Expanding Access to Palliative Care Act
This bill requires the Center for Medicare and Medicaid Innovation (CMMI) to test a model that provides community-based palliative care and care coordination for high-risk Medicare beneficiaries and that may replace the Medicare Care Choices Model (which ended on December 31, 2021).
Under the new model, multi-disciplinary teams must provide coordinated, palliative care that is available 24-7 for Medicare beneficiaries with serious illnesses or injuries, such as cancer. The CMMI must evaluate the model by comparing patients participating in the model with those outside of the model in relation to specified metrics, including the election and duration of hospice care.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1935 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 1935
To amend title XI of the Social Security Act to provide for the testing
of a community-based palliative care model.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 3, 2025
Ms. Rosen (for herself, Mr. Barrasso, Ms. Baldwin, and Mrs. Fischer)
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 provide for the testing
of a community-based palliative care model.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Expanding Access to Palliative Care
Act''.
SEC. 2. COMMUNITY-BASED PALLIATIVE CARE MODEL.
Section 1115A of the Social Security Act (42 U.S.C. 1315a) is
amended--
(1) in subsection (b)(2)(A), by adding at the end the
following new sentence: ``The models selected under this
subparagraph shall include the testing of the model described
in subsection (h).''; and
(2) by adding at the end the following new subsection:
``(h) Community-Based Palliative Care Model.--
``(1) In general.--The CMI shall develop and implement a
model to provide community-based palliative care and care
coordination for high-risk beneficiaries, in co-management with
other providers of services and suppliers, aimed at improving
outcomes and experience of care and reducing unnecessary or
unwanted emergency department visits and hospitalizations (in
this subsection referred to as the `model'), and that is
intended to replace the Medicare Care Choices Model.
``(2) Duration.--The model shall be implemented for a 5-
year period, beginning not later than one year after the date
of the enactment of this subsection.
``(3) Target population.--
``(A) In general.--The target population for the
model is an individual--
``(i) entitled to, or enrolled for,
benefits under part A of title XVIII; and
``(ii) with a diagnosis of a serious
illness or injury, which may include a
diagnosis of cancer, heart and vascular
disease, pulmonary disease, human
immunodeficiency virus/acquired
immunodeficiency, Alzheimer's and dementia,
stroke, serious injury requiring rehabilitation
including burns, kidney disease, liver disease,
Amyotrophic lateral sclerosis, any neuro
degenerative disease, or any other serious
illness or injury the Secretary determines
appropriate.
``(B) No exclusion for prior use of hospice care
benefits.--An individual shall not be excluded from
participation in the model based on prior use of
hospice care benefits during any period prior to such
participation, regardless of the source of coverage for
such benefits.
``(4) Participating providers.--Providers eligible to
participate under the model may include palliative care teams
working as an independent practice or associated with a hospice
program, home health agencies, hospitals, integrated health
systems, and other facilities determined appropriate by the
Secretary.
``(5) Team-based approach.--Under the model, at least one
member of the multi-disciplinary palliative care team shall be
certified in hospice and palliative care. This is a co-
management model with palliative care aligning with primary and
specialist care for a team-based approach. Care must be
coordinated across providers and community services for
inclusion of all pain, symptom management, disease-modifying
and curative treatments, and other palliative care services.
``(6) Location.--Care may be furnished under the model in
any beneficiary `home', including a caregiver's residence, an
extended care facility, or a community setting as appropriate
based on the individual's ability to access services. The model
shall include access within an in-patient stay so long as the
patient begins receiving palliative care services prior to
admission. Services shall not be disrupted solely due to change
in location from a residence to an in-patient setting, and
shall be part of care coordination and care planning following
hospital discharge.
``(7) Services.--The model shall include items and services
based on specific patient needs with respect to pain, symptom
management, education, disease modifying treatments, advance
care planning and shared decision making, goals clarification,
mental health services, family and caregiver support services,
spiritual support care, personal care assistance, and stress
reduction therapies. This includes a comprehensive assessment
of symptoms and stress factors that impact quality of life.
``(8) Access.--Care shall be available under the model 24
hours a day, 7 days a week, and 365 days a year, including
telehealth services. The CMI shall specifically consider the
needs of rural and underserved areas and adjust accordingly to
ensure equitable access to care. A broad range of providers
must be included with no geographic limitations.
``(9) Metrics.--The CMI shall assess the model by comparing
participants to other members of the target population who are
receiving care outside of the model, including with respect to
the following:
``(A) Demographics (including age, diagnosis,
residence type, medical encounters in preceding 12
months leading to enrollment, geographic location (such
as urban or rural) and others as determined by the
CMI).
``(B) Impact on utilization of items and services
under title XVIII (such as emergency department
services, hospital observation services, inpatient
admissions, and intensive care unit (ICU) stays).
``(C) Election of hospice care.
``(D) Duration of hospice care.
``(E) Care Experience (beneficiary and
caregiver).''.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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