S 1263 ISCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes.CommentsClose CommentsPermalink

June 15, 2009CommentsClose CommentsPermalink

Mr. WARNER introduced the following bill; which was read twice and referred to the Committee on FinanceCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes.CommentsClose CommentsPermalink

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the ‘Senior Navigation and Planning Act of 2009’.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink





Sec. 2. Medicare and Medicaid coverage of advanced illness care management services.CommentsClose CommentsPermalink





Sec. 3. Increasing awareness of the importance of end-of-life planning.CommentsClose CommentsPermalink





Sec. 4. Inclusion of end-of-life planning materials in the Medicare & You handbook.CommentsClose CommentsPermalink





Sec. 5. Senior Navigation Advisory Board.CommentsClose CommentsPermalink





Sec. 6. Requirement for physicians and nurse practitioners to provide certain Medicare beneficiaries with information on advance directives and other end-of-life planning tools.CommentsClose CommentsPermalink





Sec. 7. Improvement of policies related to the use and portability of advance directives.CommentsClose CommentsPermalink





Sec. 8. Additional requirements for facilities.CommentsClose CommentsPermalink





Sec. 9. Requirement for Medicare providers to honor written orders for medical care.CommentsClose CommentsPermalink





Sec. 10. Incentives for accreditation and certification in hospice and palliative care.CommentsClose CommentsPermalink





Sec. 11. Discharge checklist pilot program.CommentsClose CommentsPermalink





Sec. 12. Office of Medicare/Medicaid Integration.CommentsClose CommentsPermalink





Sec. 13. Web-based materials and grants.CommentsClose CommentsPermalink





Sec. 14. HHS study and report on the storage of advance directives.CommentsClose CommentsPermalink





Sec. 15. GAO study and report on the provisions of, and amendments made by, this Act.CommentsClose CommentsPermalink

SEC. 2. MEDICARE AND MEDICAID COVERAGE OF ADVANCED ILLNESS CARE MANAGEMENT SERVICES.

(a) Medicare Coverage of Advanced Illness Care Management Services-CommentsClose CommentsPermalink





(1) COVERAGE- Section 1812(a)(5) of the Social Security Act (42 U.S.C. 1395d(a)(5)) is amended to read as follows:CommentsClose CommentsPermalink





‘(5) for individuals who have a life expectancy of 18 months or less and who have not made an election under subsection (d)(1) to receive hospice care under this part, advanced illness care management services (as defined in section 1861(hhh)).’.CommentsClose CommentsPermalink





(2) DEFINITION- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink

‘Advanced Illness Care Management Services

‘(hhh)(1) The term ‘advanced illness care management services’ means the following services furnished to an individual by a hospice program, as defined in subsection (dd)(2):CommentsClose CommentsPermalink





‘(A) Palliative care consultation services.CommentsClose CommentsPermalink





‘(B) Care planning services.CommentsClose CommentsPermalink





‘(C) Counseling of individual and family members.CommentsClose CommentsPermalink





‘(D) Discussions regarding the availability of supportive services (including information on advance care planning).CommentsClose CommentsPermalink





‘(E) Patient-centered care.CommentsClose CommentsPermalink





‘(F) Family conference services.CommentsClose CommentsPermalink





‘(G) Respite services.CommentsClose CommentsPermalink





‘(H) Onsite caregiver training.CommentsClose CommentsPermalink





‘(I) Such other services as may be appropriate under a hospice model of care.CommentsClose CommentsPermalink





‘(2) For purposes of paragraph (1)(F), the term ‘family conference services’ means a family conference held by a hospice program (as so defined) for the individual and the family members of the individual, including services for the facilitation and provision of adequate follow-up to such family conference, which includes additional collaboration and coordination with the hospice physician or other hospice personnel to clarify and put into action the goals of care as outlined by the individual and the family members of the individual.CommentsClose CommentsPermalink





‘(3)(A) For purposes of paragraph (1)(G), the term ‘respite services’ means the provision of additional hours of care to individuals who are unable to perform 2 or more activities of daily living. Such services shall be targeted toward furnishing services to the individual and providing the caregivers of the individual a needed break outside of the home of the individual.CommentsClose CommentsPermalink





‘(B) For purposes of subparagraph (A), the Secretary shall establish, on an annual basis, a minimum and maximum number of hours (not to exceed 16 hours each month) for which respite services may be provided to individuals eligible to receive such services.CommentsClose CommentsPermalink





‘(C) In subparagraph (A), the term ‘activities of daily living’ means bathing, transferring, toileting, and feeding.CommentsClose CommentsPermalink





‘(4) For purposes of paragraph (1)(H), the term ‘onsite caregiver training’ means training provided to the caregivers of an individual, which is focused on training such caregivers to provide effective personal and technical care to individuals, with an emphasis on what the caregiver can expect with the disease process of the individual or the needs of the individual at the end of life. Such training shall be pragmatic and easily understood by non-health professionals as well as culturally and educationally appropriate.CommentsClose CommentsPermalink





‘(5) In the case of a hospice program that is furnishing advanced illness care management services to an individual who becomes eligible for hospice care under this title, the hospice program shall notify the individual of such eligibility.’.CommentsClose CommentsPermalink





(3) PAYMENT BASED ON THE PHYSICIAN FEE SCHEDULE- Section 1814(i)(4) of the Social Security Act (42 U.S.C. 1395f(i)(4)) is amended to read as follows:CommentsClose CommentsPermalink





‘(4) The amount paid to a hospice program with respect to the advanced illness care management services (as defined in section 1861(hhh)) for which payment may be made under this part shall be--CommentsClose CommentsPermalink





‘(A) with respect to such services, other than respite services, furnished by a hospice physician, an amount equal to the amount that would be paid for an equivalent physician consultation under the fee schedule established under section 1848(b);CommentsClose CommentsPermalink





‘(B) with respect to such services, other than respite services, furnished by other hospice personnel, an amount equal to 85 percent of such fee schedule amount; andCommentsClose CommentsPermalink





‘(C) with respect to respite services, payment shall be at an appropriate rate to be determined by the Secretary’.CommentsClose CommentsPermalink





(4) CONFORMING AMENDMENTS- Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)) is amended--CommentsClose CommentsPermalink





(A) in paragraph (1)--CommentsClose CommentsPermalink





(i) by striking ‘and’ at the end of subparagraph (N);CommentsClose CommentsPermalink





(ii) by striking the semicolon at the end of subparagraph (O) and inserting ‘, and’; andCommentsClose CommentsPermalink





(iii) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(P) in the case of advanced illness care management services which are respite services (as defined in section 1861(hhh)(3)), which are performed more frequently than is provided under clause (ii) of such section;’; andCommentsClose CommentsPermalink





(B) in paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’.CommentsClose CommentsPermalink





(5) EFFECTIVE DATE- The amendments made by this subsection shall apply to services furnished on or after January 1, 2011.CommentsClose CommentsPermalink





(b) Medicaid Coverage of Advanced Illness Care Management Services-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended--CommentsClose CommentsPermalink





(A) by redesignating paragraph (28) as paragraph (29);CommentsClose CommentsPermalink





(B) in paragraph (27), by striking at the end ‘and’; andCommentsClose CommentsPermalink





(C) by inserting after paragraph (27) the following new paragraph:CommentsClose CommentsPermalink





‘(28) advanced illness care management services (as defined in section 1861(hhh)) for individuals described in section 1812(a)(5); and’.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENT- Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking ‘and (21)’ and inserting ‘, (21), and (28)’.CommentsClose CommentsPermalink





(3) EFFECTIVE DATE-CommentsClose CommentsPermalink





(A) IN GENERAL- Except as provided in subparagraph (B), the amendments made by paragraphs (1) and (2) take effect on January 1, 2011.CommentsClose CommentsPermalink





(B) EXTENSION OF EFFECTIVE DATE FOR STATE LAW AMENDMENT- In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary determines requires State legislation in order for the plan to meet the additional requirements imposed by the amendments made by paragraph (1), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.CommentsClose CommentsPermalink





(c) Education on Advanced Illness Care Management Services- The Secretary of Health and Human Services (in this section referred to as the ‘Secretary’) shall establish a program under which physicians (as defined in subsection (r) of section 1861 of the Social Security Act (42 U.S.C. 1395x)) are educated on the coverage of advanced illness care management services (as defined in subsection (hhh) of such section) under the Medicare and Medicaid programs under titles XVIII and XIX, respectively, of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.), including the importance of early intervention in providing such care to individuals.CommentsClose CommentsPermalink

SEC. 3. INCREASING AWARENESS OF THE IMPORTANCE OF END-OF-LIFE PLANNING.

Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended by adding at the end the following new part:CommentsClose CommentsPermalink

‘PART S--PROGRAMS TO INCREASE AWARENESS OF ADVANCE CARE PLANNING ISSUES

‘SEC. 399GG. ADVANCE CARE PLANNING EDUCATION CAMPAIGNS AND INFORMATION PHONE LINE AND CLEARINGHOUSE.

‘(a) Advance Care Planning Education Campaign- The Secretary shall, directly or through grants awarded under subsection (c), conduct a national public education campaign--CommentsClose CommentsPermalink





‘(1) to raise public awareness of the importance of planning for care near the end of life;CommentsClose CommentsPermalink





‘(2) to improve the public’s understanding of the various situations in which individuals may find themselves if they become unable to express their health care wishes;CommentsClose CommentsPermalink





‘(3) to explain the need for readily available legal documents that express an individual’s wishes through--CommentsClose CommentsPermalink





‘(A) advance directives (including living wills, comfort care orders, and durable powers of attorney for health care); andCommentsClose CommentsPermalink





‘(B) other planning tools, such as a physician’s orders for life-sustaining treatment (POLST); andCommentsClose CommentsPermalink





‘(4) to educate the public about the availability of hospice care and palliative care.CommentsClose CommentsPermalink





‘(b) Information Phone Line and Clearinghouse- The Secretary, directly or through grants awarded under subsection (c), shall provide for the establishment of a national, toll-free, information telephone line and a clearinghouse that the public and health care professionals may access to find out about State-specific and other information regarding advance directive and end-of-life decisions.CommentsClose CommentsPermalink





‘(c) Grants-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary shall use funds appropriated under subsection (d) for the purpose of awarding grants to public or nonprofit private entities (including States or political subdivisions of a State), or a consortium of any of such entities, for the purpose of conducting education campaigns under subsection (a).CommentsClose CommentsPermalink





‘(2) PERIOD- Any grant awarded under paragraph (1) shall be for a period of 3 years.CommentsClose CommentsPermalink





‘(d) Authorization of Appropriations- There are authorized to be appropriated--CommentsClose CommentsPermalink





‘(1) for purposes of carrying out subsection (b), $5,000,000 for fiscal year 2010 and each subsequent year; andCommentsClose CommentsPermalink





‘(2) for purposes of making grants under subsection (c), $10,000,000 for fiscal year 2010, to remain available until expended.’.CommentsClose CommentsPermalink

SEC. 4. INCLUSION OF END-OF-LIFE PLANNING MATERIALS IN THE MEDICARE & YOU HANDBOOK.

(a) In General- Section 1804(a) of the Social Security Act (42 U.S.C. 1395b-2(a)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (2), by striking ‘and’ at the end;CommentsClose CommentsPermalink





(2) in paragraph (3), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(3) by inserting after paragraph (3) the following new paragraph:CommentsClose CommentsPermalink





‘(4) information on advance directives, other end-of-life planning tools, and the hospice care benefit under this title.’.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by this section shall apply to notices distributed on or after January 1, 2011.CommentsClose CommentsPermalink

SEC. 5. SENIOR NAVIGATION ADVISORY BOARD.

(a) Establishment- The Secretary of Health and Human Services shall establish the Senior Navigation Advisory Board (in this section referred to as the ‘Advisory Board’).CommentsClose CommentsPermalink





(b) Membership- The Board shall be comprised of advocates, researchers, government officials, health care providers, ethicists, caregivers, and other individuals with expertise in issues related to end-of-life care.CommentsClose CommentsPermalink





(c) Duties- The Advisory Board shall advise the Secretary on issues related to end-of-life care and advance care planning, including how to--CommentsClose CommentsPermalink





(1) increase patients’ quality of life;CommentsClose CommentsPermalink





(2) reduce current legal hurdles to the enforcement of advance directives;CommentsClose CommentsPermalink





(3) encourage provider participation in educational and training activities surrounding advanced illnesses and end-of-life care planning;CommentsClose CommentsPermalink





(4) develop quality and outcome measures that hospice programs should report for advanced illness care management services (as defined in section 1861(hhh) of the Social Security Act, as added by section 2);CommentsClose CommentsPermalink





(5) determine what information should be discussed in discharge planning; andCommentsClose CommentsPermalink





(6) enhance advance care planning.CommentsClose CommentsPermalink





(d) Application of FACA- The Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the Advisory Board.CommentsClose CommentsPermalink





(e) Pay and Reimbursement-CommentsClose CommentsPermalink





(1) NO COMPENSATION FOR MEMBERS OF ADVISORY BOARD- Except as provided in paragraph (2), a member of the Advisory Board may not receive pay, allowances, or benefits by reason of their service on the Board.CommentsClose CommentsPermalink





(2) TRAVEL EXPENSES- Each member shall receive travel expenses, including per diem in lieu of subsistence under subchapter I of chapter 57 of title 5, United States Code.CommentsClose CommentsPermalink





(f) Report- Not later than 3 years after the establishment of the Advisory Board, the Advisory Board shall submit to Congress a final report containing the findings and conclusions of the Advisory Board, together with recommendations for such legislation and administrative actions as the Advisory Board considers appropriate.CommentsClose CommentsPermalink





(g) Termination- The Advisory Board shall terminate 30 days after submitting the report under subsection (f).CommentsClose CommentsPermalink





(h) Authorization of Appropriations- There are authorized to be appropriated such sums as may be necessary to carry out this section.CommentsClose CommentsPermalink

SEC. 6. REQUIREMENT FOR PHYSICIANS AND NURSE PRACTITIONERS TO PROVIDE CERTAIN MEDICARE BENEFICIARIES WITH INFORMATION ON ADVANCE DIRECTIVES AND OTHER END-OF-LIFE PLANNING TOOLS.

Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(n) Requirement for Physicians and Nurse Practitioners To Provide Certain Individuals With Information on Advance Directives and Other End-of-Life Planning Tools-CommentsClose CommentsPermalink





‘(1) IN GENERAL- No payment may be made under this title to a physician (as defined in section 1861(r)) or a nurse practitioner (as defined in section 1861(aa)(5)(A)) for items and services furnished on or after January 1, 2014, unless the physician or nurse practitioner agrees (under a process established by the Secretary) to provide individuals described in paragraph (2) with information on advance directives and other end-of-life planning tools. Such information shall be provided in a form and manner, and at a time, determined appropriate by the Secretary.CommentsClose CommentsPermalink





‘(2) INDIVIDUAL DESCRIBED- An individual described in this paragraph is an individual entitled to, or enrolled for, benefits under part A or enrolled for benefits under this part with--CommentsClose CommentsPermalink





‘(A) metastatic solid organ cancer;CommentsClose CommentsPermalink





‘(B) congestive heart failure;CommentsClose CommentsPermalink





‘(C) end stage renal disease;CommentsClose CommentsPermalink





‘(D) a progressive neurodegenerative disorder;CommentsClose CommentsPermalink





‘(E) oxygen dependent chronic pulmonary disease; orCommentsClose CommentsPermalink





‘(F) any other condition with a similar level of medical necessity determined appropriate by the Secretary.’.CommentsClose CommentsPermalink

SEC. 7. IMPROVEMENT OF POLICIES RELATED TO THE USE AND PORTABILITY OF ADVANCE DIRECTIVES.

(a) Medicare- Section 1866(f) of the Social Security Act (42 U.S.C. 1395cc(f)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1)--CommentsClose CommentsPermalink





(A) in subparagraph (B), by inserting ‘and if presented by the individual (or on behalf of the individual), to include the content of such advance directive in a prominent part of such record’ before the semicolon at the end;CommentsClose CommentsPermalink





(B) in subparagraph (D), by striking ‘and’ after the semicolon at the end;CommentsClose CommentsPermalink





(C) in subparagraph (E), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(D) by inserting after subparagraph (E) the following new subparagraph:CommentsClose CommentsPermalink





‘(F) to provide each individual with the opportunity to discuss issues relating to the information provided to that individual pursuant to subparagraph (A) with an appropriately trained professional.’;CommentsClose CommentsPermalink





(2) in paragraph (3), by striking ‘a written’ and inserting ‘an’; andCommentsClose CommentsPermalink





(3) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(5)(A) In addition to the requirements of paragraph (1), a provider of services, Medicare Advantage organization, or prepaid or eligible organization (as the case may be) shall give effect to an advance directive executed outside the State in which such directive is presented, even one that does not appear to meet the formalities of execution, form, or language required by the State in which it is presented to the same extent as such provider or organization would give effect to an advance directive that meets such requirements, except that a provider or organization may decline to honor such a directive if the provider or organization can reasonably demonstrate that it is not an authentic expression of the individual’s wishes concerning his or her health care. Nothing in this paragraph shall be construed to authorize the administration of medical treatment otherwise prohibited by the laws of the State in which the directive is presented.CommentsClose CommentsPermalink





‘(B) The provisions of this paragraph shall preempt any State law to the extent such law is inconsistent with such provisions. The provisions of this paragraph shall not preempt any State law that provides for greater portability, more deference to a patient’s wishes, or more latitude in determining a patient’s wishes.’.CommentsClose CommentsPermalink





(b) Medicaid- Section 1902(w) of the Social Security Act (42 U.S.C. 1396a(w)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1)--CommentsClose CommentsPermalink





(A) in subparagraph (B)--CommentsClose CommentsPermalink





(i) by striking ‘in the individual’s medical record’ and inserting ‘in a prominent part of the individual’s current medical record’; andCommentsClose CommentsPermalink





(ii) by inserting ‘and if presented by the individual (or on behalf of the individual), to include the content of such advance directive in a prominent part of such record’ before the semicolon at the end;CommentsClose CommentsPermalink





(B) in subparagraph (D), by striking ‘and’ after the semicolon at the end;CommentsClose CommentsPermalink





(C) in subparagraph (E), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(D) by inserting after subparagraph (E) the following new subparagraph:CommentsClose CommentsPermalink





‘(F) to provide each individual with the opportunity to discuss issues relating to the information provided to that individual pursuant to subparagraph (A) with an appropriately trained professional.’;CommentsClose CommentsPermalink





(2) in paragraph (4), by striking ‘a written’ and inserting ‘an’; andCommentsClose CommentsPermalink





(3) by adding at the end the following paragraph:CommentsClose CommentsPermalink





‘(6)(A) In addition to the requirements of paragraph (1), a provider or organization (as the case may be) shall give effect to an advance directive executed outside the State in which such directive is presented, even one that does not appear to meet the formalities of execution, form, or language required by the State in which it is presented to the same extent as such provider or organization would give effect to an advance directive that meets such requirements, except that a provider or organization may decline to honor such a directive if the provider or organization can reasonably demonstrate that it is not an authentic expression of the individual’s wishes concerning his or her health care. Nothing in this paragraph shall be construed to authorize the administration of medical treatment otherwise prohibited by the laws of the State in which the directive is presented.CommentsClose CommentsPermalink





‘(B) The provisions of this paragraph shall preempt any State law to the extent such law is inconsistent with such provisions. The provisions of this paragraph shall not preempt any State law that provides for greater portability, more deference to a patient’s wishes, or more latitude in determining a patient’s wishes.’.CommentsClose CommentsPermalink





(c) Effective Dates-CommentsClose CommentsPermalink





(1) IN GENERAL- Subject to paragraph (2), the amendments made by subsections (a) and (b) shall apply to provider agreements and contracts entered into, renewed, or extended under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), and to State plans under title XIX of such Act (42 U.S.C. 1396 et seq.), on or after such date as the Secretary of Health and Human Services specifies, but in no case may such date be later than 1 year after the date of enactment of this Act.CommentsClose CommentsPermalink





(2) EXTENSION OF EFFECTIVE DATE FOR STATE LAW AMENDMENT- In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirements imposed by the amendments made by subsection (b), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.CommentsClose CommentsPermalink

SEC. 8. ADDITIONAL REQUIREMENTS FOR FACILITIES.

(a) Requirements-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended--CommentsClose CommentsPermalink





(A) in subsection (a)(1)--CommentsClose CommentsPermalink





(i) in subparagraph (U), by striking ‘and’ at the end;CommentsClose CommentsPermalink





(ii) in subparagraph (V), by striking the period at the end and inserting a comma; andCommentsClose CommentsPermalink





(iii) by inserting after subparagraph (V) the following new subparagraphs:CommentsClose CommentsPermalink





‘(W) in the case of hospitals, skilled nursing facilities, home health agencies, and hospice programs, to provide individuals receiving care by or through the provider (and their caregivers and families, with the patient’s consent, or their surrogate decision-makers) with the opportunity to discuss the general course of treatment expected, the likely impact on length of life and function, and the procedures they should use to secure help if an unexpected situation arises, andCommentsClose CommentsPermalink





‘(X) in the case of hospitals, skilled nursing facilities, and hospice programs, to--CommentsClose CommentsPermalink





‘(i) provide for an assessment of each individual (at the time of discharge from the provider) using an assessment instrument that is at least as informative as the continuity assessment record and evaluation (CARE) instrument developed by the Centers for Medicare & Medicaid Services; andCommentsClose CommentsPermalink





‘(ii) include the results of such assessment in the individual’s medical record.’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendments made by this subsection shall apply to agreements entered into or renewed on or after January 1, 2012.CommentsClose CommentsPermalink





(b) HHS Study and Report on Appropriate Assessments at Discharge-CommentsClose CommentsPermalink





(1) STUDY- The Secretary of Health and Human Services shall conduct a study on the extent to which the assessment of individual by hospitals, skilled nursing facilities, and hospice programs under section 1886(a)(1)(X) of the Social Security Act, as added by subsection (a), accurately reflects the actual diagnosis and care plan of the individual involved at the time of discharge.CommentsClose CommentsPermalink





(2) REPORT- Not later than January 1, 2014, the Secretary of Health and Human Services shall submit to Congress a report on the study conducted under paragraph (1) together with recommendations for such legislation and administrative action as the Secretary determines to be appropriate.CommentsClose CommentsPermalink

SEC. 9. REQUIREMENT FOR MEDICARE PROVIDERS TO HONOR WRITTEN ORDERS FOR MEDICAL CARE.

Section 1834 of the Social Security Act (42 U.S.C. 1395m), as amended by section 6, is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(o) Requirement To Honor Written Orders for Medical Care- No payment may be made under this title to a provider of services or a supplier for items and services furnished on or after January 1, 2013, unless the provider or supplier agrees (under a process established by the Secretary) to, in the case of an individual with a written order for medical care (such as a physician’s orders for life-sustaining treatment (POLST)), follow such order when furnishing items and services to the individual.’.CommentsClose CommentsPermalink

SEC. 10. INCENTIVES FOR ACCREDITATION AND CERTIFICATION IN HOSPICE AND PALLIATIVE CARE.

(a) Hospitals- Section 1886 of the Social Security Act (42 U.S.C. 1395ww) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(o) Incentives for Accreditation in Palliative Care-CommentsClose CommentsPermalink





‘(1) INCENTIVE PAYMENT-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Subject to subparagraph (3), with respect to inpatient hospital services and inpatient critical access hospital services furnished by an eligible hospital during a payment year, if the eligible hospital has in place an accredited palliative care program (as determined by the Secretary) with respect to such year and meets utilization criteria for such program (as established by the Secretary) with respect to such year, in addition to the amount otherwise paid under this section or section 1814, there shall also be paid to the eligible hospital, from the Federal Hospital Insurance Trust Fund established under section 1817, an amount equal to the applicable percent of the amount that would otherwise be paid under this section or section 1814 for such services for the hospital for such year.CommentsClose CommentsPermalink





‘(B) APPLICABLE PERCENT DEFINED- The term ‘applicable percent’ means--CommentsClose CommentsPermalink





‘(i) for fiscal years 2011 through 2016, 2 percent; andCommentsClose CommentsPermalink





‘(ii) for fiscal years 2017 through 2020, 1 percent.CommentsClose CommentsPermalink





‘(C) FORM OF PAYMENT- The payment under this paragraph for a payment year may be in the form of a single consolidated payment or in the form of such periodic installments as the Secretary may specify.CommentsClose CommentsPermalink





‘(2) INCENTIVE PAYMENT ADJUSTMENT- Subject to paragraph (3), with respect to inpatient hospital services and inpatient critical access hospital services furnished by an eligible hospital during a fiscal year after fiscal year 2020, if the eligible hospital does not have in place an accredited palliative care program (as determined by the Secretary) with respect to such fiscal year, the amount otherwise paid under this section or section 1814 for such services for the hospital for the year shall be reduced by 1 percent.CommentsClose CommentsPermalink





‘(3) EXCEPTION- In the case of an eligible hospital with fewer than 50 beds, such hospital shall be deemed to meet the requirement in paragraphs (1)(A) and (2) if, in lieu of having in place an accredited palliative care program, the hospital provides patients and family members with access to a local or regional accredited palliative care team or program.CommentsClose CommentsPermalink





‘(4) DEFINITIONS- In this subsection:CommentsClose CommentsPermalink





‘(A) ELIGIBLE HOSPITAL- The term ‘eligible hospital’ means--CommentsClose CommentsPermalink





‘(i) a hospital (as defined in section 1861(e)); andCommentsClose CommentsPermalink





‘(ii) a critical access hospital (as defined in section 1861(mm)(1)).CommentsClose CommentsPermalink





‘(B) PAYMENT YEAR- The term ‘payment year’ means fiscal years 2011 through 2020.CommentsClose CommentsPermalink





‘(5) LIMITATIONS ON REVIEW- There shall be no administrative or judicial review under section 1869, section 1878, or otherwise, of--CommentsClose CommentsPermalink





‘(A) the methodology and standards for determining payment amounts under paragraph (1) and payment adjustments under paragraph (2);CommentsClose CommentsPermalink





‘(B) the methodology and standards for determining whether the eligible hospital has in place an accredited palliative care program; andCommentsClose CommentsPermalink





‘(C) the application of the exception under paragraph (3).’.CommentsClose CommentsPermalink





(b) Skilled Nursing Facilities- Section 1888 of the Social Security Act (42 U.S.C. 1395yy) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(f) Incentives for Accreditation in Palliative Care-CommentsClose CommentsPermalink





‘(1) INCENTIVE PAYMENT-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Subject to subparagraph (3), with respect to covered skilled nursing facility services (as defined in subsection (e)(2)(A)) furnished by a skilled nursing facility during a payment year, if the facility has in place an accredited palliative care program (as determined by the Secretary) with respect to such year and meets utilization criteria for such program (as established by the Secretary) with respect to such year, in addition to the amount otherwise paid under this subsection (e), there shall also be paid to the facility, from the Federal Hospital Insurance Trust Fund established under section 1817, an amount equal to the applicable percent of the amount that would otherwise be paid under subsection (e) for such services for the facility for such year.CommentsClose CommentsPermalink





‘(B) DEFINITIONS- In this subsection:CommentsClose CommentsPermalink





‘(i) APPLICABLE PERCENT- The term ‘applicable percent’ means--CommentsClose CommentsPermalink





‘(I) for fiscal years 2011 through 2016, 2 percent; andCommentsClose CommentsPermalink





‘(II) for fiscal years 2017 through 2020, 1 percent.CommentsClose CommentsPermalink





‘(ii) PAYMENT YEAR- The term ‘payment year’ means fiscal years 2011 through 2020.CommentsClose CommentsPermalink





‘(C) FORM OF PAYMENT- The payment under this paragraph for a payment year may be in the form of a single consolidated payment or in the form of such periodic installments as the Secretary may specify.CommentsClose CommentsPermalink





‘(2) INCENTIVE PAYMENT ADJUSTMENT- Subject to paragraph (3), with respect to covered skilled nursing facility services (as defined in subsection (e)(2)(A)) furnished by a skilled nursing facility during a fiscal year after fiscal year 2020, if the facility does not have in place an accredited palliative care program (as determined by the Secretary) with respect to such fiscal year, the amount otherwise paid under subsection (e) for such services for the facility for the year shall be reduced by 1 percent.CommentsClose CommentsPermalink





‘(3) EXCEPTION- In the case of a skilled nursing facility with fewer than 60 beds, such facility shall be deemed to meet the requirement in paragraphs (1)(A) and (2) if, in lieu of having in place an accredited palliative care program, the facility provides patients and family members with access to a local or regional accredited palliative care team or program.CommentsClose CommentsPermalink





‘(4) LIMITATIONS ON REVIEW- There shall be no administrative or judicial review under section 1869, section 1878, or otherwise, of--CommentsClose CommentsPermalink





‘(A) the methodology and standards for determining payment amounts under paragraph (1) and payment adjustments under paragraph (2);CommentsClose CommentsPermalink





‘(B) the methodology and standards for determining whether the skilled nursing facility has in place an accredited palliative care program; andCommentsClose CommentsPermalink





‘(C) the application of the exception under paragraph (3).’.CommentsClose CommentsPermalink





(c) Physicians- Section 1848 of the Social Security Act (42 U.S.C. 1395w-4) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(p) Incentives for Certification in Hospice and Palliative Care-CommentsClose CommentsPermalink





‘(1) INCENTIVE PAYMENT-CommentsClose CommentsPermalink





‘(A) IN GENERAL- With respect to physicians’ services furnished by a physician during a payment year, if the physician is certified in hospice and palliative care (as determined by the Secretary) with respect to such year, in addition to the amount otherwise paid under this part, there shall also be paid to the physician, from the Federal Supplementary Medical Insurance Trust Fund established under section 1841, an amount equal to the applicable percent of the Secretary’s estimate (based on claims submitted not later than 2 months after the end of the payment year) of the allowed charges under this part for all covered professional services (as defined in subsection (k)(3)) furnished by the physician during such year.CommentsClose CommentsPermalink





‘(B) DEFINITIONS- In this subsection:CommentsClose CommentsPermalink





‘(i) APPLICABLE PERCENT- The term ‘applicable percent’ means--CommentsClose CommentsPermalink





‘(I) for 2011 through 2016, 2 percent; andCommentsClose CommentsPermalink





‘(II) for 2017 through 2020, 1 percent.CommentsClose CommentsPermalink





‘(ii) PAYMENT YEAR- The term ‘payment year’ means 2011 through 2020.CommentsClose CommentsPermalink





‘(C) FORM OF PAYMENT- The payment under this subsection for a payment year may be in the form of a single consolidated payment or in the form of such periodic installments as the Secretary may specify.CommentsClose CommentsPermalink





‘(2) LIMITATIONS ON REVIEW- There shall be no administrative or judicial review under section 1869, section 1878, or otherwise, of--CommentsClose CommentsPermalink





‘(A) the methodology and standards for determining payment amounts under paragraph (1); andCommentsClose CommentsPermalink





‘(B) the methodology and standards for determining whether the physician is certified in hospice and palliative care.’.CommentsClose CommentsPermalink

SEC. 11. DISCHARGE CHECKLIST PILOT PROGRAM.

(a) Establishment- Not later than July 1, 2010, the Secretary of Health and Human Services (in this section referred to as the ‘Secretary’) shall conduct a pilot program under title XVIII of the Social Security Act to test the use of the Centers for Medicare and Medicaid Services’ discharge checklist included in the publication entitled ‘Planning for Your Discharge: A checklist for patients and caregivers preparing to leave a hospital, nursing home, or other health care setting’.CommentsClose CommentsPermalink





(b) Waiver Authority- The Secretary may waive compliance of such requirements of titles XI and XVIII of the Social Security Act as the Secretary determines necessary to conduct the pilot program under this section.CommentsClose CommentsPermalink





(c) Report- Not later than 6 months after the completion of the pilot program under this section, the Secretary shall submit to Congress a final report on the pilot program, together with recommendations for such legislation and administrative action as the Secretary determines appropriate.CommentsClose CommentsPermalink





(d) Funding- There are authorized to be appropriated such sums as may be necessary for purposes of conducting the pilot program under this section.CommentsClose CommentsPermalink

SEC. 12. OFFICE OF MEDICARE/MEDICAID INTEGRATION.

(a) Establishment- The Secretary shall establish or designate an Office on Medicare/Medicaid Integration (in this subsection referred to as the ‘Office’) for the purpose of aligning Medicare and Medicaid program policies and procedures and developing tools to support State integration efforts in order to--CommentsClose CommentsPermalink





(1) simplify dual eligible access to Medicare and Medicaid program benefits and services;CommentsClose CommentsPermalink





(2) improve care continuity and ensure safe and effective care transitions;CommentsClose CommentsPermalink





(3) eliminate cost shifting between the Medicare and Medicaid programs and among related care providers;CommentsClose CommentsPermalink





(4) eliminate regulatory conflicts between Medicare and Medicaid program rules; andCommentsClose CommentsPermalink





(5) improve total cost and quality performance.CommentsClose CommentsPermalink





(b) Responsibilities- The responsibilities of the Office are to develop policies and procedures to--CommentsClose CommentsPermalink





(1) identify incentives for States to advance the integration of the Medicare and Medicaid programs to improve total cost and quality performance, including shared cost savings among consumers, plans, and Federal and State governments with respect to State initiatives for advancing Medicare and Medicaid program integration;CommentsClose CommentsPermalink





(2) provide support for coordination of Federal and State contracting and oversight for dual integration programs supportive of the goals described in subsection (a);CommentsClose CommentsPermalink





(3) serve as a liaison between Centers for Medicare & Medicaid Services central and regional offices to ensure consistent application of Centers for Medicare & Medicaid Services rules, policies, and auditing practices as such rules, policies, and auditing practices pertain to dual eligibles;CommentsClose CommentsPermalink





(4) monitor total combined Medicare and Medicaid program costs in serving dual eligibles and make recommendations for optimizing total quality and cost performance across both programs; andCommentsClose CommentsPermalink





(5) identify legislative and administrative changes that are needed to facilitate the integration of benefits and oversight functions of the Medicare and Medicaid programs with respect to dual eligibles.CommentsClose CommentsPermalink





(c) Dual Eligible Defined- In this section, the term ‘dual eligible’ means an individual who is--CommentsClose CommentsPermalink





(1) entitled to, or enrolled for, benefits under part A of title XVIII of the Social Security Act or enrolled for benefits under part B of such title; andCommentsClose CommentsPermalink





(2) entitled to medical assistance under a State plan under title XIX of such Act.CommentsClose CommentsPermalink





(d) Study- Not later than January 1, 2011, the Secretary of Health and Human Services, in consultation with private health information technology stakeholders and in coordination with other Federal health information technology efforts, shall conduct a study to determine the data that the Office should collect and analyze in order to improve health care outcomes, create efficiencies in care delivery, and impact Federal health care spending.CommentsClose CommentsPermalink





(e) Funding- There are authorized to be appropriated such sums as may be necessary to carry out the provisions of this section.CommentsClose CommentsPermalink

SEC. 13. WEB-BASED MATERIALS AND GRANTS.

(a) Web-Based Materials- The Secretary of Health and Human Services (in this section referred to as the ‘Secretary’) shall establish and maintain a website that provides information, online training, and instructional materials for entities, including faith-based organizations, on end-of-life issues, which shall include content addressing--CommentsClose CommentsPermalink





(1) advance care planning, including common issues and questions regarding advance directives and their uses;CommentsClose CommentsPermalink





(2) hospice benefits under Medicare, Medicaid, and the State Children’s Health Insurance Program established under the Social Security Act, including information on how hospice care is administered and provided to terminally ill individuals;CommentsClose CommentsPermalink





(3) palliative care, including information on services that palliative care units provide for terminally ill patients; andCommentsClose CommentsPermalink





(4) any additional information related to end-of-life care and associated issues, as determined by the Secretary.CommentsClose CommentsPermalink





(b) Grants-CommentsClose CommentsPermalink





(1) HOSPICE CARE GRANT PROGRAM-CommentsClose CommentsPermalink





(A) GRANTS AUTHORIZED- The Secretary is authorized to award grants to entities, including faith-based organizations, to develop and provide services for terminally ill individuals who are receiving hospice care in their own homes.CommentsClose CommentsPermalink





(B) REQUIREMENTS-CommentsClose CommentsPermalink





(i) DURATION- The grant program shall be conducted for a 5-year period, beginning not later than January 1, 2011.CommentsClose CommentsPermalink





(ii) AMOUNT OF GRANTS- An entity may be awarded a grant under this paragraph for a fiscal year that is not less than $5,000 and not more than $250,000.CommentsClose CommentsPermalink





(iii) NUMBER OF GRANTS- The Secretary shall award grants under this paragraph to not more than 100 entities.CommentsClose CommentsPermalink





(C) ADDITIONAL MEDICAID FUNDS- A State may elect to provide additional funds to recipients of a grant under this section, with such funds to be considered as amounts expended for the proper and efficient administration of the State plan under title XIX of the Social Security Act for purposes of the State receiving payments under section 1903(a)(7) of that Act.CommentsClose CommentsPermalink





(D) USE OF FUNDS- Grants awarded pursuant to this paragraph shall be used by entities to develop and provide end-of-life support services for terminally ill individuals who are receiving care in their own homes, including--CommentsClose CommentsPermalink





(i) support for caregivers;CommentsClose CommentsPermalink





(ii) if the entity is a hospice program under the Medicare program, any additional hospice care determined appropriate by the Secretary; andCommentsClose CommentsPermalink





(iii) any additional end-of-life information or materials relating to support services determined appropriate by the Secretary.CommentsClose CommentsPermalink





(E) APPLICATION- Each entity desiring a grant under this paragraph shall submit an application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may reasonably require.CommentsClose CommentsPermalink





(F) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out the grant program established under this paragraph, there is authorized to be appropriated $15,000,000 for the period of fiscal years 2011 through 2015.CommentsClose CommentsPermalink





(2) END-OF-LIFE EDUCATIONAL GRANT PROGRAM-CommentsClose CommentsPermalink





(A) GRANTS AUTHORIZED- The Secretary is authorized to award grants to entities, including faith-based organizations and religious educational institutions, to develop and provide appropriate training and educational programs addressing end-of-life care issues.CommentsClose CommentsPermalink





(B) REQUIREMENTS-CommentsClose CommentsPermalink





(i) DURATION- The grant program shall be conducted for a 5-year period, beginning not later than January 1, 2011.CommentsClose CommentsPermalink





(ii) AMOUNT OF GRANTS- An entity may be awarded a grant under this paragraph for a fiscal year that is not less than $5,000, and not more than $50,000.CommentsClose CommentsPermalink





(iii) NUMBER OF GRANTS- The Secretary shall award grants under this paragraph to not more than 100 entities.CommentsClose CommentsPermalink





(C) USE OF FUNDS- Grants awarded pursuant to this paragraph shall be used by entities to develop appropriate training and education programs addressing end-of-life care issues and include such programs as part of their educational curriculum, continuing education programs, or vocational training.CommentsClose CommentsPermalink





(D) APPLICATION- Each entity desiring a grant under this paragraph shall submit an application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may reasonably require.CommentsClose CommentsPermalink





(E) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out the grant program established under this paragraph, there is authorized to be appropriated $10,000,000 for the period of fiscal years 2011 through 2015.CommentsClose CommentsPermalink

SEC. 14. HHS STUDY AND REPORT ON THE STORAGE OF ADVANCE DIRECTIVES.

(a) Study- The Secretary of Health and Human Services shall conduct a study on the best methods of storing completed advance directives. Such study shall include an analysis of the feasibility of establishing a national registry for completed advance directives, taking into consideration the constraints created by the privacy provisions enacted as a result of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191).CommentsClose CommentsPermalink





(b) Report- Not later than January 1, 2012, the Secretary of Health and Human Services shall submit to Congress a report on the study conducted under subsection (a) together with recommendations for such legislation and administrative action as the Secretary determines to be appropriate.CommentsClose CommentsPermalink

SEC. 15. GAO STUDY AND REPORT ON THE PROVISIONS OF, AND AMENDMENTS MADE BY, THIS ACT.

(a) Study- The Comptroller General of the United States (in this section referred to as the ‘Comptroller General’) shall conduct a study on the provisions of, and amendments made by, this Act, including the quality and costs (such as patient and family experience, patient understanding of treatment choices, and any decrease in avoidable hospital admissions) associated with such provisions and such amendments.CommentsClose CommentsPermalink





(b) Report- Not later than January 1, 2012, the Comptroller General shall submit to Congress a report containing the results of the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.CommentsClose CommentsPermalink