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 accred-
ited allopathic and osteopathic medical schools, nursing 
schools, and other programs, to promote education in 
palliative care and hospice, and to support the develop-
ment of faculty careers in academic palliative medicine. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Palliative Care and 
Hospice Education and Training Act’’. 
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SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Health care providers need better education 
about pain management and palliative care. Stu-
dents graduating from medical school have very lit-
tle, if any, training in the core precepts of pain and 
symptom management, advance care planning, com-
munication skills, and care coordination for patients 
with serious, life-threatening, or terminal illness. 
(2) Palliative care is interdisciplinary, patient- 
and family-centered health care for people with seri-
ous illnesses. This type of care is focused on pro-
viding patients with relief from the symptoms, pain, 
and stress of a serious illness, whatever the diag-
nosis. The goal of palliative care is to relieve suf-
fering and improve quality of life for both patients 
and their families. Palliative care is provided by a 
team of doctors, nurses, social workers, chaplains, 
and other specialists who work with a patient’s other 
health care providers to provide an extra layer of 
support, including assistance with difficult medical 
decisionmaking and coordination of care among spe-
cialists. Palliative care is appropriate at any age and 
at any stage in a serious illness, and can be provided 
together with curative treatment. Palliative care is 
not dependent on a life-limiting prognosis and may 
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actually help an individual recover from illness by re-
lieving symptoms, such as pain, anxiety, or loss of 
appetite, while undergoing sometimes difficult med-
ical treatments or procedures, such as surgery or 
chemotherapy. There were 1,623 hospitals with pal-
liative care programs in 2012. 
(3) Hospice is palliative care for patients in 
their last year of life. Considered the model for qual-
ity compassionate care for individuals facing a life- 
limiting illness, hospice provides expert medical care, 
pain management, and emotional and spiritual sup-
port expressly tailored to the patient’s needs and 
wishes. In most cases, care is provided in the pa-
tient’s home but may also be provided in free-
standing hospice centers, hospitals, nursing homes, 
and other long-term care facilities. In 2011, an esti-
mated 1,650,000 patients received services from hos-
pice, and nearly 45 percent of all deaths in the 
United States occurred under the care of a hospice 
program. Hospice is a covered benefit under the 
Medicare program. There were 3,630 Medicare-cer-
tified hospices serving more than 1,200,000 bene-
ficiaries in 2011. 
(4) A 2005 study at Michigan State University 
found that the formal training of United States doc-
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tors in palliative care is ‘‘grossly inadequate’’. When 
the American Society of Clinical Oncology surveyed 
their members, 65 percent said they had received in-
adequate education in controlling symptoms associ-
ated with cancer, and 81 percent felt they had inad-
equate mentoring in discussing a poor prognosis 
with their patients and families. Training in pedi-
atric palliative care is also seriously lacking accord-
ing to physicians, residents, and medical students re-
sponding to a survey presented at a meeting of 
American Federation for Medical Research. 
(5) The American Board of Medical Specialties 
(ABMS) and the Accreditation Council for Graduate 
Medical Education (ACGME) provided formal sub-
specialty status for hospice and palliative medicine 
(HPM) in 2006, and the Centers for Medicare & 
Medicaid Services recognized hospice and palliative 
medicine as a medical subspecialty in October of 
2008. 
(6) As of February 2013, there were a total of 
89 hospice and palliative medicine training programs 
accredited by the Accreditation Council for Graduate 
Medical Education. For the 2012–2013 academic 
year, these programs were training 206 physicians in 
hospice and palliative medicine. Some programs in-
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clude an additional track in research, geriatrics, or 
public health. 
(7) There is a large gap between those prac-
ticing in the palliative medicine field and the number 
of physicians needed. A mid-range estimate by the 
American Academy of Hospice and Palliative Medi-
cine’s Workforce Task Force calls for 6,000 or more 
full time equivalents to serve current needs in hos-
pice and palliative care programs. At maximum ca-
pacity, the current system would produce roughly 
4,600 new hospice and palliative medicine certified 
physicians over the next 20 years, during which time 
some 70,000,000 new Medicare beneficiaries will 
enter the Medicare program. At the same time, there 
is expected to be increasing acceptance of the hos-
pice and palliative approach to care among the gen-
eral population and health care providers. 
SEC. 3. PALLIATIVE CARE AND HOSPICE EDUCATION AND 
TRAINING. 
(a) IN GENERAL.—Part D of title VII of the Public 
Health Service Act (42 U.S.C. 294 et seq.) is amended 
by adding at the end the following: 
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‘‘SEC. 759A. PALLIATIVE CARE AND HOSPICE EDUCATION 
AND TRAINING. 
‘‘(a) PALLIATIVE CARE AND HOSPICE EDUCATION 
CENTERS.— 
‘‘(1) IN GENERAL.—The Secretary shall award 
grants or contracts under this section to entities de-
scribed in paragraph (1), (3), or (4) of section 
799B, and section 801(2), for the establishment or 
operation of Palliative Care and Hospice Education 
Centers that meet the requirements of paragraph 
(2). 
‘‘(2) REQUIREMENTS.—A Palliative Care and 
Hospice Education Center meets the requirements of 
this paragraph if such Center— 
‘‘(A) improves the training of health pro-
fessionals in palliative care, including residen-
cies, traineeships, or fellowships; 
‘‘(B) develops and disseminates curricula 
relating to the palliative treatment of the com-
plex health problems of individuals with serious 
or life threatening illnesses; 
‘‘(C) supports the training and retraining 
of faculty to provide instruction in palliative 
care; 
‘‘(D) supports continuing education of 
health professionals who provide palliative care 
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to patients with serious or life threatening ill-
ness; 
‘‘(E) provides students (including resi-
dents, trainees, and fellows) with clinical train-
ing in palliative care in the home, long-term 
care facilities, home care, hospices, chronic and 
acute disease hospitals, and ambulatory care 
centers; 
‘‘(F) establishes traineeships for individ-
uals who are preparing for advanced education 
nursing degrees in palliative care nursing, home 
care, hospice, in the home, long-term care, or 
other nursing areas that specialize in palliative 
care; and 
‘‘(G) does not duplicate the activities of ex-
isting education centers funded under this sec-
tion or under section 753 or 865. 
‘‘(3) EXPANSION
OF
EXISTING
CENTERS.— 
Nothing in this section shall be construed to— 
‘‘(A) prevent the Secretary from providing 
grants to expand existing education centers, in-
cluding geriatric education centers established 
under section 753 or 865, to provide for edu-
cation and training focused specifically on pal-
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liative care, including for non-geriatric popu-
lations; or 
‘‘(B) limit the number of education centers 
that may be funded in a community. 
‘‘(b) PALLIATIVE MEDICINE PHYSICIAN TRAINING.— 
‘‘(1) IN GENERAL.—The Secretary may make 
grants to, and enter into contracts with, schools of 
medicine, schools of osteopathic medicine, teaching 
hospitals, and graduate medical education programs, 
for the purpose of providing support for projects 
that fund the training of physicians (including resi-
dents, trainees, and fellows) who plan to teach pal-
liative medicine. 
‘‘(2) REQUIREMENTS.—Each project for which 
a grant or contract is made under this subsection 
shall— 
‘‘(A) be staffed by full-time teaching physi-
cians who have experience or training in pallia-
tive medicine; 
‘‘(B) be based in a hospice and palliative 
medicine fellowship program accredited by the 
Accreditation Council for Graduate Medical 
Education; 
‘‘(C) provide training in palliative medicine 
through a variety of service rotations, such as 
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consultation services, acute care services, ex-
tended care facilities, ambulatory care and com-
prehensive evaluation units, hospice, home 
health, and community care programs; 
‘‘(D) develop specific performance-based 
measures to evaluate the competency of train-
ees; and 
‘‘(E) provide training in palliative medicine 
through one or both of the training options de-
scribed in subparagraphs (A) and (B) of para-
graph (3). 
‘‘(3) TRAINING OPTIONS.—The training options 
referred to in subparagraph (E) of paragraph (2) 
shall be as follows: 
‘‘(A) 1-year retraining programs in hospice 
and palliative medicine for physicians who are 
faculty at schools of medicine and osteopathic 
medicine, or others determined appropriate by 
the Secretary. 
‘‘(B) 1- or 2-year training programs that 
shall be designed to provide training in hospice 
and palliative medicine for physicians who have 
completed graduate medical education programs 
in any medical specialty leading to board eligi-
bility in hospice and palliative medicine pursu-
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ant to the American Board of Medical Special-
ties. 
‘‘(4) DEFINITIONS.—For purposes of this sub-
section the term ‘graduate medical education’ means 
a program sponsored by a school of medicine, a 
school of osteopathic medicine, a hospital, or a pub-
lic or private institution that— 
‘‘(A) offers postgraduate medical training 
in the specialties and subspecialties of medicine; 
and 
‘‘(B) has been accredited by the Accredita-
tion Council for Graduate Medical Education or 
the American Osteopathic Association through 
its Committee on Postdoctoral Training. 
‘‘(c) PALLIATIVE MEDICINE
AND HOSPICE ACA-
DEMIC CAREER AWARDS.— 
‘‘(1) ESTABLISHMENT OF PROGRAM.—The Sec-
retary shall establish a program to provide awards, 
to be known as the ‘Palliative Medicine and Hospice 
Academic Career Awards’, to eligible individuals to 
promote the career development of such individuals 
as academic hospice and palliative care physicians. 
‘‘(2) ELIGIBLE INDIVIDUALS.—To be eligible to 
receive an award under paragraph (1), an individual 
shall— 
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‘‘(A) be board certified or board eligible in 
hospice and palliative medicine; and 
‘‘(B) have a junior (non-tenured) faculty 
appointment at an accredited (as determined by 
the Secretary) school of medicine or osteopathic 
medicine. 
‘‘(3) LIMITATIONS.—No award under para-
graph (1) may be made to an eligible individual un-
less the individual— 
‘‘(A) has submitted to the Secretary an ap-
plication, at such time, in such manner, and 
containing such information as the Secretary 
may require, and the Secretary has approved 
such application; 
‘‘(B) provides, in such form and manner as 
the Secretary may require, assurances that the 
individual will meet the service requirement de-
scribed in paragraph (6); and 
‘‘(C) provides, in such form and manner as 
the Secretary may require, assurances that the 
individual has a full-time faculty appointment 
in a health professions institution and docu-
mented commitment from such institution to 
spend a majority of the total funded time of 
such individual on teaching and developing 
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skills in interdisciplinary education in palliative 
care. 
‘‘(4) MAINTENANCE OF EFFORT.—An eligible 
individual who receives an award under paragraph 
(1) shall provide assurances to the Secretary that 
funds provided to the eligible individual under this 
subsection will be used only to supplement, not to 
supplant, the amount of Federal, State, and local 
funds otherwise expended by the eligible individual. 
‘‘(5) AMOUNT AND TERM.— 
‘‘(A) AMOUNT.—The amount of an award 
under this subsection shall be equal to the 
award amount provided for under section 
753(c)(5)(A) for the fiscal year involved. 
‘‘(B) TERM.—The term of an award made 
under this subsection shall not exceed 5 years. 
‘‘(C) PAYMENT
TO
INSTITUTION.—The 
Secretary shall make payments for awards 
under this subsection to institutions which in-
clude schools of medicine and osteopathic medi-
cine. 
‘‘(6) SERVICE
REQUIREMENT.—An individual 
who receives an award under this subsection shall 
provide training in palliative care and hospice, in-
cluding the training of interdisciplinary teams of 
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health care professionals. The provision of such 
training shall constitute a majority of the total fund-
ed obligations of such individual under the award. 
‘‘(d) PALLIATIVE
CARE
WORKFORCE
DEVELOP-
MENT.— 
‘‘(1) IN GENERAL.—The Secretary shall award 
grants or contracts under this subsection to entities 
that operate a Palliative Care and Hospice Edu-
cation Center pursuant to subsection (a)(1). 
‘‘(2) APPLICATION.—To be eligible for an 
award under paragraph (1), an entity described in 
such paragraph shall submit to the Secretary an ap-
plication at such time, in such manner, and con-
taining such information as the Secretary may re-
quire. 
‘‘(3) USE OF FUNDS.—Amounts awarded under 
a grant or contract under paragraph (1) shall be 
used to carry out the fellowship program described 
in paragraph (4). 
‘‘(4) FELLOWSHIP PROGRAM.— 
‘‘(A) IN
GENERAL.—Pursuant to para-
graph (3), a Palliative Care and Hospice Edu-
cation Center that receives an award under this 
subsection shall use such funds to offer short- 
term intensive courses (referred to in this sub-
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‘‘(C) CME CREDIT.—Participation in a fel-
lowship under this paragraph shall be accepted 
with respect to complying with continuing 
health profession education requirements. As a 
condition of such acceptance, the recipient shall 
subsequently provide a minimum of 18 hours of 
voluntary instruction in palliative care content 
(that has been approved by a palliative care and 
hospice education center) to students or train-
ees in health-related educational, home, hospice, 
or long-term care settings. 
‘‘(5) TARGETS.—A Palliative Care and Hospice 
Education Center that receives an award under this 
subsection shall meet targets approved by the Sec-
retary for providing palliative care training to a cer-
tain number of faculty or practitioners during the 
term of the award, as well as other parameters es-
tablished by the Secretary. 
‘‘(6) AMOUNT
OF
AWARD.—An award under 
this subsection shall be in an amount of $150,000. 
Not more than 24 Palliative Care and Hospice Edu-
cation Centers may receive an award under this sub-
section. 
‘‘(7) MAINTENANCE OF EFFORT.—A Palliative 
Care and Hospice Education Center that receives an 
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award under this subsection shall provide assurances 
to the Secretary that funds provided to the Center 
under the award will be used only to supplement, 
not to supplant, the amount of Federal, State, and 
local funds otherwise expended by such Center. 
‘‘(e) PALLIATIVE CARE AND HOSPICE CAREER IN-
CENTIVE AWARDS.— 
‘‘(1) IN GENERAL.—The Secretary shall award 
grants or contracts under this subsection to individ-
uals described in paragraph (2) to foster greater in-
terest among a variety of health professionals in en-
tering the field of palliative care. 
‘‘(2) ELIGIBLE INDIVIDUALS.—To be eligible to 
receive an award under paragraph (1), an individual 
shall— 
‘‘(A) be an advanced practice nurse, a clin-
ical social worker, a pharmacist, a chaplain, or 
student of psychology who is pursuing a doc-
torate or other advanced degree in palliative 
care or related fields in an accredited health 
professions school; and 
‘‘(B) submit to the Secretary an applica-
tion at such time, in such manner, and con-
taining such information as the Secretary may 
require. 
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‘‘(3) CONDITIONS OF AWARD.—As a condition 
of receiving an award under this subsection, an indi-
vidual shall agree that, following completion of the 
award period, the individual will teach or practice 
palliative care in health-related educational, home, 
hospice or long-term care settings for a minimum of 
5 years under guidelines established by the Sec-
retary. 
‘‘(4) PAYMENT
TO
INSTITUTION.—The Sec-
retary shall make payments for awards under this 
subsection to institutions which include schools of 
medicine, osteopathic medicine, nursing, social work, 
psychology, chaplaincy or pastoral care education, 
dentistry, and pharmacy, or other allied health dis-
cipline in an accredited health professions school 
that is approved by the Secretary. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$44,100,000 for each of the fiscal years 2014 through 
2018.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall be effective beginning on the date that 
is 90 days after the date of enactment of this Act. 
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SEC. 4. APPLICATION TO ADVANCED PRACTICE NURSES. 
(a) ADVANCED EDUCATION NURSING GRANTS.—Sec-
tion 811(a) of the Public Health Service Act (42 U.S.C. 
296j(a)) is amended— 
(1) in paragraph (1), by striking ‘‘and’’ at the 
end; 
(2) by redesignating paragraph (2) as para-
graph (3); and 
(3) by inserting after paragraph (1), the fol-
lowing: 
‘‘(2) palliative care and hospice career incentive 
awards authorized under section 759A(e); and’’. 
(b) IN GENERAL.—Part D of title VIII of the Public 
Health Service Act (42 U.S.C. 296p et seq.) is amended 
by adding at the end the following: 
‘‘SEC. 832. PALLIATIVE CARE AND HOSPICE EDUCATION 
AND TRAINING. 
‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall 
award grants to eligible entities to develop and implement, 
in coordination with programs under section 759A, pro-
grams and initiatives to train and educate individuals in 
providing palliative care in health related educational, hos-
pice, home, or long-term care settings. 
‘‘(b) USE OF FUNDS.—An eligible entity that receives 
a grant under subsection (a) shall use funds under such 
grant to— 
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‘‘(1) provide training to individuals who will 
provide palliative care in health-related educational, 
home, hospice, or long-term care settings; 
‘‘(2) develop and disseminate curricula relating 
to palliative care in health-related educational, home, 
hospice, or long-term care settings; 
‘‘(3) train faculty members in palliative care in 
health related educational, home, hospice, or long- 
term care settings; or 
‘‘(4) provide continuing education to individuals 
who provide palliative care in health-related edu-
cational, home, hospice, or long-term care settings. 
‘‘(c) APPLICATION.—An eligible entity desiring a 
grant under subsection (a) shall submit an application to 
the Secretary at such time, in such manner, and con-
taining such information as the Secretary may reasonably 
require. 
‘‘(d) ELIGIBLE ENTITY.—For purposes of this sec-
tion, the term ‘eligible entity’ shall include a school of 
nursing, a health care facility, a program leading to cer-
tification as a certified nurse assistant, a partnership of 
such a school and facility, or a partnership of such a pro-
gram and facility. 
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‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2014 through 2018.’’. 
Æ 
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