Palliative Care and Hospice Education and Training Act - Amends the Public Health Service Act to direct the Secretary of Health and Human Services (HHS) to award grants or contracts for the establishment or operation of Palliative Care and Hospice Education Centers.
Requires such Centers to: (1) improve the training of health professionals in palliative care for individuals with serious or life-threatening illnesses; (2) develop and disseminate related curricula; (3) support the training and retraining of faculty to provide instruction in palliative care; (4) support continuing education of health professionals who provide palliative care; (5) provide students with clinical training in palliative care in long-term care facilities, home care, hospices, chronic and acute disease hospitals, and ambulatory care centers; and (6) establish traineeships for individuals preparing for advanced education nursing degrees in palliative care.
Authorizes the Secretary to make grants to and enter into contracts with schools of medicine, schools of osteopathic medicine, teaching hospitals, and graduate medical education programs to provide support for projects that fund the training of physicians who plan to teach palliative medicine.
Directs the Secretary to: (1) establish a program to provide Palliative Medicine and Hospice Academic Career Awards to eligible individuals; (2) award grants or contracts to entities that operate a Palliative Care and Hospice Education Center; (3) award incentive grants or contracts to advanced practice nurses, clinical social workers, pharmacists, chaplains, or students of psychology pursuing an advanced degree in palliative care or related fields; and (4) award grants to schools of nursing, health care facilities, or programs leading to certification as a certified nurse assistant to develop and implement programs and initiatives to train individuals in providing palliative care in health-related educational, hospice, home, or long-term care settings.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 641 Introduced in Senate (IS)]
113th CONGRESS
1st Session
S. 641
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, to
promote education in palliative care and hospice, and to support the
development of faculty careers in academic palliative medicine.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 21, 2013
Mr. Wyden (for himself and Mr. Reed) 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, to
promote education 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 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. FINDINGS.
Congress makes the following findings:
(1) Health care providers need better education about pain
management and palliative care. Students graduating from
medical school have very little, if any, training in the core
precepts of pain and symptom management, advance care planning,
communication skills, and care coordination for patients with
serious, life-threatening, or terminal illness.
(2) Palliative care is interdisciplinary, patient- and
family-centered health care for people with serious illnesses.
This type of care is focused on providing patients with relief
from the symptoms, pain, and stress of a serious illness,
whatever the diagnosis. The goal of palliative care is to
relieve suffering and improve quality of life for both patients
and their families. Palliative care is provided by a team of
doctors, nurses, social workers, chaplains, and other
specialists who work with a patient's other health care
providers to provide an extra layer of support, including
assistance with difficult medical decisionmaking and
coordination of care among specialists. Palliative care is
appropriate at any age and at any stage in a serious illness,
and can be provided together with curative treatment.
Palliative care is not dependent on a life-limiting prognosis
and may actually help an individual recover from illness by
relieving symptoms, such as pain, anxiety, or loss of appetite,
while undergoing sometimes difficult medical treatments or
procedures, such as surgery or chemotherapy. There were 1,623
hospitals with palliative care programs in 2012.
(3) Hospice is palliative care for patients in their last
year of life. Considered the model for quality compassionate
care for individuals facing a life-limiting illness, hospice
provides expert medical care, pain management, and emotional
and spiritual support expressly tailored to the patient's needs
and wishes. In most cases, care is provided in the patient's
home but may also be provided in freestanding hospice centers,
hospitals, nursing homes, and other long-term care facilities.
In 2011, an estimated 1,650,000 patients received services from
hospice, and nearly 45 percent of all deaths in the United
States occurred under the care of a hospice program. Hospice is
a covered benefit under the Medicare program. There were 3,630
Medicare-certified hospices serving more than 1,200,000
beneficiaries in 2011.
(4) A 2005 study at Michigan State University found that
the formal training of United States doctors in palliative care
is ``grossly inadequate''. When the American Society of
Clinical Oncology surveyed their members, 65 percent said they
had received inadequate education in controlling symptoms
associated with cancer, and 81 percent felt they had inadequate
mentoring in discussing a poor prognosis with their patients
and families. Training in pediatric palliative care is also
seriously lacking according to physicians, residents, and
medical students responding to a survey presented at a meeting
of American Federation for Medical Research.
(5) The American Board of Medical Specialties (ABMS) and
the Accreditation Council for Graduate Medical Education
(ACGME) provided formal subspecialty status for hospice and
palliative medicine (HPM) in 2006, and the Centers for Medicare
& Medicaid Services recognized hospice and palliative medicine
as a medical subspecialty in October of 2008.
(6) As of February 2013, there were a total of 89 hospice
and palliative medicine training programs accredited by the
Accreditation Council for Graduate Medical Education. For the
2012-2013 academic year, these programs were training 206
physicians in hospice and palliative medicine. Some programs
include an additional track in research, geriatrics, or public
health.
(7) There is a large gap between those practicing in the
palliative medicine field and the number of physicians needed.
A mid-range estimate by the American Academy of Hospice and
Palliative Medicine's Workforce Task Force calls for 6,000 or
more full time equivalents to serve current needs in hospice
and palliative care programs. At maximum capacity, the current
system would produce roughly 4,600 new hospice and palliative
medicine certified physicians over the next 20 years, during
which time some 70,000,000 new Medicare beneficiaries will
enter the Medicare program. At the same time, there is expected
to be increasing acceptance of the hospice and palliative
approach to care among the general population and health care
providers.
SEC. 3. 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 adding at the end 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 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 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 training of health professionals
in palliative care, including residencies,
traineeships, or fellowships;
``(B) develops and disseminates 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 palliative care;
``(D) supports continuing education of health
professionals who provide palliative care to patients
with serious or life-threatening illness;
``(E) provides students (including residents,
trainees, and fellows) with clinical training in
palliative care in the home, long-term care facilities,
home care, hospices, chronic and acute disease
hospitals, and ambulatory care centers;
``(F) establishes traineeships for individuals who
are preparing for advanced education nursing degrees in
palliative care nursing, home care, hospice, in the
home, long-term care, or other nursing areas that
specialize in palliative care; and
``(G) 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, including
geriatric education centers 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 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 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
residents, trainees, and fellows) who plan to teach 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 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 palliative medicine
through a variety of service rotations, such as
consultation services, acute care services, extended
care facilities, ambulatory care and comprehensive
evaluation units, hospice, home health, and community
care programs;
``(D) develop specific performance-based measures
to evaluate the competency of trainees; and
``(E) provide training in palliative medicine
through one or both of the training options described
in subparagraphs (A) and (B) of paragraph (3).
``(3) Training options.--The training options referred to
in subparagraph (E) of paragraph (2) shall be 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 shall be
designed to provide training in 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 Medicine and Hospice Academic Career Awards.--
``(1) Establishment of program.--The Secretary 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 the
Secretary) school of medicine or osteopathic medicine.
``(3) Limitations.--No award under paragraph (1) may be
made to an eligible individual unless the 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 interdisciplinary education in
palliative care.
``(4) Maintenance of effort.--An eligible individual who
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(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 which include 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, including the training of
interdisciplinary 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 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 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 Center 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
palliative care that provide supplemental training for
faculty members in medical schools and other health
professions schools with programs in psychology,
pharmacy, nursing, social work, chaplaincy, 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 teaching skills.
``(B) Location.--A fellowship under this paragraph
shall be offered either at the Palliative 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
nursing, schools of pharmacy, schools of social work,
schools of chaplaincy or pastoral care education,
graduate programs in psychology, or other health
professions schools approved by the Secretary with
which the Centers are affiliated.
``(C) CME credit.--Participation in a fellowship
under this paragraph shall be accepted with respect to
complying with continuing health profession education
requirements. As a condition of such acceptance, the
recipient shall subsequently provide a minimum of 18
hours of voluntary instruction 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 this subsection shall meet
targets approved by the Secretary for providing palliative care
training 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.--An award under this subsection
shall be in an amount of $150,000. Not more than 24 Palliative
Care and Hospice Education Centers may receive an award under
this subsection.
``(7) Maintenance of effort.--A Palliative Care and Hospice
Education Center that receives an award under this subsection
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 Incentive Awards.--
``(1) In general.--The Secretary shall award grants or
contracts under this subsection to 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 clinical
social worker, a pharmacist, a chaplain, or student of
psychology who is pursuing a doctorate or other
advanced degree in palliative care or related fields in
an accredited health professions school; 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 this subsection, 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 this subsection to institutions which
include schools of medicine, osteopathic medicine, nursing,
social work, psychology, chaplaincy or pastoral care education,
dentistry, and pharmacy, or other allied health discipline in
an accredited health professions school that is approved by the
Secretary.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $44,100,000 for each of the
fiscal years 2014 through 2018.''.
(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. 4. APPLICATION TO ADVANCED PRACTICE NURSES.
(a) Advanced Education Nursing Grants.--Section 811(a) of the
Public Health Service Act (42 U.S.C. 296j(a)) is amended--
(1) in paragraph (1), by striking ``and'' at the end;
(2) by redesignating paragraph (2) as paragraph (3); and
(3) by inserting after paragraph (1), the following:
``(2) palliative care and hospice career incentive awards
authorized under section 759A(e); and''.
(b) In General.--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, programs and initiatives to train and
educate individuals in providing palliative care in health-related
educational, 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, home, hospice,
or long-term care settings;
``(2) develop and disseminate curricula relating to
palliative care in health-related educational, home, hospice,
or long-term care settings;
``(3) train faculty members in palliative care in health-
related educational, 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 fiscal
years 2014 through 2018.''.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S2149)
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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