Title: Removing Barriers to Person- and Family-Centered Care Act of 2019
Policy area: Health

Summary:
Removing Barriers to Person- and Family-Centered Care Act of 2019
This bill establishes a program through which entities may implement alternative payment models for providing care to individuals who (1) are enrolled in Medicare, Medicaid, or both; (2) have advanced chronic conditions (e.g., late-stage cancer); and (3) have demonstrated cognitive impairment or functional limitations.
Specifically, the Centers for Medicare & Medicaid Services must award cooperative agreements to specified organizations to provide person- and family-centered care for such individuals, particularly through collaboratives with providers and community-based organizations. Participants may receive waivers from certain coverage requirements (e.g., Medicare hospice, skilled nursing facility, and home health services requirements) to implement program initiatives and must report data using identified quality measures.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 829 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                 S. 829

   To amend title XI of the Social Security Act to award cooperative 
agreements to improve care for individuals with advanced illnesses, and 
                          for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 14, 2019

Mr. Whitehouse introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To amend title XI of the Social Security Act to award cooperative 
agreements to improve care for individuals with advanced illnesses, and 
                          for other purposes.

    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 ``Removing Barriers to Person- and 
Family-Centered Care Act of 2019''.

SEC. 2. COOPERATIVE AGREEMENTS TO IMPROVE CARE FOR INDIVIDUALS WITH 
              ADVANCED ILLNESSES.

    (a) In General.--Section 1115A of the Social Security Act (42 
U.S.C. 1315a) is amended--
            (1) in the last sentence of subparagraph (A) of subsection 
        (b)(2), by inserting ``, and the model described in subsection 
        (h)'' before the period at the end; and
            (2) by adding at the end the following new subsection:
    ``(h) Cooperative Agreements To Improve Care for Individuals With 
Advanced Illnesses.--
            ``(1) In general.--The Secretary shall, acting through the 
        Centers for Medicare & Medicaid Services, award up to 15 
        cooperative agreements to eligible entities with the goals of--
                    ``(A) addressing gaps in community capacity to 
                provide high-quality, person- and family-centered care;
                    ``(B) improving the integration and coordination of 
                clinical and nonclinical services;
                    ``(C) expanding access to a comprehensive care 
                planning process and services; and
                    ``(D) developing and implementing alternative 
                payment models that provide accountability for health 
                care costs and quality outcomes.
            ``(2) Eligible entity.--In this subsection, the term 
        `eligible entity' means the following:
                    ``(A) A State Medicaid agency.
                    ``(B) A State, local, or tribal health agency.
                    ``(C) An accountable care organization under 
                section 1899 or an accountable care organization model 
                tested under title XVIII or with respect to such title 
                under this section.
                    ``(D) A Lead Organization (as defined in paragraph 
                (9)).
                    ``(E) A quality improvement organization, such as a 
                Quality Innovation Network-Quality Improvement 
                Organization with a contract pursuant to part B of this 
                title.
            ``(3) Application.--
                    ``(A) In general.--Eligible entities seeking a 
                cooperative agreement under this subsection shall 
                submit to the Secretary an application, at such time, 
                and in such manner as the Secretary may require. An 
                application must include--
                            ``(i) a list of participating 
                        practitioners, providers of services, 
                        community-based organizations, and other 
                        individuals and entities;
                            ``(ii) a description of the target 
                        population or populations and geographic 
                        service area;
                            ``(iii) a description of the intended uses 
                        of amounts awarded under paragraph (4), and a 
                        plan for leveraging existing funding sources to 
                        deliver services to the target population or 
                        populations;
                            ``(iv) a description of the intended care 
                        delivery model and how the model supports high-
                        quality, person- and family-centered care;
                            ``(v) a plan for--
                                    ``(I) working with community-based 
                                organizations, including faith-based 
                                organizations and aging and disability 
                                organizations;
                                    ``(II) improving community-based 
                                supports for family caregivers; and
                                    ``(III) increasing the number of 
                                individuals within the target 
                                population or populations who--
                                            ``(aa) have communicated 
                                        their wishes regarding medical 
                                        treatment using State or 
                                        locally recognized forms, such 
                                        as advance directives or 
                                        portable medical orders;
                                            ``(bb) have comprehensive 
                                        care plans that are concrete 
                                        and actionable; and
                                            ``(cc) have access to 
                                        community-based palliative care 
                                        services; and
                            ``(vi) other information as determined 
                        appropriate by the Secretary.
            ``(4) Award amounts.--
                    ``(A) In general.--The Secretary may award up to 
                $5,000,000 under each cooperative agreement under this 
                subsection.
                    ``(B) Use of funds.--Funds awarded under a 
                cooperative agreement may be used for the following 
                purposes:
                            ``(i) To develop and implement a care 
                        delivery model as described in paragraph 
                        (5)(B)(i) and an alternative payment model as 
                        described in paragraph (5)(B)(ii).
                            ``(ii) To conduct education and training 
                        for health care professionals, beneficiaries 
                        and family caregivers, or community-based 
                        organizations in methods for documenting and 
                        sharing an individual's care goals, 
                        preferences, and values under such model.
                            ``(iii) To hire staff to conduct care 
                        management and coordination activities as part 
                        of an interdisciplinary care team under such 
                        model.
                            ``(iv) To support the development of 
                        community-based palliative care teams and the 
                        delivery of related services.
                            ``(v) To modify, upgrade, or purchase 
                        health information technology, including 
                        technologies that support data aggregation and 
                        analytics, electronic exchange of health 
                        information, accessibility of an individual's 
                        comprehensive care plan, or remote monitoring 
                        under such model.
                            ``(vi) To conduct other activities 
                        determined appropriate by the Secretary.
            ``(5) Implementation.--
                    ``(A) Duration.--Each cooperative agreement under 
                this subsection shall be awarded for a period of 7 
                years.
                    ``(B) Pre-implementation period.--During the first 
                2 years of a cooperative agreement, an awardee shall 
                work with the Secretary to--
                            ``(i) develop a care delivery model using 
                        one or more of the waivers and expanded 
                        services described in paragraphs (7) and (8);
                            ``(ii) develop an alternative payment 
                        model; and
                            ``(iii) identify a set of quality measures 
                        that will be reported on annually by 
                        participants in such model.
                    ``(C) Model implementation.--Beginning with the 
                third year of a cooperative agreement, an awardee--
                            ``(i) shall implement the care delivery 
                        model developed under subparagraph (B)(i) and 
                        the alternative payment model developed under 
                        subparagraph (B)(ii);
                            ``(ii) shall annually report data on 
                        quality measures identified under subparagraph 
                        (B)(iii) to the Secretary; and
                            ``(iii) may, in accordance with paragraphs 
                        (7) and (8), receive waivers and provide 
                        expanded services as described in such 
                        paragraphs, respectively, as part of a care 
                        delivery model that provides high-quality, 
                        person- and family-centered care to the target 
                        population or populations.
            ``(6) Notification.--The Secretary shall provide guidance 
        on notification and continuity-of-care plan requirements in the 
        event a participating provider leaves a model pursuant to a 
        cooperative agreement under this subsection.
            ``(7) Waiver of certain requirements.--In addition to any 
        waivers pursuant to subsection (d)(1), the Secretary shall 
        include the following waivers of requirements and, where 
        applicable, permit Medicare Advantage organizations flexibility 
        to waive such requirements, with respect to coverage of, and 
        payment for, items and services furnished to individuals 
        pursuant to a cooperative agreement under this subsection:
                    ``(A) Coverage of services related to an 
                individual's terminal illness.--A waiver of the 
                requirement described in section 1812(d)(2)(A) that an 
                individual electing to receive hospice care shall be 
                deemed to have waived all rights to have payment made 
                under title XVIII with respect to services described in 
                clause (ii)(I) of such section.
                    ``(B) Alternatives in furnishing of home care.--
                With respect to home health services furnished to an 
                individual by a home health agency, a waiver of the 
                requirements described in sections 1814(a)(2) and 
                1835(a)(2)(A), that--
                            ``(i) a physician makes the certification 
                        (and recertification, where such services are 
                        provided over a period of time) as described in 
                        such sections;
                            ``(ii) a plan for furnishing such services 
                        to such individual is established and 
                        periodically reviewed by a physician;
                            ``(iii) such services are or were furnished 
                        while the individual was under the care of a 
                        physician; and
                            ``(iv) the physician documents that the 
                        individual has had a face-to-face encounter as 
                        described in such sections,
                provided that a nurse practitioner, clinical nurse 
                specialist, or physician assistant (as those terms are 
                defined in section 1861(aa)(5)), in accordance with 
                State law, makes such certification and 
                recertification, establishes and periodically reviews 
                such plan, has the individual under their care when 
                such services are or were furnished, and documents such 
                face-to-face encounter.
                    ``(C) Alternative certification for hospice care.--
                A waiver of the requirements described in subparagraphs 
                (A) and (B) of section 1814(a)(7) that an individual's 
                attending physician and the medical director (or 
                physician member of the interdisciplinary group 
                described in section 1861(dd)(2)(B)) of the hospice 
                program providing (or arranging for) the individual's 
                hospice care certify that the individual is terminally 
                ill and periodically review the written plan for 
                hospice care, provided that such certification and 
                review is conducted by a nurse practitioner, clinical 
                nurse specialist, or physician assistant (as those 
                terms are defined in section 1861(aa)(5)) in accordance 
                with State law.
                    ``(D) Coverage of skilled nursing services without 
                inpatient stay.--With respect to extended care services 
                furnished to an individual by a skilled nursing 
                facility, a waiver of the requirement described in 
                section 1861(i) that an individual must have been an 
                inpatient in a hospital for not less than 3 consecutive 
                days before his discharge and transfer to the skilled 
                nursing facility before such extended care services may 
                be deemed post-hospital extended care services.
                    ``(E) Coverage of home health care without 
                homebound status requirement.--With respect to home 
                health services furnished to an individual by a home 
                health agency (as defined in section 1861(o)), a waiver 
                of the requirements described in sections 1814(a)(2)(C) 
                and 1835(a)(2)(A) that the individual is or was 
                confined to his or her home.
            ``(8) Availability of expanded services.--A hospice program 
        that participates in an alternative payment model pursuant to a 
        cooperative agreement under this subsection may receive an add-
        on payment, as determined by the Secretary, for furnishing the 
        following services to the target population or populations 
        under such model:
                    ``(A) Inpatient alternative to routine hospice 
                care.--
                            ``(i) In general.--Notwithstanding 
                        regulations in effect prior to the enactment of 
                        this subsection, if an assessment meeting such 
                        requirements as the Secretary determines 
                        appropriate has been made that the home of an 
                        individual who is certified for hospice care 
                        and has elected to receive hospice care is 
                        unsafe or unsuitable for the provision of such 
                        care, such individual may receive such care in 
                        an inpatient setting, including a hospice 
                        program that meets the conditions of 
                        participation specified in section 418.110 of 
                        title 42, Code of Federal Regulations (as in 
                        effect on the date of enactment of this 
                        subparagraph), or a skilled nursing facility 
                        that meets the standards specified in 
                        subsections (b) and (e) of such section, for 
                        the duration an individual has elected to 
                        receive hospice care. The assessment described 
                        in the preceding sentence may be conducted by 
                        the individual's attending physician, a nurse 
                        practitioner, clinical nurse specialist, or 
                        physician assistant (as those terms are defined 
                        in section 1861(aa)(5)), or the medical 
                        director (or physician member of the 
                        interdisciplinary group described in section 
                        1861(dd)(2)(B)) of the hospice program 
                        providing (or arranging for) the individual's 
                        hospice care.
                            ``(ii) Application of limitation on 
                        inpatient care days.--For purposes of any 
                        limitation on the number of total inpatient 
                        care days for which a hospice may receive 
                        payment, hospice care that is provided in an 
                        inpatient setting under this subparagraph (but 
                        would otherwise be provided in an outpatient 
                        setting) shall not count towards such 
                        limitation.
                    ``(B) Home-based alternative to inpatient respite 
                care.--
                            ``(i) In general.--Notwithstanding section 
                        1861(dd)(1)(G), an individual who is certified 
                        for hospice care and has elected to receive 
                        hospice care may receive short-term, home-based 
                        respite care as an alternative to inpatient 
                        respite care.
                            ``(ii) Limitations.--The home-based respite 
                        care described in clause (i) is subject to the 
                        same limitations that apply to inpatient 
                        respite care under section 1861(dd)(1)(G), 
                        including the limitation that respite care may 
                        be provided only on an intermittent, non-
                        routine, and occasional basis and may not be 
                        provided consecutively over longer than 5 days.
            ``(9) Definitions.--In this subsection:
                    ``(A) Lead organization.--The term `Lead 
                Organization' means a covered entity for purposes of 
                compliance with the regulations promulgated under 
                section 264(c) of the Health Insurance Portability and 
                Accountability Act of 1996 (42 U.S.C. 1320d-2 note) 
                that will convene community partners to coordinate, 
                manage, and expand services for the target population 
                or populations and be accountable for costs and quality 
                outcomes under the cooperative agreement.
                    ``(B) Cooperative agreement.--The term `cooperative 
                agreement' means an agreement between the Secretary and 
                an eligible entity under this subsection.
                    ``(C) Physician.--The term `physician' has the 
                meaning given such term in section 1861(r)(1).
                    ``(D) Practitioner.--The term `practitioner' has 
                the meaning given such term in section 1842(b)(18)(C).
                    ``(E) Provider of services.--The term `provider of 
                services' has the meaning given such term in section 
                1861(u).
                    ``(F) Target population.--The term `target 
                population' means individuals who--
                            ``(i) are enrolled for benefits under parts 
                        A and B of title XVIII, enrolled in a Medicare 
                        Advantage plan under part C of such title, 
                        enrolled under a State Medicaid plan, or dually 
                        eligible for benefits under titles XVIII and 
                        XIX;
                            ``(ii) have one or more advanced chronic 
                        conditions, as determined by the Secretary, 
                        such as late-stage cancer, congestive heart 
                        failure, chronic kidney disease, chronic 
                        obstructive pulmonary disease, geriatric 
                        frailty, Alzheimer's disease, or other forms of 
                        progressive dementia; and
                            ``(iii) have demonstrated--
                                    ``(I) evidence of recent and 
                                progressive cognitive impairment; or
                                    ``(II) a functional limitation 
                                requiring the assistance of another 
                                person (such as an inability to perform 
                                two or more activities of daily 
                                living).''.
    (b) Availability of Funding.--Section 1115A(f)(2) of the Social 
Security Act (42 U.S.C. 1315a(f)(2)) is amended--
            (1) by striking ``Out of amounts appropriated'' and 
        inserting ``(A) Out of amounts appropriated''; and
            (2) by adding at the end the following new subparagraph:
                    ``(B) Out of the amount appropriated under 
                subparagraph (C) of paragraph (1), $75,000,000 shall be 
                made available for the purpose of awarding funds under 
                subsection (h)(4), which shall remain available for 
                such purpose until expended.''.

SEC. 3. IDENTIFICATION AND DEVELOPMENT OF QUALITY MEASURES RELATING TO 
              ADVANCED ILLNESS CARE.

    Section 1890A of the Social Security Act (42 U.S.C. 1395aaa-1) is 
amended by adding at the end the following new subsection:
    ``(h) Advanced Illness Care Quality Measures.--
            ``(1) In general.--The Secretary, in consultation with the 
        Administrator of the Centers for Medicare & Medicaid Services, 
        the Director of the Agency for Healthcare Research and Quality, 
        the Administrator of the Administration for Community Living, 
        and the entity with a contract under section 1890(a), shall 
        establish a core set of evidence-based quality measures 
        relating to advanced illness care. Such quality measures may 
        include outcome, structural, and process measures in the 
        following domains:
                    ``(A) Person and family experience of care.
                    ``(B) Access to needed services (medical and 
                supportive), such as home care, palliative care, and 
                timely referral to hospice.
                    ``(C) Alignment of care with an individual's 
                preferences, goals, and values.
                    ``(D) Screening and treatment for physical 
                symptoms, such as dyspnea, nausea, and constipation.
                    ``(E) Utilization of health care and support 
                services.
                    ``(F) Shared decision making and informed consent.
            ``(2) Process for identifying and developing quality 
        measures.--In identifying and developing the quality measures 
        for the core set described in paragraph (1), the Secretary 
        shall take the following actions:
                    ``(A) Identify existing measures.--Identify 
                existing quality measures relating to advanced illness 
                care that are in use under public and privately 
                sponsored health care arrangements.
                    ``(B) Development of measures.--Enter into grants, 
                contracts, or intergovernmental agreements with 
                eligible entities for the purposes of developing 
                quality measures (which may include improving existing 
                quality measures) relating to advanced illness care 
                that, to the extent practicable, allow for the use of 
                health information technologies in collecting data 
                relating to such quality measures.
                    ``(C) Stakeholder feedback.--Solicit feedback from 
                a wide array of stakeholders on quality measures to 
                include in the core set.
            ``(3) Publication and updates.--
                    ``(A) Publication.--Not later than January 1, 2022, 
                the Secretary shall publish a core set of quality 
                measures for advanced illness care.
                    ``(B) Updates.--Beginning January 1, 2024 (and 
                every 2 years thereafter), the Secretary, in 
                coordination with the entity with a contract under 
                section 1890(a), shall solicit stakeholder feedback and 
                publish an updated set of quality measures, 
                prioritizing measures that address gap areas related to 
                advanced illness care.
            ``(4) Funding.--There are authorized to be appropriated 
        such sums as may be necessary to carry out this subsection.''.
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