119-s1935

[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).''.
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