II

104TH CONGRESS

1ST SESSION S. 612

To amend title 38, United States Code, to provide for a hospice care pilot

program for the Department of Veterans Affairs.

IN THE SENATE OF THE UNITED STATES

MARCH 24 (legislative day, MARCH 23), 1995

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

to the Committee on Veterans’ Affairs

A BILL

To amend title 38, United States Code, to provide for a

hospice care pilot program for the Department of Veterans Affairs.

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 Care Services Act of 1995’’.
2

•S 612 IS

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.

26 ‘‘(2) The term ‘hospice care services’ means—
3

•S 612 IS

1 ‘‘(A) the care, items, and services referred

2 to in subparagraphs (A) through (H) of section

3 1861(dd)(1) of the Social Security Act (42

4 U.S.C. 1395x(dd)(1)); and

5 ‘‘(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-
4

•S 612 IS

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 1995, and ending on December 31, 2000, the Secretary

6 shall conduct a pilot program in order—

7 ‘‘(A) to assess the desirability of furnishing hos8 pice care services to terminally ill veterans; and

9 ‘‘(B) to determine the most effective and effi10 cient means of furnishing such services to such vet11 erans.

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

13 in accordance with this section.

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

15 shall—

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

17 30 medical facilities of the Department at or

18 through which to conduct hospice care services dem19 onstration projects;

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

21 services shall be provided to terminally ill veterans

22 under each demonstration project pursuant to sub23 section (c);

24 ‘‘(C) allocate such personnel and other re25 sources of the Department as the Secretary consid-
5

•S 612 IS

1 ers necessary to ensure that services are provided to

2 terminally ill veterans by the designated means

3 under each demonstration project; and

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

5 other arrangement that the Secretary considers nec6 essary to ensure the provision of such services by the

7 designated means under each such project.

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

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

10 need to provide for and conduct the demonstration

11 projects so as to provide the Secretary with such informa12 tion as is necessary for the Secretary to evaluate and as13 sess the furnishing of hospice care services to terminally

14 ill veterans by a variety of means and in a variety of cir15 cumstances.

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

17 paragraph (2), the Secretary shall, to the maximum extent

18 feasible, ensure that—

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

20 selected to conduct demonstration projects under the

21 pilot program include facilities located in urban

22 areas of the United States and rural areas of the

23 United States;

24 ‘‘(B) the full range of affiliations between medi25 cal facilities of the Department and medical schools
6

•S 612 IS

1 is represented by the facilities selected to conduct

2 demonstration projects under the pilot program, in3 cluding no affiliation, minimal affiliation, and exten4 sive affiliation;

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

6 that they operate and maintain; and

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

8 conducted in accordance with any other criteria or

9 standards that the Secretary considers relevant or

10 necessary to furnish and to evaluate and assess fully

11 the furnishing of hospice care services to terminally

12 ill veterans.

13 ‘‘(c)(1) Subject to paragraph (2), hospice care to ter14 minally ill veterans shall be furnished under a demonstra15 tion project by one or more of the following means des16 ignated by the Secretary:

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

18 the Department providing hospice care services pur19 suant to a hospice program established by the Sec20 retary at that facility.

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

22 care services under a contract with that program

23 and pursuant to which contract any necessary inpa24 tient services are provided at a medical facility of

25 the Department.
7

•S 612 IS

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

2 care services under a contract with that program

3 and pursuant to which contract any necessary inpa4 tient services are provided at a non-Department

5 medical facility.

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

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

8 paragraph (1)(A) at not less than five medical facili9 ties of the Department; and

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

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

12 connection with not less than five such facilities for

13 each such means.

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

15 under subparagraph (B) or (C) of paragraph (1) that in16 patient care may be provided to terminally ill veterans at

17 a medical facility other than that designated in the con18 tract if the provision of such care at such other facility

19 is necessary under the circumstances.

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

21 amount paid to a hospice program for care furnished pur22 suant to subparagraph (B) or (C) of subsection (c)(1) may

23 not exceed the amount that would be paid to that program

24 for such care under section 1814(i) of the Social Security

25 Act (42 U.S.C. 1395f(i)) if such care were hospice care
8

•S 612 IS

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

2 XVIII of such Act.

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

4 the amount referred to in paragraph (1) (or furnish serv5 ices whose value, together with any payment by the Sec6 retary, exceeds such amount) to a hospice program for

7 furnishing care to a terminally ill veteran pursuant to sub8 paragraph (B) or (C) of subsection (c)(1) if the Secretary

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

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

11 is necessary and appropriate; and

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

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

14 Act would not compensate the program for the cost

15 of furnishing such care.

16 ‘‘§ 1763. Care for terminally ill veterans

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

18 1762(a)(1) of this title, the Secretary shall designate not

19 less than 10 medical facilities of the Department at which

20 hospital care is being furnished to terminally ill veterans

21 in order to furnish the care referred to in subsection

22 (b)(1).

23 ‘‘(b)(1) Palliative care to terminally ill veterans shall

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

25 by one of the following means designated by the Secretary:
9

•S 612 IS

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

2 one or more hospice care services to such veterans

3 at or through medical facilities of the Department.

4 ‘‘(B) By personnel of the Department monitor5 ing the furnishing of one or more of such services

6 to such veterans at or through non-Department fa7 cilities.

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

9 referred to in each of subparagraphs (A) and (B) of para10 graph (1) at not less than five medical facilities designated

11 under subsection (a).

12 ‘‘§ 1764. Information relating to hospice care services

13 ‘‘The Secretary shall ensure to the extent practicable

14 that terminally ill veterans who have been informed of

15 their medical prognosis receive information relating to the

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

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

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

19 ‘‘§ 1765. Evaluation and reports

20 ‘‘(a) Not later than September 30, 1996, and on an

21 annual basis thereafter until October 1, 2001, the Sec22 retary shall submit a written report to the Committees on

23 Veterans’ Affairs of the Senate and House of Representa24 tives relating to the conduct of the pilot program under

25 section 1762 of this title and the furnishing of hospice
10

•S 612 IS

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

2 shall include the following information:

3 ‘‘(1) The location of the sites of the demonstra4 tion projects provided for under the pilot program.

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

6 Department at or through which hospice care serv7 ices are being furnished under section 1763 of this

8 title.

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

10 veterans is being furnished under each such project

11 and at or through each such facility.

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

13 such care under each such project and at or through

14 each such facility.

15 ‘‘(5) An assessment by the Secretary of any dif16 ficulties in furnishing such care and the actions

17 taken to resolve such difficulties.

18 ‘‘(b) Not later than August 1, 1999, the Secretary

19 shall submit to the committees referred to in subsection

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

21 the Under Secretary for Health of the hospice care pilot

22 program under section 1762 of this title and the furnish23 ing of hospice care services under section 1763 of this

24 title. The report shall contain such information (and shall

25 be presented in such form) as will enable the committees
11

•S 612 IS

1 to evaluate fully the desirability of furnishing hospice care

2 services to terminally ill veterans.

3 ‘‘(c) The report under subsection (b) shall include the

4 following:

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

6 program.

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

8 conducted under the pilot program—

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

10 project;

11 ‘‘(B) a description of the facility conduct12 ing the demonstration project and a discussion

13 of how such facility was selected in accordance

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

15 Secretary pursuant to, subparagraphs (A)

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

17 ‘‘(C) the means by which hospice care serv18 ices care are being furnished to terminally ill

19 veterans under the demonstration project;

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

21 services under the demonstration project;

22 ‘‘(E) a detailed factual analysis with re23 spect to the furnishing of such services, includ24 ing (i) the number of veterans being furnished

25 such services, (ii) the number, if any, of inpa-
12

•S 612 IS

1 tient admissions for each veteran being fur2 nished such services and the length of stay for

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

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

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

6 to each such veteran;

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

8 terminally ill veterans, the members of the fam9 ilies of such veterans, and other individuals in

10 close relationships with such veterans in connec11 tion with the participation of veterans in the

12 demonstration project;

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

14 in conducting the demonstration project, includ15 ing an analysis of the costs, if any, of the dem16 onstration project that are attributable to (i)

17 furnishing such services in facilities of the De18 partment, (ii) furnishing such services in non19 Department facilities, and (iii) administering

20 the furnishing of such services; and

21 ‘‘(H) the unreimbursed costs, if any, in22 curred by any other entity in furnishing services

23 to terminally ill veterans under the project pur24 suant to section 1762(c)(1)(C) of this title.
13

•S 612 IS

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

2 persons’ satisfaction with the services furnished to

3 terminally ill veterans under each demonstration

4 project:

5 ‘‘(A) Terminally ill veterans who receive

6 such services, members of the families of such

7 veterans, and other individuals in close relation8 ships with such veterans.

9 ‘‘(B) Personnel of the Department respon10 sible for furnishing such services under the

11 project.

12 ‘‘(C) Personnel of non-Department facili13 ties responsible for furnishing such services

14 under the project.

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

16 of furnishing hospice care services at or through

17 each medical facility of the Department designated

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

19 ‘‘(5) With respect to each such means, the in20 formation referred to in paragraphs (2) and (3).

21 ‘‘(6) A comparative analysis by the Under Sec22 retary for Health of the services furnished to termi23 nally ill veterans under the various demonstration

24 projects referred to in section 1762 of this title and

25 at or through the designated facilities referred to in
14

•S 612 IS

1 section 1763 of this title, with an emphasis in such

2 analysis on a comparison relating to—

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

4 symptoms of terminally ill veterans by such

5 projects and facilities;

6 ‘‘(B) the number of inpatient admissions

7 of such veterans and the length of inpatient

8 stays for such admissions under such projects

9 and facilities;

10 ‘‘(C) the number and type of medical pro11 cedures employed with respect to such veterans

12 by such projects and facilities; and

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

14 facilities in providing care to such veterans at

15 the homes of such veterans or in nursing

16 homes.

17 ‘‘(7) An assessment by the Under Secretary for

18 Health of the desirability of furnishing hospice care

19 services by various means to terminally ill veterans,

20 including an assessment by the Director of the opti21 mal means of furnishing such services to such veter22 ans.

23 ‘‘(8) Any recommendations for additional legis24 lation regarding the furnishing of care to terminally
15

•S 612 IS

1 ill veterans that the Secretary considers appro2 priate.’’.

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

4 at the beginning of such chapter is amended by adding

5 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.’’.

6 (c) AUTHORITY TO CARRY OUT OTHER HOSPICE

7 CARE PROGRAMS.—The amendments made by subsection

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

9 the Secretary of Veterans Affairs to provide hospice care

10 services to terminally ill veterans under any program in

11 addition to the programs required under the provisions

12 added by such amendments.

13 (d) AUTHORIZATION OF APPROPRIATIONS.—Funds

14 are authorized to be appropriated for the Department of

15 Veterans Affairs for the purposes of carrying out the eval16 uation of the hospice care pilot programs under section

17 1765 of title 38, United States Code (as added by sub18 section (a)), as follows:

19 (1) For fiscal year 1996, $1,200,000.

20 (2) For fiscal year 1997, $2,500,000.

21 (3) For fiscal year 1998, $2,200,000.
16

•S 612 IS

1 (4) For fiscal year 1999, $100,000.

Æ