programs should become a permanent part of the 
Medicare program. 
(h) ANNUAL REPORTS.—The Secretary, in consulta-
tion with the Secretary of Veterans Affairs and other ap-
propriate Federal agencies, shall submit an annual report 
to Congress on end-of-life care and on the research, dem-
onstration, and education programs and studies conducted 
under this section. The Centers for Disease Control and 
Prevention shall be the lead agency for integrating and 
preparing the annual reports under this subsection unless 
the Secretary designates otherwise. 
(i) DEFINITIONS.—For purposes of this section: 
(1) The term ‘‘fatal chronic illness’’ means a 
disease (or diseases), condition (or conditions), or 
disorder (or disorders) that ordinarily worsens and 
causes death and that causes a physical or mental 
disability or periodic episodes of significant loss of 
functional capacity. 
(2) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
(j) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated— 
(1) such sums as may be necessary to carry out 
subsections (a), (b), (e), and (f);
(2) $50,000,000 for the 5-fiscal-year period (be-
ginning with fiscal year 2006) to carry out sub-
section (c), excluding paragraph (5) of that sub-
section; 
(3) $100,000,000 for the 3-fiscal-year period 
(beginning with fiscal year 2006) to carry out sub-
section (c)(5); 
(4) $20,000,000 for the 5-fiscal-year period (be-
ginning with fiscal year 2006) to carry out sub-
section (d); 
(5) to carry out subsection (g) for each of fiscal 
years 2006 through 2010— 
(A) $50,000,000 for the purposes of con-
ducting evaluations of pilot programs; and 
(B) $50,000,000 for the purpose of pro-
viding clinical services under pilot programs; 
and 
(6) $500,000 for each fiscal year during the 5- 
fiscal-year period beginning with fiscal year 2006 to 
carry out subsection (h). 
SEC. 3. PROGRAMS THROUGH DEPARTMENT OF VETERANS 
AFFAIRS REGARDING PATIENTS WITH FATAL 
CHRONIC ILLNESSES. 
(a) IN GENERAL.—
(1) VETERANS PROGRAMS.—Chapter 73 of title 
38, United States Code, is amended by adding at 
the end of subchapter II the following new section: 
‘‘§ 7329. Programs for patients with fatal chronic ill-
nesses 
‘‘(a) ESTABLISHMENT
OF PROGRAMS.—The Sec-
retary shall develop and carry out programs to improve 
the delivery of appropriate health and support services for 
patients with fatal chronic illnesses. As part of those pro-
grams, the Secretary shall seek to develop services in col-
laboration with community service providers serving popu-
lations of persons other than veterans, especially those 
populations that use the Medicare program. 
‘‘(b) COMMUNITY SERVICE PROVIDERS.—For pur-
poses of this section, a community service provider is an 
entity outside the Department that provides health care 
services to persons in the community in which it is located. 
‘‘(c) ROLE OF GRECCS AND HEALTH SERVICES RE-
SEARCH.—The Secretary shall take appropriate steps to 
involve in programs under this section both geriatric re-
search, education, and clinical centers under section 7314 
of this title and activities of health services research and 
quality improvement initiatives of the Department. As 
part of those steps, the Secretary shall seek to target the
work of such centers and initiatives to improve care for 
veterans with fatal chronic illnesses. 
‘‘(d) TRAINING.—In conducting programs of profes-
sional training and staff development for health-care per-
sonnel of the Department and persons being trained 
through health-care programs conducted by the Secretary, 
the Secretary shall ensure that those programs include 
training in pain relief and end-of-life care for persons with 
fatal chronic illnesses. Such training shall address symp-
toms, advance care planning, and quality improvement for 
those with fatal chronic illnesses. 
‘‘(e) ANNUAL REPORT.—The Secretary shall prepare 
an annual report on care for veterans with fatal chronic 
illnesses and the activities of the Secretary under this sec-
tion. The Secretary shall furnish such report to the Sec-
retary of Health and Human Services each year in suffi-
cient time for inclusion in the annual report of that Sec-
retary under section 2(h) of the Living Well with Fatal 
Chronic Illness Act of 2005. 
‘‘(f) COOPERATION WITH COMMUNITY SERVICE PRO-
VIDERS.—(1) In carrying out this section, the Secretary 
shall, to the extent practicable, take appropriate steps, 
through collaborative agreements or otherwise, to cooper-
ate with community service providers that provide home 
and hospice care.
‘‘(2) Such steps shall, to the extent practicable, in-
clude— 
‘‘(A) developing documentation of advance care 
plans for persons with fatal chronic illnesses that are 
acceptable to all providers of care for those persons; 
‘‘(B) developing service programs for persons 
with fatal chronic illnesses under which Department 
facilities or personnel may be used for part of the 
array of services provided to such persons; and 
‘‘(C) developing protocols that facilitate the 
placement with community service providers sup-
ported by the medicare or medicaid programs of vet-
erans with fatal chronic illnesses when such a place-
ment would be more efficient or effective for the 
timely provision of services for the community in 
which the facilities are located and for such veterans 
than the provision of those services directly through 
Department facilities. 
‘‘(3) When the Secretary, as part of service programs 
authorized by this subsection, provides services to a person 
with a fatal chronic illness who is not a veteran, the Sec-
retary shall, as a condition of providing such services, be 
reimbursed by appropriate community service providers 
for the costs of such services.
‘‘(g) SUPPORT FOR VOLUNTEER AND COMMUNITY 
SUPPORT OF VETERANS LIVING AT HOME.—The Sec-
retary shall make grants to support volunteer and commu-
nity support of veterans living at home who have fatal 
chronic illnesses. The Secretary may establish the min-
imum number of volunteers an entity must have in order 
to be eligible for a grant under this subsection. 
‘‘(h) FATAL CHRONIC ILLNESS DEFINED.—For pur-
poses of this section, the term ‘fatal chronic illness’ means 
a disease (or diseases), condition (or conditions), or dis-
order (or disorders) that ordinarily worsens and causes 
death and that causes a physical or mental disability or 
periodic episodes of significant loss of functional capac-
ity.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended 
by inserting after the item relating to section 7328 
the following new item: 
‘‘7329. Programs for patients with fatal chronic illnesses.’’. 
(b) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Secretary of Vet-
erans Affairs to carry out section 7329 of title 38, United 
States Code, as added by subsection (a), the amount of 
$5,000,000 for each of fiscal years 2006 through 2010.
SEC. 4. STUDY BY INSTITUTE OF MEDICINE. 
(a) STUDY.—The Secretary of Health and Human 
Services shall request the Institute of Medicine of the Na-
tional Academy of Sciences to enter into an agreement 
under which the Institute agrees to conduct a study on 
the following: 
(1) The level of care for the elderly provided by 
family members. 
(2) The coordination of care for the elderly pro-
vided by family members with more formal care pro-
vided by health care providers. 
(b) REPORT.—The Secretary of Health and Human 
Services shall ensure that the agreement under subsection 
(a) provides for the submission of a report to the Con-
gress, not later than one year after the date of the enact-
ment of this Act, on the results of the study conducted 
under this section. 
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