‘‘(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 ac-
credited palliative care program, the hospital pro-
vides patients 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 ‘eli-
gible hospital’ means— 
‘‘(i) a hospital (as defined in section 
1861(e)); and 
‘‘(ii) a critical access hospital (as de-
fined in section 1861(mm)(1)). 
‘‘(B) PAYMENT YEAR.—The term ‘payment 
year’ means fiscal years 2011 through 2020. 
‘‘(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); 
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‘‘(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: 
‘‘(f) INCENTIVES FOR ACCREDITATION IN PALLIA-
TIVE CARE.— 
‘‘(1) INCENTIVE PAYMENT.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (3), with respect to covered skilled nurs-
ing 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 Fed-
eral Hospital Insurance Trust Fund established 
under section 1817, an amount equal to the ap-
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plicable percent of the amount that would oth-
erwise 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 
2011 
through 2016, 2 percent; and 
‘‘(II) 
for 
fiscal 
years 
2017 
through 2020, 1 percent. 
‘‘(ii) 
PAYMENT
YEAR.—The 
term 
‘payment year’ means fiscal years 2011 
through 2020. 
‘‘(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.—Sub-
ject to paragraph (3), with respect to covered skilled 
nursing facility services (as defined in subsection 
(e)(2)(A)) furnished by a skilled nursing facility dur-
ing a fiscal year after fiscal year 2020, if the facility 
does not have in place an accredited palliative care 
program (as determined by the Secretary) with re-
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spect 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 facil-
ity shall be deemed to meet the requirement in para-
graphs (1)(A) and (2) if, in lieu of having in place 
an accredited palliative care program, the facility 
provides patients 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 pro-
gram; and 
‘‘(C) the application of the exception under 
paragraph (3).’’. 
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(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: 
‘‘(p) INCENTIVES FOR CERTIFICATION IN HOSPICE 
AND PALLIATIVE CARE.— 
‘‘(1) INCENTIVE PAYMENT.— 
‘‘(A) IN GENERAL.—With respect to physi-
cians’ 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 ad-
dition to the amount otherwise paid under this 
part, there shall also be paid to the physician, 
from the Federal Supplementary Medical Insur-
ance Trust Fund established under section 
1841, an amount equal to the applicable per-
cent 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 profes-
sional 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— 
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‘‘(I) for 2011 through 2016, 2 
percent; and 
‘‘(II) for 2017 through 2020, 1 
percent. 
‘‘(ii) 
PAYMENT
YEAR.—The 
term 
‘payment year’ means 2011 through 2020. 
‘‘(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. 11. DISCHARGE CHECKLIST PILOT PROGRAM. 
(a) ESTABLISHMENT.—Not later than July 1, 2010, 
the Secretary of Health and Human Services (in this sec-
tion referred to as the ‘‘Secretary’’) shall conduct a pilot 
program under title XVIII of the Social Security Act to 
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test the use of the Centers for Medicare & Medicaid Serv-
ices’ discharge checklist included in the publication enti-
tled ‘‘Planning for Your Discharge: A checklist for pa-
tients and caregivers preparing to leave a hospital, nursing 
home, or other health care setting’’. 
(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 nec-
essary to conduct the pilot program under this section. 
(c) REPORT.—Not later than 6 months after the com-
pletion of the pilot program under this section, the Sec-
retary shall submit to Congress a final report on the pilot 
program, together with recommendations for such legisla-
tion and administrative action as the Secretary determines 
appropriate. 
(d) FUNDING.—There are authorized to be appro-
priated such sums as may be necessary for purposes of 
conducting the pilot program under this section. 
SEC. 12. OFFICE OF MEDICARE/MEDICAID INTEGRATION. 
(a) ESTABLISHMENT.—The Secretary shall establish 
or designate an Office on Medicare/Medicaid Integration 
(in this subsection referred to as the ‘‘Office’’) for the pur-
pose of aligning Medicare and Medicaid program policies 
and procedures and developing tools to support State inte-
gration efforts in order to— 
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(1) simplify dual eligible access to Medicare and 
Medicaid program benefits and services; 
(2) improve care continuity and ensure safe and 
effective care transitions; 
(3) eliminate cost shifting between the Medicare 
and Medicaid programs and among related care pro-
viders; 
(4) eliminate regulatory conflicts between Medi-
care and Medicaid program rules; and 
(5) improve total cost and quality performance. 
(b) RESPONSIBILITIES.—The responsibilities of the 
Office are to develop policies and procedures to— 
(1) identify incentives for States to advance the 
integration of the Medicare and Medicaid programs 
to improve total cost and quality performance, in-
cluding shared cost savings among consumers, plans, 
and Federal and State governments with respect to 
State initiatives for advancing Medicare and Med-
icaid program integration; 
(2) provide support for coordination of Federal 
and State contracting and oversight for dual inte-
gration programs supportive of the goals described 
in subsection (a); 
(3) serve as a liaison between Centers for Medi-
care & Medicaid Services central and regional offices 
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to ensure consistent application of Centers for Medi-
care & Medicaid Services rules, policies, and auditing 
practices as such rules, policies, and auditing prac-
tices pertain to dual eligibles; 
(4) monitor total combined Medicare and Med-
icaid program costs in serving dual eligibles and 
make recommendations for optimizing total quality 
and cost performance across both programs; and 
(5) 
identify 
legislative 
and 
administrative 
changes that are needed to facilitate the integration 
of benefits and oversight functions of the Medicare 
and Medicaid programs with respect to dual eligi-
bles. 
(c) DUAL ELIGIBLE DEFINED.—In this section, the 
term ‘‘dual eligible’’ means an individual who is— 
(1) entitled to, or enrolled for, benefits under 
part A of title XVIII of the Social Security Act or 
enrolled for benefits under part B of such title; and 
(2) entitled to medical assistance under a State 
plan under title XIX of such Act. 
(d) STUDY.—Not later than January 1, 2011, the 
Secretary of Health and Human Services, in consultation 
with private health information technology stakeholders 
and in coordination with other Federal health information 
technology efforts, shall conduct a study to determine the 
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data that the Office should collect and analyze in order 
to improve health care outcomes, create efficiencies in care 
delivery, and impact Federal health care spending. 
(e) FUNDING.—There are authorized to be appro-
priated such sums as may be necessary to carry out the 
provisions of this section. 
SEC. 13. 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 website 
that provides information, online training, and instruc-
tional materials for entities, including faith-based organi-
zations, on end-of-life issues, which shall include content 
addressing— 
(1) advance care planning, including common 
issues and questions regarding advance directives 
and their uses; 
(2) 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; 
(3) palliative care, including information on 
services that palliative care units provide for termi-
nally ill patients; and 
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(4) any additional information related to end- 
of-life care 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, in-
cluding faith-based organizations, to develop 
and provide services for terminally ill individ-
uals who are receiving hospice care in their own 
homes. 
(B) REQUIREMENTS.— 
(i) DURATION.—The grant program 
shall be conducted for a 5-year period, be-
ginning not later than January 1, 2011. 
(ii) AMOUNT OF GRANTS.—An entity 
may be awarded a grant under this para-
graph for a fiscal year that is not less than 
$5,000 and not more than $250,000. 
(iii) NUMBER OF GRANTS.—The Sec-
retary shall award grants under this para-
graph 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 
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