the 
line are unable to find a job in this economy. They come home from 
overseas to find their homes underwater or chronic unemployment in 
their communities. While a number of veterans have fallen on tough 
times financially, some have had difficulty adjusting to civilian life. 
Congress should make it a priority that necessary resources are made 
available to those who have bravely served our Nation. We must also not 
forget the families of our veterans, particularly those who have lost 
loved ones in combat.
  So I am proud to join with Senator Burr to introduce the Veterans 
Small Business Act, which simply ensures that surviving spouses and 
children are eligible for small business benefits. Congress has 
provided numerous benefits to our Nation's veterans who own small 
businesses, including sole-source contracting, low-interest loans, and 
other resources in order to help these small businesses grow and create 
jobs. However, should a spouse or a child of a veteran lose a loved one 
in combat, they can no longer receive these benefits or enroll in these 
programs.
  My legislation closes this large gap in Federal law that does little 
for those who own businesses before their activation and were killed in 
the line of duty. As a Member of Congress, we must honor our Nation's 
fallen as well as ensuring that the loved ones they leave behind have 
the same economic opportunities afforded to that veteran.
  We should be doing all we can to provide all of our Nation's small 
businesses with the tools needed to survive in this current economic 
climate. Congress needs to stop worrying about the next election and 
put in place policies that will not only ignite economic growth, but 
also get our country back to work.
  While there are larger issues we must address, such as tax reform, 
there are smaller commonsense measures, such as this bill, that we can 
pass right now if given the opportunity. Measures such as this will 
make a big difference in our Nation's veterans and job creators.
  If it is any indication of how important these issues are to Nevada, 
I had a constituent, Dan Lyons, who walked from Reno, NV, to 
Washington, DC, because he didn't think Washington was doing enough for 
veterans. This was a 6-month walk from Reno, NV, to Washington, DC. He 
felt he was not getting through to his elected officials via

[[Page 11736]]

phone or e-mails. So Dan, with a tent, a map, and a plan, started 
walking across America to see his elected officials face to face.
  He walked 25 miles a day, battling treacherous weather, snakes, long, 
lonely miles, and probably a few blisters just for the chance to sit 
down and ask that we do more to help struggling veterans. I was proud 
to meet with Dan, and he is a reminder of what is right with society. 
He reminds us that we must honor our obligation to our veterans. When 
they have sacrificed so much to preserve and protect our freedoms, we 
should at least ensure their needs are met when they and their 
surviving families fall on hard economic times.
                                 ______
                                 
      By Mr. WYDEN:
  S. 3407. A bill to amend the Public Health Service Act to increase 
the number of permanent faculty in palliative care at accredited 
allopathic and osteopathic medical schools, nursing schools, and other 
programs, to promote education in palliative care and hospice, and to 
support the development of faculty careers in academic palliative 
medicine; to the Committee on Health, Education, Labor, and Pensions.
  Mr. WYDEN. Mr. President, I rise today to discuss the critical need 
in today's health care workforce for additional training related to 
palliative care. Palliative care is an interdisciplinary model of care 
focused on relieving 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.
  Many people mistakenly believe that palliative care is only 
beneficial when a cure is not possible. Actually, palliative care is 
not dependent on a life-limiting prognosis and may actually help 
individuals recover by relieving symptoms--such as pain, anxiety or 
loss of appetite--while they are undergoing sometimes difficult medical 
treatments or procedures, such as surgery or chemotherapy. Palliative 
care is provided by a team of doctors, nurses, social workers, and 
other specialists who work with a patient's other health care providers 
to provide an extra layer of support, including assistance with 
difficult medical decision-making and coordination of care among 
specialists. Palliative care is appropriate for people of any age and 
at any stage in an illness, whether that illness is curable, chronic or 
life-threatening.
  There is a specific type of palliative care, called hospice, for 
people for whom a cure is no longer possible and who likely have 6 
months or less to live. Hospice care can be provided at one's home, a 
hospice facility, a hospital or a nursing home. Hospice care is about 
giving patients control, dignity and comfort so they have the best 
possible quality of life during the time they have. Hospice care also 
provides support and grief therapy for loved ones whose struggles are 
often cast aside or forgotten during treatment.
  A growing evidence base has demonstrated that palliative care, 
including hospice, improves quality, controls cost and enhances patient 
and family satisfaction for the rapidly expanding population of 
individuals with serious or life-threatening illness. Palliative care 
may also prolong the lives of some seriously ill patients.
  Over the last 10 years, the number of hospital-based palliative care 
programs has more than doubled due to the increasing number of 
Americans living with serious, complex and chronic illnesses and the 
realities of the care responsibilities faced by their families. Studies 
suggest that in states with more hospital-based palliative care 
programs, patients are less likely to die in the hospital, are likely 
to spend fewer days in the ICU, have better pain management and higher 
satisfaction with their health care.
  As usual, Oregon is ahead of the curve and I am proud to say that in 
a 2011 report ranking states on their citizens' access to hospital-
based palliative care programs, Oregon was among the seven states who 
earned an ``A'' rating, with 88 percent of Oregon hospitals offering 
palliative care.
  Unfortunately, many seriously ill patients and their families lack 
the access available to Oregonians. Palliative care is a relatively new 
medical specialty and more must be done to ensure an adequate, well-
trained palliative care workforce is available to provide comprehensive 
symptom management, intensive communication and a level of care 
coordination that addresses the episodic and long-term nature of 
serious, chronic illness. I believe that, with Federal support, we can 
help address the workforce gap between those currently practicing in 
palliative care and hospice and the number of health care professionals 
required to care for this expanding patient population That is why 
today I am introducing the Palliative Care and Hospice Education and 
Training Act or PCHETA. This authorizing legislation focuses on three 
key areas to grow the palliative care and hospice workforce.
  Education centers to expand interdisciplinary training in palliative 
and hospice care.
  Training of physicians who plan to teach palliative medicine and 
fellowships to encourage re-training for mid-career physicians, and 
academic career awards and career incentive awards to support 
physicians and other health care providers who provide palliative and 
hospice care training.
  With this legislation, patients and families who are facing serious 
or life-threatening illness will have access to the high-quality 
palliative care and hospice services that can maximize their quality of 
life. I urge my colleagues to join me in this effort.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 3407

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

     SECTION 1. SHORT TITLE.

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

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Health care providers need better education about pain 
     management and palliative care. Students graduating from 
     medical school have very little, if any, training in the core 
     precepts of pain and symptom management, advance care 
     planning, communication skills, and care coordination for 
     patients with serious, life-threatening, or terminal illness.
       (2) Palliative care is interdisciplinary, patient- and 
     family-centered health care for people with serious 
     illnesses. This type of care is focused on providing patients 
     with relief from the symptoms, pain, and stress of a serious 
     illness, whatever the diagnosis. The goal of palliative care 
     is to relieve suffering and improve quality of life for both 
     patients and their families. Palliative care is provided by a 
     team of doctors, nurses, social workers, chaplains, and other 
     specialists who work with a patient's other health care 
     providers to provide an extra layer of support, including 
     assistance with difficult medical decisionmaking and 
     coordination of care among specialists. Palliative care is 
     appropriate at any age and at any stage in a serious illness, 
     and can be provided together with curative treatment. 
     Palliative care is not dependent on a life-limiting prognosis 
     and may actually help an individual recover from illness by 
     relieving symptoms, such as pain, anxiety, or loss of 
     appetite, while undergoing sometimes difficult medical 
     treatments or procedures, such as surgery or chemotherapy. 
     There were 1,623 hospitals with palliative care programs in 
     2012.
       (3) Hospice is palliative care for patients in their last 
     year of life. Considered the model for quality compassionate 
     care for individuals facing a life-limiting illness, hospice 
     provides expert medical care, pain management, and emotional 
     and spiritual support expressly tailored to the patient's 
     needs and wishes. In most cases, care is provided in the 
     patient's home but may also be provided in freestanding 
     hospice centers, hospitals, nursing homes, and other long-
     term care facilities. In 2010, an estimated 1,580,000 
     patients received services from hospice or approximately 41.9 
     percent of all United States deaths. Hospice is a covered 
     benefit under the Medicare program. There were 3,509 
     Medicare-certified hospices in 2010.
       (4) A 2005 study at Michigan State University found that 
     the formal training of United States doctors in palliative 
     care is ``grossly inadequate''. When the American Society of 
     Clinical Oncology surveyed their members, 65 percent said 
     they had received inadequate education in controlling 
     symptoms associated with cancer, and 81 percent felt they

[[Page 11737]]

     had inadequate mentoring in discussing a poor prognosis with 
     their patients and families. Training in pediatric palliative 
     care is also seriously lacking according to physicians, 
     residents, and medical students responding to a survey 
     presented at a meeting of American Federation for Medical 
     Research.
       (5) The American Board of Medical Specialties (ABMS) and 
     the Accreditation Council for Graduate Medical Education 
     (ACGME) provided formal subspecialty status for hospice and 
     palliative medicine (HPM) in 2006, and the Centers for 
     Medicare & Medicaid Services recognized hospice and 
     palliative medicine as a medical subspecialty in October of 
     2008.
       (6) As of June 2012, there were a total of 86 hospice and 
     palliative medicine training programs. Seventy-eight programs 
     have been accredited by the Accreditation Council for 
     Graduate Medical Education and seven programs have been 
     accredited by the American Osteopathic Association. For the 
     2011-2012 academic year, these programs were training 176 
     physicians in hospice and palliative medicine. Some programs 
     include an additional track in research, geriatrics, or 
     public health.
       (7) There is a large gap between those practicing in the 
     palliative medicine field and the number of physicians 
     needed. A mid-range estimate by the American Academy of 
     Hospice and Palliative Medicine's Workforce Task Force calls 
     for 6,000 or more full time equivalents to serve current 
     needs in hospice and palliative care programs. At maximum 
     capacity, the current system would produce roughly 4,600 new 
     hospice and palliative medicine certified physicians over the 
     next 20 years, during which time some 70,000,000 new Medicare 
     beneficiaries will enter the Medicare program. At the same 
     time, there is expected to be increasing acceptance of the 
     hospice and palliative approach to care among the general 
     population and health care providers.

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

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

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

       ``(a) Palliative Care and Hospice Education Centers.--
       ``(1) In general.--The Secretary shall award grants or 
     contracts under this section to entities described in 
     paragraph (1), (3), or (4) of section 799B, and section 
     801(2), for the establishment or operation of Palliative Care 
     and Hospice Education Centers that meet the requirements of 
     paragraph (2).
       ``(2) Requirements.--A Palliative Care and Hospice 
     Education Center meets the requirements of this paragraph if 
     such Center--
       ``(A) improves the training of health professionals in 
     palliative care, including residencies, traineeships, or 
     fellowships;
       ``(B) develops and disseminates curricula relating to the 
     palliative treatment of the complex health problems of 
     individuals with serious or life threatening illnesses;
       ``(C) supports the training and retraining of faculty to 
     provide instruction in palliative care;
       ``(D) supports continuing education of health professionals 
     who provide palliative care to patients with serious or life 
     threatening illness;
       ``(E) provides students (including residents, trainees, and 
     fellows) with clinical training in palliative care in the 
     home, long-term care facilities, home care, hospices, chronic 
     and acute disease hospitals, and ambulatory care centers;
       ``(F) establishes traineeships for individuals who are 
     preparing for advanced education nursing degrees in 
     palliative care nursing, home care, hospice, in the home, 
     long-term care, or other nursing areas that specialize in 
     palliative care; and
       ``(G) does not duplicate the activities of existing 
     education centers funded under this section or under section 
     753 or 865.
       ``(3) Expansion of existing centers.--Nothing in this 
     section shall be construed to--
       ``(A) prevent the Secretary from providing grants to expand 
     existing education centers, including geriatric education 
     centers established under section 753 or 865, to provide for 
     education and training focused specifically on palliative 
     care, including for non-geriatric populations; or
       ``(B) limit the number of education centers that may be 
     funded in a community.
       ``(b) Palliative Medicine Physician Training.--
       ``(1) In general.--The Secretary may make grants to, and 
     enter into contracts with, schools of medicine, schools of 
     osteopathic medicine, teaching hospitals, and graduate 
     medical education programs, for the purpose of providing 
     support for projects that fund the training of physicians 
     (including residents, trainees, and fellows) who plan to 
     teach palliative medicine.
       ``(2) Requirements.--Each project for which a grant or 
     contract is made under this subsection shall--
       ``(A) be staffed by full-time teaching physicians who have 
     experience or training in palliative medicine;
       ``(B) be based in a hospice and palliative medicine 
     fellowship program accredited by the Accreditation Council 
     for Graduate Medical Education;
       ``(C) provide training in palliative medicine through a 
     variety of service rotations, such as consultation services, 
     acute care services, extended care facilities, ambulatory 
     care and comprehensive evaluation units, hospice, home 
     health, and community care programs;
       ``(D) develop specific performance-based measures to 
     evaluate the competency of trainees; and
       ``(E) provide training in palliative medicine through one 
     or both of the training options described in subparagraphs 
     (A) and (B) of paragraph (3).
       ``(3) Training options.--The training options referred to 
     in subparagraph (E) of paragraph (2) shall be as follows:
       ``(A) 1-year retraining programs in hospice and palliative 
     medicine for physicians who are faculty at schools of 
     medicine and osteopathic medicine, or others determined 
     appropriate by the Secretary.
       ``(B) 1- or 2-year training programs that shall be designed 
     to provide training in hospice and palliative medicine for 
     physicians who have completed graduate medical education 
     programs in any medical specialty leading to board 
     eligibility in hospice and palliative medicine pursuant to 
     the American Board of Medical Specialties.
       ``(4) Definitions.--For purposes of this subsection the 
     term `graduate medical education' means a program sponsored 
     by a school of medicine, a school of osteopathic medicine, a 
     hospital, or a public or private institution that--
       ``(A) offers postgraduate medical training in the 
     specialties and subspecialties of medicine; and
       ``(B) has been accredited by the Accreditation Council for 
     Graduate Medical Education or the American Osteopathic 
     Association through its Committee on Postdoctoral Training.
       ``(c) Palliative Medicine and Hospice Academic Career 
     Awards.--
       ``(1) Establishment of program.--The Secretary shall 
     establish a program to provide awards, to be known as the 
     `Palliative Medicine and Hospice Academic Career Awards', to 
     eligible individuals to promote the career development of 
     such individuals as academic hospice and palliative care 
     physicians.
       ``(2) Eligible individuals.--To be eligible to receive an 
     award under paragraph (1), an individual shall--
       ``(A) be board certified or board eligible in hospice and 
     palliative medicine; and
       ``(B) have a junior (non-tenured) faculty appointment at an 
     accredited (as determined by the Secretary) school of 
     medicine or osteopathic medicine.
       ``(3) Limitations.--No award under paragraph (1) may be 
     made to an eligible individual unless the individual--
       ``(A) has submitted to the Secretary an application, at 
     such time, in such manner, and containing such information as 
     the Secretary may require, and the Secretary has approved 
     such application;
       ``(B) provides, in such form and manner as the Secretary 
     may require, assurances that the individual will meet the 
     service requirement described in paragraph (6); and
       ``(C) provides, in such form and manner as the Secretary 
     may require, assurances that the individual has a full-time 
     faculty appointment in a health professions institution and 
     documented commitment from such institution to spend a 
     majority of the total funded time of such individual on 
     teaching and developing skills in interdisciplinary education 
     in palliative care.
       ``(4) Maintenance of effort.--An eligible individual who 
     receives an award under paragraph (1) shall provide 
     assurances to the Secretary that funds provided to the 
     eligible individual under this subsection will be used only 
     to supplement, not to supplant, the amount of Federal, State, 
     and local funds otherwise expended by the eligible 
     individual.
       ``(5) Amount and term.--
       ``(A) Amount.--The amount of an award under this subsection 
     shall be equal to the award amount provided for under section 
     753(c)(5)(A) for the fiscal year involved.
       ``(B) Term.--The term of an award made under this 
     subsection shall not exceed 5 years.
       ``(C) Payment to institution.--The Secretary shall make 
     payments for awards under this subsection to institutions 
     which include schools of medicine and osteopathic medicine.
       ``(6) Service requirement.--An individual who receives an 
     award under this subsection shall provide training in 
     palliative care and hospice, including the training of 
     interdisciplinary teams of health care professionals. The 
     provision of such training shall constitute a majority of the 
     total funded obligations of such individual under the award.
       ``(d) Palliative Care Workforce Development.--
       ``(1) In general.--The Secretary shall award grants or 
     contracts under this subsection to entities that operate a 
     Palliative Care and Hospice Education Center pursuant to 
     subsection (a)(1).
       ``(2) Application.--To be eligible for an award under 
     paragraph (1), an entity described in such paragraph shall 
     submit to the

[[Page 11738]]

     Secretary an application at such time, in such manner, and 
     containing such information as the Secretary may require.
       ``(3) Use of funds.--Amounts awarded under a grant or 
     contract under paragraph (1) shall be used to carry out the 
     fellowship program described in paragraph (4).
       ``(4) Fellowship program.--
       ``(A) In general.--Pursuant to paragraph (3), a Palliative 
     Care and Hospice Education Center that receives an award 
     under this subsection shall use such funds to offer short-
     term intensive courses (referred to in this subsection as a 
     `fellowship') that focus on palliative care that provide 
     supplemental training for faculty members in medical schools 
     and other health professions schools with programs in 
     psychology, pharmacy, nursing, social work, chaplaincy, or 
     other health disciplines, as approved by the Secretary. Such 
     a fellowship shall be open to current faculty, and 
     appropriately credentialed volunteer faculty and 
     practitioners, who do not have formal training in palliative 
     care, to upgrade their knowledge and clinical skills for the 
     care of individuals with serious or life-threatening illness 
     and to enhance their interdisciplinary teaching skills.
       ``(B) Location.--A fellowship under this paragraph shall be 
     offered either at the Palliative Care and Hospice Education 
     Center that is sponsoring the course, in collaboration with 
     other Palliative Care and Hospice Education Centers, or at 
     medical schools, schools of nursing, schools of pharmacy, 
     schools of social work, schools of chaplaincy or pastoral 
     care education, graduate programs in psychology, or other 
     health professions schools approved by the Secretary with 
     which the Centers are affiliated.
       ``(C) CME credit.--Participation in a fellowship under this 
     paragraph shall be accepted with respect to complying with 
     continuing health profession education requirements. As a 
     condition of such acceptance, the recipient shall 
     subsequently provide a minimum of 18 hours of voluntary 
     instruction in palliative care content (that has been 
     approved by a palliative care and hospice education center) 
     to students or trainees in health-related educational, home, 
     hospice, or long-term care settings.
       ``(5) Targets.--A Palliative Care and Hospice Education 
     Center that receives an award under this subsection shall 
     meet targets approved by the Secretary for providing 
     palliative care training to a certain number of faculty or 
     practitioners during the term of the award, as well as other 
     parameters established by the Secretary.
       ``(6) Amount of award.--An award under this subsection 
     shall be in an amount of $150,000. Not more than 24 
     Palliative Care and Hospice Education Centers may receive an 
     award under this subsection.
       ``(7) Maintenance of effort.--A Palliative Care and Hospice 
     Education Center that receives an award under this subsection 
     shall provide assurances to the Secretary that funds provided 
     to the Center under the award will be used only to 
     supplement, not to supplant, the amount of Federal, State, 
     and local funds otherwise expended by such Center.
       ``(e) Palliative Care and Hospice Career Incentive 
     Awards.--
       ``(1) In general.--The Secretary shall award grants or 
     contracts under this subsection to individuals described in 
     paragraph (2) to foster greater interest among a variety of 
     health professionals in entering the field of palliative 
     care.
       ``(2) Eligible individuals.--To be eligible to receive an 
     award under paragraph (1), an individual shall--
       ``(A) be an advanced practice nurse, a clinical social 
     worker, a pharmacist, a chaplain, or student of psychology 
     who is pursuing a doctorate or other advanced degree in 
     palliative care or related fields in an accredited health 
     professions school; and
       ``(B) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require.
       ``(3) Conditions of award.--As a condition of receiving an 
     award under this subsection, an individual shall agree that, 
     following completion of the award period, the individual will 
     teach or practice palliative care in health-related 
     educational, home, hospice or long-term care settings for a 
     minimum of 5 years under guidelines established by the 
     Secretary.
       ``(4) Payment to institution.--The Secretary shall make 
     payments for awards under this subsection to institutions 
     which include schools of medicine, osteopathic medicine, 
     nursing, social work, psychology, chaplaincy or pastoral care 
     education, dentistry, and pharmacy, or other allied health 
     discipline in an accredited health professions school that is 
     approved by the Secretary.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $44,100,000 for each of the fiscal years 2013 through 
     2017.''.
       (b) Effective Date.--The amendment made by this section 
     shall be effective beginning on the date that is 90 days 
     after the date of enactment of this Act.

     SEC. 4. APPLICATION TO ADVANCED PRACTICE NURSES.

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

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

       ``(a) Program Authorized.--The Secretary shall award grants 
     to eligible entities to develop and implement, in 
     coordination with programs under section 759A, programs and 
     initiatives to train and educate individuals in providing 
     palliative care in health related educational, hospice, home, 
     or long-term care settings.
       ``(b) Use of Funds.--An eligible entity that receives a 
     grant under subsection (a) shall use funds under such grant 
     to--
       ``(1) provide training to individuals who will provide 
     palliative care in health-related educational, home, hospice, 
     or long-term care settings;
       ``(2) develop and disseminate curricula relating to 
     palliative care in health-related educational, home, hospice, 
     or long-term care settings;
       ``(3) train faculty members in palliative care in health 
     related educational, home, hospice, or long-term care 
     settings; or
       ``(4) provide continuing education to individuals who 
     provide palliative care in health-related educational, home, 
     hospice, or long-term care settings.
       ``(c) Application.--An eligible entity desiring a grant 
     under subsection (a) shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may reasonably require.
       ``(d) Eligible Entity.--For purposes of this section, the 
     term `eligible entity' shall include a school of nursing, a 
     health care facility, a program leading to certification as a 
     certified nurse assistant, a partnership of such a school and 
     facility, or a partnership of such a program and facility.
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $5,000,000 for each of fiscal years 2013 through 2017.''.
                                 ______
                                 
      By Mr. REID:
  S. 3412. A bill to amend the Internal Revenue Code of 1986 to provide 
tax relief to middle-class families; placed on the calendar.
  Mr. REID. Mr. President, I ask unanimous consent that the text of the 
bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record as follows:

                                S. 3412

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

     SECTION 1. SHORT TITLE; ETC.

       (a) Short Title.--This Act may be cited as the ``Middle 
     Class Tax Cut Act''.
       (b) Amendment of 1986 Code.--Except as otherwise expressly 
     provided, whenever in this Act an amendment or repeal is 
     expressed in terms of an amendment to, or repeal of, a 
     section or other provision, the reference shall be considered 
     to be made to a section or other provision of the Internal 
     Revenue Code of 1986.
       (c) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; etc.

               TITLE I--TEMPORARY EXTENSION OF TAX RELIEF

Sec. 101. Temporary extension of 2001 tax relief.
Sec. 102. Temporary extension of 2003 tax relief.
Sec. 103. Temporary extension of 2010 tax relief.
Sec. 104. Temporary extension of election to expense certain 
              depreciable business assets.

                TITLE II--ALTERNATIVE MINIMUM TAX RELIEF

Sec. 201. Temporary extension of increased alternative minimum tax 
              exemption amount.
Sec. 202. Temporary extension of alternative minimum tax relief for 
              nonrefundable personal credits.

                      TITLE III--BUDGETARY EFFECTS

Sec. 301. Budgetary effects.

               TITLE I--TEMPORARY EXTENSION OF TAX RELIEF

     SEC. 101. TEMPORARY EXTENSION OF 2001 TAX RELIEF.

       (a) Temporary Extension.--
       (1) In general.--Section 901(a)(1) of the Economic Growth 
     and Tax Relief Reconciliation Act of 2001 is amended by 
     striking ``December 31, 2012'' and inserting ``December 31, 
     2013''.
       (2) Effective date.--The amendment made by this subsection 
     shall take effect as

[[Page 11739]]

     if included in the enactment of the Economic Growth and Tax 
     Relief Reconciliation Act of 2001.
       (b) Application to Certain High-income Taxpayers.--
       (1) Income tax rates.--
       (A) Treatment of 25- and 28- percent rate brackets.--
     Paragraph (2) of section 1(i) is amended to read as follows:
       ``(2) 25- and 28- percent rate brackets.--The tables under 
     subsections (a), (b), (c), (d), and (e) shall be applied--
       ``(A) by substituting `25%' for `28%' each place it appears 
     (before the application of subparagraph (B)), and
       ``(B) by substituting `28%' for `31%' each place it 
     appears.''.
       (B) 33-percent rate bracket.--Subsection (i) of section 1 
     is amended by redesignating paragraph (3) as paragraph (4) 
     and by inserting after paragraph (2) the following new 
     paragraph:
       ``(3) 33-percent rate bracket.--
       ``(A) In general.--In the case of taxable years beginning 
     after December 31, 2012--
       ``(i) the rate of tax under subsections (a), (b), (c), and 
     (d) on a taxpayer's taxable income in the fourth rate bracket 
     shall be 33 percent to the extent such income does not exceed 
     an amount equal to the excess of--

       ``(I) the applicable amount, over
       ``(II) the dollar amount at which such bracket begins, and

       ``(ii) the 36 percent rate of tax under such subsections 
     shall apply only to the taxpayer's taxable income in such 
     bracket in excess of the amount to which clause (i) applies.
       ``(B) Applicable amount.--For purposes of this paragraph, 
     the term `applicable amount' means the excess of--
       ``(i) the applicable threshold, over
       ``(ii) the sum of the following amounts in effect for the 
     taxable year:

       ``(I) the basic standard deduction (within the meaning of 
     section 63(c)(2)), and
       ``(II) the exemption amount (within the meaning of section 
     151(d)(1) (or, in the case of subsection (a), 2 such 
     exemption amounts).

       ``(C) Applicable threshold.--For purposes of this 
     paragraph, the term `applicable threshold' means--
       ``(i) $250,000 in the case of subsection (a),
       ``(ii) $225,000 in the case of subsection (b),
       ``(iii) $200,000 in the case of subsections (c), and
       ``(iv) \1/2\ the amount applicable under clause (i) (after 
     adjustment, if any, under subparagraph (E)) in the case of 
     subsection (d).
       ``(D) Fourth rate bracket.--For purposes of this paragraph, 
     the term `fourth rate bracket' means the bracket which would 
     (determined without regard to this paragraph) be the 36-
     percent rate bracket.
       ``(E) Inflation adjustment.--For purposes of this 
     paragraph, with respect to taxable years beginning in 
     calendar years after 2012, each of the dollar amounts under 
     clauses (i), (ii), and (iii) of subparagraph (C) shall be 
     adjusted in the same manner as under paragraph (1)(C), except 
     that subsection (f)(3)(B) shall be applied by substituting 
     `2008' for `1992'.''.
       (2) Phaseout of personal exemptions and itemized 
     deductions.--
       (A) Overall limitation on itemized deductions.--Section 68 
     is amended--
       (i) by striking ``the applicable amount'' the first place 
     it appears in subsection (a) and inserting ``the applicable 
     threshold in effect under section 1(i)(3)'',
       (ii) by striking ``the applicable amount'' in subsection 
     (a)(1) and inserting ``such applicable threshold'',
       (iii) by striking subsection (b) and redesignating 
     subsections (c), (d), and (e) as subsections (b), (c), and 
     (d), respectively, and
       (iv) by striking subsections (f) and (g).
       (B) Phaseout of deductions for personal exemptions.--
       (i) In general.--Paragraph (3) of section 151(d) is 
     amended--

       (I) by striking ``the threshold amount'' in subparagraphs 
     (A) and (B) and inserting ``the applicable threshold in 
     effect under section 1(i)(3)'',
       (II) by striking subparagraph (C) and redesignating 
     subparagraph (D) as subparagraph (C), and
       (III) by striking subparagraphs (E) and (F).

       (ii) Conforming amendments.--Paragraph (4) of section 
     151(d) is amended--

       (I) by striking subparagraph (B),
       (II) by redesignating clauses (i) and (ii) of subparagraph 
     (A) as subparagraphs (A) and (B), respectively, and by 
     indenting such subparagraphs (as so redesignated) 
     accordingly, and
       (III) by striking all that precedes ``in a calendar year 
     after 1989,'' and inserting the following:

       ``(4) Inflation adjustment.--In the case of any taxable 
     year beginning''.
       (c) Effective Date.--Except as otherwise provided, the 
     amendments made by this section shall apply to taxable years 
     beginning after December 31, 2012.
       (d) Application of EGTRRA Sunset.--Each amendment made by 
     subsection (b) shall be subject to title IX of the Economic 
     Growth and Tax Relief Reconciliation Act of 2001 to the same 
     extent and in the same manner as if such amendment was 
     included in title I of such Act.

     SEC. 102. TEMPORARY EXTENSION OF 2003 TAX RELIEF.

       (a) Extension.--
       (1) In general.--Section 303 of the Jobs and Growth Tax 
     Relief Reconciliation Act of 2003 is amended by striking 
     ``December 31, 2012'' and inserting ``December 31, 2013''.
       (2) Effective date.--The amendment made by this subsection 
     shall take effect as if included in the enactment of the Jobs 
     and Growth Tax Relief Reconciliation Act of 2003.
       (b) 20-percent Capital Gains Rate for Certain High Income 
     Individuals.--
       (1) In general.--Paragraph (1) of section 1(h) is amended 
     by striking subparagraph (C), by redesignating subparagraphs 
     (D) and (E) as subparagraphs (E) and (F) and by inserting 
     after subparagraph (B) the following new subparagraphs:
       ``(C) 15 percent of the lesser of--
       ``(i) so much of the adjusted net capital gain (or, if 
     less, taxable income) as exceeds the amount on which a tax is 
     determined under subparagraph (B), or
       ``(ii) the excess (if any) of--

       ``(I) the amount of taxable income which would (without 
     regard to this paragraph) be taxed at a rate below 36 
     percent, over
       ``(II) the sum of the amounts on which a tax is determined 
     under subparagraphs (A) and (B),

       ``(D) 20 percent of the adjusted net capital gain (or, if 
     less, taxable income) in excess of the sum of the amounts on 
     which tax is determined under subparagraphs (B) and (C),''.
       (2) Minimum tax.--Paragraph (3) of section 55(b) is amended 
     by striking subparagraph (C), by redesignating subparagraph 
     (D) as subparagraph (E), and by inserting after subparagraph 
     (B) the following new subparagraphs:
       ``(C) 15 percent of the lesser of--
       ``(i) so much of the adjusted net capital gain (or, if 
     less, taxable excess) as exceeds the amount on which tax is 
     determined under subparagraph (B), or
       ``(ii) the excess described in section 1(h)(1)(C)(ii), plus
       ``(D) 20 percent of the adjusted net capital gain (or, if 
     less, taxable excess) in excess of the sum of the amounts on 
     which tax is determined under subparagraphs (B) and (C), 
     plus''.
       (c) Conforming Amendments.--
       (1) The following provisions are each amended by striking 
     ``15 percent'' and inserting ``20 percent'':
       (A) Section 531.
       (B) Section 541.
       (C) Section 1445(e)(1).
       (D) The second sentence of section 7518(g)(6)(A).
       (E) Section 53511(f)(2) of title 46, United States Code.
       (2) Sections 1(h)(1)(B) and 55(b)(3)(B) are each amended by 
     striking ``5 percent (0 percent in the case of taxable years 
     beginning after 2007)'' and inserting ``0 percent''.
       (3) Section 1445(e)(6) is amended by striking ``15 percent 
     (20 percent in the case of taxable years beginning after 
     December 31, 2010)'' and inserting ``20 percent''.
       (d) Effective Dates.--
       (1) In general.--Except as otherwise provided, the 
     amendments made by subsections (b) and (c) shall apply to 
     taxable years beginning after December 31, 2012.
       (2) Withholding.--The amendments made by paragraphs (1)(C) 
     and (3) of subsection (c) shall apply to amounts paid on or 
     after January 1, 2013.
       (e) Application of JGTRRA Sunset.--Each amendment made by 
     subsections (b) and (c) shall be subject to section 303 of 
     the Jobs and Growth Tax Relief Reconciliation Act of 2003 to 
     the same extent and in the same manner as if such amendment 
     was included in title III of such Act.

     SEC. 103. TEMPORARY EXTENSION OF 2010 TAX RELIEF.

       (a) American Opportunity Tax Credit.--
       (1) In general.--Section 25A(i) is amended by striking ``or 
     2012'' and inserting ``2012, or 2013''.
       (2) Treatment of possessions.--Section 1004(c)(1) of 
     division B of the American Recovery and Reinvestment Tax Act 
     of 2009 is amended by striking ``and 2012'' each place it 
     appears and inserting ``2012, and 2013''.
       (b) Child Tax Credit.--Section 24(d)(4) is amended--
       (1) by striking ``and 2012'' in the heading and inserting 
     ``2012, and 2013'', and
       (2) by striking ``or 2012'' and inserting ``2012, or 
     2013''.
       (c) Earned Income Tax Credit.--Section 32(b)(3) is 
     amended--
       (1) by striking ``and 2012'' in the heading and inserting 
     ``2012, and 2013'', and
       (2) by striking ``or 2012'' and inserting ``2012, or 
     2013''.
       (d) Temporary Extension of Rule Disregarding Refunds in the 
     Administration of Federal Programs and Federally Assisted 
     Programs.--Subsection (b) of section 6409 is amended by 
     striking ``December 31, 2012'' and inserting ``December 31, 
     2013''.
       (e) Effective Dates.--
       (1) In general.--Except as provided in paragraph (2), the 
     amendments made by this section shall apply to taxable years 
     beginning after December 31, 2012.
       (2) Rule disregarding refunds in the administration of 
     certain programs.--The amendment made by subsection (d) shall 
     apply to amounts received after December 31, 2012.

[[Page 11740]]



     SEC. 104. TEMPORARY EXTENSION OF ELECTION TO EXPENSE CERTAIN 
                   DEPRECIABLE BUSINESS ASSETS.

       (a) In General.--
       (1) Dollar limitation.--Section 179(b)(1) is amended--
       (A) by striking ``and'' at the end of subparagraph (C),
       (B) by redesignating subparagraph (D) as subparagraph (E),
       (C) by inserting after subparagraph (C) the following new 
     subparagraph:
       ``(D) $250,000 in the case of taxable years beginning in 
     2013, and'', and
       (D) in subparagraph (E), as so redesignated, by striking 
     ``2012'' and inserting ``2013''.
       (2) Reduction in limitation.--Section 179(b)(2) is 
     amended--
       (A) by striking ``and'' at the end of subparagraph (C),
       (B) by redesignating subparagraph (D) as subparagraph (E),
       (C) by inserting after subparagraph (C) the following new 
     subparagraph:
       ``(D) $800,000 in the case of taxable years beginning in 
     2013, and'', and
       (D) in subparagraph (E), as so redesignated, by striking 
     ``2012'' and inserting ``2013''.
       (b) Computer Software.--Section 179(d)(1)(A)(ii) is amended 
     by striking ``2013'' and inserting ``2014''.
       (c) Election.--Section 179(c)(2) is amended by striking 
     ``2013'' and inserting ``2014''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2012.

                TITLE II--ALTERNATIVE MINIMUM TAX RELIEF

     SEC. 201. TEMPORARY EXTENSION OF INCREASED ALTERNATIVE 
                   MINIMUM TAX EXEMPTION AMOUNT.

       (a) In General.--Paragraph (1) of section 55(d) is 
     amended--
       (1) by striking ``$72,450'' and all that follows through 
     ``2011'' in subparagraph (A) and inserting ``$78,750 in the 
     case of taxable years beginning in 2012'', and
       (2) by striking ``$47,450'' and all that follows through 
     ``2011'' in subparagraph (B) and inserting ``$50,600 in the 
     case of taxable years beginning in 2012''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2011.

     SEC. 202. TEMPORARY EXTENSION OF ALTERNATIVE MINIMUM TAX 
                   RELIEF FOR NONREFUNDABLE PERSONAL CREDITS.

       (a) In General.--Paragraph (2) of section 26(a) is 
     amended--
       (1) by striking ``or 2011'' and inserting ``2011, or 
     2012'', and
       (2) by striking ``2011'' in the heading thereof and 
     inserting ``2012''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2011.

                      TITLE III--BUDGETARY EFFECTS

     SEC. 301. BUDGETARY EFFECTS.

       (a) PAYGO Scorecard.--The budgetary effects of this Act 
     shall not be entered on either PAYGO scorecard maintained 
     pursuant to section 4(d) of the Statutory Pay-As-You-Go Act 
     of 2010.
       (b) Senate PAYGO Scorecard.--The budgetary effects of this 
     Act shall not be entered on any PAYGO scorecard maintained 
     for purposes of section 201 of S. Con Res. 21 (110th 
     Congress).
                                 ______
                                 
      By Mr. INHOFE (for himself and Mr. Vitter):
  S. 3415. A bill to require the disclosure of all payments made under 
the Equal Access to Justice Act; to the Committee on the Judiciary.
  Mr. INHOFE. Mr. President, I rise today to introduce the Government 
Transparency and Recordkeeping Act along with Senator Vitter.
  The purpose of this bill is to require that all records of individual 
payments under 31 U.S.C. 1304, which is the Judgment Fund, are reported 
to Congress and made available to the public. It further requires that 
agencies provide this information by keeping accurate and thorough 
records.
  Simply put, most Americans have a checking account. When you write a 
check, you also record it in your checking book. This checking book is 
your record of how much you paid and to whom you paid. Simply put, the 
Federal Government does not do this in terms of the Judgment Fund. The 
Federal government has not been keeping track of its Judgment Fund 
payments because they are not required to do so. In this age of 
technology, shouldn't the federal government keep track of its 
finances?
  If the Federal Government is named as a defendant and the plaintiffs 
are successful then the plaintiffs may be awarded for certain attorney 
fees and costs. Such payments are made from the Judgment Fund.
  The Judgment Fund was created in 1956 and is a permanent fund 
available to pay judgments against the government and settlements 
resulting from lawsuits.
  As the Ranking Member of the Senate Environment and Public Works 
Committee, I had to request that GAO investigate how much the Judgment 
Fund has paid related to the environmental statutes in our jurisdiction 
and get back to me. Even GAO had trouble getting complete records over 
the past ten years. This is federal taxpayers' money that we are 
spending without keeping accurate and up to date records. This 
information needs to be readily available and accessible to the public.
  Federal agencies that are impacted by these costs as well as 
policymakers and taxpayers should be able to track payments from the 
Judgment Fund to determine who is suing a particular Federal agency, 
the nature of their claims, how often agencies settle and agree to pay 
plaintiffs' legal fees, and so forth. If Congress and the public had 
access to this information in a useable form, they could identify 
problem areas and work to save taxpayer money by bringing loss rates 
down.
  Article I, section 9 of the U.S. Constitution provides ``that a 
regular Statement and Account of the Receipts of all public money shall 
be published from time to time.'' The operation and payment of Judgment 
fund monies should not be an exception. This bill will ensure that 
Congress and the public have access to such information.

                          ____________________