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[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1141 Introduced in Senate (IS)]

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veterans' Hospice Services Act of 
1993''.

SEC. 2. PROGRAMS FOR FURNISHING HOSPICE CARE TO VETERANS.

    (a) Establishment of Programs.--Chapter 17 of title 38, United 
States Code, is amended by adding at the end the following:

  ``subchapter vii--hospice care pilot program; hospice care services

``Sec. 1761. Definitions
    ``For the purposes of this subchapter--
            ``(1) The term `terminally ill veteran' means any veteran--
                    ``(A) who is (i) entitled to receive hospital care 
                in a medical facility of the Department under section 
                1710(a)(1) of this title, (ii) eligible for hospital or 
                nursing home care in such a facility and receiving such 
                care, (iii) receiving care in a State home facility for 
                which care the Secretary is paying per diem under 
                section 1741 of this title, or (iv) transferred to a 
                non-Department nursing home for nursing home care under 
                section 1720 of this title and receiving such care; and
                    ``(B) who has a medical prognosis (as certified by 
                a Department physician) of a life expectancy of six 
                months or less.
            ``(2) The term `hospice care services' means (A) the care, 
        items, and services referred to in subparagraphs (A) through 
        (H) of section 1861(dd)(1) of the Social Security Act (42 
        U.S.C. 1395x(dd)(1)), and (B) personal care services.
            ``(3) The term `hospice program' means any program that 
        satisfies the requirements of section 1861(dd)(2) of the Social 
        Security Act (42 U.S.C. 1395x(dd)(2)).
            ``(4) The term `medical facility of the Department' means a 
        facility referred to in section 1701(4)(A) of this title.
            ``(5) The term `non-Department facility' means a facility 
        (other than a medical facility of the Department) at which care 
        to terminally ill veterans is furnished, regardless of whether 
        such care is furnished pursuant to a contract, agreement, or 
        other arrangement referred to in section 1762(b)(1)(D) of this 
        title.
            ``(6) The term `personal care services' means any care or 
        service furnished to a person that is necessary to maintain a 
        person's health and safety within the home or nursing home of 
        the person, including care or services related to dressing and 
        personal hygiene, feeding and nutrition, and environmental 
        support.
``Sec. 1762. Hospice care: pilot program requirements
    ``(a)(1) During the period beginning on October 1, 1993, and ending 
on December 31, 1998, the Secretary shall conduct a pilot program in 
order--
            ``(A) to assess the feasibility and desirability of 
        furnishing hospice care services to terminally ill veterans; 
        and
            ``(B) to determine the most efficient and effective means 
        of furnishing such services to such veterans.
    ``(2) The Secretary shall conduct the pilot program in accordance 
with this section.
    ``(b)(1) Under the pilot program, the Secretary shall--
            ``(A) designate not less than 15 nor more than 30 medical 
        facilities of the Department at or through which to conduct 
        hospice care services demonstration projects;
            ``(B) designate the means by which hospice care services 
        shall be provided to terminally ill veterans under each 
        demonstration project pursuant to subsection (c);
            ``(C) allocate such personnel and other resources of the 
        Department as the Secretary considers necessary to ensure that 
        services are provided to terminally ill veterans by the 
        designated means under each demonstration project; and
            ``(D) enter into any contract, agreement, or other 
        arrangement that the Secretary considers necessary to ensure 
        the provision of such services by the designated means under 
        each such project.
    ``(2) In carrying out the responsibilities referred to in paragraph 
(1) the Secretary shall take into account the need to provide for and 
conduct the demonstration projects so as to provide the Secretary with 
such information as is necessary for the Secretary to evaluate and 
assess the furnishing of hospice care services to terminally ill 
veterans by a variety of means and in a variety of circumstances.
    ``(3) In carrying out the requirement described in paragraph (2), 
the Secretary shall ensure, to the maximum extent feasible, that--
            ``(A) the medical facilities of the Department selected to 
        conduct demonstration projects under the pilot program include 
        facilities located in urban areas of the United States and 
        rural areas of the United States;
            ``(B) the full range of affiliations between medical 
        facilities of the Department and medical schools is represented 
        by the facilities selected to conduct demonstration projects 
        under the pilot program, including no affiliation, minimal 
        affiliation, and extensive affiliation;
            ``(C) such facilities vary in the number of beds that they 
        operate and maintain; and
            ``(D) the demonstration projects are located or conducted 
        in accordance with any other criteria or standards that the 
        Secretary considers relevant or necessary to furnish and to 
        evaluate and assess fully the furnishing of hospice care 
        services to terminally ill veterans.
    ``(c)(1) Subject to paragraph (2), hospice care to terminally ill 
veterans shall be furnished under a demonstration project by one or 
more of the following means designated by the Secretary:
            ``(A) By the personnel of a medical facility of the 
        Department providing hospice care services pursuant to a 
        hospice program established by the Secretary at that facility.
            ``(B) By a hospice program providing hospice care services 
        under a contract with that program and pursuant to which 
        contract any necessary inpatient services are provided at a 
        medical facility of the Department.
            ``(C) By a hospice program providing hospice care services 
        under a contract with that program and pursuant to which 
        contract any necessary inpatient services are provided at a 
        non-Department medical facility.
    ``(2)(A) The Secretary shall provide that--
            ``(i) care is furnished by the means described in paragraph 
        (1)(A) at not less than five medical facilities of the 
        Department; and
            ``(ii) care is furnished by the means described in 
        subparagraphs (B) and (C) of paragraph (1) in connection with 
        not less than five such facilities for each such means.
    ``(B) The Secretary shall provide in any contract under 
subparagraph (B) or (C) of paragraph (1) that inpatient care may be 
provided to terminally ill veterans at a medical facility other than 
that designated in the contract if the provision of such care at such 
other facility is necessary under the circumstances.
    ``(d)(1) Except as provided in paragraph (2), the amount paid to a 
hospice program for care furnished pursuant to subparagraph (B) or (C) 
of subsection (c)(1) may not exceed the amount that would be paid to 
that program for such care under section 1814(i) of the Social Security 
Act (42 U.S.C. 1395f(i)) if such care were hospice care for which 
payment would be made under part A of title XVIII of such Act.
    ``(2) The Secretary may pay an amount in excess of the amount 
referred to in paragraph (1) (or furnish services whose value, together 
with any payment by the Secretary, exceeds such amount) to a hospice 
program for furnishing care to a terminally ill veteran pursuant to 
subparagraph (B) or (C) of subsection (c)(1) if the Secretary 
determines, on a case-by-case basis, that--
            ``(A) the furnishing of such care to the veteran is 
        necessary and appropriate; and
            ``(B) the amount that would be paid to that program under 
        section 1814(i) of the Social Security Act would not compensate 
        the program for the cost of furnishing such care.
``Sec. 1763. Care for terminally ill veterans
    ``(a) During the period referred to in section 1762(a)(1) of this 
title, the Secretary shall designate not less than 10 medical 
facilities of the Department at which hospital care is being furnished 
to terminally ill veterans to furnish the care referred to in 
subsection (b)(1).
    ``(b)(1) Palliative care to terminally ill veterans shall be 
furnished at the facilities referred to in subsection (a) by one of the 
following means designated by the Secretary:
            ``(A) By personnel of the Department providing one or more 
        hospice care services to such veterans at or through medical 
        facilities of the Department.
            ``(B) By personnel of the Department monitoring the 
        furnishing of one or more of such services to such veterans at 
        or through non-Department facilities.
    ``(2) The Secretary shall furnish care by the means referred to in 
each of subparagraphs (A) and (B) of paragraph (1) at not less than 
five medical facilities designated under subsection (a).
``Sec. 1764. Information relating to hospice care services
    ``The Secretary shall ensure to the extent practicable that 
terminally ill veterans who have been informed of their medical 
prognosis receive information relating to the eligibility, if any, of 
such veterans for hospice care and services under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.).
``Sec. 1765. Evaluation and reports
    ``(a) Not later than September 30, 1994, and on an annual basis 
thereafter until October 1, 1999, the Secretary shall submit a written 
report to the Committees on Veterans' Affairs of the Senate and House 
of Representatives relating to the conduct of the pilot program under 
section 1762 of this title and the furnishing of hospice care services 
under section 1763 of this title. Each report shall include the 
following information:
            ``(1) The location of the sites of the demonstration 
        projects provided for under the pilot program.
            ``(2) The location of the medical facilities of the 
        Department at or through which hospice care services are being 
        furnished under section 1763 of this title.
            ``(3) The means by which care to terminally ill veterans is 
        being furnished under each such project and at or through each 
        such facility.
            ``(4) The number of veterans being furnished such care 
        under each such project and at or through each such facility.
            ``(5) An assessment by the Secretary of any difficulties in 
        furnishing such care and the actions taken to resolve such 
        difficulties.
    ``(b) Not later than August 1, 1997, the Secretary shall submit to 
the committees referred to in subsection (a) a report containing an 
evaluation and assessment by the Director of the Health Services 
Research and Development Service of the hospice care pilot program 
under section 1762 of this title and the furnishing of hospice care 
services under section 1763 of this title. The report shall contain 
such information (and shall be presented in such form) as will enable 
the committees to evaluate fully the feasibility and desirability of 
furnishing hospice care services to terminally ill veterans.
    ``(c) The report shall include the following:
            ``(1) A description and summary of the pilot program.
            ``(2) With respect to each demonstration project conducted 
        under the pilot program--
                    ``(A) a description and summary of the project;
                    ``(B) a description of the facility conducting the 
                demonstration project and a discussion of how such 
                facility was selected in accordance with the criteria 
                set out in, or prescribed by the Secretary pursuant to, 
                subparagraphs (A) through (D) of section 1762(b)(3) of 
                this title;
                    ``(C) the means by which hospice care services care 
                are being furnished to terminally ill veterans under 
                the demonstration project;
                    ``(D) the personnel used to furnish such services 
                under the demonstration project;
                    ``(E) a detailed factual analysis with respect to 
                the furnishing of such services, including (i) the 
                number of veterans being furnished such services, (ii) 
                the number, if any, of inpatient admissions for each 
                veteran being furnished such services and the length of 
                stay for each such admission, (iii) the number, if any, 
                of outpatient visits for each such veteran, and (iv) 
                the number, if any, of home-care visits provided to 
                each such veteran;
                    ``(F) the direct costs, if any, incurred by 
                terminally ill veterans, the members of the families of 
                such veterans, and other individuals in close 
                relationships with such veterans in connection with the 
                participation of veterans in the demonstration project;
                    ``(G) the costs incurred by the Department in 
                conducting the demonstration project, including an 
                analysis of the costs, if any, of the demonstration 
                project that are attributable to (i) furnishing such 
                services in facilities of the Department, (ii) 
                furnishing such services in non-Department facilities, 
                and (iii) administering the furnishing of such 
                services; and
                    ``(H) the unreimbursed costs, if any, incurred by 
                any other entity in furnishing services to terminally 
                ill veterans under the project pursuant to section 
                1762(c)(1)(C) of this title.
            ``(3) An analysis of the level of the following persons' 
        satisfaction with the services furnished to terminally ill 
        veterans under each demonstration project:
                    ``(A) Terminally ill veterans who receive such 
                services, members of the families of such veterans, and 
                other individuals in close relationships with such 
                veterans.
                    ``(B) Personnel of the Department responsible for 
                furnishing such services under the project.
                    ``(C) Personnel of non-Department facilities 
                responsible for furnishing such services under the 
                project.
            ``(4) A description and summary of the means of furnishing 
        hospice care services at or through each medical facility of 
        the Department designated under section 1763(a)(1) of this 
        title.
            ``(5) With respect to each such means, the information 
        referred to in paragraphs (2) and (3).
            ``(6) A comparative analysis by the Director of the 
        services furnished to terminally ill veterans under the various 
        demonstration projects referred to in section 1762 of this 
        title and at or through the designated facilities referred to 
        in section 1763 of this title, with an emphasis in such 
        analysis on a comparison relating to--
                    ``(A) the management of pain and health symptoms of 
                terminally ill veterans by such projects and 
                facilities;
                    ``(B) the number of inpatient admissions of such 
                veterans and the length of inpatient stays for such 
                admissions under such projects and facilities;
                    ``(C) the number and type of medical procedures 
                employed with respect to such veterans by such projects 
                and facilities; and
                    ``(D) the effectiveness of such projects and 
                facilities in providing care to such veterans at the 
                homes of such veterans or in nursing homes.
            ``(7) An assessment by the Director of the feasibility and 
        desirability of furnishing hospice care services by various 
        means to terminally ill veterans, including an assessment by 
        the Director of the optimal means of furnishing such services 
        to such veterans.
            ``(8) Any recommendations for additional legislation 
        regarding the furnishing of care to terminally ill veterans 
        that the Secretary considers appropriate.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by adding 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.''.
    (c) Authority To Carry Out Other Hospice Care Programs.--The 
amendments made by subsection (a) may not be construed as terminating 
the authority of the Secretary of Veterans Affairs to provide hospice 
care services to terminally ill veterans under any program in addition 
to the programs required under the provisions added by such amendments.

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