II 

117TH CONGRESS 

1ST SESSION S. 2565 

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 

JULY 29, 2021 

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. 

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 ‘‘Expanding Access to 

5 Palliative Care Act’’. 

6 SEC. 2. COMMUNITY-BASED PALLIATIVE CARE MODEL. 

7 Section 1115A of the Social Security Act (42 U.S.C. 

8 1315a) is amended 

9 (1) in subsection (b)(2)(A), by adding at the 

10 end the following new sentence: ‘‘The models seVerDate Sep 11 2014 04:01 Aug 04, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2565.IS S2565

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1 lected under this subparagraph shall include the 

2 testing of the model described in subsection (h).’’; 

3 and 

4 (2) by adding at the end the following new sub5 section: 

6 ‘‘(h) COMMUNITY-BASED PALLIATIVE CARE

7 MODEL.— 

8 ‘‘(1) IN GENERAL.—The CMI shall develop and 

9 implement a model to provide community-based pal10 liative care and care coordination for high risk bene11 ficiaries, in co-management with other providers of 

12 services and suppliers, aimed at improving outcomes 

13 and experience of care and reducing unnecessary or 

14 unwanted emergency department visits and hos15 pitalizations (in this subsection referred to as the 

16 ‘model’), and that is intended to replace the Medi17 care Care Choices Model due to sunset on December 

18 31, 2021. 

19 ‘‘(2) DURATION.—The model shall be imple20 mented for a 5 year period, beginning not later than 

21 one year after the date of the enactment of this sub22 section. 

23 ‘‘(3) TARGET POPULATION.— 

24 ‘‘(A) IN GENERAL.—The target population 

25 for the model is an individual— 


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1 ‘‘(i) entitled to, or enrolled for, bene2 fits under part A of title XVIII; and 

3 ‘‘(ii) with a diagnosis of a serious ill4 ness or injury, which may include a diag5 nosis of cancer, heart and vascular disease, 

6 pulmonary disease, human immuno7 deficiency virus/acquired immunodeficiency, 

8 Alzheimer’s and dementia, stroke, serious 

9 injury requiring rehabilitation including 

10 burns, kidney disease, liver disease, 

11 Amyotrophic lateral sclerosis, any neuro 

12 degenerative disease, or any other serious 

13 illness or injury the Secretary determines 

14 appropriate. 

15 ‘‘(B) NO EXCLUSION FOR PRIOR USE OF

16 HOSPICE CARE BENEFITS.—An individual shall 

17 not be excluded from participation in the model 

18 based on prior use of hospice care benefits dur19 ing any period prior to such participation, re20 gardless of the source of coverage for such ben21 efits. 

22 ‘‘(4) PARTICIPATING PROVIDERS.—Providers el23 igible to participate under the model may include 

24 palliative care teams working as an independent 

25 practice or associated with a hospice program, home 


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1 health agencies, hospitals, integrated health systems, 

2 and other facilities determined appropriate by the 

3 Secretary. 

4 ‘‘(5) TEAM-BASED APPROACH.—Under the 

5 model, at least one member of the multi-disciplinary 

6 palliative care team shall be certified in hospice and 

7 palliative care. This is a co-management model with 

8 palliative care aligning with primary and specialist 

9 care for a team-based approach. Care must be co10 ordinated across providers and community services 

11 for inclusion of all pain, symptom management, dis12 ease-modifying and curative treatments, and other 

13 palliative care services. 

14 ‘‘(6) LOCATION.—Care may be furnished under 

15 the model in any beneficiary ‘home’, including a 

16 caregiver’s residence, an extended care facility, or a 

17 community setting as appropriate based on the indi18 vidual’s ability to access services. The model shall 

19 include access within an in-patient stay so long as 

20 the patient begins receiving palliative care services 

21 prior to admission. Services shall not be disrupted 

22 solely due to change in location from a residence to 

23 an in-patient setting, and shall be part of care co24 ordination and care planning following hospital dis25 charge. 


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1 ‘‘(7) SERVICES.—The model shall include items 

2 and services based on specific patient needs with re3 spect to pain, symptom management, education, dis4 ease modifying treatments, advance care planning 

5 and shared decision-making, goals clarification, men6 tal health services, family and caregiver support 

7 services, spiritual support care, personal care assist8 ance, and stress reduction therapies. This includes a 

9 comprehensive assessment of symptoms and stress 

10 factors that impact quality of life. 

11 ‘‘(8) ACCESS.—Care shall be available under 

12 the model 24 hours a day, 7 days a week, and 365 

13 days a year, including telehealth services. The CMI 

14 shall specifically consider the needs of rural and un15 derserved areas and adjust accordingly to ensure eq16 uitable access to care. A broad range of providers 

17 must be included with no geographic limitations. 

18 ‘‘(9) METRICS.—The CMI shall assess the 

19 model by comparing participants to other members 

20 of the target population who are receiving care out21 side of the model, including with respect to the fol22 lowing: 

23 ‘‘(A) Demographics (including age, diag24 nosis, residence type, medical encounters in pre25 ceding 12 months leading to enrollment, geoVerDate Sep 11 2014 04:01 Aug 04, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2565.IS S2565

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1 graphic location (such as urban or rural) and 

2 others as determined by the CMI). 

3 ‘‘(B) Impact on utilization of items and 

4 services under title XVIII (such as emergency 

5 department services, hospital observation serv6 ices, inpatient admissions, and intensive care 

7 unit (ICU) stays). 

8 ‘‘(C) Election of hospice care. 

9 ‘‘(D) Duration of hospice care. 

10 ‘‘(E) Care Experience (beneficiary and 

11 caregiver).’’. 

Æ 


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