Removing Barriers to Person- and Family-Centered Care Act of 2019

II 116TH CONGRESS 1ST SESSION S. 829 To amend title XI of the Social Security Act to award cooperative agreements to improve care for individuals with advanced illnesses, and for other purposes. IN THE SENATE OF THE UNITED STATES MARCH 14, 2019 Mr. WHITEHOUSE introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XI of the Social Security Act to award cooperative agreements to improve care for individuals with advanced illnesses, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Removing Barriers to 4 Person- and Family-Centered Care Act of 2019’’. 5 SEC. 2. COOPERATIVE AGREEMENTS TO IMPROVE CARE 6 FOR INDIVIDUALS WITH ADVANCED ILL- 7 NESSES. 8 (a) IN GENERAL.—Section 1115A of the Social Secu- 9 rity Act (42 U.S.C. 1315a) is amended— 10 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 829 IS (1) in the last sentence of subparagraph (A) of 1 subsection (b)(2), by inserting ‘‘, and the model de- 2 scribed in subsection (h)’’ before the period at the 3 end; and 4 (2) by adding at the end the following new sub- 5 section: 6 ‘‘(h) COOPERATIVE AGREEMENTS TO IMPROVE CARE 7 FOR INDIVIDUALS WITH ADVANCED ILLNESSES.— 8 ‘‘(1) IN GENERAL.—The Secretary shall, acting 9 through the Centers for Medicare & Medicaid Serv- 10 ices, award up to 15 cooperative agreements to eligi- 11 ble entities with the goals of— 12 ‘‘(A) addressing gaps in community capac- 13 ity to provide high-quality, person- and family- 14 centered care; 15 ‘‘(B) improving the integration and coordi- 16 nation of clinical and nonclinical services; 17 ‘‘(C) expanding access to a comprehensive 18 care planning process and services; and 19 ‘‘(D) developing and implementing alter- 20 native payment models that provide account- 21 ability for health care costs and quality out- 22 comes. 23 ‘‘(2) ELIGIBLE ENTITY.—In this subsection, the 24 term ‘eligible entity’ means the following: 25 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 829 IS ‘‘(A) A State Medicaid agency. 1 ‘‘(B) A State, local, or tribal health agen- 2 cy. 3 ‘‘(C) An accountable care organization 4 under section 1899 or an accountable care or- 5 ganization model tested under title XVIII or 6 with respect to such title under this section. 7 ‘‘(D) A Lead Organization (as defined in 8 paragraph (9)). 9 ‘‘(E) A quality improvement organization, 10 such as a Quality Innovation Network–Quality 11 Improvement Organization with a contract pur- 12 suant to part B of this title. 13 ‘‘(3) APPLICATION.— 14 ‘‘(A) IN GENERAL.—Eligible entities seek- 15 ing a cooperative agreement under this sub- 16 section shall submit to the Secretary an applica- 17 tion, at such time, and in such manner as the 18 Secretary may require. An application must in- 19 clude— 20 ‘‘(i) a list of participating practi- 21 tioners, providers of services, community- 22 based organizations, and other individuals 23 and entities; 24 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 829 IS ‘‘(ii) a description of the target popu- 1 lation or populations and geographic serv- 2 ice area; 3 ‘‘(iii) a description of the intended 4 uses of amounts awarded under paragraph 5 (4), and a plan for leveraging existing 6 funding sources to deliver services to the 7 target population or populations; 8 ‘‘(iv) a description of the intended 9 care delivery model and how the model 10 supports high-quality, person- and family- 11 centered care; 12 ‘‘(v) a plan for— 13 ‘‘(I) working with community- 14 based organizations, including faith- 15 based organizations and aging and 16 disability organizations; 17 ‘‘(II) improving community-based 18 supports for family caregivers; and 19 ‘‘(III) increasing the number of 20 individuals within the target popu- 21 lation or populations who— 22 ‘‘(aa) have communicated 23 their wishes regarding medical 24 treatment using State or locally 25 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 829 IS recognized forms, such as ad- 1 vance directives or portable med- 2 ical orders; 3 ‘‘(bb) have comprehensive 4 care plans that are concrete and 5 actionable; and 6 ‘‘(cc) have access to commu- 7 nity-based palliative care services; 8 and 9 ‘‘(vi) other information as determined 10 appropriate by the Secretary. 11 ‘‘(4) AWARD AMOUNTS.— 12 ‘‘(A) IN GENERAL.—The Secretary may 13 award up to $5,000,000 under each cooperative 14 agreement under this subsection. 15 ‘‘(B) USE OF FUNDS.—Funds awarded 16 under a cooperative agreement may be used for 17 the following purposes: 18 ‘‘(i) To develop and implement a care 19 delivery model as described in paragraph 20 (5)(B)(i) and an alternative payment 21 model as described in paragraph (5)(B)(ii). 22 ‘‘(ii) To conduct education and train- 23 ing for health care professionals, bene- 24 ficiaries and family caregivers, or commu- 25 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 829 IS nity-based organizations in methods for 1 documenting and sharing an individual’s 2 care goals, preferences, and values under 3 such model. 4 ‘‘(iii) To hire staff to conduct care 5 management and coordination activities as 6 part of an interdisciplinary care team 7 under such model. 8 ‘‘(iv) To support the development of 9 community-based palliative care teams and 10 the delivery of related services. 11 ‘‘(v) To modify, upgrade, or purchase 12 health information technology, including 13 technologies that support data aggregation 14 and analytics, electronic exchange of health 15 information, accessibility of an individual’s 16 comprehensive care plan, or remote moni- 17 toring under such model. 18 ‘‘(vi) To conduct other activities de- 19 termined appropriate by the Secretary. 20 ‘‘(5) IMPLEMENTATION.— 21 ‘‘(A) DURATION.—Each cooperative agree- 22 ment under this subsection shall be awarded for 23 a period of 7 years. 24 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 829 IS ‘‘(B) PRE-IMPLEMENTATION PERIOD.— 1 During the first 2 years of a cooperative agree- 2 ment, an awardee shall work with the Secretary 3 to— 4 ‘‘(i) develop a care delivery model 5 using one or more of the waivers and ex- 6 panded services described in paragraphs 7 (7) and (8); 8 ‘‘(ii) develop an alternative payment 9 model; and 10 ‘‘(iii) identify a set of quality meas- 11 ures that will be reported on annually by 12 participants in such model. 13 ‘‘(C) MODEL IMPLEMENTATION.—Begin- 14 ning with the third year of a cooperative agree- 15 ment, an awardee— 16 ‘‘(i) shall implement the care delivery 17 model developed under subparagraph 18 (B)(i) and the alternative payment model 19 developed under subparagraph (B)(ii); 20 ‘‘(ii) shall annually report data on 21 quality measures identified under subpara- 22 graph (B)(iii) to the Secretary; and 23 ‘‘(iii) may, in accordance with para- 24 graphs (7) and (8), receive waivers and 25 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 829 IS provide expanded services as described in 1 such paragraphs, respectively, as part of a 2 care delivery model that provides high- 3 quality, person- and family-centered care 4 to the target population or populations. 5 ‘‘(6) NOTIFICATION.—The Secretary shall pro- 6 vide guidance on notification and continuity-of-care 7 plan requirements in the event a participating pro- 8 vider leaves a model pursuant to a cooperative 9 agreement under this subsection. 10 ‘‘(7) WAIVER OF CERTAIN REQUIREMENTS.—In 11 addition to any waivers pursuant to subsection 12 (d)(1), the Secretary shall include the following 13 waivers of requirements and, where applicable, per- 14 mit Medicare Advantage organizations flexibility to 15 waive such requirements, with respect to coverage 16 of, and payment for, items and services furnished to 17 individuals pursuant to a cooperative agreement 18 under this subsection: 19 ‘‘(A) COVERAGE OF SERVICES RELATED TO 20 AN INDIVIDUAL’S TERMINAL ILLNESS.—A waiv- 21 er of the requirement described in section 22 1812(d)(2)(A) that an individual electing to re- 23 ceive hospice care shall be deemed to have 24 waived all rights to have payment made under 25 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 9 •S 829 IS title XVIII with respect to services described in 1 clause (ii)(I) of such section. 2 ‘‘(B) ALTERNATIVES IN FURNISHING OF 3 HOME CARE.—With respect to home health 4 services furnished to an individual by a home 5 health agency, a waiver of the requirements de- 6 scribed in sections 1814(a)(2) and 7 1835(a)(2)(A), that— 8 ‘‘(i) a physician makes the certifi- 9 cation (and recertification, where such 10 services are provided over a period of time) 11 as described in such sections; 12 ‘‘(ii) a plan for furnishing such serv- 13 ices to such individual is established and 14 periodically reviewed by a physician; 15 ‘‘(iii) such services are or were fur- 16 nished while the individual was under the 17 care of a physician; and 18 ‘‘(iv) the physician documents that the 19 individual has had a face-to-face encounter 20 as described in such sections, 21 provided that a nurse practitioner, clinical 22 nurse specialist, or physician assistant (as those 23 terms are defined in section 1861(aa)(5)), in 24 accordance with State law, makes such certifi- 25 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 10 •S 829 IS cation and recertification, establishes and peri- 1 odically reviews such plan, has the individual 2 under their care when such services are or were 3 furnished, and documents such face-to-face en- 4 counter. 5 ‘‘(C) ALTERNATIVE CERTIFICATION FOR 6 HOSPICE CARE.—A waiver of the requirements 7 described in subparagraphs (A) and (B) of sec- 8 tion 1814(a)(7) that an individual’s attending 9 physician and the medical director (or physician 10 member of the interdisciplinary group described 11 in section 1861(dd)(2)(B)) of the hospice pro- 12 gram providing (or arranging for) the individ- 13 ual’s hospice care certify that the individual is 14 terminally ill and periodically review the written 15 plan for hospice care, provided that such certifi- 16 cation and review is conducted by a nurse prac- 17 titioner, clinical nurse specialist, or physician 18 assistant (as those terms are defined in section 19 1861(aa)(5)) in accordance with State law. 20 ‘‘(D) COVERAGE OF SKILLED NURSING 21 SERVICES WITHOUT INPATIENT STAY.—With 22 respect to extended care services furnished to 23 an individual by a skilled nursing facility, a 24 waiver of the requirement described in section 25 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 11 •S 829 IS 1861(i) that an individual must have been an 1 inpatient in a hospital for not less than 3 con- 2 secutive days before his discharge and transfer 3 to the skilled nursing facility before such ex- 4 tended care services may be deemed post-hos- 5 pital extended care services. 6 ‘‘(E) COVERAGE OF HOME HEALTH CARE 7 WITHOUT HOMEBOUND STATUS REQUIRE- 8 MENT.—With respect to home health services 9 furnished to an individual by a home health 10 agency (as defined in section 1861(o)), a waiver 11 of the requirements described in sections 12 1814(a)(2)(C) and 1835(a)(2)(A) that the indi- 13 vidual is or was confined to his or her home. 14 ‘‘(8) AVAILABILITY OF EXPANDED SERVICES.— 15 A hospice program that participates in an alter- 16 native payment model pursuant to a cooperative 17 agreement under this subsection may receive an add- 18 on payment, as determined by the Secretary, for fur- 19 nishing the following services to the target popu- 20 lation or populations under such model: 21 ‘‘(A) INPATIENT ALTERNATIVE TO ROU- 22 TINE HOSPICE CARE.— 23 ‘‘(i) IN GENERAL.—Notwithstanding 24 regulations in effect prior to the enactment 25 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 12 •S 829 IS of this subsection, if an assessment meet- 1 ing such requirements as the Secretary de- 2 termines appropriate has been made that 3 the home of an individual who is certified 4 for hospice care and has elected to receive 5 hospice care is unsafe or unsuitable for the 6 provision of such care, such individual may 7 receive such care in an inpatient setting, 8 including a hospice program that meets the 9 conditions of participation specified in sec- 10 tion 418.110 of title 42, Code of Federal 11 Regulations (as in effect on the date of en- 12 actment of this subparagraph), or a skilled 13 nursing facility that meets the standards 14 specified in subsections (b) and (e) of such 15 section, for the duration an individual has 16 elected to receive hospice care. The assess- 17 ment described in the preceding sentence 18 may be conducted by the individual’s at- 19 tending physician, a nurse practitioner, 20 clinical nurse specialist, or physician as- 21 sistant (as those terms are defined in sec- 22 tion 1861(aa)(5)), or the medical director 23 (or physician member of the interdiscipli- 24 nary group described in section 25 VerDate Sep 11 2014 18:17 Mar 28, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S829.IS S829 pamtmann on DSKBFK8HB2PROD with BILLS 13 •S 829 IS 1861(dd)(2)(B)) of the hospice program 1 providing (or arranging for) the individ- 2 ual’s hospice care. 3 ‘‘(ii) APPLICATION OF LIMITATION ON 4 INPATIENT CARE DAYS.—For purposes of 5 any limitation on the number of total inpa- 6 tient care days for which a hospice may re- 7 ceive payment, hospice care that is pro- 8 vided in an inpatient setting under this 9 subparagraph (but would otherwise be pro- 10 vided in an outpatient setting) shall not 11 count towards such limitation. 12 ‘‘(B) HOME-BASED ALTE [Text truncated for display. 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