Expanding Access to Palliative Care Act

Bill Summary: Expanding Access to Palliative Care Act (S. 1935)

Overview

The Expanding Access to Palliative Care Act is a legislative proposal designed to improve the quality of life for Medicare beneficiaries facing serious illnesses. The bill seeks to establish a new, community-based palliative care model under the Center for Medicare and Medicaid Innovation (CMI) to provide coordinated, multi-disciplinary care that reduces unnecessary hospitalizations and emergency room visits.

Main Purpose and Intent

The primary goal of the bill is to transition from the "Medicare Care Choices Model" to a more robust Community-Based Palliative Care Model. This model focuses on "co-management," meaning palliative care works in tandem with primary care physicians and specialists to ensure that patients receive comprehensive symptom management and support without sacrificing curative treatments.

Key Provisions

1. Target Population

The model is available to individuals enrolled in Medicare Part A who have a serious illness or injury, including:
* Cancer, heart/vascular disease, and pulmonary disease.
* Alzheimer’s, dementia, and other neurodegenerative diseases.
* Kidney, liver, and HIV/AIDS diagnoses.
* Serious injuries requiring rehabilitation (e.g., burns).
* Important: Individuals are not excluded from this model even if they have previously used hospice care benefits.

2. The Care Model & Team Approach

• Multi-disciplinary Teams: Care must be provided by a team where at least one member is certified in hospice and palliative care.
• Comprehensive Services: Coverage includes pain and symptom management, mental health services, spiritual support, caregiver support, advance care planning, and stress reduction therapies.
• Accessibility: Care must be available 24/7, 365 days a year, including via telehealth.
• Flexible Locations: Services can be provided in the patient's home, a caregiver's residence, extended care facilities, or community settings. Crucially, care remains continuous if a patient is admitted to a hospital.

3. Eligible Providers

A wide range of entities can participate, including:
* Independent palliative care practices.
* Hospice programs and home health agencies.
* Hospitals and integrated health systems.

Impact and Implementation

Who is Affected?

• Patients: High-risk Medicare beneficiaries with chronic or terminal illnesses will have increased access to specialized support.
• Healthcare Providers: A broader array of providers (from independent practitioners to large health systems) can participate in this coordinated care model.
• Rural Communities: The bill specifically mandates that the CMI consider the needs of rural and underserved areas to ensure equitable access.

Timeline and Metrics

• Duration: The model will be implemented for a 5-year period, starting no later than one year after the Act is enacted.
• Evaluation: The CMI will measure the model's success by comparing participants against a control group, focusing on:
  • Reduction in ER visits and ICU stays.
  • Impact on the election and duration of hospice care.
  • The overall care experience for both the beneficiary and their caregiver.

Procedural Status

The bill was introduced in the Senate on June 3, 2025, and has been referred to the Committee on Finance.