Expanding Access to Palliative Care Act
Bill: S.2565 | Sponsor: Sen. Rosen, Jacky (D-NV)
Policy area: Health

Summary:
Expanding Access to Palliative Care Act
This bill requires the Center for Medicare and Medicaid Innovation (CMMI) to test a model that provides community-based palliative care and care coordination for high-risk Medicare beneficiaries and that may replace the Medicare Care Choices Model (currently set to expire on December 31, 2021).
Under the new model, multi-disciplinary teams must provide coordinated, palliative care that is available 24-7 for Medicare beneficiaries with serious illnesses or injuries, such as cancer. The CMMI must evaluate the model by comparing patients participating in the model with those outside of the model in relation to specified metrics, including the election and duration of hospice care.

To amend title XI of the Social Security Act to provide for the testing 
              of a community-based palliative care model.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Expanding Access to Palliative Care 
Act''.

SEC. 2. COMMUNITY-BASED PALLIATIVE CARE MODEL.

    Section 1115A of the Social Security Act (42 U.S.C. 1315a) is 
amended
            (1) in subsection (b)(2)(A), by adding at the end the 
        following new sentence: ``The models selected under this 
        subparagraph shall include the testing of the model described 
        in subsection (h).''; and
            (2) by adding at the end the following new subsection:
    ``(h) Community-Based Palliative Care Model.--
            ``(1) In general.--The CMI shall develop and implement a 
        model to provide community-based palliative care and care 
        coordination for high risk beneficiaries, in co-management with 
        other providers of services and suppliers, aimed at improving 
        outcomes and experience of care and reducing unnecessary or 
        unwanted emergency department visits and hospitalizations (in 
        this subsection referred to as the `model'), and that is 
        intended to replace the Medicare Care Choices Model due to 
        sunset on December 31, 2021.
            ``(2) Duration.--The model shall be implemented for a 5 
        year period, beginning not later than one year after the date 
        of the enactment of this subsection.
            ``(3) Target population.--
                    ``(A) In general.--The target population for the 
                model is an individual--
                            ``(i) entitled to, or enrolled for, 
                        benefits under part A of title XVIII; and
                            ``(ii) with a diagnosis of a serious 
                        illness or injury, which may include a 
                        diagnosis of cancer, heart and vascular 
                        disease, pulmonary disease, human 
                        immunodeficiency virus/acquired 
                        immunodeficiency, Alzheimer's and dementia, 
                        stroke, serious injury requiring rehabilitation 
                        including burns, kidney disease, liver disease, 
                        Amyotrophic lateral sclerosis, any neuro 
                        degenerative disease, or any other serious 
                        illness or injury the Secretary determines 
                        appropriate.
                    ``(B) No exclusion for prior use of hospice care 
                benefits.--An individual shall not be excluded from 
                participation in the model based on prior use of 
                hospice care benefits during any period prior to such 
                participation, regardless of the source of coverage for 
                such benefits.
            ``(4) Participating providers.--Providers eligible to 
        participate under the model may include palliative care teams 
        working as an independent practice or associated with a hospice 
        program, home health agencies, hospitals, integrated health 
        systems, and other facilities determined appropriate by the 
        Secretary.
            ``(5) Team-based approach.--Under the model, at least one 
        member of the multi-disciplinary palliative care team shall be 
        certified in hospice and palliative care. This is a co-
        management model with palliative care aligning with primary and 
        specialist care for a team-based approach. Care must be 
        coordinated across providers and community services for 
        inclusion of all pain, symptom management, disease-modifying 
        and curative treatments, and other palliative care services.
            ``(6) Location.--Care may be furnished under the model in 
        any beneficiary `home', including a caregiver's residence, an 
        extended care facility, or a community setting as appropriate 
        based on the individual's ability to access services. The model 
        shall include access within an in-patient stay so long as the 
        patient begins receiving palliative care services prior to 
        admission. Services shall not be disrupted solely due to change 
        in location from a residence to an in-patient setting, and 
        shall be part of care coordination and care planning following 
        hospital discharge.
            ``(7) Services.--The model shall include items and services 
        based on specific patient needs with respect to pain, symptom 
        management, education, disease modifying treatments, advance 
        care planning and shared decision-making, goals clarification, 
        mental health services, family and caregiver support services, 
        spiritual support care, personal care assistance, and stress 
        reduction therapies. This includes a comprehensive assessment 
        of symptoms and stress factors that impact quality of life.
            ``(8) Access.--Care shall be available under the model 24 
        hours a day, 7 days a week, and 365 days a year, including 
        telehealth services. The CMI shall specifically consider the 
        needs of rural and underserved areas and adjust accordingly to 
        ensure equitable access to care. A broad range of providers 
        must be included with no geographic limitations.
            ``(9) Metrics.--The CMI shall assess the model by comparing 
        participants to other members of the target population who are 
        receiving care outside of the model, including with respect to 
        the following:
                    ``(A) Demographics (including age, diagnosis, 
                residence type, medical encounters in preceding 12 
                months leading to enrollment, geographic location (such 
                as urban or rural) and others as determined by the 
                CMI).
                    ``(B) Impact on utilization of items and services 
                under title XVIII (such as emergency department 
                services, hospital observation services, inpatient 
                admissions, and intensive care unit (ICU) stays).
                    ``(C) Election of hospice care.
                    ``(D) Duration of hospice care.
                    ``(E) Care Experience (beneficiary and 
                caregiver).''.
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