This Legislation would provide expanded education, training, research and awareness of palliative care impact. The bill amends the Public Health Service Act to require the Department of Health and Human Services (HHS) to award grants or contracts for Palliative Care and Hospice Education Centers. These Centers must improve the training of health professionals in palliative care and establish traineeships for individuals preparing for advanced education nursing degrees, social work degrees, or advanced degrees in physician assistant studies in palliative care.
In summary, the bill stipulates that HHS must: (1) provide Palliative Medicine and Hospice Academic Career Awards to individuals to promote their career development; (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, social workers, physician assistants, 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 nurse assistant to train individuals in providing palliative care.
Introduced in June, 2016 this bill has been assigned to the Senate Finance and Special Aging Committees. To date, there has been no roll call votes on this bill.
This Act would test a shared savings payment model in ‘Advanced Care Collaboratives’ of affiliated health care providers and community-based social service organizations. Collaboratives would receive a planning grant to assess the needs of the population of patients it would serve. Once planning is complete, collaboratives would enter a three-year payment agreement with Medicare to provide coordinated, high-quality care for their target patient population. Under the terms of the pilot program, CMS would waive regulations to promote innovative care for patients with advanced illness.
Waivers would be granted to:
- Allow Medicare patients to receive hospice care and curative treatment at the same time. CMS’s current regulations force patients to choose one or the other for their terminal illness.
- Allow patients to receive Medicare coverage in a skilled nursing home without a consecutive three-day inpatient hospital stay. Under current Medicare rules, patients are often charged for skilled nursing care after they leave an inpatient hospital stay because they were hospitalized for observation rather than admitted to the hospital.
- Allow Medicare patients to receive home health services without the requirement that they be homebound. Under current rules, a patient’s condition must have progressed such that there “exists a normal inability to leave home,” denying these services to those who are seriously ill but still mobile.
- Allow nurse practitioners to sign home health and hospice care plans and certify patients for services. Right now, only doctors can do so, even though nurse practitioners are often the ones overseeing the patient’s health care. This forms another barrier for patients seeking these services, especially in underserved and rural areas.
The bill would also create two new coverage options under Medicare’s hospice benefit, which is available for terminally-ill Medicare beneficiaries with a life prognosis of six months.
Those options would:
- Allow Medicare coverage of room and board at inpatient facilities for individuals who elect and are certified for routine hospice care, but whose home environment is not safe for home-based hospice care. Currently, Medicare does not pay for room and board at nursing facilities for individuals who elect routine-level hospice care. Dying patients whose home environment is not conducive to home-based care often opt to receive rehabilitative services to retain Medicare coverage of facility-based care, leading to patients receiving unnecessary and possibly harmful rehab.
- Allow Medicare coverage for short-term, home-based respite care as an alternative to inpatient respite care for individuals who elect and are certified for routine hospice care. Providing patients and their caregivers the option to stay in their home for the receipt of respite care would alleviate the stress of transporting a dying patient to and from an inpatient facility.
What is the Palliative Care Information Act and what does that mean for New York State residents? On August 13th, 2010 Governor David A. Paterson signed the New York Palliative Care Information Act into law. The law, which went into effect on February 9th, 2011 requires physicians and nurse practitioners treating patients diagnosed with a terminal illness or condition to offer the patient or their surrogate representative information and counseling on the available options for palliative care and end-of-life care including aggressive pain management and hospice care as well as the possibilities for further life-sustaining treatment.
The Palliative Care Access Act (PCAA) became effective on September 27, 2011. Like the Palliative Care Information Act (PCIA) Like the PCIA, the PCAA is intended to ensure that patients are fully informed of the options available to them when they are faced with a serious illness or condition, so that they are empowered to make choices consistent with their goals for care, wishes and beliefs, and to optimize their quality of life.
The law is not intended to limit the options available to patients. Patients and providers should recognize that palliative care and disease-modifying therapies are not mutually exclusive. Patients may opt to pursue palliative care while also pursuing aggressive treatment. Palliative care may be provided together with life-prolonging or curative care or as the main focus of care. The NYS Department of Health (DOH) has posted frequently asked questions about the PCAA for patients and their families in the next few weeks which you can view using this link.
If you have any additional questions, please contact us at the Hospice & Palliative Care Association directly at: firstname.lastname@example.org or call 518-446-1483
The Hospice Modernization Bill was Signed into Law!
On August 18th, 2011 Governor Cuomo signed A. 7650A/S. 5554, a Hospice Modernization bill, into law! This new statute, which becomes effective immediately makes the following changes: 1) changes the definition of terminal prognosis from 6 months to 12 months, and; 2) allows hospices to employ/contract with physicians for the provision of palliative care.
The Family Health Care Decisions Act (FHCDA) is a law that allows family members to make decisions regarding medical treatment for their loved ones who have lost the ability to make such decisions and who have not prepared an advance directive stating their wishes. The law includes many safeguards to ensure that the patient receives sound medical treatment and that decisions are made consistent with the patient’s wishes and best interests.
The FHCDA establishes a process for determining whether an adult patient without a health care proxy has decision-making capacity. If the patient’s physician and a consulting physician agree that the patient lacks the capacity to make health care decisions, the law establishes a priority list for choosing a person to be the surrogate decision maker. Anyone lower in the hierarchy (e.g., an adult child instead of a spouse) or in the same category (e.g., another sibling) can challenge the designation. Also, in the case of vulnerable patients, the choice of surrogate and that surrogate’s decisions may be subject to review.
In July of 2011, New York State passed a new law expanding the FHCDA to include decisions regarding hospice care. Previously, the law had applied only to patients in general hospitals or residents in nursing homes, not to people at home, in assisted living facilities, or in hospice care. The new law allows surrogates to make decisions regarding hospice care, including the decision to elect hospice and consent to the hospice plan of care, regardless of where the decision is made and where the hospice care is provided.
The American Cancer Society’s Cancer Action Network released their “2012 Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality” which includes a section on palliative care and a team approach to pain control. The sections on palliative care and pain control begin on page 42.
Rhode Island has become the fifth state in 2013 to pass palliative care legislation. Driving these bills has been the growing awareness that palliative care can benefit all people with serious illness, not just those who may be at the end of life, and that this care is a crucial aspect of healthcare quality. This page summarizes the key provisions of the laws passed Maryland, Connecticut, Rhode Island, New Hampshire, and Massachusetts in 2013.