S AMDT 1263

S 1263 IS

To amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes.

June 15, 2009

Mr. WARNER introduced the following bill; which was read twice and referred to the Committee on Finance

To amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the ‘Senior Navigation and Planning Act of 2009’.

(b) Table of Contents- The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Medicare and Medicaid coverage of advanced illness care management services.

Sec. 3. Increasing awareness of the importance of end-of-life planning.

Sec. 4. Inclusion of end-of-life planning materials in the Medicare & You handbook.

Sec. 5. Senior Navigation Advisory Board.

Sec. 6. Requirement for physicians and nurse practitioners to provide certain Medicare beneficiaries with information on advance directives and other end-of-life planning tools.

Sec. 7. Improvement of policies related to the use and portability of advance directives.

Sec. 8. Additional requirements for facilities.

Sec. 9. Requirement for Medicare providers to honor written orders for medical care.

Sec. 10. Incentives for accreditation and certification in hospice and palliative care.

Sec. 11. Discharge checklist pilot program.

Sec. 12. Office of Medicare/Medicaid Integration.

Sec. 13. Web-based materials and grants.

Sec. 14. HHS study and report on the storage of advance directives.

Sec. 15. GAO study and report on the provisions of, and amendments made by, this Act.

SEC. 2. MEDICARE AND MEDICAID COVERAGE OF ADVANCED ILLNESS CARE MANAGEMENT SERVICES.

(a) Medicare Coverage of Advanced Illness Care Management Services-

(1) COVERAGE- Section 1812(a)(5) of the Social Security Act (42 U.S.C. 1395d(a)(5)) is amended to read as follows:

‘(5) for individuals who have a life expectancy of 18 months or less and who have not made an election under subsection (d)(1) to receive hospice care under this part, advanced illness care management services (as defined in section 1861(hhh)).’.

(2) DEFINITION- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:

‘Advanced Illness Care Management Services

‘(hhh)(1) The term ‘advanced illness care management services’ means the following services furnished to an individual by a hospice program, as defined in subsection (dd)(2):

‘(A) Palliative care consultation services.

‘(B) Care planning services.

‘(C) Counseling of individual and family members.

‘(D) Discussions regarding the availability of supportive services (including information on advance care planning).

‘(E) Patient-centered care.

‘(F) Family conference services.

‘(G) Respite services.

‘(H) Onsite caregiver training.

‘(I) Such other services as may be appropriate under a hospice model of care.

‘(2) For purposes of paragraph (1)(F), the term ‘family conference services’ means a family conference held by a hospice program (as so defined) for the individual and the family members of the individual, including services for the facilitation and provision of adequate follow-up to such family conference, which includes additional collaboration and coordination with the hospice physician or other hospice personnel to clarify and put into action the goals of care as outlined by the individual and the family members of the individual.

‘(3)(A) For purposes of paragraph (1)(G), the term ‘respite services’ means the provision of additional hours of care to individuals who are unable to perform 2 or more activities of daily living. Such services shall be targeted toward furnishing services to the individual and providing the caregivers of the individual a needed break outside of the home of the individual.

‘(B) For purposes of subparagraph (A), the Secretary shall establish, on an annual basis, a minimum and maximum number of hours (not to exceed 16 hours each month) for which respite services may be provided to individuals eligible to receive such services.

‘(C) In subparagraph (A), the term ‘activities of daily living’ means bathing, transferring, toileting, and feeding.

‘(4) For purposes of paragraph (1)(H), the term ‘onsite caregiver training’ means training provided to the caregivers of an individual, which is focused on training such caregivers to provide effective personal and technical care to individuals, with an emphasis on what the caregiver can expect with the disease process of the individual or the needs of the individual at the end of life. Such training shall be pragmatic and easily understood by non-health professionals as well as culturally and educationally appropriate.

‘(5) In the case of a hospice program that is furnishing advanced illness care management services to an individual who becomes eligible for hospice care under this title, the hospice program shall notify the individual of such eligibility.’.

(3) PAYMENT BASED ON THE PHYSICIAN FEE SCHEDULE- Section 1814(i)(4) of the Social Security Act (42 U.S.C. 1395f(i)(4)) is amended to read as follows:

‘(4) The amount paid to a hospice program with respect to the advanced illness care management services (as defined in section 1861(hhh)) for which payment may be made under this part shall be--

‘(A) with respect to such services, other than respite services, furnished by a hospice physician, an amount equal to the amount that would be paid for an equivalent physician consultation under the fee schedule established under section 1848(b);

‘(B) with respect to such services, other than respite services, furnished by other hospice personnel, an amount equal to 85 percent of such fee schedule amount; and

‘(C) with respect to respite services, payment shall be at an appropriate rate to be determined by the Secretary’.

(4) CONFORMING AMENDMENTS- Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)) is amended--

(A) in paragraph (1)--

(i) by striking ‘and’ at the end of subparagraph (N);

(ii) by striking the semicolon at the end of subparagraph (O) and inserting ‘, and’; and

(iii) by adding at the end the following new subparagraph:

‘(P) in the case of advanced illness care management services which are respite services (as defined in section 1861(hhh)(3)), which are performed more frequently than is provided under clause (ii) of such section;’; and

(B) in paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’.

(5) EFFECTIVE DATE- The amendments made by this subsection shall apply to services furnished on or after January 1, 2011.

(b) Medicaid Coverage of Advanced Illness Care Management Services-

(1) IN GENERAL- Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended--

(A) by redesignating paragraph (28) as paragraph (29);

(B) in paragraph (27), by striking at the end ‘and’; and

(C) by inserting after paragraph (27) the following new paragraph:

‘(28) advanced illness care management services (as defined in section 1861(hhh)) for individuals described in section 1812(a)(5); and’.

(2) CONFORMING AMENDMENT- Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking ‘and (21)’ and inserting ‘, (21), and (28)’.

(3) EFFECTIVE DATE-

(A) IN GENERAL- Except as provided in subparagraph (B), the amendments made by paragraphs (1) and (2) take effect on January 1, 2011.

(B) EXTENSION OF EFFECTIVE DATE FOR STATE LAW AMENDMENT- In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary determines requires State legislation in order for the plan to meet the additional requirements imposed by the amendments made by paragraph (1), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.

(c) Education on Advanced Illness Care Management Services- The Secretary of Health and Human Services (in this section referred to as the ‘Secretary’) shall establish a program under which physicians (as defined in subsection (r) of section 1861 of the Social Security Act (42 U.S.C. 1395x)) are educated on the coverage of advanced illness care management services (as defined in subsection (hhh) of such section) under the Medicare and Medicaid programs under titles XVIII and XIX, respectively, of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.), including the importance of early intervention in providing such care to individuals.

SEC. 3. INCREASING AWARENESS OF THE IMPORTANCE OF END-OF-LIFE PLANNING.