Sec. 5. Medicaid reimbursement for hospice services. The Department of Human Services shall adopt rules to amend its state plan to provide Medicaid reimbursement for hospice care. The rules must meet the following requirements.

1. For hospice patients residing in nursing facilities, the department shall diligently pursue mechanisms that will provide for direct payment to nursing facilities for room and board. In addition, receiving the Medicaid benefit should not preclude access to other Medicaid services not covered by hospice.

2. The rate of reimbursement must be at least $130 per day.

3. The rules must provide for expedited determination of eligibility within 14 days of application. The rules must also cover other hospice eligibility issues, including, but not limited to, physician certification of terminal illness, election of hospice benefit and delineation of services that are reasonable and necessary for the palliation or management of terminal illness or related conditions.

4. The rules must address outlier payments for necessary palliation for hospice patients, including chemotherapy, radiation therapy, HIV/AIDS related medications, blood products, total parenteral nutrition and radiographic diagnostics.

Rules adopted pursuant to this section are major substantive rules as defined by the Maine Revised Statutes, Title 5, chapter 375, subchapter II-A.

The department shall report to the Joint Standing Committee on Health and Human Services by January 1, 2002 regarding the rulemaking.

Sec. 6. Maine Center for End-of-life Care. The Department of Human Services, Bureau of Health may establish, through contract or otherwise, the Maine Center for End-of-life Care. The purpose of the center is to educate health care providers and the public regarding pain management and palliative and end-of-life care. The center must maintain a registry of health professionals trained in pain management and palliative and end-of-life care. The bureau may solicit and accept outside funding through grants and other sources to establish and operate the center, which may be hosted by an educational institution, professional association or other entity interested in the care of the terminally ill. By January 15th each year the bureau shall report to the joint

standing committee of the Legislature having jurisdiction over health and human services matters regarding the operation of the center and its funding.

Sec. 7. Professional education. The Department of Professional and Financial Regulation, Office of Licensing and Registration shall undertake a study of professional entry-level and continuing educational requirements related to end-of-life care, palliative care, hospice, pain management, advanced health care directives, appointment of health care decision surrogates and do-not- resuscitate orders. In considering the requirements for professional training, licensure and registration, the office shall work cooperatively with boards of licensure and registration and with professionals working in end-of-life care. The office shall work with boards and members of the following professions: counselors, social workers, psychologists, medicine, osteopathic licensure, nursing, funeral directors, complimentary health care providers, hospice caregivers and clergy. The office shall report to the Joint Standing Committee on Health and Human Services by January 15, 2002 regarding findings and any recommendations from the office.

Sec. 8. Baseline data and standardized assessment tools. The Maine Health Data Organization, referred to in this section as the "organization," established in the Maine Revised Statutes, Title 22, chapter 1683, shall direct an effort to gather baseline data and standardized assessment tools regarding end-of-life care, palliative care, pain and symptom management and quality indicators for the care of terminally ill persons. The organization shall work with professionals in the care of persons who are terminally ill and shall consider the cost of untreated pain, the effect of untreated pain on the workplace, the impact of untreated pain on emergency room use and hospitalizations and possible drug and alcohol abuse. The organization shall report by January 15, 2002 to the Joint Standing Committee on Health and Human Services regarding its findings and any recommended legislation.

Sec. 9. Study. The Joint Standing Committee on Health and Human Services shall undertake a study of end-of-life and palliative care, pain management and barriers to the establishment of inpatient hospice programs in the State. The study must include recommendations for overcoming those barriers and a strategic plan for providing end-of-life and palliative care statewide and consider other issues as determined by the committee. The committee shall meet at least 4 times prior to January 1, 2002.

Sec. 10. Appropriation. The following funds are appropriated from the General Fund to carry out the purposes of this Act.

2001-02

HUMAN SERVICES, DEPARTMENT OF

Maine Hospice Council

All Other $50,000

Provides funds to support volunteer hospice programs.

SUMMARY

This bill contains a number of provisions regarding hospice, end-of-life and palliative care.

1. It requires health insurance and health maintenance contracts to cover palliative, hospice and end-of-life care.

2. It provides reimbursement under the Medicaid program for hospice care at $130 per day.

3. It authorizes the Department of Human Services to establish the Maine Center for End-of-life Care.

4. It requires a report from the Department of Professional and Financial Regulation, Office of Licensing and Registration by January 15, 2002 regarding professional education requirements regarding end-of-life care, palliative care, hospice, pain management, advanced health care directives, appointment of health care decision surrogates and do-not-resuscitate orders.

5. It requires the Maine Health Data Organization to gather baseline data and standardized assessment tools regarding end-of- life care, palliative care, pain and symptom management and quality indicators for the care of terminally ill persons.

6. It requires the Joint Standing Committee on Health and Human Services to undertake a study of palliative care, hospice care and the barriers to inpatient hospice care.

7. It appropriates $50,000 for the Maine Hospice Council.