[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2243 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 2243
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.
_______________________________________________________________________
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.
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 ``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 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.
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 ``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:
``SEC. 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.''.
SEC. 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:
``SEC. 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.''.
SEC. 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.
SEC. 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:
``SEC. 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''.
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