II

103D CONGRESS

1ST SESSION S. 1141

To amend chapter 17 of title 38, United States Code, to require the Secretary

of Veterans Affairs to conduct a hospice care pilot program and to

provide certain hospice care services to terminally ill veterans.

IN THE SENATE OF THE UNITED STATES

JUNE 22, 1993

Mr. ROCKEFELLER (for himself, Mr. GRAHAM, Mr. AKAKA, and Mr. MURKOWSKI) introduced the following bill; which was read twice and referred to

the Committee on Veterans’ Affairs

A BILL

To amend chapter 17 of title 38, United States Code, to

require the Secretary of Veterans Affairs to conduct a

hospice care pilot program and to provide certain hospice

care services to terminally ill veterans.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Veterans’ Hospice

5 Services Act of 1993’’.
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1 SEC. 2. PROGRAMS FOR FURNISHING HOSPICE CARE TO

2 VETERANS.

3 (a) ESTABLISHMENT OF PROGRAMS.—Chapter 17 of

4 title 38, United States Code, is amended by adding at the

5 end the following:

6 ‘‘SUBCHAPTER VII—HOSPICE CARE PILOT PROGRAM;

7 HOSPICE CARE SERVICES

8 ‘‘§ 1761. Definitions

9 ‘‘For the purposes of this subchapter—

10 ‘‘(1) The term ‘terminally ill veteran’ means

11 any veteran—

12 ‘‘(A) who is (i) entitled to receive hospital

13 care in a medical facility of the Department

14 under section 1710(a)(1) of this title, (ii) eligi15 ble for hospital or nursing home care in such a

16 facility and receiving such care, (iii) receiving

17 care in a State home facility for which care the

18 Secretary is paying per diem under section

19 1741 of this title, or (iv) transferred to a non20 Department nursing home for nursing home

21 care under section 1720 of this title and receiv22 ing such care; and

23 ‘‘(B) who has a medical prognosis (as cer24 tified by a Department physician) of a life ex25 pectancy of six months or less.
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1 ‘‘(2) The term ‘hospice care services’ means (A)

2 the care, items, and services referred to in subpara3 graphs (A) through (H) of section 1861(dd)(1) of

4 the Social Security Act (42 U.S.C. 1395x(dd)(1)),

5 and (B) personal care services.

6 ‘‘(3) The term ‘hospice program’ means any

7 program that satisfies the requirements of section

8 1861(dd)(2) of the Social Security Act (42 U.S.C.

9 1395x(dd)(2)).

10 ‘‘(4) The term ‘medical facility of the Depart11 ment’ means a facility referred to in section

12 1701(4)(A) of this title.

13 ‘‘(5) The term ‘non-Department facility’ means

14 a facility (other than a medical facility of the De15 partment) at which care to terminally ill veterans is

16 furnished, regardless of whether such care is fur17 nished pursuant to a contract, agreement, or other

18 arrangement referred to in section 1762(b)(1)(D) of

19 this title.

20 ‘‘(6) The term ‘personal care services’ means

21 any care or service furnished to a person that is nec22 essary to maintain a person’s health and safety

23 within the home or nursing home of the person, in24 cluding care or services related to dressing and per-
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1 sonal hygiene, feeding and nutrition, and environ2 mental support.

3 ‘‘§ 1762. Hospice care: pilot program requirements

4 ‘‘(a)(1) During the period beginning on October 1,

5 1993, and ending on December 31, 1998, the Secretary

6 shall conduct a pilot program in order—

7 ‘‘(A) to assess the feasibility and desirability of

8 furnishing hospice care services to terminally ill vet9 erans; and

10 ‘‘(B) to determine the most efficient and effec11 tive means of furnishing such services to such veter12 ans.

13 ‘‘(2) The Secretary shall conduct the pilot program

14 in accordance with this section.

15 ‘‘(b)(1) Under the pilot program, the Secretary

16 shall—

17 ‘‘(A) designate not less than 15 nor more than

18 30 medical facilities of the Department at or

19 through which to conduct hospice care services dem20 onstration projects;

21 ‘‘(B) designate the means by which hospice care

22 services shall be provided to terminally ill veterans

23 under each demonstration project pursuant to sub24 section (c);
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1 ‘‘(C) allocate such personnel and other re2 sources of the Department as the Secretary consid3 ers necessary to ensure that services are provided to

4 terminally ill veterans by the designated means

5 under each demonstration project; and

6 ‘‘(D) enter into any contract, agreement, or

7 other arrangement that the Secretary considers nec8 essary to ensure the provision of such services by the

9 designated means under each such project.

10 ‘‘(2) In carrying out the responsibilities referred to

11 in paragraph (1) the Secretary shall take into account the

12 need to provide for and conduct the demonstration

13 projects so as to provide the Secretary with such informa14 tion as is necessary for the Secretary to evaluate and as15 sess the furnishing of hospice care services to terminally

16 ill veterans by a variety of means and in a variety of cir17 cumstances.

18 ‘‘(3) In carrying out the requirement described in

19 paragraph (2), the Secretary shall ensure, to the maxi20 mum extent feasible, that—

21 ‘‘(A) the medical facilities of the Department

22 selected to conduct demonstration projects under the

23 pilot program include facilities located in urban

24 areas of the United States and rural areas of the

25 United States;
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1 ‘‘(B) the full range of affiliations between medi2 cal facilities of the Department and medical schools

3 is represented by the facilities selected to conduct

4 demonstration projects under the pilot program, in5 cluding no affiliation, minimal affiliation, and exten6 sive affiliation;

7 ‘‘(C) such facilities vary in the number of beds

8 that they operate and maintain; and

9 ‘‘(D) the demonstration projects are located or

10 conducted in accordance with any other criteria or

11 standards that the Secretary considers relevant or

12 necessary to furnish and to evaluate and assess fully

13 the furnishing of hospice care services to terminally

14 ill veterans.

15 ‘‘(c)(1) Subject to paragraph (2), hospice care to ter16 minally ill veterans shall be furnished under a demonstra17 tion project by one or more of the following means des18 ignated by the Secretary:

19 ‘‘(A) By the personnel of a medical facility of

20 the Department providing hospice care services pur21 suant to a hospice program established by the Sec22 retary at that facility.

23 ‘‘(B) By a hospice program providing hospice

24 care services under a contract with that program

25 and pursuant to which contract any necessary inpa-
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1 tient services are provided at a medical facility of

2 the Department.

3 ‘‘(C) By a hospice program providing hospice

4 care services under a contract with that program

5 and pursuant to which contract any necessary inpa6 tient services are provided at a non-Department

7 medical facility.

8 ‘‘(2)(A) The Secretary shall provide that—

9 ‘‘(i) care is furnished by the means described in

10 paragraph (1)(A) at not less than five medical facili11 ties of the Department; and

12 ‘‘(ii) care is furnished by the means described

13 in subparagraphs (B) and (C) of paragraph (1) in

14 connection with not less than five such facilities for

15 each such means.

16 ‘‘(B) The Secretary shall provide in any contract

17 under subparagraph (B) or (C) of paragraph (1) that in18 patient care may be provided to terminally ill veterans at

19 a medical facility other than that designated in the con20 tract if the provision of such care at such other facility

21 is necessary under the circumstances.

22 ‘‘(d)(1) Except as provided in paragraph (2), the

23 amount paid to a hospice program for care furnished pur24 suant to subparagraph (B) or (C) of subsection (c)(1) may

25 not exceed the amount that would be paid to that program
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1 for such care under section 1814(i) of the Social Security

2 Act (42 U.S.C. 1395f(i)) if such care were hospice care

3 for which payment would be made under part A of title

4 XVIII of such Act.

5 ‘‘(2) The Secretary may pay an amount in excess of

6 the amount referred to in paragraph (1) (or furnish serv7 ices whose value, together with any payment by the Sec8 retary, exceeds such amount) to a hospice program for

9 furnishing care to a terminally ill veteran pursuant to sub10 paragraph (B) or (C) of subsection (c)(1) if the Secretary

11 determines, on a case-by-case basis, that—

12 ‘‘(A) the furnishing of such care to the veteran

13 is necessary and appropriate; and

14 ‘‘(B) the amount that would be paid to that

15 program under section 1814(i) of the Social Security

16 Act would not compensate the program for the cost

17 of furnishing such care.

18 ‘‘§ 1763. Care for terminally ill veterans

19 ‘‘(a) During the period referred to in section

20 1762(a)(1) of this title, the Secretary shall designate not

21 less than 10 medical facilities of the Department at which

22 hospital care is being furnished to terminally ill veterans

23 to furnish the care referred to in subsection (b)(1).
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1 ‘‘(b)(1) Palliative care to terminally ill veterans shall

2 be furnished at the facilities referred to in subsection (a)

3 by one of the following means designated by the Secretary:

4 ‘‘(A) By personnel of the Department providing

5 one or more hospice care services to such veterans

6 at or through medical facilities of the Department.

7 ‘‘(B) By personnel of the Department monitor8 ing the furnishing of one or more of such services

9 to such veterans at or through non-Department fa10 cilities.

11 ‘‘(2) The Secretary shall furnish care by the means

12 referred to in each of subparagraphs (A) and (B) of para13 graph (1) at not less than five medical facilities designated

14 under subsection (a).

15 ‘‘§ 1764. Information relating to hospice care services

16 ‘‘The Secretary shall ensure to the extent practicable

17 that terminally ill veterans who have been informed of

18 their medical prognosis receive information relating to the

19 eligibility, if any, of such veterans for hospice care and

20 services under title XVIII of the Social Security Act (42

21 U.S.C. 1395 et seq.).

22 ‘‘§ 1765. Evaluation and reports

23 ‘‘(a) Not later than September 30, 1994, and on an

24 annual basis thereafter until October 1, 1999, the Sec25 retary shall submit a written report to the Committees on
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1 Veterans’ Affairs of the Senate and House of Representa2 tives relating to the conduct of the pilot program under

3 section 1762 of this title and the furnishing of hospice

4 care services under section 1763 of this title. Each report

5 shall include the following information:

6 ‘‘(1) The location of the sites of the demonstra7 tion projects provided for under the pilot program.

8 ‘‘(2) The location of the medical facilities of the

9 Department at or through which hospice care serv10 ices are being furnished under section 1763 of this

11 title.

12 ‘‘(3) The means by which care to terminally ill

13 veterans is being furnished under each such project

14 and at or through each such facility.

15 ‘‘(4) The number of veterans being furnished

16 such care under each such project and at or through

17 each such facility.

18 ‘‘(5) An assessment by the Secretary of any dif19 ficulties in furnishing such care and the actions

20 taken to resolve such difficulties.

21 ‘‘(b) Not later than August 1, 1997, the Secretary

22 shall submit to the committees referred to in subsection

23 (a) a report containing an evaluation and assessment by

24 the Director of the Health Services Research and Develop25 ment Service of the hospice care pilot program under sec-
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1 tion 1762 of this title and the furnishing of hospice care

2 services under section 1763 of this title. The report shall

3 contain such information (and shall be presented in such

4 form) as will enable the committees to evaluate fully the

5 feasibility and desirability of furnishing hospice care serv6 ices to terminally ill veterans.

7 ‘‘(c) The report shall include the following:

8 ‘‘(1) A description and summary of the pilot

9 program.

10 ‘‘(2) With respect to each demonstration project

11 conducted under the pilot program—

12 ‘‘(A) a description and summary of the

13 project;

14 ‘‘(B) a description of the facility conduct15 ing the demonstration project and a discussion

16 of how such facility was selected in accordance

17 with the criteria set out in, or prescribed by the

18 Secretary pursuant to, subparagraphs (A)

19 through (D) of section 1762(b)(3) of this title;

20 ‘‘(C) the means by which hospice care serv21 ices care are being furnished to terminally ill

22 veterans under the demonstration project;

23 ‘‘(D) the personnel used to furnish such

24 services under the demonstration project;
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1 ‘‘(E) a detailed factual analysis with re2 spect to the furnishing of such services, includ3 ing (i) the number of veterans being furnished

4 such services, (ii) the number, if any, of inpa5 tient admissions for each veteran being fur6 nished such services and the length of stay for

7 each such admission, (iii) the number, if any, of

8 outpatient visits for each such veteran, and (iv)

9 the number, if any, of home-care visits provided

10 to each such veteran;

11 ‘‘(F) the direct costs, if any, incurred by

12 terminally ill veterans, the members of the fam13 ilies of such veterans, and other individuals in

14 close relationships with such veterans in connec15 tion with the participation of veterans in the

16 demonstration project;

17 ‘‘(G) the costs incurred by the Department

18 in conducting the demonstration project, includ19 ing an analysis of the costs, if any, of the dem20 onstration project that are attributable to (i)

21 furnishing such services in facilities of the De22 partment, (ii) furnishing such services in non23 Department facilities, and (iii) administering

24 the furnishing of such services; and
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1 ‘‘(H) the unreimbursed costs, if any, in2 curred by any other entity in furnishing services

3 to terminally ill veterans under the project pur4 suant to section 1762(c)(1)(C) of this title.

5 ‘‘(3) An analysis of the level of the following

6 persons’ satisfaction with the services furnished to

7 terminally ill veterans under each demonstration

8 project:

9 ‘‘(A) Terminally ill veterans who receive

10 such services, members of the families of such

11 veterans, and other individuals in close relation12 ships with such veterans.

13 ‘‘(B) Personnel of the Department respon14 sible for furnishing such services under the

15 project.

16 ‘‘(C) Personnel of non-Department facili17 ties responsible for furnishing such services

18 under the project.

19 ‘‘(4) A description and summary of the means

20 of furnishing hospice care services at or through

21 each medical facility of the Department designated

22 under section 1763(a)(1) of this title.

23 ‘‘(5) With respect to each such means, the in24 formation referred to in paragraphs (2) and (3).
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1 ‘‘(6) A comparative analysis by the Director of

2 the services furnished to terminally ill veterans

3 under the various demonstration projects referred to

4 in section 1762 of this title and at or through the

5 designated facilities referred to in section 1763 of

6 this title, with an emphasis in such analysis on a

7 comparison relating to—

8 ‘‘(A) the management of pain and health

9 symptoms of terminally ill veterans by such

10 projects and facilities;

11 ‘‘(B) the number of inpatient admissions

12 of such veterans and the length of inpatient

13 stays for such admissions under such projects

14 and facilities;

15 ‘‘(C) the number and type of medical pro16 cedures employed with respect to such veterans

17 by such projects and facilities; and

18 ‘‘(D) the effectiveness of such projects and

19 facilities in providing care to such veterans at

20 the homes of such veterans or in nursing

21 homes.

22 ‘‘(7) An assessment by the Director of the fea23 sibility and desirability of furnishing hospice care

24 services by various means to terminally ill veterans,

25 including an assessment by the Director of the
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1 optimal means of furnishing such services to such

2 veterans.

3 ‘‘(8) Any recommendations for additional legis4 lation regarding the furnishing of care to terminally

5 ill veterans that the Secretary considers appro6 priate.’’.

7 (b) CLERICAL AMENDMENT.—The table of sections

8 at the beginning of such chapter is amended by adding

9 at the end the following:

‘‘SUBCHAPTER VII—HOSPICE CARE PILOT PROGRAM; HOSPICE CARE SERVICES

‘‘1761. Definitions.

‘‘1762. Hospice care: pilot program requirements.

‘‘1763. Care for terminally ill veterans.

‘‘1764. Information relating to hospice care services.

‘‘1765. Evaluation and reports.’’.

10 (c) AUTHORITY TO CARRY OUT OTHER HOSPICE

11 CARE PROGRAMS.—The amendments made by subsection

12 (a) may not be construed as terminating the authority of

13 the Secretary of Veterans Affairs to provide hospice care

14 services to terminally ill veterans under any program in

15 addition to the programs required under the provisions

16 added by such amendments.

Æ