II 118th CONGRESS 1st Session S. 2243 IN THE SENATE OF THE UNITED STATES July 11, 2023 Ms. Baldwin (for herself, Mrs. Capito , Mr. Merkley , Ms. Murkowski , Mr. Reed , Mr. Rounds , Ms. Sinema , Mr. King , Mrs. Hyde-Smith , Mr. Marshall , Mrs. Blackburn , Ms. Cantwell , Mr. Boozman , and Mrs. Gillibrand ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL 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, including social work, physician assistant, and chaplaincy education programs, to promote education and research in palliative care and hospice, and to support the development of faculty careers in academic palliative and hospice care.

1. Short title This Act may be cited as the Palliative Care and Hospice Education and Training Act . 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: 759A. Palliative care and hospice education and training (a) Palliative care and hospice education programs (1) In general The Secretary shall award grants or contracts under this section to entities described in paragraph (1), (3), or (4) of section 799B, and section 801(2), for the establishment or operation of Palliative Care and Hospice Education Programs that meet the requirements of paragraph (2). (2) Requirements (A) In general A Palliative Care and Hospice Education Program receiving an award under this section shall support the training of health professionals in palliative and hospice care, including traineeships or fellowships. Such programs shall emphasize, as appropriate, patient and family engagement, integration of palliative and hospice care with primary and specialty care, and collaboration with community partners to address gaps in health care for individuals with serious or life-threatening illnesses. (B) Activities Activities conducted by a program under this section may include the following: (i) Clinical training on providing integrated palliative and hospice care services. (ii) Interprofessional training to practitioners from multiple disciplines and specialties, including training on the provision of care to individuals with serious or life-threatening illnesses. (iii) Establishing or maintaining training-related community-based programs for individuals with serious or life-threatening illnesses and caregivers to improve quality of life, and where appropriate, health outcomes for individuals who have serious or life-threatening illnesses. (C) Nonduplication A Palliative Care and Hospice Education Program under this section shall not duplicate the activities of existing education centers funded under this section or under section 753 or 865. (3) Priorities in making awards In awarding grants and contracts under paragraph (1), the Secretary— (A) shall give priority to programs that demonstrate coordination with another Federal or State program, or another public or private entity; (B) shall give priority to applicants with programs or activities that are expected to substantially benefit— (i) individuals in rural or medically underserved areas, frontier health professional shortage areas (as defined in section 799B), or Indian Tribes or Tribal organizations; (ii) pediatric populations; or (iii) racial and ethnic minority populations; and (C) may give priority to any program that— (i) integrates palliative and hospice care into primary care practice; (ii) provides training to integrate palliative and hospice care into other specialties across care settings, including practicing clinical specialists, health care administrators, faculty without backgrounds in palliative or hospice care, and students from all health professions; (iii) emphasizes integration of palliative and hospice care into existing service delivery locations and care across settings, including primary care clinics, medical homes, Federally qualified health centers, ambulatory care clinics, hospitals, including critical access hospitals, emergency care settings, assisted living and nursing facilities, and home- and community-based settings; (iv) supports the training and retraining of faculty, primary and specialty care providers, other direct care providers, and other appropriate professionals on palliative or hospice care; (v) emphasizes education and engagement of family or caregivers on palliative and hospice care management within the context of chronic disease management and strategies to meet the needs of such family or caregivers; or (vi) proposes to conduct outreach to communities that have a shortage of palliative and hospice workforce professionals. (4) Expansion of existing programs Nothing in this section shall be construed to— (A) prevent the Secretary from providing grants or contracts to expand existing education programs, including geriatric education programs established under section 753 or 865, to provide for education and training focused specifically on palliative care, including for non-geriatric populations; or (B) limit the number of education programs 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 who plan to teach or practice palliative medicine. (2) Requirements Each project for which a grant or contract is made under this subsection shall— (A) be staffed by full-time teaching physicians who have experience or training in interprofessional 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 variety of service rotations, such as consultation services, acute care services, extended care facilities, ambulatory care and comprehensive evaluation units, hospices, home care, and community care programs; (D) develop specific performance-based measures to evaluate the competency of trainees; and (E) provide training in interprofessional team-based palliative medicine through one or both of the training options described in paragraph (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 interprofessional team-based hospice and palliative medicine for physicians who have completed graduate medical education programs in any medical specialty leading to board eligibility in hospice and palliative medicine pursuant to the American Board of Medical Specialties. (4) Definitions For purposes of this subsection, the term graduate medical education 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 Accreditation Council for Graduate Medical Education or the American Osteopathic Association through its Committee on Postdoctoral Training. (c) Palliative care and hospice academic career awards (1) Establishment of program The Secretary shall establish a program to provide awards, to be known as the Palliative Care and Hospice Academic Career Awards , to allopathic and osteopathic medical schools, nursing schools, and other programs, including social work, physician assistant, and chaplaincy education programs, or other schools or programs identified by the Secretary applying on behalf of eligible individuals to promote the career development of such individuals as academic hospice and palliative care specialists. (2) Eligible individuals For purposes of this subsection, the term eligible individual means an individual who— (A) is board certified or board eligible in hospice and palliative medicine or has completed required specialty training in palliative and hospice care in the disciplines of nursing, social work, physician assistant, chaplaincy, or other discipline identified by the Secretary; and (B) has a junior (nontenured) faculty appointment at an accredited (as determined by the Secretary) allopathic or osteopathic medical school, nursing school, or other programs, including social work, physician assistant, chaplaincy, or other education programs identified by the Secretary. (3) Limitations No award under paragraph (1) may be made to an eligible individual unless the entity on behalf of the eligible individual— (A) has submitted to the Secretary an application, 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 described 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 documented 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 entity which 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(b)(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 allopathic and osteopathic medical schools, nursing schools, and other programs, including social work, physician assistant, or chaplaincy education programs. (6) Service requirement An individual who receives an award under this subsection shall provide training in palliative care and hospice, including the training of interprofessional teams of health care professionals. The provision of such training shall constitute a majority of the total funded obligations of such individual under the award. (d) Palliative care workforce development (1) In general The Secretary shall award grants or contracts under this subsection to entities that operate a Palliative Care and Hospice Education Program 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 application at such time, in such manner, and containing such information as the Secretary may require. (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 paragraph (3), a Palliative Care and Hospice Education Program that receives an award under this subsection shall use such funds to offer short-term intensive courses (referred to in this subsection as a fellowship ) that focus on interprofessional team-based palliative care that provide supplemental training for faculty members in allopathic and osteopathic medical schools, nursing schools, and other programs, including psychology, pharmacy, social work, physician assistant, and chaplaincy education programs, or other health disciplines, as approved by the Secretary. Such a fellowship shall be open to current faculty, and appropriately credentialed volunteer faculty and practitioners, who do not have formal training in palliative care, to upgrade their knowledge and clinical skills for the care of individuals with serious 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 Palliative Care and Hospice Education Program that is sponsoring the course, in collaboration with other Palliative Care and Hospice Education Programs, or at allopathic and osteopathic medical schools, nursing schools, or other programs, including pharmacy, social work, physician assistant, chaplaincy, and psychology education programs, or other health professions schools and programs approved by the Secretary. (5) Targets A Palliative Care and Hospice Education Program 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 not more than $150,000. Not more than 24 Palliative Care and Hospice Education Programs may receive an award under such paragraph. (7) Maintenance of effort A Palliative Care and Hospice Education Program that receives an award under paragraph (1) shall provide assurances to the Secretary that funds provided to the Program under the award will be used only to supplement, not to supplant, the amount of Federal, State, and local funds otherwise expended by such Program. (e) Palliative care and hospice career incentive awards (1) In general The Secretary shall award grants or contracts under this subsection to institutions, including allopathic and osteopathic medical schools, nursing schools, and other programs, including social work, physician assistant, psychology, chaplaincy, and pharmacy education programs, or other programs approved by the Secretary, applying on behalf of individuals described in paragraph (2) to foster greater interest among a variety of health professionals in entering 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 social worker, physician assistant, pharmacist, chaplain, psychologist, or other health care professional pursuing a doctorate, masters, or other advanced degree with a focus in interprofessional team-based palliative care or related fields in an accredited school or education program; and (B) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require. (3) Conditions of award As a condition of receiving an award under paragraph (1), an individual 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 Secretary. (4) Payment to institution The Secretary shall make payments for awards under paragraph (1) to institutions that include allopathic and osteopathic medical schools, nursing schools, and other programs, including social work, physician assistant, psychology, chaplaincy, and pharmacy education programs or other programs 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 2024 through 2028. . (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. 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 hospice 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: 832. Palliative care and hospice education and training (a) Program authorized The Secretary shall award grants to, or enter into contracts with, eligible entities to develop and implement, in coordination with programs under section 759A, programs 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— (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, hospital, 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 educational, 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 containing such information as the Secretary may reasonably require. (d) Eligible entity For purposes of this section, the term eligible entity shall include a school of nursing, a health care facility, a program leading to certification as a certified nurse assistant, a partnership of such a school and facility, or a partnership of such a program and facility. (e) Authorization of appropriations There are authorized to be appropriated to carry out this section $5,000,000 for each of the fiscal years 2024 through 2028. . 4. Dissemination of palliative care information 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: 904. Dissemination of palliative care information (a) In general Under the authority under section 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 Director elects to disseminate information under subsection (a), such dissemination shall include the following: (A) Palliative care Information, resources, and communication materials about palliative care as an essential part of the continuum of quality care for patients and families facing serious or life-threatening illness (including cancer, heart, kidney, liver, lung, and infectious diseases; as well as neurodegenerative disease such as dementia, Parkinson’s disease, or amyotrophic lateral sclerosis). (B) Palliative care services Specific information regarding the services provided to patients by professionals trained in hospice and palliative care, including pain and symptom management, support for shared decision making, care coordination, psychosocial care, and spiritual care, explaining that such services may be provided starting at the point of diagnosis and alongside curative treatment and are intended to— (i) provide patient-centered and family-centered support throughout the continuum of care for serious and life-threatening illness; (ii) anticipate, prevent, and treat physical, emotional, social, and spiritual suffering; (iii) optimize quality of life; and (iv) facilitate and support the goals and values of patients and families. (C) Palliative care professionals Specific materials that explain the role of professionals trained in hospice and palliative care in providing team-based care (including pain and symptom management, support for shared decision making, care coordination, psychosocial care, and spiritual care) for patients and families throughout the continuum of care for serious or life-threatening illness. (D) Research Evidence-based research demonstrating the benefits of patient access to palliative care throughout the continuum of care for serious or life-threatening illness. (E) Population-specific materials Materials targeting specific populations, including beneficiaries of Medicare, Medicaid, and the Veterans Health Administration, and patients with serious or life-threatening illness who are among medically underserved populations (as defined in section 330(b)(3)) and families of such patients or health professionals serving medically underserved populations, including pediatric patients, young adult and adolescent patients, racial and ethnic minority populations, and other priority populations specified by the Director. (2) Required publication Information and materials disseminated under paragraph (1) shall be posted on the internet websites of relevant Federal departments and agencies, including the Department of Veterans Affairs, the Centers for Medicare & Medicaid Services, and the Administration on Aging. (c) Consultation The Director shall consult with appropriate professional societies, hospice and palliative care stakeholders, and relevant patient advocate organizations with respect to palliative care, psychosocial care, and complex chronic illness with respect to the following: (1) The planning and implementation of the dissemination of palliative care information under this section. (2) The development of information to be disseminated under this section. (3) A definition of the term serious or life-threatening illness for purposes of this section. . 5. Clarification (a) Restriction on the use of Federal funds None of the funds made available under this Act (or an amendment made by this Act) may be used to provide, promote, or provide training with regard to any item or service for which Federal funding is unavailable under section 3 of Public Law 105–12 ( 42 U.S.C. 14402 ). (b) Additional clarification As used in this Act (or an amendment made by this Act), palliative care and hospice shall not be furnished for the purpose of causing, or the purpose of assisting in causing, a patient’s death, for any reason. 6. Enhancing NIH research in palliative care (a) In general Part B of title IV of the Public Health Service Act ( 42 U.S.C. 284 et seq. ) is amended by adding at the end the following new section: 409K. Enhancing research in palliative care The Secretary, or his or her designee, shall develop and implement a strategy to be applied across the institutes and centers of the National Institutes of Health to expand and intensify national research programs in palliative care in order to address the quality of care and quality of life for the rapidly growing population of patients in the United States with serious or life-threatening illnesses, including cancer; heart, kidney, liver, lung, and infectious diseases; as well as neurodegenerative diseases such as dementia, Parkinson’s disease, or amyotrophic lateral sclerosis. . (b) Expanding trans-NIH research reporting To include palliative care research Section 402A(c)(2)(B) of the Public Health Service Act ( 42 U.S.C. 282a(c)(2)(B) ) is amended by inserting and, beginning January 1, 2024, for conducting or supporting research with respect to palliative care after or national centers .