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[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 3684 Introduced in Senate (IS)]

112th CONGRESS
  2d Session
                                S. 3684

To amend title XVIII of the Social Security Act to provide for advanced 
illness care coordination services for Medicare beneficiaries, and for 
                            other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           December 17, 2012

  Mr. Warner introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
To amend title XVIII of the Social Security Act to provide for advanced 
illness care coordination services for Medicare beneficiaries, and for 
                            other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Senior Navigation 
and Planning Act of 2012''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Medicare and Medicaid coverage of advanced illness care 
                            coordination services.
Sec. 4. Increasing awareness of the importance of advance care 
                            planning.
Sec. 5. Inclusion of advance care planning materials in the Medicare & 
                            You handbook.
Sec. 6. Senior Navigation Advisory Board.
Sec. 7. Improvement of policies related to the use and portability of 
                            advanced directives.
Sec. 8. Additional requirements for facilities.
Sec. 9. Incentives for accreditation and certification in hospice and 
                            palliative care.
Sec. 10. Discharge checklist pilot program.
Sec. 11. Web-based materials and grants.
Sec. 12. HHS study and report on the storage of advanced directives.
Sec. 13. GAO study and report on the provisions of, and amendments made 
                            by, this Act.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Whereas the population of the United States is 
        estimated to age rapidly, with the number of people over the 
        age of 65 set to double to more than 72,000,000, or 1 in 5 
        Americans, over the next two decades.
            (2) Whereas Americans today are living longer and healthier 
        lives than ever before in the history of the United States yet 
        are also facing increased incidence of multiple chronic 
        conditions as aging progresses. Advanced illness occurs when 
        one or more conditions become serious enough that general 
        health and functioning decline and quality of life increasingly 
        becomes the primary focus of care.
            (3) Whereas older Americans with advanced illness face an 
        increasingly complicated and fragmented system of care delivery 
        and are at greater risk for repeat hospitalizations, adverse 
        drug reactions, and conflicting medical advice that may be 
        overwhelming to individuals and families.
            (4) Whereas the progression of advanced illness over time 
        leads to more intense needs that require greater time and 
        assistance from that individual's caregiver, be it a family 
        member or a direct care worker and significantly increased 
        medical needs, including the need to see multiple specialists 
        across the health care system, which often results in 
        uncoordinated care, making individuals more prone to adverse 
        health outcomes, increased frustration, and decreased 
        satisfaction.
            (5) Whereas advanced illness imposes financial and 
        emotional burdens on families, friends, and co-workers, in 
        addition to leading to billions per year in lost productivity 
        due to caregivers having to take time off of work to care for 
        frail and elderly loved ones.
            (6) Whereas numerous private sector leaders, including 
        hospitals, health systems, home health agencies, hospice 
        programs, long-term care providers, employers, and other 
        entities, have put in place innovative solutions to providing 
        more comprehensive and coordinated care for Americans living 
        with advanced illness.
            (7) Whereas hospice programs, as one of the longest 
        standing Medicare care coordination benefits that entails 
        administering a comprehensive set of services via an 
        interdisciplinary team working to provide person-centered care 
        to the frailest and most vulnerable individuals in our 
        communities, can help serve as a model for advanced illness 
        care delivery.
            (8) Whereas the Government of the United States, as the 
        Nation's largest purchaser of health care services, must learn 
        from these innovators and encourage health care providers to 
        furnish more supportive and comprehensive advanced illness care 
        coordination services to improve individual's experiences and 
        ensure a more sustainable system of care delivery for 
        generations of Americans to come.

SEC. 3. MEDICARE AND MEDICAID COVERAGE OF ADVANCED ILLNESS CARE 
              COORDINATION SERVICES.

    (a) Medicare Coverage of Advanced Illness Care Coordination 
Services.--
            (1) Coverage.--Section 1812(a)(5) of the Social Security 
        Act (42 U.S.C. 1395d(a)(5)) is amended to read as follows:
            ``(5) for individuals with advanced illness (as determined 
        under section 1861(iii)(2)) who have not made an election under 
        subsection (d)(1) to receive hospice care under this part, 
        advanced illness care coordination services (as defined in 
        section 1861(iii)(1)).''.
            (2) Definition.--Section 1861 of the Social Security Act 
        (42 U.S.C. 1395x) is amended by adding at the end the following 
        new subsection:

             ``Advanced Illness Care Coordination Services

    ``(iii)(1) The term `advanced illness care coordination services' 
means the following services furnished to an individual with advanced 
illness by an applicable provider:
            ``(A) Palliative care consultation services.
            ``(B) Person and family centered care planning services, 
        including information on advance care planning.
            ``(C) Medication management.
            ``(D) Individual and family counseling services, including 
        assistance with the identification of care options and the 
        goals of care.
            ``(E) Culturally and educationally appropriate family 
        caregiver training and support services, including respite 
        services.
            ``(F) Such other services the Secretary may specify.
    ``(2)(A) An individual is considered to have `advanced illness' if 
the individual has a medical prognosis that the individual's life 
expectancy is 18 months or less or meets other criteria specified by 
the Secretary in accordance with subparagraph (B).
    ``(B) In specifying criteria under subparagraph (A), the Secretary 
shall consider--
            ``(i) the severity of illness, including the diagnosis, 
        stage, comorbidities, functional status, hospitalization, and 
        other objective factors determined appropriate by the 
        Secretary;
            ``(ii) the acuity of illness, as measured by the 
        progression of illness and disability over the immediately 
        preceding 30- and 90-day periods; and
            ``(iii) treatment response, such as, in the case of cancer, 
        resistance to chemotherapy.
    ``(3) For purposes of this subsection, the term `applicable 
provider' means--
            ``(A) a hospice program (as defined in subsection (dd)(2)); 
        or
            ``(B) other provider of services or supplier specified by 
        the Secretary.
    ``(4) In the case of an applicable provider that is furnishing 
advanced illness care coordination services to an individual who 
becomes eligible for hospice care under this title, the applicable 
provider shall notify the individual of such eligibility.''.
            (3) Payment based on the physician fee schedule.--Section 
        1814(i)(4) of the Social Security Act (42 U.S.C. 1395f(i)(4)) 
        is amended to read as follows:
    ``(4) The amount paid to an applicable provider with respect to 
advanced illness care coordination services (as defined in section 
1861(iii)) for which payment may be made under this part shall be--
            ``(A) with respect to such services furnished by a 
        physician, an amount equal to the amount that would be paid for 
        an equivalent physician's service under the fee schedule 
        established under section 1848(b);
            ``(B) with respect to such services, other than respite 
        services, furnished by a non-physician practitioner, an amount 
        equal to the amount that would be paid for an equivalent 
        service under section 1833(a)(1)(O); and
            ``(C) with respect to respite services, payment shall be at 
        an appropriate rate to be determined by the Secretary''.
            (4) Effective date.--The amendments made by this subsection 
        shall apply to services furnished on or after January 1, 2013.
    (b) Medicaid Coverage of Advanced Illness Care Coordination 
Services.--
            (1) In general.--Section 1905(a) of the Social Security Act 
        (42 U.S.C. 1396d(a)) is amended--
                    (A) by redesignating paragraph (29) as paragraph 
                (30);
                    (B) in paragraph (28), by striking at the end 
                ``and''; and
                    (C) by inserting after paragraph (28) the following 
                new paragraph:
            ``(29) advanced illness care coordination services (as 
        defined in section 1861(iii)) for individuals described in 
        section 1812(a)(5); and''.
            (2) Conforming amendment.--Section 1902(a)(10)(A) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by 
        striking ``and (28)'' and inserting ``, (28), and (29)''.
            (3) Effective date.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the amendments made by paragraphs (1) and (2) take 
                effect on January 1, 2013.
                    (B) Extension of effective date for state law 
                amendment.--In the case of a State plan under title XIX 
                of the Social Security Act (42 U.S.C. 1396 et seq.) 
                which the Secretary determines requires State 
                legislation in order for the plan to meet the 
                additional requirements imposed by the amendments made 
                by paragraphs (1) and (2), the State plan shall not be 
                regarded as failing to comply with the requirements of 
                such title solely on the basis of its failure to meet 
                these additional requirements before the first day of 
                the first calendar quarter beginning after the close of 
                the first regular session of the State legislature that 
                begins after the date of enactment of this Act. For 
                purposes of the previous sentence, in the case of a 
                State that has a 2-year legislative session, each year 
                of the session is considered to be a separate regular 
                session of the State legislature.
    (c) Education on Advanced Illness Care Coordination Services.--The 
Secretary of Health and Human Services (in this section referred to as 
the ``Secretary'') shall establish a program under which physicians (as 
defined in subsection (r) of section 1861 of the Social Security Act 
(42 U.S.C. 1395x)) are educated on the coverage of advanced illness 
care coordination services (as defined in subsection (iii) of such 
section) under the Medicare and Medicaid programs under titles XVIII 
and XIX, respectively, of the Social Security Act (42 U.S.C. 1395 et 
seq.; 1396 et seq.), including the importance of early intervention in 
providing such care to individuals.

SEC. 4. INCREASING AWARENESS OF THE IMPORTANCE OF ADVANCE CARE 
              PLANNING.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following new part:

   ``PART W--PROGRAMS TO INCREASE AWARENESS OF ADVANCE CARE PLANNING 
                                 ISSUES

``SEC. 399OO. ADVANCE CARE PLANNING EDUCATION CAMPAIGNS AND INFORMATION 
              PHONE LINE AND CLEARINGHOUSE.

    ``(a) Advance Care Planning Education Campaign.--The Secretary 
shall, directly or through grants awarded under subsection (c), conduct 
a national public education campaign--
            ``(1) to raise public awareness of the importance of 
        planning for care throughout the life cycle and as illness 
        progresses;
            ``(2) to explain the need for readily available legal 
        documents and medical orders that express an individual's 
        wishes through--
                    ``(A) advance directives (including living wills, 
                comfort care orders, and durable powers of attorney for 
                health care); and
                    ``(B) other planning tools, such as Physician's 
                Orders for Life-Sustaining Treatment (POLST) or a State 
                authorized portable order; and
            ``(3) to educate the public about the availability of 
        advanced illness care, palliative care, and hospice care.
    ``(b) Communications Resources.--The Secretary, directly or through 
grants awarded under subsection (c), shall provide for multiple, 
innovative communications resources, including a toll-free information 
telephone line, that the public and health care professionals may 
access to find out about State-specific information regarding advance 
directives and end-of-life decisions.
    ``(c) Grants.--
            ``(1) In general.--The Secretary shall use funds 
        appropriated under subsection (d) for the purpose of awarding 
        grants to public or nonprofit private entities (including 
        States or political subdivisions of a State), or a consortium 
        of any of such entities, for the purpose of conducting 
        education campaigns under subsection (a).
            ``(2) Period.--Any grant awarded under paragraph (1) shall 
        be for a period of 3 years.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated--
            ``(1) for purposes of carrying out subsection (b), 
        $5,000,000 for fiscal year 2013 and each subsequent year; and
            ``(2) for purposes of making grants under subsection (c), 
        $10,000,000 for fiscal year 2013, to remain available until 
        expended.''.

SEC. 5. INCLUSION OF ADVANCE CARE PLANNING MATERIALS IN THE MEDICARE & 
              YOU HANDBOOK.

    (a) In General.--Section 1804(a) of the Social Security Act (42 
U.S.C. 1395b-2(a)) is amended--
            (1) in paragraph (2), by striking ``and'' at the end;
            (2) in paragraph (3), by striking the period at the end and 
        inserting ``; and''; and
            (3) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) information on advanced illness care coordination, 
        palliative care, other end-of-life planning tools, and the 
        hospice care benefit under this title.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to notices distributed on or after January 1, 2013.

SEC. 6. SENIOR NAVIGATION ADVISORY BOARD.

    (a) Establishment.--The Secretary of Health and Human Services 
shall establish the Senior Navigation Advisory Board (in this section 
referred to as the ``Advisory Board'').
    (b) Membership.--The Board shall be comprised of advocates, 
consumer representatives, researchers, government officials, health 
care providers, ethicists, members of the faith-based community, family 
caregivers, medical providers, and other individuals with expertise in 
issues related to end-of-life care.
    (c) Duties.--The Advisory Board shall advise the Secretary on 
issues related to end-of-life care and advance care planning, including 
how to--
            (1) improve the quality of life for beneficiaries;
            (2) reduce current legal barriers to the enforcement of 
        advance directives;
            (3) encourage provider participation in educational and 
        training activities surrounding advanced illnesses and personal 
        care planning;
            (4) develop quality and outcome measures that applicable 
        programs should report for advanced illness care coordination 
        services (as defined in section 1861(iii) of the Social 
        Security Act, as added by section 3);
            (5) determine what information should be discussed in 
        discharge planning;
            (6) enhance advance care planning; and
            (7) develop and sustain an optimal service array for 
        implementing quality care coordination services.
    (d) Application of FACA.--The Federal Advisory Committee Act (5 
U.S.C. App.) shall apply to the Advisory Board.
    (e) Pay and Reimbursement.--
            (1) No compensation for members of advisory board.--Except 
        as provided in paragraph (2), a member of the Advisory Board 
        may not receive pay, allowances, or benefits by reason of their 
        service on the Board.
            (2) Travel expenses.--Each member shall receive travel 
        expenses, including per diem in lieu of subsistence under 
        subchapter I of chapter 57 of title 5, United States Code.
    (f) Report.--Not later than 3 years after the establishment of the 
Advisory Board, the Advisory Board shall submit to Congress a final 
report containing the findings and conclusions of the Advisory Board, 
together with recommendations for such legislation and administrative 
actions as the Advisory Board considers appropriate.
    (g) Termination.--The Advisory Board shall terminate 30 days after 
submitting the report under subsection (f).
    (h) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 7. IMPROVEMENT OF POLICIES RELATED TO THE USE AND PORTABILITY OF 
              ADVANCED DIRECTIVES.

    (a) Medicare.--Section 1866(f) of the Social Security Act (42 
U.S.C. 1395cc(f)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (B), by inserting ``and if 
                presented by the individual (or on behalf of the 
                individual), to include the content of such advance 
                directive in a prominent part of such record'' before 
                the semicolon at the end;
                    (B) in subparagraph (D)--
                            (i) by inserting ``paragraph (5) and 
                        applicable'' after ``requirements of''; and
                            (ii) by striking ``and'' after the 
                        semicolon at the end;
                    (C) in subparagraph (E), by striking the period at 
                the end and inserting ``; and''; and
                    (D) by inserting after subparagraph (E) the 
                following new subparagraph:
            ``(F) to provide each individual with the opportunity to 
        discuss issues relating to the information provided to that 
        individual pursuant to subparagraph (A) with an appropriately 
        trained professional.'';
            (2) in paragraph (3), by striking ``a written'' and 
        inserting ``an''; and
            (3) by adding at the end the following new paragraph:
    ``(5)(A) An advance directive or State authorized portable order 
validly executed outside of the State in which the directive or order 
is presented shall be given effect by a provider of services or 
organization (as the case may be) to the same extent as an advance 
directive or order validly executed under the law of the State in which 
it is presented.
    ``(B) In the absence of knowledge to the contrary, a physician or 
other health care provider or a provider of services or organization 
may presume that a written advance health care directive or similar 
instrument or a State authorized portable order, regardless of where 
executed, is valid.
    ``(C) In the absence of a validly executed advance directive or 
State authorized portable order, a provider of services or organization 
shall honor any authentic expression of an individual's wishes with 
respect to health care.
    ``(D) The provisions of this paragraph shall preempt any State law 
with respect to advance directive portability to the extent such law is 
inconsistent with such provisions. Nothing in this paragraph shall be 
construed to authorize the administration of health care treatment 
otherwise prohibited by the laws of the State in which the directive is 
presented.''.
    (b) Medicaid.--Section 1902(w) of the Social Security Act (42 
U.S.C. 1396a(w)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (B)--
                            (i) by striking ``in the individual's 
                        medical record'' and inserting ``in a prominent 
                        part of the individual's current medical 
                        record''; and
                            (ii) by inserting ``and if presented by the 
                        individual (or on behalf of the individual), to 
                        include the content of such advance directive 
                        in a prominent part of such record'' before the 
                        semicolon at the end;
                    (B) in subparagraph (D)--
                            (i) by inserting ``paragraph (6) and 
                        applicable'' after ``requirements of''; and
                            (ii) by striking ``and'' after the 
                        semicolon at the end;
                    (C) in subparagraph (E), by striking the period at 
                the end and inserting ``; and''; and
                    (D) by inserting after subparagraph (E) the 
                following new subparagraph:
            ``(F) to provide each individual with the opportunity to 
        discuss issues relating to the information provided to that 
        individual pursuant to subparagraph (A) with an appropriately 
        trained professional.'';
            (2) in paragraph (4), by striking ``a written'' and 
        inserting ``an''; and
            (3) by adding at the end the following paragraph:
    ``(6)(A) An advance directive or State authorized portable order 
validly executed outside of the State in which the directive is 
presented shall be given effect by a provider of services or 
organization (as the case may be) to the same extent as an advance 
directive or order validly executed under the law of the State in which 
it is presented.
    ``(B) In the absence of knowledge to the contrary, a physician or 
other health care provider or a provider of services or organization 
may presume that a written advance health care directive or similar 
instrument or a State authorized portable order, regardless of where 
executed, is valid.
    ``(C) In the absence of a validly executed advance directive or 
State authorized portable order, a provider of services or organization 
shall honor any authentic expression of an individual's wishes with 
respect to health care.
    ``(D) The provisions of this paragraph shall preempt any State law 
with respect to advance directive portability to the extent such law is 
inconsistent with such provisions. Nothing in this paragraph shall be 
construed to authorize the administration of health care treatment 
otherwise prohibited by the laws of the State in which the directive is 
presented.''.
    (c) Effective Dates.--
            (1) In general.--Subject to paragraph (2), the amendments 
        made by subsections (a) and (b) shall apply to provider 
        agreements and contracts entered into, renewed, or extended 
        under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
        seq.), and to State plans under title XIX of such Act (42 
        U.S.C. 1396 et seq.), on or after such date as the Secretary of 
        Health and Human Services specifies, but in no case may such 
        date be later than 1 year after the date of enactment of this 
        Act.
            (2) Extension of effective date for state law amendment.--
        In the case of a State plan under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
        Health and Human Services determines requires State legislation 
        in order for the plan to meet the additional requirements 
        imposed by the amendments made by subsection (b), the State 
        plan shall not be regarded as failing to comply with the 
        requirements of such title solely on the basis of its failure 
        to meet these additional requirements before the first day of 
        the first calendar quarter beginning after the close of the 
        first regular session of the State legislature that begins 
        after the date of enactment of this Act. For purposes of the 
        previous sentence, in the case of a State that has a 2-year 
        legislative session, each year of the session is considered to 
        be a separate regular session of the State legislature.

SEC. 8. ADDITIONAL REQUIREMENTS FOR FACILITIES.

    (a) Requirements.--
            (1) In general.--Section 1866(a)(1) of the Social Security 
        Act (42 U.S.C. 1395cc(a)(1)) is amended--
                    (A) in subparagraph (V), by striking ``and'' at the 
                end;
                    (B) in subparagraph (W), as added by section 
                3005(1)(C) of the Patient Protection and Affordable 
                Care Act (Public Law 111-148), by redesignating such 
                subparagraph as subparagraph (X), moving such 
                subparagraph to follow subparagraph (V), moving such 
                subparagraph 2 ems to the left, and striking the period 
                at the end and inserting a comma;
                    (C) in subparagraph (W), as added by section 
                6406(b)(3) of the Patient Protection and Affordable 
                Care Act (Public Law 111-148), by redesignating such 
                subparagraph as subparagraph (Y), moving such 
                subparagraph to follow subparagraph (X), as added by 
                subparagraph (B), moving such subparagraph 2 ems to the 
                left, and striking the period at the end and inserting 
                ``, and''; and
                    (D) by inserting after subparagraph (Y) the 
                following new subparagraphs:
            ``(Z) in the case of hospitals, skilled nursing facilities, 
        home health agencies, and hospice programs, to provide an 
        individual (and the caregivers and family of the individual, 
        with the individual's consent, and the legal representative of 
        the individual) who is receiving care by or through the 
        provider with the opportunity to discuss the general course of 
        treatment expected, the likely impact on length of life and 
        function, and the procedures they should use to secure help if 
        an unexpected situation arises, and
            ``(AA) in the case of hospitals, skilled nursing 
        facilities, home health agencies, hospice programs, and 
        applicable providers of advanced illness care coordination 
        services (as defined in section 1861(iii)(3)) to--
                    ``(i) provide for an assessment of each individual 
                (at the time of discharge from the provider) using an 
                assessment instrument that is at least as informative 
                as the continuity assessment record and evaluation 
                (CARE) instrument developed by the Centers for Medicare 
                & Medicaid Services; and
                    ``(ii) include the results of such assessment in 
                the individual's medical record.''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to agreements entered into or renewed on or after 
        January 1, 2014.
    (b) HHS Study and Report on Appropriate Assessments at Discharge.--
            (1) Study.--The Secretary of Health and Human Services 
        shall conduct a study on the extent to which the assessment of 
        individuals by hospitals, skilled nursing facilities, hospice 
        programs, home health agencies, and applicable providers of 
        advanced illness care coordination services under section 
        1886(a)(1)(AA) of the Social Security Act, as added by 
        subsection (a), accurately reflects the actual diagnosis and 
        care plan, including care coordination, of the individual at 
        the time of discharge. Such study shall include an analysis of 
        how successful the hospital, skilled nursing facility, hospice 
        program, home health agency, or applicable provider is in 
        converting care goals and preferences expressed by the 
        individual into a valid advance directive.
            (2) Report.--Not later than January 1, 2016, the Secretary 
        of Health and Human Services shall submit to Congress a report 
        on the study conducted under paragraph (1) together with 
        recommendations for such legislation and administrative action 
        as the Secretary determines to be appropriate.

SEC. 9. INCENTIVES FOR ACCREDITATION AND CERTIFICATION IN HOSPICE AND 
              PALLIATIVE CARE.

    (a) Hospitals.--Section 1886 of the Social Security Act (42 U.S.C. 
1395ww) is amended by adding at the end the following new subsection:
    ``(t) Incentives for Accreditation in Palliative Care.--
            ``(1) Incentive payment.--
                    ``(A) In general.--Subject to paragraph (3), with 
                respect to inpatient hospital services and inpatient 
                critical access hospital services furnished by an 
                eligible hospital during a payment year, if the 
                eligible hospital has in place an accredited palliative 
                care program (as determined by the Secretary) with 
                respect to such year and meets utilization criteria for 
                such program (as established by the Secretary) with 
                respect to such year, in addition to the amount 
                otherwise paid under this section or section 1814, 
                there shall also be paid to the eligible hospital, from 
                the Federal Hospital Insurance Trust Fund established 
                under section 1817, an amount equal to the applicable 
                percent of the amount that would otherwise be paid 
                under this section or section 1814 for such services 
                for the hospital for such year.
                    ``(B) Applicable percent defined.--The term 
                `applicable percent' means--
                            ``(i) for fiscal years 2013 through 2018, 2 
                        percent; and
                            ``(ii) for fiscal years 2019 through 2022, 
                        1 percent.
                    ``(C) Form of payment.--The payment under this 
                paragraph for a payment year may be in the form of a 
                single consolidated payment or in the form of such 
                periodic installments as the Secretary may specify.
            ``(2) Incentive payment adjustment.--Subject to paragraph 
        (3), with respect to inpatient hospital services and inpatient 
        critical access hospital services furnished by an eligible 
        hospital during a fiscal year after fiscal year 2022, if the 
        eligible hospital does not have in place an accredited 
        palliative care program (as determined by the Secretary) with 
        respect to such fiscal year, the amount otherwise paid under 
        this section or section 1814 for such services for the hospital 
        for the year shall be reduced by 1 percent.
            ``(3) Exception.--In the case of an eligible hospital with 
        fewer than 50 beds, such hospital shall be deemed to meet the 
        requirement in paragraphs (1)(A) and (2) if, in lieu of having 
        in place an accredited palliative care program, the hospital 
        provides individuals and family members with access to a local 
        or regional accredited palliative care team or program.
            ``(4) Definitions.--In this subsection:
                    ``(A) Eligible hospital.--The term `eligible 
                hospital' means--
                            ``(i) a hospital (as defined in section 
                        1861(e)); and
                            ``(ii) a critical access hospital (as 
                        defined in section 1861(mm)(1)).
                    ``(B) Payment year.--The term `payment year' means 
                fiscal years 2013 through 2022.
            ``(5) Limitations on review.--There shall be no 
        administrative or judicial review under section 1869, section 
        1878, or otherwise, of--
                    ``(A) the methodology and standards for determining 
                payment amounts under paragraph (1) and payment 
                adjustments under paragraph (2);
                    ``(B) the methodology and standards for determining 
                whether the eligible hospital has in place an 
                accredited palliative care program; and
                    ``(C) the application of the exception under 
                paragraph (3).''.
    (b) Skilled Nursing Facilities.--Section 1888 of the Social 
Security Act (42 U.S.C. 1395yy) is amended by adding at the end the 
following new subsection:
    ``(g) Incentives for Accreditation in Palliative Care.--
            ``(1) Incentive payment.--
                    ``(A) In general.--Subject to paragraph (3), with 
                respect to covered skilled nursing facility services 
                (as defined in subsection (e)(2)(A)) furnished by a 
                skilled nursing facility during a payment year, if the 
                facility has in place an accredited palliative care 
                program (as determined by the Secretary) with respect 
                to such year and meets utilization criteria for such 
                program (as established by the Secretary) with respect 
                to such year, in addition to the amount otherwise paid 
                under this subsection (e), there shall also be paid to 
                the facility, from the Federal Hospital Insurance Trust 
                Fund established under section 1817, an amount equal to 
                the applicable percent of the amount that would 
                otherwise be paid under subsection (e) for such 
                services for the facility for such year.
                    ``(B) Definitions.--In this subsection:
                            ``(i) Applicable percent.--The term 
                        `applicable percent' means--
                                    ``(I) for fiscal years 2013 through 
                                2018, 2 percent; and
                                    ``(II) for fiscal years 2019 
                                through 2022, 1 percent.
                            ``(ii) Payment year.--The term `payment 
                        year' means fiscal years 2013 through 2022.
                    ``(C) Form of payment.--The payment under this 
                paragraph for a payment year may be in the form of a 
                single consolidated payment or in the form of such 
                periodic installments as the Secretary may specify.
            ``(2) Incentive payment adjustment.--Subject to paragraph 
        (3), with respect to covered skilled nursing facility services 
        (as defined in subsection (e)(2)(A)) furnished by a skilled 
        nursing facility during a fiscal year after fiscal year 2022, 
        if the facility does not have in place an accredited palliative 
        care program (as determined by the Secretary) with respect to 
        such fiscal year, the amount otherwise paid under subsection 
        (e) for such services for the facility for the year shall be 
        reduced by 1 percent.
            ``(3) Exception.--In the case of a skilled nursing facility 
        with fewer than 60 beds, such facility shall be deemed to meet 
        the requirement in paragraphs (1)(A) and (2) if, in lieu of 
        having in place an accredited palliative care program, the 
        facility provides individuals and family members with access to 
        a local or regional accredited palliative care team or program.
            ``(4) Limitations on review.--There shall be no 
        administrative or judicial review under section 1869, section 
        1878, or otherwise, of--
                    ``(A) the methodology and standards for determining 
                payment amounts under paragraph (1) and payment 
                adjustments under paragraph (2);
                    ``(B) the methodology and standards for determining 
                whether the skilled nursing facility has in place an 
                accredited palliative care program; and
                    ``(C) the application of the exception under 
                paragraph (3).''.
    (c) Physicians.--Section 1848 of the Social Security Act (42 U.S.C. 
1395w-4) is amended by adding at the end the following new subsection:
    ``(q) Incentives for Certification in Hospice and Palliative 
Care.--
            ``(1) Incentive payment.--
                    ``(A) In general.--With respect to physician's 
                services furnished by a physician during a payment 
                year, if the physician is certified in hospice and 
                palliative care (as determined by the Secretary) with 
                respect to such year, in addition to the amount 
                otherwise paid under this part, there shall also be 
                paid to the physician, from the Federal Supplementary 
                Medical Insurance Trust Fund established under section 
                1841, an amount equal to the applicable percent of the 
                Secretary's estimate (based on claims submitted not 
                later than 2 months after the end of the payment year) 
                of the allowed charges under this part for all covered 
                professional services (as defined in subsection (k)(3)) 
                furnished by the physician during such year.
                    ``(B) Definitions.--In this subsection:
                            ``(i) Applicable percent.--The term 
                        `applicable percent' means--
                                    ``(I) for 2013 through 2018, 2 
                                percent; and
                                    ``(II) for 2019 through 2022, 1 
                                percent.
                            ``(ii) Payment year.--The term `payment 
                        year' means 2013 through 2022.
                    ``(C) Form of payment.--The payment under this 
                subsection for a payment year may be in the form of a 
                single consolidated payment or in the form of such 
                periodic installments as the Secretary may specify.
            ``(2) Limitations on review.--There shall be no 
        administrative or judicial review under section 1869, section 
        1878, or otherwise, of--
                    ``(A) the methodology and standards for determining 
                payment amounts under paragraph (1); and
                    ``(B) the methodology and standards for determining 
                whether the physician is certified in hospice and 
                palliative care.''.

SEC. 10. DISCHARGE CHECKLIST PILOT PROGRAM.

    (a) Establishment.--Not later than July 1, 2013, the Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary'') shall conduct a pilot program under title XVIII of the 
Social Security Act to test the use of the Centers for Medicare and 
Medicaid Services' discharge checklist included in the publication 
entitled ``Planning for Your Discharge: A checklist for individuals and 
caregivers preparing to leave a hospital, nursing home, or other health 
care setting'' and the continuity assessment record and evaluation 
(CARE) instrument development by the Centers for Medicare and Medicaid 
Services.
    (b) Waiver Authority.--The Secretary may waive compliance of such 
requirements of titles XI and XVIII of the Social Security Act as the 
Secretary determines necessary to conduct the pilot program under this 
section.
    (c) Report.--Not later than 6 months after the completion of the 
pilot program under this section, the Secretary shall submit to 
Congress a final report on the pilot program, together with 
recommendations for such legislation and administrative action as the 
Secretary determines appropriate.
    (d) Funding.--There are authorized to be appropriated such sums as 
may be necessary for purposes of conducting the pilot program under 
this section.

SEC. 11. WEB-BASED MATERIALS AND GRANTS.

    (a) Web-Based Materials.--The Secretary of Health and Human 
Services (in this section referred to as the ``Secretary'') shall 
establish and maintain a Web site that provides information, online 
training, and instructional materials for entities, including faith-
based organizations, on advance care planning, which shall include 
content addressing--
            (1) advance care planning, including common issues and 
        questions regarding advance directives and their uses;
            (2) Physician Orders for Life-Sustaining Treatment (POLST);
            (3) hospice benefits under Medicare, Medicaid, and the 
        State Children's Health Insurance Program established under the 
        Social Security Act, including information on how hospice care 
        is administered and provided to terminally ill individuals;
            (4) palliative care, including information on services that 
        palliative care consultation teams and designated units provide 
        for terminally ill individuals; and
            (5) any additional information related to advanced 
        progressive conditions and associated issues, as determined by 
        the Secretary.
    (b) Grants.--
            (1) Hospice care grant program.--
                    (A) Grants authorized.--The Secretary is authorized 
                to award grants to entities, including faith-based 
                organizations, to develop and provide services for 
                terminally ill individuals who are receiving hospice 
                care in their own homes.
                    (B) Requirements.--
                            (i) Duration.--The grant program shall be 
                        conducted for a 5-year period, beginning not 
                        later than January 1, 2013.
                            (ii) Amount of grants.--An entity may be 
                        awarded a grant under this paragraph for a 
                        fiscal year that is not less than $5,000 and 
                        not more than $250,000.
                            (iii) Number of grants.--The Secretary 
                        shall award grants under this paragraph to not 
                        more than 100 entities.
                    (C) Additional medicaid funds.--A State may elect 
                to provide additional funds to recipients of a grant 
                under this section, with such funds to be considered as 
                amounts expended for the proper and efficient 
                administration of the State plan under title XIX of the 
                Social Security Act for purposes of the State receiving 
                payments under section 1903(a)(7) of that Act (42 
                U.S.C. 1396b(a)(7)).
                    (D) Use of funds.--Grants awarded pursuant to this 
                paragraph shall be used by entities to develop and 
                provide end-of-life support services for terminally ill 
                individuals who are receiving care in their own homes, 
                including--
                            (i) support for family or other designated 
                        caregivers; and
                            (ii) any additional information or 
                        materials relating to support services 
                        determined appropriate by the Secretary.
                    (E) Application.--Each entity desiring a grant 
                under this paragraph shall submit an application to the 
                Secretary at such time, in such manner, and accompanied 
                by such information as the Secretary may reasonably 
                require.
                    (F) Authorization of appropriations.--For the 
                purpose of carrying out the grant program established 
                under this paragraph, there is authorized to be 
                appropriated $15,000,000 for the period of fiscal years 
                2013 through 2017.
            (2) Advanced illness care educational grant program.--
                    (A) Grants authorized.--The Secretary is authorized 
                to award grants to entities, including faith-based 
                organizations and religious educational institutions, 
                to develop and provide appropriate training and 
                educational programs addressing the care of individuals 
                with advanced illness.
                    (B) Requirements.--
                            (i) Duration.--The grant program shall be 
                        conducted for a 5-year period, beginning not 
                        later than January 1, 2013.
                            (ii) Amount of grants.--An entity may be 
                        awarded a grant under this paragraph for a 
                        fiscal year that is not less than $5,000, and 
                        not more than $50,000.
                            (iii) Number of grants.--The Secretary 
                        shall award grants under this paragraph to not 
                        more than 100 entities.
                    (C) Use of funds.--Grants awarded pursuant to this 
                paragraph shall be used by entities to develop 
                appropriate training and education programs addressing 
                care of individuals with advanced illness and include 
                such programs as part of their educational curriculum, 
                continuing education programs, or vocational training.
                    (D) Application.--Each entity desiring a grant 
                under this paragraph shall submit an application to the 
                Secretary at such time, in such manner, and accompanied 
                by such information as the Secretary may reasonably 
                require.
                    (E) Authorization of appropriations.--For the 
                purpose of carrying out the grant program established 
                under this paragraph, there is authorized to be 
                appropriated $10,000,000 for the period of fiscal years 
                2013 through 2017.

SEC. 12. HHS STUDY AND REPORT ON THE STORAGE OF ADVANCED DIRECTIVES.

    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study on State and regional activities with respect to 
storing completed advance directives and Physician Orders for Life-
Sustaining Treatment. Such study shall include an analysis of the 
practicality and feasibility of establishing a national registry for 
completed advance directives and Physician Orders for Life-Sustaining 
Treatment, taking into consideration the constraints created by the 
privacy provisions enacted as a result of the Health Insurance 
Portability and Accountability Act of 1996 (Public Law 104-191).
    (b) Report.--Not later than January 1, 2015, the Secretary of 
Health and Human Services shall submit to Congress a report on the 
study conducted under subsection (a) together with recommendations for 
such legislation and administrative action as the Secretary determines 
to be appropriate.

SEC. 13. GAO STUDY AND REPORT ON THE PROVISIONS OF, AND AMENDMENTS MADE 
              BY, THIS ACT.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall conduct a 
study on the provisions of, and amendments made by, this Act, including 
the quality and costs (such as individual and family experience, 
individual understanding of treatment choices, and any decrease in 
avoidable hospital admissions) associated with such provisions and such 
amendments.
    (b) Report.--Not later than January 1, 2015, the Comptroller 
General shall submit to Congress a report containing the results of the 
study conducted under subsection (a), together with recommendations for 
such legislation and administrative action as the Comptroller General 
determines appropriate.
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