I 
116TH CONGRESS 
1ST SESSION 
H. R. 647 
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, social work schools, and other programs, includ-
ing physician assistant education programs, to promote education and 
research in palliative care and hospice, and to support the development 
of faculty careers in academic palliative medicine. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 17, 2019 
Mr. ENGEL (for himself, Mr. REED, Ms. CLARKE of New York, Mr. CARTER 
of Georgia, Mr. PALLONE, and Mr. WALDEN) 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, social work schools, and other programs, includ-
ing physician assistant education programs, to promote 
education and research in palliative care and hospice, 
and to support the development 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, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Palliative Care and 
Hospice Education and Training Act’’. 
SEC. 2. 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 inserting after section 759 the following: 
‘‘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 interprofessional team- 
based training of health professionals in pallia-
tive care, including residencies, traineeships, or 
fellowships; 
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‘‘(B) develops and disseminates inter-
professional team-based curricula relating to 
the palliative treatment of the complex health 
problems of individuals with serious or life- 
threatening illnesses; 
‘‘(C) supports the training and retraining 
of faculty to provide instruction in interprofes-
sional team-based palliative care; 
‘‘(D) supports interprofessional team-based 
continuing education of health professionals 
who provide palliative care to patients with seri-
ous or life-threatening illness; 
‘‘(E) provides students (including resi-
dents, trainees, and fellows) with clinical train-
ing in interprofessional team-based palliative 
care in appropriate health settings, including 
hospitals, hospices, home care, long-term care 
facilities, and ambulatory care centers; 
‘‘(F) establishes traineeships for individ-
uals who are preparing for advanced education 
nursing degrees, social work degrees, or ad-
vanced degrees in physician assistant studies, 
with a focus in interprofessional team-based 
palliative care in appropriate health settings, in-
cluding hospitals, hospices, home care, long- 
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term care facilities, and ambulatory care cen-
ters; 
‘‘(G) supports collaboration between mul-
tiple specialty training programs (such as medi-
cine, nursing, social work, physician assistant, 
chaplaincy, and pharmacy) and clinical training 
sites to provide training in interprofessional 
team-based palliative care; and 
‘‘(H) does not duplicate the activities of 
existing education centers funded under this 
section 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-
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 
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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 inter-
professional team-based palliative 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 interprofessional 
team-based palliative medicine through a vari-
ety of service rotations, such as consultation 
services, acute care services, extended care fa-
cilities, ambulatory care and comprehensive 
evaluation units, hospices, home care, and com-
munity care programs; 
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‘‘(D) develop specific performance-based 
measures to evaluate the competency of train-
ees; and 
‘‘(E) provide training in interprofessional 
team-based palliative medicine through one or 
both of the training options described in para-
graph (3). 
‘‘(3) TRAINING OPTIONS.—The training options 
referred to in subparagraph (E) of paragraph (2) 
are 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 
are designed to provide training in interprofes-
sional team-based hospice and palliative medi-
cine for physicians who have completed grad-
uate medical education programs in any med-
ical specialty leading to board eligibility in hos-
pice and palliative medicine pursuant to the 
American Board of Medical Specialties. 
‘‘(4) DEFINITIONS.—For purposes of this sub-
section, the term ‘graduate medical education’ 
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means a program sponsored by a school of medicine, 
a school of osteopathic medicine, a hospital, or a 
public 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— 
‘‘(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 
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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 
skills in education in interprofessional team- 
based palliative care. 
‘‘(4) MAINTENANCE OF EFFORT.—An eligible 
individual who receives an award under paragraph 
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(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, including 
schools of medicine and osteopathic medicine. 
‘‘(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 interprofessional teams of 
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.— 
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‘‘(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-
section as a ‘fellowship’) that focus on inter-
professional team-based palliative care that pro-
vide supplemental training for faculty members 
in medical schools and other health professions 
schools with programs in psychology, pharmacy, 
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nursing, social work, physician assistant edu-
cation, chaplaincy, or other health disciplines, 
as approved by the Secretary. Such a fellowship 
shall be open to current faculty, and appro-
priately credentialed volunteer faculty and prac-
titioners, who do not have formal training in 
palliative care, to upgrade their knowledge and 
clinical skills for the care of individuals with se-
rious or life-threatening illness and to enhance 
their interdisciplinary and interprofessional 
teaching skills. 
‘‘(B) LOCATION.—A fellowship under this 
paragraph shall be offered either at the Pallia-
tive Care and Hospice Education Center that is 
sponsoring the course, in collaboration with 
other Palliative Care and Hospice Education 
Centers, or at medical schools, schools of nurs-
ing, schools of pharmacy, schools of social work, 
schools of chaplaincy or pastoral care education, 
graduate programs in psychology, physician as-
sistant education programs, or other health pro-
fessions schools approved by the Secretary with 
which the Centers are affiliated. 
‘‘(C) CONTINUING EDUCATION CREDIT.— 
Participation in a fellowship under this para-
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graph shall be accepted with respect to com-
plying with continuing health profession edu-
cation requirements. As a condition of such ac-
ceptance, the recipient shall subsequently pro-
vide a minimum of 18 hours of voluntary in-
struction in palliative care content (that has 
been approved by a palliative care and hospice 
education center) to students or trainees 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 
paragraph (1) shall meet targets approved by the 
Secretary for providing training in interprofessional 
team-based palliative care to a certain number of 
faculty or practitioners during the term of the 
award, as well as other parameters established by 
the Secretary. 
‘‘(6) AMOUNT OF AWARD.—Each award under 
paragraph (1) shall be in the amount of $150,000. 
Not more than 24 Palliative Care and Hospice Edu-
cation Centers may receive an award under such 
paragraph. 
‘‘(7) MAINTENANCE OF EFFORT.—A Palliative 
Care and Hospice Education Center that receives an 
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award under paragraph (1) 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 so-
cial worker, physician assistant, pharmacist, 
chaplain, or student of psychology who is pur-
suing a doctorate, masters, or other advanced 
degree with a focus in interprofessional team- 
based palliative care or related fields in an ac-
credited health professions school; and 
‘‘(B) submit to the Secretary an applica-
tion at such time, in such manner, and con-
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taining such information as the Secretary may 
require. 
‘‘(3) CONDITIONS OF AWARD.—As a condition 
of receiving an award under paragraph (1), 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 para-
graph (1) to institutions that include schools of med-
icine, 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 or 
program (such as a physician assistant education 
program) that is approved by the Secretary. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$15,000,000 for each of the fiscal years 2020 through 
2024.’’. 
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(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. 
SEC. 3. HOSPICE AND PALLIATIVE NURSING. 
(a) NURSE EDUCATION, PRACTICE, AND QUALITY 
GRANTS.—Section 831(b)(3) of the Public Health Service 
Act (42 U.S.C. 296p(b)(3)) is amended by inserting ‘‘hos-
pice and palliative nursing,’’ after ‘‘coordinated care,’’. 
(b) PALLIATIVE CARE
AND HOSPICE EDUCATION 
AND TRAINING PROGRAMS.—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 interprofessional team-based palliative care in 
health-related educational, hospital, hospice, 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, 
hospital, home, hospice, or long-term care settings; 
‘‘(2) develop and disseminate curricula relating 
to palliative care in health-related educational, hos-
pital, home, hospice, or long-term care settings; 
‘‘(3) train faculty members in palliative care in 
health-related educational, hospital, 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 2020 through 2024.’’. 
SEC. 4. DISSEMINATION OF PALLIATIVE CARE INFORMA-
TION. 
Part A of title IX of the Public Health Service Act 
(42 U.S.C. 299 et seq.) is amended by adding at the end 
the following new section: 
‘‘SEC. 904. DISSEMINATION OF PALLIATIVE CARE INFORMA-
TION. 
‘‘(a) IN GENERAL.—Under the authority under sec-
tion 902(a) to disseminate information on health care and 
on systems for the delivery of such care, the Director may 
disseminate information to inform patients, families, and 
health professionals about the benefits of palliative care 
throughout the continuum of care for patients with serious 
or life-threatening illness. 
‘‘(b) INFORMATION DISSEMINATED.— 
‘‘(1) MANDATORY INFORMATION.—If the Direc-
tor elects to disseminate information under sub-
section (a), such dissemination shall include the fol-
lowing: 
‘‘(A) PALLIATIVE CARE.—Information, re-
sources, and communication materials about 
palliative care as an essential part of the con-
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