H.R. 4425 amends the Public Health Service Act to create a coordinated federal program of grants, contracts, fellowships, and career awards aimed at increasing permanent faculty and clinical trainers in palliative care and hospice across medical, nursing, and other health professions programs. It authorizes new HHS grant streams for multidisciplinary education programs, short-term fellowships for faculty retraining, academic career awards for junior faculty in palliative disciplines, career incentive awards for trainees, targeted nurse education grants, consumer-facing dissemination materials, and an NIH strategy to expand palliative-care research.
The bill matters because it moves beyond ad hoc training and establishes explicit federal funding lines and priorities (rural/underserved populations, pediatrics, minority groups) to improve access to team-based palliative services. For compliance officers and academic administrators, the statute sets award conditions (maintenance-of-effort, service commitments, accreditation and fellowship-base requirements), fixed appropriation levels, and program caps that will shape how institutions plan faculty hiring, fellowship accreditation, and curriculum development.
At a Glance
What It Does
Directs HHS to award grants and contracts to academic and health education entities to run Palliative Care and Hospice Education Programs, provides physician retraining and fellowship options, creates Palliative Care Academic Career Awards and career incentive awards, funds nurse-focused education grants, requires consumer information dissemination, and tasks NIH with a cross-institute palliative research strategy. It authorizes specific annual appropriation amounts for these activities.
Who It Affects
Allopathic and osteopathic medical schools, nursing schools, programs in social work, physician assistant, chaplaincy, pharmacy, psychology and similar disciplines; teaching hospitals and accredited hospice and palliative medicine fellowships; faculty (including junior nontenured faculty) and clinical trainees; and Federal agencies that fund or disseminate health information (NIH, HRSA, AHRQ, VA, CMS).
Why It Matters
The bill operationalizes federal investment in palliative-care workforce capacity and research rather than leaving expansion to states or private funders. It sets conditions—service requirements, maintenance-of-effort, accreditation baselines, program priorities and caps—that determine which institutions can scale palliative care education and how quickly clinical capacity can grow.
More articles like this one.
A weekly email with all the latest developments on this topic.
What This Bill Actually Does
The bill inserts a new Part (section 759A) into Title VII authorizing Palliative Care and Hospice Education Programs via HHS grants and contracts to accredited institutions and eligible entities under existing workforce sections. Those programs must support traineeships and fellowships, teach interprofessional team-based care, run community-based training, and emphasize patient and family engagement.
HHS must avoid duplicating existing centers and must prioritize applicants that coordinate with federal or state programs or serve rural, frontier, tribal, pediatric, or racial and ethnic minority populations.
For physicians, the statute allows grants and contracts to medical schools, teaching hospitals, and GME programs to fund training of physicians who will teach or practice palliative medicine. Projects must be staffed by full-time teaching physicians, be anchored in ACGME-accredited hospice and palliative medicine fellowship programs, offer diverse service rotations, use performance-based competency measures, and deliver either 1-year retraining programs for faculty or 1–2 year fellowship-style training paths for physicians already board-eligible in hospice and palliative medicine.The bill creates three targeted award streams to build academic capacity: Palliative Care and Hospice Academic Career Awards for junior (nontenured) faculty (payments made to institutions, five-year maximum awards, amount tied to section 753(b)(5)(A) for that fiscal year), Palliative Care Workforce Development fellowships (short intensive courses for faculty needing supplemental training, awards capped at $150,000 and limited to no more than 24 programs), and Palliative Care and Hospice Career Incentive Awards that fund advanced-degree trainees across professions who accept a minimum five-year post-award practice or teaching commitment in palliative settings.
All award recipients and grantees must provide assurances that federal funds supplement, not supplant, existing expenditures.Separately, the bill amends Title VIII to add nurse-focused education, authorizing $5 million per year (2026–2030) for grants that train clinicians and faculty in hospice and palliative nursing and to develop curricula. It also adds a new authority under Title IX directing the Department’s communications office to develop and post consumer- and provider-facing materials on palliative care benefits, services, professionals’ roles, evidence of benefit, and population-specific materials (Medicare/Medicaid/Veterans and underserved populations), in consultation with professional societies and stakeholders.
A new NIH directive requires a cross-institute strategy to increase palliative-care research. The bill includes a statutory clarification that federal funds under the Act may not be used to provide or promote items barred by 42 U.S.C. 14402 and states that palliative care shall not be furnished for the purpose of causing or assisting in causing a patient’s death.
The primary Title VII amendment is effective 90 days after enactment and the bill authorizes $15 million per year for 2026–2030 for the Title VII programs.
The Five Things You Need to Know
The bill authorizes $15 million per year (FY2026–FY2030) for the Title VII Palliative Care and Hospice Education Programs and related awards.
Palliative Care and Hospice fellowship grants used for short-term intensive faculty courses are capped at $150,000 per award and no more than 24 programs may receive these awards.
Palliative Care Academic Career Awards target junior (nontenured) faculty, are paid to institutions, may run up to 5 years, and the award amount is set equal to section 753(b)(5)(A) for the fiscal year.
Career Incentive Awards require recipients (advanced practice nurses, social workers, PAs, pharmacists, chaplains, psychologists, etc.) to commit to at least 5 years of teaching or practicing palliative care after the award period.
The bill requires NIH to develop a cross‑institute strategy to expand palliative-care research and directs HHS to post consumer- and provider-oriented palliative-care information on federal websites.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Short title
Names the measure the 'Palliative Care and Hospice Education and Training Act.' This is administrative but frames the bill's scope around education, training, and workforce development rather than direct care payment or service delivery reform.
Palliative Care and Hospice Education Programs — grants and priorities
Establishes the primary grant and contract authority to fund Palliative Care and Hospice Education Programs at entities eligible under existing workforce sections. Requires programs to provide interdisciplinary clinical training, traineeships/fellowships, community-based training, and family engagement components. Directs HHS to prioritize applicants that coordinate with other federal/state programs and those focusing on rural/underserved areas, tribal organizations, pediatrics, and racial/ethnic minority populations. Also authorizes expansion of existing geriatric programs to include palliative training and explicitly allows multiple programs in a community.
Physician training and fellowship requirements
Authorizes grants/contracts to medical schools, teaching hospitals, and GME programs to support physicians who will teach or practice palliative medicine. Projects must be staffed by full-time teaching physicians, be based in ACGME-accredited hospice and palliative medicine fellowships, offer diverse clinical rotations, define performance-based competency measures, and offer either a 1-year retraining option for faculty or 1–2 year training programs for physicians completing specialty GME leading to hospice and palliative medicine board eligibility.
Academic Career Awards, Workforce Fellowships, and Career Incentives
Creates three distinct award streams. Academic Career Awards support junior faculty (non-tenured) with institutional payments, a majority-of-time teaching/service requirement, and up to five-year terms; award amounts reference an existing statutory figure (section 753(b)(5)(A)). Workforce Development fellowships fund short intensive retraining courses for faculty and volunteer practitioners, are limited to $150,000 per award, and to 24 programs. Career Incentive Awards subsidize advanced-degree trainees across professions who commit to at least five years of subsequent palliative practice or teaching; payments flow to institutions. All streams require maintenance-of-effort assurances that federal funds supplement rather than supplant existing funds.
Hospice and palliative nursing education grants
Amends nurse education provisions to explicitly include hospice and palliative nursing and creates a Title VIII grant program (sec. 832) to train clinicians and faculty, develop curricula, and support continuing education in palliative care settings. Authorizes $5 million per year for FY2026–FY2030 for these activities, defines eligible entities (nursing schools, healthcare facilities, CNA programs, partnerships), and requires applications per HHS rules.
Dissemination of palliative-care information
Gives the Director authority to disseminate materials that explain palliative-care services, professional roles, and evidence of benefit; requires posting materials on federal websites (e.g., VA, CMS, AoA) and developing population-specific content for Medicare/Medicaid/VA beneficiaries and medically underserved groups. Calls for stakeholder consultation and asks the Director to define 'serious or life‑threatening illness' for program purposes.
Clarifications and funding restrictions
Prohibits use of program funds for items or training barred under 42 U.S.C. 14402 and states that palliative care and hospice funded under the Act are not to be furnished for the purpose of causing or assisting in causing death. These clauses function as statutory guardrails addressing controversial end-of-life practices and federally barred activities.
NIH strategy to enhance palliative-care research
Directs the Secretary (or designee) to develop and implement a cross‑institute NIH strategy to expand palliative-care research across conditions including cancer, organ disease, infectious disease, and neurodegenerative illnesses, and amends reporting to include palliative-care research starting January 1, 2026.
This bill is one of many.
Codify tracks hundreds of bills on Healthcare across all five countries.
Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Junior and nontenured faculty in palliative disciplines — the Academic Career Awards provide multi-year salary support and institutional payments to preserve time for teaching and curriculum development, improving retention and career tracks in academic palliative care.
- Educational programs (medical, nursing, social work, PA, chaplaincy, pharmacy, psychology) — new grant streams fund curriculum development, faculty retraining fellowships, and expanded interdisciplinary training capacity.
- Patients in rural, frontier, tribal, pediatric, and racial/ethnic minority communities — the statute gives priority to programs serving these populations, which aims to increase provider capacity where shortages are often greatest.
- NIH and research-oriented institutions — a mandated cross‑institute NIH strategy creates a clearer federal research agenda and potential funding pathways for palliative-care studies across disease areas.
- Health systems and hospices seeking faculty partnerships — grants encourage integration of palliative care into primary care, hospitals, FQHCs, nursing facilities, and home- and community-based settings, supporting workforce development that systems can leverage.
Who Bears the Cost
- Academic institutions receiving awards — they must provide maintenance-of-effort assurances, institutional matching or continued spending, and commit faculty time (majority-of-funded-time) which constrains budgeting and staffing plans.
- Teaching hospitals and fellowship programs — projects must be anchored in accredited fellowships and staffed by full-time teaching physicians, which increases demand for accredited positions and may require program restructuring or new hires.
- Smaller or non-academic providers (community clinics, some rural providers) — program design favors accredited schools and fellowship-linked entities, so community-based organizations may face barriers to direct funding unless they partner with academic centers.
- HHS/NIH administrative units — the agencies must develop new grant program rules, review applications, manage service-requirement compliance, publish dissemination materials, and implement an NIH research strategy without specific administrative appropriations beyond the program caps.
- Award recipients under service commitments — individuals who accept Career Incentive Awards owe a minimum five-year service period, creating potential retention monitoring and liability if service requirements are unmet.
Key Issues
The Core Tension
The bill's central dilemma is between rigorous, accredited academic training that safeguards quality and evidence-based practice, and the urgent need to scale up palliative-care capacity quickly across diverse, often under-resourced settings: tight eligibility, accreditation and faculty‑time requirements improve training quality but limit who can receive funds and how fast the workforce can expand, while looser standards would scale faster but risk uneven training and weaker integration with academic practice.
The bill creates focused federal funding lines but on a modest scale relative to the size of the workforce gap; $15 million per year for Title VII programs and $5 million per year for nurse education will seed activity but will not on its own create a nationwide palliative workforce. Program design choices—anchoring physician training to ACGME-accredited fellowships and tying academic awards to junior faculty appointments—prioritize high-quality, academically grounded training but may slow deployment by excluding capable community trainers who lack formal academic appointments or fellowship affiliations.
The maintenance-of-effort provisions and majority-of-time teaching commitments protect against supplantation but shift financial and administrative burdens onto institutions that must demonstrate continued funding and allocate faculty time.
Several implementation questions could materially affect program outcomes. The bill requires the HHS Director to define 'serious or life‑threatening illness' for dissemination purposes, which will shape outreach and eligible populations; variable definitions across agencies could produce uneven messaging.
The cap of 24 fellowships at $150,000 each creates a tight bottleneck for intensive retraining, and the statutory linkage of Academic Career Award amounts to another section of law means the actual award size will depend on future rulemaking or appropriations language. Finally, service requirements (five years) and the maintenance-of-effort standard necessitate compliance monitoring; the statute lacks detailed enforcement mechanisms for recipients who fail to meet post-award obligations, leaving practical enforcement to HHS rulemaking.
Try it yourself.
Ask a question in plain English, or pick a topic below. Results in seconds.