Expanding Access to Palliative Care Act

II 118TH CONGRESS 1ST SESSION S. 1845 To amend title XI of the Social Security Act to provide for the testing of a community-based palliative care model. IN THE SENATE OF THE UNITED STATES JUNE 7, 2023 Ms. ROSEN (for herself, Mr. BARRASSO, Ms. BALDWIN, and Mrs. FISCHER) 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 provide for the testing of a community-based palliative care model. 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 ‘‘Expanding Access to 4 Palliative Care Act’’. 5 SEC. 2. COMMUNITY-BASED PALLIATIVE CARE MODEL. 6 Section 1115A of the Social Security Act (42 U.S.C. 7 1315a) is amended— 8 (1) in subsection (b)(2)(A), by adding at the 9 end the following new sentence: ‘‘The models se- 10 VerDate Sep 11 2014 22:04 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1845.IS S1845 TKELLEY on DSK125TN23PROD with BILLS 2 •S 1845 IS lected under this subparagraph shall include the 1 testing of the model described in subsection (h).’’; 2 and 3 (2) by adding at the end the following new sub- 4 section: 5 ‘‘(h) COMMUNITY-BASED PALLIATIVE CARE 6 MODEL.— 7 ‘‘(1) IN GENERAL.—The CMI shall develop and 8 implement a model to provide community-based pal- 9 liative care and care coordination for high-risk bene- 10 ficiaries, in co-management with other providers of 11 services and suppliers, aimed at improving outcomes 12 and experience of care and reducing unnecessary or 13 unwanted emergency department visits and hos- 14 pitalizations (in this subsection referred to as the 15 ‘model’), and that is intended to replace the Medi- 16 care Care Choices Model. 17 ‘‘(2) DURATION.—The model shall be imple- 18 mented for a 5-year period, beginning not later than 19 one year after the date of the enactment of this sub- 20 section. 21 ‘‘(3) TARGET POPULATION.— 22 ‘‘(A) IN GENERAL.—The target population 23 for the model is an individual— 24 VerDate Sep 11 2014 22:04 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1845.IS S1845 TKELLEY on DSK125TN23PROD with BILLS 3 •S 1845 IS ‘‘(i) entitled to, or enrolled for, bene- 1 fits under part A of title XVIII; and 2 ‘‘(ii) with a diagnosis of a serious ill- 3 ness or injury, which may include a diag- 4 nosis of cancer, heart and vascular disease, 5 pulmonary disease, human immuno- 6 deficiency virus/acquired immunodeficiency, 7 Alzheimer’s and dementia, stroke, serious 8 injury requiring rehabilitation including 9 burns, kidney disease, liver disease, 10 Amyotrophic lateral sclerosis, any neuro 11 degenerative disease, or any other serious 12 illness or injury the Secretary determines 13 appropriate. 14 ‘‘(B) NO EXCLUSION FOR PRIOR USE OF 15 HOSPICE CARE BENEFITS.—An individual shall 16 not be excluded from participation in the model 17 based on prior use of hospice care benefits dur- 18 ing any period prior to such participation, re- 19 gardless of the source of coverage for such ben- 20 efits. 21 ‘‘(4) PARTICIPATING PROVIDERS.—Providers el- 22 igible to participate under the model may include 23 palliative care teams working as an independent 24 practice or associated with a hospice program, home 25 VerDate Sep 11 2014 01:09 Jun 23, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1845.IS S1845 TKELLEY on DSK125TN23PROD with BILLS 4 •S 1845 IS health agencies, hospitals, integrated health systems, 1 and other facilities determined appropriate by the 2 Secretary. 3 ‘‘(5) TEAM-BASED APPROACH.—Under the 4 model, at least one member of the multi-disciplinary 5 palliative care team shall be certified in hospice and 6 palliative care. This is a co-management model with 7 palliative care aligning with primary and specialist 8 care for a team-based approach. Care must be co- 9 ordinated across providers and community services 10 for inclusion of all pain, symptom management, dis- 11 ease-modifying and curative treatments, and other 12 palliative care services. 13 ‘‘(6) LOCATION.—Care may be furnished under 14 the model in any beneficiary ‘home’, including a 15 caregiver’s residence, an extended care facility, or a 16 community setting as appropriate based on the indi- 17 vidual’s ability to access services. The model shall 18 include access within an in-patient stay so long as 19 the patient begins receiving palliative care services 20 prior to admission. Services shall not be disrupted 21 solely due to change in location from a residence to 22 an in-patient setting, and shall be part of care co- 23 ordination and care planning following hospital dis- 24 charge. 25 VerDate Sep 11 2014 01:09 Jun 23, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1845.IS S1845 TKELLEY on DSK125TN23PROD with BILLS 5 •S 1845 IS ‘‘(7) SERVICES.—The model shall include items 1 and services based on specific patient needs with re- 2 spect to pain, symptom management, education, dis- 3 ease modifying treatments, advance care planning 4 and shared decision making, goals clarification, men- 5 tal health services, family and caregiver support 6 services, spiritual support care, personal care assist- 7 ance, and stress reduction therapies. This includes a 8 comprehensive assessment of symptoms and stress 9 factors that impact quality of life. 10 ‘‘(8) ACCESS.—Care shall be available under 11 the model 24 hours a day, 7 days a week, and 365 12 days a year, including telehealth services. The CMI 13 shall specifically consider the needs of rural and un- 14 derserved areas and adjust accordingly to ensure eq- 15 uitable access to care. A broad range of providers 16 must be included with no geographic limitations. 17 ‘‘(9) METRICS.—The CMI shall assess the 18 model by comparing participants to other members 19 of the target population who are receiving care out- 20 side of the model, including with respect to the fol- 21 lowing: 22 ‘‘(A) Demographics (including age, diag- 23 nosis, residence type, medical encounters in pre- 24 ceding 12 months leading to enrollment, geo- 25 VerDate Sep 11 2014 22:04 Jun 26, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1845.IS S1845 TKELLEY on DSK125TN23PROD with BILLS 6 •S 1845 IS graphic location (such as urban or rural) and 1 others as determined by the CMI). 2 ‘‘(B) Impact on utilization of items and 3 services under title XVIII (such as emergency 4 department services, hospital observation serv- 5 ices, inpatient admissions, and intensive care 6 unit (ICU) stays). 7 ‘‘(C) Election of hospice care. 8 ‘‘(D) Duration of hospice care. 9 ‘‘(E) Care Experience (beneficiary and 10 caregiver).’’. 11 Æ VerDate Sep 11 2014 01:09 Jun 23, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\S1845.IS S1845 TKELLEY on DSK125TN23PROD with BILLS