IIB 

115TH CONGRESS 

2D SESSION H. R. 1676 

IN THE SENATE OF THE UNITED STATES 

JULY 24, 2018 

Received; read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

AN ACT 

To amend the Public Health Service Act to increase the 

number of permanent faculty in palliative care at accredited allopathic and osteopathic medical schools, nursing 

schools, social work schools, and other programs, including physician assistant education programs, to promote 

education and research in palliative care and hospice, 

and to support the development of faculty careers in 

academic palliative medicine. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Palliative Care and 

3 Hospice Education and Training Act’’. 

4 SEC. 2. PALLIATIVE CARE AND HOSPICE EDUCATION AND 

5 TRAINING. 

6 (a) IN GENERAL.—Part D of title VII of the Public 

7 Health Service Act (42 U.S.C. 294 et seq.) is amended 

8 by inserting after section 759 the following: 

9 ‘‘SEC. 759A. PALLIATIVE CARE AND HOSPICE EDUCATION 

10 AND TRAINING. 

11 ‘‘(a) PALLIATIVE CARE AND HOSPICE EDUCATION

12 CENTERS.— 

13 ‘‘(1) IN GENERAL.—The Secretary shall award 

14 grants or contracts under this section to entities de15 scribed in paragraph (1), (3), or (4) of section 

16 799B, and section 801(2), for the establishment or 

17 operation of Palliative Care and Hospice Education 

18 Centers that meet the requirements of paragraph 

19 (2). 

20 ‘‘(2) REQUIREMENTS.—A Palliative Care and 

21 Hospice Education Center meets the requirements of 

22 this paragraph if such Center— 

23 ‘‘(A) improves the interprofessional team24 based training of health professionals in pallia25 tive care, including residencies, traineeships, or 

26 fellowships; 


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1 ‘‘(B) develops and disseminates inter2 professional team-based curricula relating to 

3 the palliative treatment of the complex health 

4 problems of individuals with serious or life5 threatening illnesses; 

6 ‘‘(C) supports the training and retraining 

7 of faculty to provide instruction in interprofes8 sional team-based palliative care; 

9 ‘‘(D) supports interprofessional team-based 

10 continuing education of health professionals 

11 who provide palliative care to patients with seri12 ous or life-threatening illness; 

13 ‘‘(E) provides students (including resi14 dents, trainees, and fellows) with clinical train15 ing in interprofessional team-based palliative 

16 care in appropriate health settings, including 

17 hospitals, hospices, home care, long-term care 

18 facilities, and ambulatory care centers; 

19 ‘‘(F) establishes traineeships for individ20 uals who are preparing for advanced education 

21 nursing degrees, social work degrees, or ad22 vanced degrees in physician assistant studies, 

23 with a focus in interprofessional team-based 

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1 term care facilities, and ambulatory care cen2 ters; 

3 ‘‘(G) supports collaboration between mul4 tiple specialty training programs (such as medi5 cine, nursing, social work, physician assistant, 

6 chaplaincy, and pharmacy) and clinical training 

7 sites to provide training in interprofessional 

8 team-based palliative care; and 

9 ‘‘(H) does not duplicate the activities of 

10 existing education centers funded under this 

11 section or under section 753 or 865. 

12 ‘‘(3) EXPANSION OF EXISTING CENTERS.— 

13 Nothing in this section shall be construed to— 

14 ‘‘(A) prevent the Secretary from providing 

15 grants to expand existing education centers, in16 cluding geriatric education centers established 

17 under section 753 or 865, to provide for edu18 cation and training focused specifically on pal19 liative care, including for non-geriatric popu20 lations; or 

21 ‘‘(B) limit the number of education centers 

22 that may be funded in a community. 

23 ‘‘(b) PALLIATIVE MEDICINE PHYSICIAN TRAINING.— 

24 ‘‘(1) IN GENERAL.—The Secretary may make 

25 grants to, and enter into contracts with, schools of 


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1 medicine, schools of osteopathic medicine, teaching 

2 hospitals, and graduate medical education programs 

3 for the purpose of providing support for projects 

4 that fund the training of physicians (including resi5 dents, trainees, and fellows) who plan to teach pal6 liative medicine. 

7 ‘‘(2) REQUIREMENTS.—Each project for which 

8 a grant or contract is made under this subsection 

9 shall— 

10 ‘‘(A) be staffed by full-time teaching physi11 cians who have experience or training in inter12 professional team-based palliative medicine; 

13 ‘‘(B) be based in a hospice and palliative 

14 medicine fellowship program accredited by the 

15 Accreditation Council for Graduate Medical 

16 Education; 

17 ‘‘(C) provide training in interprofessional 

18 team-based palliative medicine through a vari19 ety of service rotations, such as consultation 

20 services, acute care services, extended care fa21 cilities, ambulatory care and comprehensive 

22 evaluation units, hospices, home care, and com23 munity care programs; 


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1 ‘‘(D) develop specific performance-based 

2 measures to evaluate the competency of train3 ees; and 

4 ‘‘(E) provide training in interprofessional 

5 team-based palliative medicine through one or 

6 both of the training options described in para7 graph (3). 

8 ‘‘(3) TRAINING OPTIONS.—The training options 

9 referred to in subparagraph (E) of paragraph (2) 

10 are as follows: 

11 ‘‘(A) 1-year retraining programs in hospice 

12 and palliative medicine for physicians who are 

13 faculty at schools of medicine and osteopathic 

14 medicine, or others determined appropriate by 

15 the Secretary. 

16 ‘‘(B) 1- or 2-year training programs that 

17 are designed to provide training in interprofes18 sional team-based hospice and palliative medi19 cine for physicians who have completed grad20 uate medical education programs in any med21 ical specialty leading to board eligibility in hos22 pice and palliative medicine pursuant to the 

23 American Board of Medical Specialties. 

24 ‘‘(4) DEFINITIONS.—For purposes of this sub25 section, the term ‘graduate medical education’ 


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1 means a program sponsored by a school of medicine, 

2 a school of osteopathic medicine, a hospital, or a 

3 public or private institution that— 

4 ‘‘(A) offers postgraduate medical training 

5 in the specialties and subspecialties of medicine; 

6 and 

7 ‘‘(B) has been accredited by the Accredita8 tion Council for Graduate Medical Education or 

9 the American Osteopathic Association through 

10 its Committee on Postdoctoral Training. 

11 ‘‘(c) PALLIATIVE MEDICINE AND HOSPICE ACA12 DEMIC CAREER AWARDS.— 

13 ‘‘(1) ESTABLISHMENT OF PROGRAM.—The Sec14 retary shall establish a program to provide awards, 

15 to be known as the ‘Palliative Medicine and Hospice 

16 Academic Career Awards’, to eligible individuals to 

17 promote the career development of such individuals 

18 as academic hospice and palliative care physicians. 

19 ‘‘(2) ELIGIBLE INDIVIDUALS.—To be eligible to 

20 receive an award under paragraph (1), an individual 

21 shall— 

22 ‘‘(A) be board certified or board eligible in 

23 hospice and palliative medicine; and 

24 ‘‘(B) have a junior (non-tenured) faculty 

25 appointment at an accredited (as determined by 


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1 the Secretary) school of medicine or osteopathic 

2 medicine. 

3 ‘‘(3) LIMITATIONS.—No award under para4 graph (1) may be made to an eligible individual un5 less the individual— 

6 ‘‘(A) has submitted to the Secretary an ap7 plication, at such time, in such manner, and 

8 containing such information as the Secretary 

9 may require, and the Secretary has approved 

10 such application; 

11 ‘‘(B) provides, in such form and manner as 

12 the Secretary may require, assurances that the 

13 individual will meet the service requirement de14 scribed in paragraph (6); and 

15 ‘‘(C) provides, in such form and manner as 

16 the Secretary may require, assurances that the 

17 individual has a full-time faculty appointment 

18 in a health professions institution and docu19 mented commitment from such institution to 

20 spend a majority of the total funded time of 

21 such individual on teaching and developing 

22 skills in education in interprofessional team23 based palliative care. 

24 ‘‘(4) MAINTENANCE OF EFFORT.—An eligible 

25 individual who receives an award under paragraph 


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1 (1) shall provide assurances to the Secretary that 

2 funds provided to the eligible individual under this 

3 subsection will be used only to supplement, not to 

4 supplant, the amount of Federal, State, and local 

5 funds otherwise expended by the eligible individual. 

6 ‘‘(5) AMOUNT AND TERM.— 

7 ‘‘(A) AMOUNT.—The amount of an award 

8 under this subsection shall be equal to the 

9 award amount provided for under section 

10 753(c)(5)(A) for the fiscal year involved. 

11 ‘‘(B) TERM.—The term of an award made 

12 under this subsection shall not exceed 5 years. 

13 ‘‘(C) PAYMENT TO INSTITUTION.—The 

14 Secretary shall make payments for awards 

15 under this subsection to institutions, including 

16 schools of medicine and osteopathic medicine. 

17 ‘‘(6) SERVICE REQUIREMENT.—An individual 

18 who receives an award under this subsection shall 

19 provide training in palliative care and hospice, in20 cluding the training of interprofessional teams of 

21 health care professionals. The provision of such 

22 training shall constitute a majority of the total fund23 ed obligations of such individual under the award. 

24 ‘‘(d) PALLIATIVE CARE WORKFORCE DEVELOP25 MENT.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall award 

2 grants or contracts under this subsection to entities 

3 that operate a Palliative Care and Hospice Edu4 cation Center pursuant to subsection (a)(1). 

5 ‘‘(2) APPLICATION.—To be eligible for an 

6 award under paragraph (1), an entity described in 

7 such paragraph shall submit to the Secretary an ap8 plication at such time, in such manner, and con9 taining such information as the Secretary may re10 quire. 

11 ‘‘(3) USE OF FUNDS.—Amounts awarded under 

12 a grant or contract under paragraph (1) shall be 

13 used to carry out the fellowship program described 

14 in paragraph (4). 

15 ‘‘(4) FELLOWSHIP PROGRAM.— 

16 ‘‘(A) IN GENERAL.—Pursuant to para17 graph (3), a Palliative Care and Hospice Edu18 cation Center that receives an award under this 

19 subsection shall use such funds to offer short20 term intensive courses (referred to in this sub21 section as a ‘fellowship’) that focus on inter22 professional team-based palliative care that pro23 vide supplemental training for faculty members 

24 in medical schools and other health professions 

25 schools with programs in psychology, pharmacy, 


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1 nursing, social work, physician assistant edu2 cation, chaplaincy, or other health disciplines, 

3 as approved by the Secretary. Such a fellowship 

4 shall be open to current faculty, and appro5 priately credentialed volunteer faculty and prac6 titioners, who do not have formal training in 

7 palliative care, to upgrade their knowledge and 

8 clinical skills for the care of individuals with se9 rious or life-threatening illness and to enhance 

10 their interdisciplinary and interprofessional 

11 teaching skills. 

12 ‘‘(B) LOCATION.—A fellowship under this 

13 paragraph shall be offered either at the Pallia14 tive Care and Hospice Education Center that is 

15 sponsoring the course, in collaboration with 

16 other Palliative Care and Hospice Education 

17 Centers, or at medical schools, schools of nurs18 ing, schools of pharmacy, schools of social work, 

19 schools of chaplaincy or pastoral care education, 

20 graduate programs in psychology, physician as21 sistant education programs, or other health pro22 fessions schools approved by the Secretary with 

23 which the Centers are affiliated. 

24 ‘‘(C) CONTINUING EDUCATION CREDIT.— 

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1 graph shall be accepted with respect to com2 plying with continuing health profession edu3 cation requirements. As a condition of such ac4 ceptance, the recipient shall subsequently pro5 vide a minimum of 18 hours of voluntary in6 struction in palliative care content (that has 

7 been approved by a palliative care and hospice 

8 education center) to students or trainees in 

9 health-related educational, home, hospice, or 

10 long-term care settings. 

11 ‘‘(5) TARGETS.—A Palliative Care and Hospice 

12 Education Center that receives an award under 

13 paragraph (1) shall meet targets approved by the 

14 Secretary for providing training in interprofessional 

15 team-based palliative care to a certain number of 

16 faculty or practitioners during the term of the 

17 award, as well as other parameters established by 

18 the Secretary. 

19 ‘‘(6) AMOUNT OF AWARD.—Each award under 

20 paragraph (1) shall be in the amount of $150,000. 

21 Not more than 24 Palliative Care and Hospice Edu22 cation Centers may receive an award under such 

23 paragraph. 

24 ‘‘(7) MAINTENANCE OF EFFORT.—A Palliative 

25 Care and Hospice Education Center that receives an 


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1 award under paragraph (1) shall provide assurances 

2 to the Secretary that funds provided to the Center 

3 under the award will be used only to supplement, 

4 not to supplant, the amount of Federal, State, and 

5 local funds otherwise expended by such Center. 

6 ‘‘(e) PALLIATIVE CARE AND HOSPICE CAREER IN7 CENTIVE AWARDS.— 

8 ‘‘(1) IN GENERAL.—The Secretary shall award 

9 grants or contracts under this subsection to individ10 uals described in paragraph (2) to foster greater in11 terest among a variety of health professionals in en12 tering the field of palliative care. 

13 ‘‘(2) ELIGIBLE INDIVIDUALS.—To be eligible to 

14 receive an award under paragraph (1), an individual 

15 shall— 

16 ‘‘(A) be an advanced practice nurse, a so17 cial worker, physician assistant, pharmacist, 

18 chaplain, or student of psychology who is pur19 suing a doctorate, masters, or other advanced 

20 degree with a focus in interprofessional team21 based palliative care or related fields in an ac22 credited health professions school; and 

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1 taining such information as the Secretary may 

2 require. 

3 ‘‘(3) CONDITIONS OF AWARD.—As a condition 

4 of receiving an award under paragraph (1), an indi5 vidual shall agree that, following completion of the 

6 award period, the individual will teach or practice 

7 palliative care in health-related educational, home, 

8 hospice, or long-term care settings for a minimum of 

9 5 years under guidelines established by the Sec10 retary. 

11 ‘‘(4) PAYMENT TO INSTITUTION.—The Sec12 retary shall make payments for awards under para13 graph (1) to institutions that include schools of med14 icine, osteopathic medicine, nursing, social work, 

15 psychology, chaplaincy or pastoral care education, 

16 dentistry, and pharmacy, or other allied health dis17 cipline in an accredited health professions school or 

18 program (such as a physician assistant education 

19 program) that is approved by the Secretary. 

20 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

21 are authorized to be appropriated to carry out this section, 

22 $15,000,000 for each of the fiscal years 2019 through 

23 2023.’’. 


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1 (b) EFFECTIVE DATE.—The amendment made by 

2 this section shall be effective beginning on the date that 

3 is 90 days after the date of enactment of this Act. 

4 SEC. 3. HOSPICE AND PALLIATIVE NURSING. 

5 (a) NURSE EDUCATION, PRACTICE, AND QUALITY

6 GRANTS.—Section 831(b)(3) of the Public Health Service 

7 Act (42 U.S.C. 296p(b)(3)) is amended by inserting ‘‘hos8 pice and palliative nursing,’’ after ‘‘coordinated care,’’. 

9 (b) PALLIATIVE CARE AND HOSPICE EDUCATION

10 AND TRAINING PROGRAMS.—Part D of title VIII of the 

11 Public Health Service Act (42 U.S.C. 296p et seq.) is 

12 amended by adding at the end the following: 

13 ‘‘SEC. 832. PALLIATIVE CARE AND HOSPICE EDUCATION 

14 AND TRAINING. 

15 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall 

16 award grants to eligible entities to develop and implement, 

17 in coordination with programs under section 759A, pro18 grams and initiatives to train and educate individuals in 

19 providing interprofessional team-based palliative care in 

20 health-related educational, hospital, hospice, home, or 

21 long-term care settings. 

22 ‘‘(b) USE OF FUNDS.—An eligible entity that receives 

23 a grant under subsection (a) shall use funds under such 

24 grant to— 


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1 ‘‘(1) provide training to individuals who will 

2 provide palliative care in health-related educational, 

3 hospital, home, hospice, or long-term care settings; 

4 ‘‘(2) develop and disseminate curricula relating 

5 to palliative care in health-related educational, hos6 pital, home, hospice, or long-term care settings; 

7 ‘‘(3) train faculty members in palliative care in 

8 health-related educational, hospital, home, hospice, 

9 or long-term care settings; or 

10 ‘‘(4) provide continuing education to individuals 

11 who provide palliative care in health-related edu12 cational, home, hospice, or long-term care settings. 

13 ‘‘(c) APPLICATION.—An eligible entity desiring a 

14 grant under subsection (a) shall submit an application to 

15 the Secretary at such time, in such manner, and con16 taining such information as the Secretary may reasonably 

17 require. 

18 ‘‘(d) ELIGIBLE ENTITY.—For purposes of this sec19 tion, the term ‘eligible entity’ shall include a school of 

20 nursing, a health care facility, a program leading to cer21 tification as a certified nurse assistant, a partnership of 

22 such a school and facility, or a partnership of such a pro23 gram and facility. 


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1 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 $5,000,000 for each of fiscal years 2019 through 2023.’’. 

4 SEC. 4. DISSEMINATION OF PALLIATIVE CARE INFORMA5 TION. 

6 Part A of title IX of the Public Health Service Act 

7 (42 U.S.C. 299 et seq.) is amended by adding at the end 

8 the following new section: 

9 ‘‘SEC. 904. DISSEMINATION OF PALLIATIVE CARE INFORMA10 TION. 

11 ‘‘(a) IN GENERAL.—Under the authority under sec12 tion 902(a) to disseminate information on health care and 

13 on systems for the delivery of such care, the Director may 

14 disseminate information to inform patients, families, and 

15 health professionals about the benefits of palliative care 

16 throughout the continuum of care for patients with serious 

17 or life-threatening illness. 

18 ‘‘(b) INFORMATION DISSEMINATED.— 

19 ‘‘(1) MANDATORY INFORMATION.—If the Direc20 tor elects to disseminate information under sub21 section (a), such dissemination shall include the fol22 lowing: 

23 ‘‘(A) PALLIATIVE CARE.—Information, re24 sources, and communication materials about 

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1 tinuum of quality care for patients and families 

2 facing serious or life-threatening illness (includ3 ing cancer; heart, kidney, liver, lung, and infec4 tious diseases; as well as neurodegenerative dis5 ease such as dementia, Parkinson’s disease, or 

6 amyotrophic lateral sclerosis). 

7 ‘‘(B) PALLIATIVE CARE SERVICES.—Spe8 cific information regarding the services provided 

9 to patients by professionals trained in hospice 

10 and palliative care, including pain and symptom 

11 management, support for shared decision12 making, care coordination, psychosocial care, 

13 and spiritual care, explaining that such services 

14 may be provided starting at the point of diag15 nosis and alongside curative treatment and are 

16 intended to— 

17 ‘‘(i) provide patient-centered and fam18 ily-centered support throughout the con19 tinuum of care for serious and life-threat20 ening illness; 

21 ‘‘(ii) anticipate, prevent, and treat 

22 physical, emotional, social, and spiritual 

23 suffering; 

24 ‘‘(iii) optimize quality of life; and 


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1 ‘‘(iv) facilitate and support the goals 

2 and values of patients and families. 

3 ‘‘(C) PALLIATIVE CARE PROFESSIONALS.— 

4 Specific materials that explain the role of pro5 fessionals trained in hospice and palliative care 

6 in providing team-based care (including pain 

7 and symptom management, support for shared 

8 decisionmaking, care coordination, psychosocial 

9 care, and spiritual care) for patients and fami10 lies throughout the continuum of care for seri11 ous or life-threatening illness. 

12 ‘‘(D) RESEARCH.—Evidence-based re13 search demonstrating the benefits of patient ac14 cess to palliative care throughout the continuum 

15 of care for serious or life-threatening illness. 

16 ‘‘(E) POPULATION-SPECIFIC MATERIALS.— 

17 Materials targeting specific populations, includ18 ing patients with serious or life-threatening ill19 ness who are among medically underserved pop20 ulations (as defined in section 330(b)(3)) and 

21 families of such patients or health professionals 

22 serving medically underserved populations. Such 

23 populations shall include pediatric patients, 

24 young adult and adolescent patients, racial and 


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1 ethnic minority populations, and other priority 

2 populations specified by the Director. 

3 ‘‘(2) REQUIRED PUBLICATION.—Information 

4 and materials disseminated under paragraph (1) 

5 shall be posted on the Internet websites of relevant 

6 Federal agencies and departments, including the De7 partment of Veterans Affairs, the Centers for Medi8 care & Medicaid Services, and the Administration on 

9 Aging. 

10 ‘‘(c) CONSULTATION.—The Director shall consult 

11 with appropriate professional societies, hospice and pallia12 tive care stakeholders, and relevant patient advocate orga13 nizations with respect to palliative care, psychosocial care, 

14 and complex chronic illness with respect to the following: 

15 ‘‘(1) The planning and implementation of the 

16 dissemination of palliative care information under 

17 this section. 

18 ‘‘(2) The development of information to be dis19 seminated under this section. 

20 ‘‘(3) A definition of the term ‘serious or life21 threatening illness’ for purposes of this section.’’. 

22 SEC. 5. CLARIFICATION. 

23 None of the funds made available under this Act (or 

24 an amendment made by this Act) may be used to provide, 

25 promote, or provide training with regard to any item or 


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1 service for which Federal funding is unavailable under sec2 tion 3 of Public Law 105–12 (42 U.S.C. 14402). 

3 SEC. 6. ENHANCING NIH RESEARCH IN PALLIATIVE CARE. 

4 (a) IN GENERAL.—Part B of title IV of the Public 

5 Health Service Act (42 U.S.C. 284 et seq.) is amended 

6 by adding at the end the following new section: 

7 ‘‘SEC. 409K. ENHANCING RESEARCH IN PALLIATIVE CARE. 

8 ‘‘The Secretary, acting through the Director of the 

9 National Institutes of Health, shall develop and implement 

10 a strategy to be applied across the institutes and centers 

11 of the National Institutes of Health to expand and inten12 sify national research programs in palliative care in order 

13 to address the quality of care and quality of life for the 

14 rapidly growing population of patients in the United 

15 States with serious or life-threatening illnesses, including 

16 cancer; heart, kidney, liver, lung, and infectious diseases; 

17 as well as neurodegenerative diseases such as dementia, 

18 Parkinson’s disease, or amyotrophic lateral sclerosis.’’. 

19 (b) EXPANDING TRANS-NIH RESEARCH REPORTING

20 TO INCLUDE PALLIATIVE CARE RESEARCH.—Section 

21 402A(c)(2)(B) of the Public Health Service Act (42 

22 U.S.C. 282a(c)(2)(B)) is amended by inserting ‘‘and, be23 ginning January 1, 2019, for conducting or supporting re24 search with respect to palliative care’’ after ‘‘or national 

25 centers’’. 


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1 SEC. 7. CUT-GO OFFSET. 

2 The total amount authorized to be appropriated to 

3 the Office of the Secretary of Health and Human Services 

4 for each of fiscal years 2019 through 2023 is the amount 

5 that is $20,000,000 below the total amount appropriated 

6 to such Office for fiscal year 2018. 

Passed the House of Representatives July 23, 2018. 

Attest: KAREN L. HAAS, 

Clerk. 


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