I 

113TH CONGRESS 

1ST SESSION H. R. 1339 

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, and other programs, to promote education in 

palliative care and hospice, and to support the development of faculty 

careers in academic palliative medicine. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 21, 2013 

Mr. ENGEL (for himself, Mr. REED, Ms. BROWN of Florida, Mr. FARR, and 

Mr. BLUMENAUER) introduced the following bill; which was referred to 

the Committee on Energy and Commerce 

A BILL 

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, and other programs, to promote education 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, 

3 SECTION 1. SHORT TITLE. 

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

5 Hospice Education and Training Act’’. 


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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) Health care providers need better education 

4 about pain management and palliative care. Stu5 dents graduating from medical school have very lit6 tle, if any, training in the core precepts of pain and 

7 symptom management, advance care planning, com8 munication skills, and care coordination for patients 

9 with serious, life-threatening, or terminal illness. 

10 (2) Palliative care is interdisciplinary, patient11 and family-centered health care for people with seri12 ous illnesses. This type of care is focused on pro13 viding patients with relief from the symptoms, pain, 

14 and stress of a serious illness, whatever the diag15 nosis. The goal of palliative care is to relieve suf16 fering and improve quality of life for both patients 

17 and their families. Palliative care is provided by a 

18 team of doctors, nurses, social workers, chaplains, 

19 and other specialists who work with a patient’s other 

20 health care providers to provide an extra layer of 

21 support, including assistance with difficult medical 

22 decisionmaking and coordination of care among spe23 cialists. Palliative care is appropriate at any age and 

24 at any stage in a serious illness, and can be provided 

25 together with curative treatment. Palliative care is 

26 not dependent on a life-limiting prognosis and may 


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1 actually help an individual recover from illness by re2 lieving symptoms, such as pain, anxiety, or loss of 

3 appetite, while undergoing sometimes difficult med4 ical treatments or procedures, such as surgery or 

5 chemotherapy. There were 1,623 hospitals with pal6 liative care programs in 2012. 

7 (3) Hospice is palliative care for patients in 

8 their last year of life. Considered the model for qual9 ity compassionate care for individuals facing a life10 limiting illness, hospice provides expert medical care, 

11 pain management, and emotional and spiritual sup12 port expressly tailored to the patient’s needs and 

13 wishes. In most cases, care is provided in the pa14 tient’s home but may also be provided in free15 standing hospice centers, hospitals, nursing homes, 

16 and other long-term care facilities. In 2011, an esti17 mated 1,650,000 patients received services from hos18 pice, and nearly 45 percent of all deaths in the 

19 United States occurred under the care of a hospice 

20 program. Hospice is a covered benefit under the 

21 Medicare program. There were 3,630 Medicare-cer22 tified hospices serving more than 1,200,000 bene23 ficiaries in 2011. 

24 (4) A 2005 study at Michigan State University 

25 found that the formal training of United States docVerDate Mar 15 2010 21:42 Mar 28, 2013 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1339.IH H1339

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1 tors in palliative care is ‘‘grossly inadequate’’. When 

2 the American Society of Clinical Oncology surveyed 

3 their members, 65 percent said they had received in4 adequate education in controlling symptoms associ5 ated with cancer, and 81 percent felt they had inad6 equate mentoring in discussing a poor prognosis 

7 with their patients and families. Training in pedi8 atric palliative care is also seriously lacking accord9 ing to physicians, residents, and medical students re10 sponding to a survey presented at a meeting of 

11 American Federation for Medical Research. 

12 (5) The American Board of Medical Specialties 

13 (ABMS) and the Accreditation Council for Graduate 

14 Medical Education (ACGME) provided formal sub15 specialty status for hospice and palliative medicine 

16 (HPM) in 2006, and the Centers for Medicare & 

17 Medicaid Services recognized hospice and palliative 

18 medicine as a medical subspecialty in October of 

19 2008. 

20 (6) As of February 2013, there were a total of 

21 89 hospice and palliative medicine training programs 

22 accredited by the Accreditation Council for Graduate 

23 Medical Education. For the 2012–2013 academic 

24 year, these programs were training 206 physicians in 

25 hospice and palliative medicine. Some programs inVerDate Mar 15 2010 21:42 Mar 28, 2013 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1339.IH H1339

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1 clude an additional track in research, geriatrics, or 

2 public health. 

3 (7) There is a large gap between those prac4 ticing in the palliative medicine field and the number 

5 of physicians needed. A mid-range estimate by the 

6 American Academy of Hospice and Palliative Medi7 cine’s Workforce Task Force calls for 6,000 or more 

8 full time equivalents to serve current needs in hos9 pice and palliative care programs. At maximum ca10 pacity, the current system would produce roughly 

11 4,600 new hospice and palliative medicine certified 

12 physicians over the next 20 years, during which time 

13 some 70,000,000 new Medicare beneficiaries will 

14 enter the Medicare program. At the same time, there 

15 is expected to be increasing acceptance of the hos16 pice and palliative approach to care among the gen17 eral population and health care providers. 

18 SEC. 3. PALLIATIVE CARE AND HOSPICE EDUCATION AND 

19 TRAINING. 

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

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

22 by adding at the end the following: 


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

2 AND TRAINING. 

3 ‘‘(a) PALLIATIVE CARE AND HOSPICE EDUCATION

4 CENTERS.— 

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

6 grants or contracts under this section to entities de7 scribed in paragraph (1), (3), or (4) of section 

8 799B, and section 801(2), for the establishment or 

9 operation of Palliative Care and Hospice Education 

10 Centers that meet the requirements of paragraph 

11 (2). 

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

13 Hospice Education Center meets the requirements of 

14 this paragraph if such Center— 

15 ‘‘(A) improves the training of health pro16 fessionals in palliative care, including residen17 cies, traineeships, or fellowships; 

18 ‘‘(B) develops and disseminates curricula 

19 relating to the palliative treatment of the com20 plex health problems of individuals with serious 

21 or life threatening illnesses; 

22 ‘‘(C) supports the training and retraining 

23 of faculty to provide instruction in palliative 

24 care; 

25 ‘‘(D) supports continuing education of 

26 health professionals who provide palliative care 


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1 to patients with serious or life threatening ill2 ness; 

3 ‘‘(E) provides students (including resi4 dents, trainees, and fellows) with clinical train5 ing in palliative care in the home, long-term 

6 care facilities, home care, hospices, chronic and 

7 acute disease hospitals, and ambulatory care 

8 centers; 

9 ‘‘(F) establishes traineeships for individ10 uals who are preparing for advanced education 

11 nursing degrees in palliative care nursing, home 

12 care, hospice, in the home, long-term care, or 

13 other nursing areas that specialize in palliative 

14 care; and 

15 ‘‘(G) does not duplicate the activities of ex16 isting education centers funded under this sec17 tion or under section 753 or 865. 

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

19 Nothing in this section shall be construed to— 

20 ‘‘(A) prevent the Secretary from providing 

21 grants to expand existing education centers, in22 cluding geriatric education centers established 

23 under section 753 or 865, to provide for edu24 cation and training focused specifically on palVerDate Mar 15 2010 21:42 Mar 28, 2013 Jkt 029200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1339.IH H1339

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1 liative care, including for non-geriatric popu2 lations; or 

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

4 that may be funded in a community. 

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

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

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

8 medicine, schools of osteopathic medicine, teaching 

9 hospitals, and graduate medical education programs, 

10 for the purpose of providing support for projects 

11 that fund the training of physicians (including resi12 dents, trainees, and fellows) who plan to teach pal13 liative medicine. 

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

15 a grant or contract is made under this subsection 

16 shall— 

17 ‘‘(A) be staffed by full-time teaching physi18 cians who have experience or training in pallia19 tive medicine; 

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

21 medicine fellowship program accredited by the 

22 Accreditation Council for Graduate Medical 

23 Education; 

24 ‘‘(C) provide training in palliative medicine 

25 through a variety of service rotations, such as 


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1 consultation services, acute care services, ex2 tended care facilities, ambulatory care and com3 prehensive evaluation units, hospice, home 

4 health, and community care programs; 

5 ‘‘(D) develop specific performance-based 

6 measures to evaluate the competency of train7 ees; and 

8 ‘‘(E) provide training in palliative medicine 

9 through one or both of the training options de10 scribed in subparagraphs (A) and (B) of para11 graph (3). 

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

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

14 shall be as follows: 

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

16 and palliative medicine for physicians who are 

17 faculty at schools of medicine and osteopathic 

18 medicine, or others determined appropriate by 

19 the Secretary. 

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

21 shall be designed to provide training in hospice 

22 and palliative medicine for physicians who have 

23 completed graduate medical education programs 

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1 ant to the American Board of Medical Special2 ties. 

3 ‘‘(4) DEFINITIONS.—For purposes of this sub4 section the term ‘graduate medical education’ means 

5 a program sponsored by a school of medicine, a 

6 school of osteopathic medicine, a hospital, or a pub7 lic or private institution that— 

8 ‘‘(A) offers postgraduate medical training 

9 in the specialties and subspecialties of medicine; 

10 and 

11 ‘‘(B) has been accredited by the Accredita12 tion Council for Graduate Medical Education or 

13 the American Osteopathic Association through 

14 its Committee on Postdoctoral Training. 

15 ‘‘(c) PALLIATIVE MEDICINE AND HOSPICE ACA16 DEMIC CAREER AWARDS.— 

17 ‘‘(1) ESTABLISHMENT OF PROGRAM.—The Sec18 retary shall establish a program to provide awards, 

19 to be known as the ‘Palliative Medicine and Hospice 

20 Academic Career Awards’, to eligible individuals to 

21 promote the career development of such individuals 

22 as academic hospice and palliative care physicians. 

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

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

25 shall— 


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

2 hospice and palliative medicine; and 

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

4 appointment at an accredited (as determined by 

5 the Secretary) school of medicine or osteopathic 

6 medicine. 

7 ‘‘(3) LIMITATIONS.—No award under para8 graph (1) may be made to an eligible individual un9 less the individual— 

10 ‘‘(A) has submitted to the Secretary an ap11 plication, at such time, in such manner, and 

12 containing such information as the Secretary 

13 may require, and the Secretary has approved 

14 such application; 

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

16 the Secretary may require, assurances that the 

17 individual will meet the service requirement de18 scribed in paragraph (6); and 

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

20 the Secretary may require, assurances that the 

21 individual has a full-time faculty appointment 

22 in a health professions institution and docu23 mented commitment from such institution to 

24 spend a majority of the total funded time of 

25 such individual on teaching and developing 


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1 skills in interdisciplinary education in palliative 

2 care. 

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

4 individual who receives an award under paragraph 

5 (1) shall provide assurances to the Secretary that 

6 funds provided to the eligible individual under this 

7 subsection will be used only to supplement, not to 

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

9 funds otherwise expended by the eligible individual. 

10 ‘‘(5) AMOUNT AND TERM.— 

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

12 under this subsection shall be equal to the 

13 award amount provided for under section 

14 753(c)(5)(A) for the fiscal year involved. 

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

16 under this subsection shall not exceed 5 years. 

17 ‘‘(C) PAYMENT TO INSTITUTION.—The 

18 Secretary shall make payments for awards 

19 under this subsection to institutions which in20 clude schools of medicine and osteopathic medi21 cine. 

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

23 who receives an award under this subsection shall 

24 provide training in palliative care and hospice, in25 cluding the training of interdisciplinary teams of 


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1 health care professionals. The provision of such 

2 training shall constitute a majority of the total fund3 ed obligations of such individual under the award. 

4 ‘‘(d) PALLIATIVE CARE WORKFORCE DEVELOP5 MENT.— 

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

7 grants or contracts under this subsection to entities 

8 that operate a Palliative Care and Hospice Edu9 cation Center pursuant to subsection (a)(1). 

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

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

12 such paragraph shall submit to the Secretary an ap13 plication at such time, in such manner, and con14 taining such information as the Secretary may re15 quire. 

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

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

18 used to carry out the fellowship program described 

19 in paragraph (4). 

20 ‘‘(4) FELLOWSHIP PROGRAM.— 

21 ‘‘(A) IN GENERAL.—Pursuant to para22 graph (3), a Palliative Care and Hospice Edu23 cation Center that receives an award under this 

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1 section as a ‘fellowship’) that focus on palliative 

2 care that provide supplemental training for fac3 ulty members in medical schools and other 

4 health professions schools with programs in 

5 psychology, pharmacy, nursing, social work, 

6 chaplaincy, or other health disciplines, as ap7 proved by the Secretary. Such a fellowship shall 

8 be open to current faculty, and appropriately 

9 credentialed volunteer faculty and practitioners, 

10 who do not have formal training in palliative 

11 care, to upgrade their knowledge and clinical 

12 skills for the care of individuals with serious or 

13 life-threatening illness and to enhance their 

14 interdisciplinary teaching skills. 

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

16 paragraph shall be offered either at the Pallia17 tive Care and Hospice Education Center that is 

18 sponsoring the course, in collaboration with 

19 other Palliative Care and Hospice Education 

20 Centers, or at medical schools, schools of nurs21 ing, schools of pharmacy, schools of social work, 

22 schools of chaplaincy or pastoral care education, 

23 graduate programs in psychology, or other 

24 health professions schools approved by the Sec25 retary with which the Centers are affiliated. 


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1 ‘‘(C) CME CREDIT.—Participation in a fel2 lowship under this paragraph shall be accepted 

3 with respect to complying with continuing 

4 health profession education requirements. As a 

5 condition of such acceptance, the recipient shall 

6 subsequently provide a minimum of 18 hours of 

7 voluntary instruction in palliative care content 

8 (that has been approved by a palliative care and 

9 hospice education center) to students or train10 ees in health-related educational, home, hospice, 

11 or long-term care settings. 

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

13 Education Center that receives an award under this 

14 subsection shall meet targets approved by the Sec15 retary for providing palliative care training to a cer16 tain number of faculty or practitioners during the 

17 term of the award, as well as other parameters es18 tablished by the Secretary. 

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

20 this subsection shall be in an amount of $150,000. 

21 Not more than 24 Palliative Care and Hospice Edu22 cation Centers may receive an award under this sub23 section. 

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

25 Care and Hospice Education Center that receives an 


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1 award under this subsection 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 clin17 ical social worker, a pharmacist, a chaplain, or 

18 student of psychology who is pursuing a doc19 torate or other advanced degree in palliative 

20 care or related fields in an accredited health 

21 professions school; and 

22 ‘‘(B) submit to the Secretary an applica23 tion at such time, in such manner, and con24 taining such information as the Secretary may 

25 require. 


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

2 of receiving an award under this subsection, an indi3 vidual shall agree that, following completion of the 

4 award period, the individual will teach or practice 

5 palliative care in health-related educational, home, 

6 hospice or long-term care settings for a minimum of 

7 5 years under guidelines established by the Sec8 retary. 

9 ‘‘(4) PAYMENT TO INSTITUTION.—The Sec10 retary shall make payments for awards under this 

11 subsection to institutions which include schools of 

12 medicine, osteopathic medicine, nursing, social work, 

13 psychology, chaplaincy or pastoral care education, 

14 dentistry, and pharmacy, or other allied health dis15 cipline in an accredited health professions school 

16 that is approved by the Secretary. 

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

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

19 $44,100,000 for each of the fiscal years 2014 through 

20 2018.’’. 

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

22 this section shall be effective beginning on the date that 

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


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1 SEC. 4. APPLICATION TO ADVANCED PRACTICE NURSES. 

2 (a) ADVANCED EDUCATION NURSING GRANTS.—Sec3 tion 811(a) of the Public Health Service Act (42 U.S.C. 

4 296j(a)) is amended— 

5 (1) in paragraph (1), by striking ‘‘and’’ at the 

6 end; 

7 (2) by redesignating paragraph (2) as para8 graph (3); and 

9 (3) by inserting after paragraph (1), the fol10 lowing: 

11 ‘‘(2) palliative care and hospice career incentive 

12 awards authorized under section 759A(e); and’’. 

13 (b) IN GENERAL.—Part D of title VIII of the Public 

14 Health Service Act (42 U.S.C. 296p et seq.) is amended 

15 by adding at the end the following: 

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

17 AND TRAINING. 

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

19 award grants to eligible entities to develop and implement, 

20 in coordination with programs under section 759A, pro21 grams and initiatives to train and educate individuals in 

22 providing palliative care in health related educational, hos23 pice, home, or long-term care settings. 

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

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

26 grant to— 


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

2 provide palliative care in health-related educational, 

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

4 ‘‘(2) develop and disseminate curricula relating 

5 to palliative care in health-related educational, home, 

6 hospice, or long-term care settings; 

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

8 health related educational, home, hospice, or long9 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 2014 through 2018.’’. 

Æ 


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