S. 1935 — Expanding Access to Palliative Care Act

This section requires the Center for Medicare and Medicaid Innovation (CMI) to test a new community-based palliative care model (in new subsection (h)) as one of the models selected under existing subsection (b)(2)(A). (As background, CMI tests innovative payment and service delivery models for Medicare (Title XVIII) and Medicaid (Title XIX) to reduce program expenditures while preserving or enhancing care quality for beneficiaries.) The model provides community-based palliative care and care coordination for high-risk Medicare Part A beneficiaries with serious illnesses or injuries (e.g., cancer, heart disease, dementia, ALS), in co-management with other providers, to improve outcomes and care experience while reducing unnecessary emergency department visits and hospitalizations. (Thus, it is intended to replace the Medicare Care Choices Model, a prior demonstration; prior hospice use does not exclude participation.) The 5-year model, beginning no later than one year after enactment, includes: (1) eligible providers such as palliative care teams, home health agencies, hospitals, and integrated systems; (2) multidisciplinary teams with at least one member certified in hospice and palliative care; (3) services addressing pain/symptom management, advance care planning, mental health, caregiver support, and more, furnished 24/7 (including telehealth) in homes, facilities, or inpatient settings without service disruption on location changes; and (4) equitable access emphasis for rural/underserved areas. CMI must assess the model by comparing participants to similar non-participants on metrics including service utilization (e.g., emergency departments, inpatient admissions, ICU stays), hospice elections and duration, demographics, and care experience.