Compassionate Care Act

II 116TH CONGRESS 2D SESSION S. 4945 To improve end-of-life care. IN THE SENATE OF THE UNITED STATES DECEMBER 2, 2020 Mr. BLUMENTHAL introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To improve end-of-life care. 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 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Compassionate Care Act’’. 5 (b) TABLE OF CONTENTS.—The table of contents of 6 this Act is as follows: 7 Sec. 1. Short title. Sec. 2. Definitions. TITLE I—ADVANCE CARE PLANNING Subtitle A—Consumer Education Sec. 101. Advance care planning guidelines. Sec. 102. National public education campaign. Subtitle B—Provider Education VerDate Sep 11 2014 00:59 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S4945.IS S4945 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 4945 IS Sec. 111. Public provider advance care planning website. Sec. 112. Advance care curricula pilot program. Sec. 113. Development of core end-of-life care quality measures across each rel- evant provider setting. Sec. 114. Continuing education for qualified health care providers. Subtitle C—Medicare Amendments Sec. 121. Permanent extension of authorization for use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care. Sec. 122. Improvements to advance care planning through telehealth. TITLE II—REPORTS, RESEARCH, AND EVALUATIONS Sec. 201. Study and report by the Secretary regarding the establishment and implementation of a national uniform policy on advance direc- tives. Sec. 202. GAO study and report on establishment of national advance directive registry; other studies. SEC. 2. DEFINITIONS. 1 In this Act: 2 (1) ADVANCE CARE PLANNING.—The term ‘‘ad- 3 vance care planning’’ means the process of discus- 4 sion of care in the event that an individual is unable 5 to make treatment decisions on their own behalf, 6 clarification of related values and goals, and embodi- 7 ment of preferences and decision making through 8 written documents and medical orders. 9 (2) ADVANCE DIRECTIVE.—The term ‘‘advance 10 directive’’ means a written or otherwise recorded in- 11 struction, such as a living will or durable power of 12 attorney for health care, recognized under the law of 13 the State in which it was executed (whether statu- 14 tory or as recognized by the courts of the State) and 15 VerDate Sep 11 2014 00:59 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4945.IS S4945 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 4945 IS relating to the provision of such care when the indi- 1 vidual is incapacitated. 2 (3) CERTIFIED CHAPLAIN.—The term ‘‘certified 3 chaplain’’ means a member of clergy who has met 4 the requirements under the Common Qualifications 5 and Competencies for Professional Chaplains and is 6 board certified by a national chaplaincy organiza- 7 tion. 8 (4) CHIP.—The term ‘‘CHIP’’ means the 9 State Children’s Health Insurance Program under 10 title XXI of the Social Security Act (42 U.S.C. 11 1397aa et seq.) 12 (5) END-OF-LIFE CARE.—The term ‘‘end-of-life 13 care’’ means all aspects of care of a patient with a 14 potentially fatal condition, and includes care that is 15 focused on preparations for an impending death. 16 (6) HEALTH CARE AGENT.—The term ‘‘health 17 care agent’’ means the person, designated in a 18 health care power of attorney, who is selected to 19 make medical decisions on behalf of the person who 20 executed such power of attorney, in the case of inca- 21 pacity of such person who executed the power of at- 22 torney. 23 (7) HEALTH CARE POWER OF ATTORNEY.—The 24 term ‘‘health care power of attorney’’ means a legal 25 VerDate Sep 11 2014 00:59 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4945.IS S4945 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 4945 IS document that identifies the health care agent of the 1 person executing such document. 2 (8) LIVING WILL.—The term ‘‘living will’’ 3 means a written document or a video statement 4 about the kinds of medical care or other care a per- 5 son does or does not want under certain specific con- 6 ditions, in the event that such person no longer is 7 able to express those wishes. 8 (9) MEDICAID.—The term ‘‘Medicaid’’ means 9 the program established under title XIX of the So- 10 cial Security Act (42 U.S.C. 1396 et seq.). 11 (10) MEDICARE.—The term ‘‘Medicare’’ means 12 the program established under title XVIII of the So- 13 cial Security Act (42 U.S.C. 1395 et seq.). 14 (11) ORDERS FOR LIFE-SUSTAINING TREAT- 15 MENT.—The term ‘‘orders for life-sustaining treat- 16 ment’’ means a set of portable medical orders (such 17 as physician orders for life-sustaining treatment or 18 similar portable medical orders) that address key 19 medical decisions consistent with the patient’s goals 20 of care and results from a clinical process designed 21 to facilitate shared, informed medical decision mak- 22 ing and communication between qualified health care 23 professionals and patients with serious, progressive 24 illness or frailty. 25 VerDate Sep 11 2014 00:59 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4945.IS S4945 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 4945 IS (12) QUALIFIED HEALTH CARE PROVIDER.— 1 The term ‘‘qualified health care provider’’ means a 2 medical doctor, doctor of osteopathy, nurse, physi- 3 cian assistant, nurse practitioner, social worker, 4 home health aide, palliative care professional, com- 5 munity health worker, community health educator, 6 or individual in a similar position, as designated by 7 the Secretary. 8 (13) SECRETARY.—The term ‘‘Secretary’’ 9 means the Secretary of Health and Human Services. 10 TITLE I—ADVANCE CARE 11 PLANNING 12 Subtitle A—Consumer Education 13 SEC. 101. ADVANCE CARE PLANNING GUIDELINES. 14 It is the sense of the Senate that, to the extent prac- 15 ticable, advance care planning should— 16 (1) occur with an individual and such individ- 17 ual’s health care agent, primary clinician, other au- 18 thorized decisionmaker, or members of the entire 19 interdisciplinary health care team; 20 (2) be recorded and updated as needed; and 21 (3) allow for flexible decision making in the 22 context of the patient’s medical situation, in accord- 23 ance with best practice guidelines provided by the 24 Secretary. 25 VerDate Sep 11 2014 00:59 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4945.IS S4945 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 4945 IS SEC. 102. NATIONAL PUBLIC EDUCATION CAMPAIGN. 1 (a) NATIONAL PUBLIC EDUCATION CAMPAIGN.— 2 (1) IN GENERAL.—Not later than January 1, 3 2021, the Secretary, acting through the Director of 4 the Centers for Disease Control and Prevention and 5 in consultation with public and private entities, 6 shall, directly or through grants, contracts, or inter- 7 agency agreements, develop and implement a na- 8 tional campaign to inform the public of the impor- 9 tance of advance care planning and of an individ- 10 ual’s right to direct and participate in health care 11 decisions affecting such individual. 12 (2) CONTENT OF EDUCATIONAL CAMPAIGN.— 13 The national public education campaign established 14 under paragraph (1) shall— 15 (A) employ the use of various media, in- 16 cluding social media platforms and televised 17 public service announcements; 18 (B) provide culturally and linguistically ap- 19 propriate information; 20 (C) be conducted continuously over a pe- 21 riod of not less than 5 years; 22 (D) identify and promote the advance care 23 planning information available on the internet 24 websites of the Department of Health and 25 Human Service’s National Clearinghouse for 26 VerDate Sep 11 2014 00:59 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4945.IS S4945 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 4945 IS Long-Term Care Information, the Administra- 1 tion for Children and Families, the Administra- 2 tion for Community Living, and the Centers for 3 Medicare & Medicaid Services; 4 (E) address the importance of individuals 5 speaking to family members, health care prox- 6 ies, and qualified health care providers as part 7 of an ongoing dialogue regarding health care 8 choices; 9 (F) address the need for individuals to use 10 portable, interoperable, and accessible methods 11 to communicate their health care decisions 12 through a variety of means, using legally effec- 13 tuated documents that express their health care 14 decisions in the form of advance directives (in- 15 cluding living wills, orders for life-sustaining 16 treatment, and durable powers of attorney for 17 health care); 18 (G) raise public awareness regarding the 19 availability of hospice and palliative care and 20 the quality of life benefits of early use of such 21 services; 22 (H) encourage individuals to speak with 23 qualified health care professionals about their 24 options and intentions for end-of-life care; and 25 VerDate Sep 11 2014 00:59 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4945.IS S4945 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 4945 IS (I) adhere to evidence-based research on 1 the most effective ways to communicate the ne- 2 cessity and benefits of advance care planning. 3 (3) EVALUATION.—Not later than July 1, 4 2023, the Secretary shall report to the appropriate 5 committees of Congress on the effectiveness of the 6 public education campaign under this section, and 7 include in such report any recommendations that the 8 Secretary determines appropriate regarding the need 9 for continuation of legislative or administrative 10 changes to facilitate changing public awareness, atti- 11 tudes, and behaviors regarding advance care plan- 12 ning. 13 (4) AUTHORIZATION OF APPROPRIATIONS.— 14 There are authorized to be appropriated such sums 15 as may be necessary to carry out this section. 16 (b) REPEAL.—Section 4751(d) of the Omnibus 17 Budget Reconciliation Act of 1990 (42 U.S.C. 1396a note; 18 Public Law 101–508) is repealed. 19 Subtitle B—Provider Education 20 SEC. 111. PUBLIC PROVIDER ADVANCE CARE PLANNING 21 WEBSITE. 22 (a) DEVELOPMENT.—Not later than January 1, 23 2022, the Secretary, acting through the Administrator of 24 the Centers for Medicare & Medicaid Services and the Di- 25 VerDate Sep 11 2014 00:59 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4945.IS S4945 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 4945 IS rector of the Agency for Healthcare Research and Quality, 1 shall establish an, or expand upon an existing, internet 2 website for providers under Medicare, Medicaid, CHIP, 3 the Indian Health Service (including contract providers), 4 and other qualified health care providers, including quali- 5 fied health care providers receiving assistance under the 6 Older Americans Act of 1965 (42 U.S.C. 3002 et seq.) 7 to serve older individuals, on each individual’s right to 8 make decisions concerning medical care, including the 9 right to accept or refuse medical or surgical treatment, 10 and engage in advance care planning. 11 (b) MAINTENANCE.—The internet website described 12 in subsection (a) shall be maintained and publicized by 13 the Secretary on an ongoing basis. 14 (c) CONTENT.—The internet website shall include 15 content, tools, and resources necessary to do the following: 16 (1) Inform qualified health care providers and 17 certified chaplains about the advance directive re- 18 quirements under the health care programs de- 19 scribed in subsection (a) and State and Federal laws 20 and regulations related to advance care planning. 21 (2) Educate qualified health care providers and 22 certified chaplains about advance care planning 23 quality improvement activities. 24 VerDate Sep 11 2014 00:59 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4945.IS S4945 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 4945 IS (3) Provide assistance to qualified health care 1 providers to— 2 (A) integrate advance care planning docu- 3 ments into electronic health records; and 4 (B) develop and disseminate advance care 5 planning informational materials for patients. 6 (4) Inform qualified health care providers about 7 advance care planning continuing education require- 8 ments and opportunities. 9 (5) Encourage qualified health care providers to 10 discuss advance care planning with patients of all 11 ages, as appropriate. 12 (6) Assist qualified health care providers and 13 certified chaplains in understanding the continuum 14 of end-of-life care services and supports available to 15 patients, including palliative care and hospice. 16 (7) Inform qualified health care providers of 17 best practices for discussing end-of-life care with pa- 18 tients who have a serious or terminal diagnosis or 19 prognosis and their loved ones. 20 SEC. 112. ADVANCE CARE CURRICULA PILOT PROGRAM. 21 (a) IN GENERAL.—The Secretary, in consultation 22 with appropriate professional associations, shall establish 23 a pilot program by which the Secretary awards grants to 24 eligible entities for purposes of supporting such entities 25 VerDate Sep 11 2014 00:59 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4945.IS S4945 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 4945 IS in establishing end-of-life training requirements in the en- 1 tities’ applicable degree programs. 2 (b) ELIGIBILITY.—To be eligible to participate in the 3 pilot program under this section, an entity shall— 4 (1) be a school of medicine, school of osteo- 5 pathic medicine, a physician assistant education pro- 6 gram (as defined in section 799B(3) of the Public 7 Health Service Act (42 U.S.C. 295p(3))), a school of 8 allied health (as defined in section 799B(4) of the 9 Public Health Service Act (42 U.S.C. 295p(4))), a 10 school of nursing, a school of social work, a graduate 11 medical education program accredited by the Accred- 12 itation Council for Graduate Medical Education or 13 the American Osteopathic Association, or other 14 school, as the Secretary determines appropriate; 15 (2) be staffed by teaching health professionals 16 who have experience or training in palliative medi- 17 cine; 18 (3) provide training in palliative medicine 19 through a variety of service rotations, such as con- 20 sultation services, acute care services, extended care 21 facilities, ambulatory care and comprehensive eval- 22 uation units, hospice, home health, and community 23 care programs; 24 VerDate Sep 11 2014 00:59 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S4945.IS S4945 pbinns on DSKJLVW7X2PRO [Text truncated for display. 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