II 

115TH CONGRESS 

1ST SESSION S. 1334 

To amend title XVIII of the Social Security Act to provide for advanced 

illness care coordination services for Medicare beneficiaries, and for other 

purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 12, 2017 

Mr. WARNER (for himself, Mr. ISAKSON, Ms. BALDWIN, Ms. COLLINS, Ms. 

KLOBUCHAR, and Mrs. CAPITO) introduced the following bill; which was 

read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for advanced illness care coordination services for Medicare beneficiaries, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Patient Choice and Quality Care Act of 2017’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

Sec. 3. Advanced illness care and management model. 


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Sec. 4. Quality measurement development and implementation. 

Sec. 5. Enhancing coverage of advance care planning services. 

Sec. 6. Advance care planning support tools. 

Sec. 7. Advance directives. 

Sec. 8. Additional requirements for facilities. 

Sec. 9. Grants for increasing public awareness and training. 

Sec. 10. Advance Care Planning Advisory Council. 

Sec. 11. Annual report on Medicare decedents. 

Sec. 12. Rule of construction. 

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) The population of the United States is esti4 mated to age rapidly, with the number of people over 

5 the age of 65 set to double to more than 98 million, 

6 or 1 in 5 Americans, by 2040. 

7 (2) As Americans live longer and healthier lives, 

8 they also face increased incidence of multiple serious 

9 or chronic progressive conditions and advanced ill10 ness as they age. 

11 (3) Americans with serious, chronic progressive, 

12 or advanced illness face a complicated and frag13 mented system of care delivery that puts them at 

14 risk for repeat hospitalizations, adverse drug reac15 tions, and conflicting medical advice that may be 

16 overwhelming to individuals and families. 

17 (4) The progression of serious, chronic progres18 sive, or advanced illness leads to the need for in19 creasingly intensive decision support, health care 

20 services, and support from family caregivers. 


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1 (5) The complexity of care needed by individ2 uals with serious, chronic progressive, or advanced 

3 illness may result in uncoordinated care, adverse 

4 health outcomes, frustration, wasted time, and 

5 undue emotional burdens on individuals and their 

6 family caregivers. 

7 (6) Numerous private sector leaders, including 

8 hospitals, health systems, home health agencies, hos9 pice programs, long-term care providers, employers, 

10 and other entities, have put in place innovative solu11 tions to provide more comprehensive and coordinated 

12 care for Americans living with serious, chronic pro13 gressive, or advanced illness. 

14 (7) Hospice and palliative care programs offer 

15 patients and families appropriate and patient-cen16 tered care, delivered by an interdisciplinary care 

17 team. These programs should serve as models for se18 rious, chronic progressive, or advanced illness care 

19 delivery. 

20 (8) Individuals have the well-established right 

21 to accept or reject medical treatment that is offered 

22 and all individuals should be afforded the oppor23 tunity to fully participate in decisions related to 

24 their health care. 


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1 (9) Too often, individuals with serious, chronic 

2 progressive, or advanced illness do not understand 

3 the conditions they are facing or their treatment op4 tions, and they do not receive the information or 

5 support they need to evaluate treatment options in 

6 light of their personal goals and values and to docu7 ment treatment plans in a manner that allows pro8 viders and facilities to follow their plans. 

9 (10) Providing high-quality advanced care plan10 ning services and supports to individuals with seri11 ous, chronic progressive, or advanced illness will pro12 tect and preserve their dignity and ensure care is 

13 aligned with an individual’s goals, values, and stated 

14 preferences. 

15 SEC. 3. ADVANCED ILLNESS CARE AND MANAGEMENT 

16 MODEL. 

17 Section 1115A of the Social Security Act (42 U.S.C. 

18 1315a) is amended— 

19 (1) in subsection (b)(2)(A), by adding at the 

20 end the following new sentence: ‘‘The models se21 lected under this subparagraph shall include the 

22 model described in subsection (h), which shall be im23 plemented by not later than 1 year after the date of 

24 the enactment of the Patient Choice and Quality 

25 Care Act of 2017.’’; 


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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘(h) ADVANCED ILLNESS CARE AND MANAGEMENT

4 MODEL.— 

5 ‘‘(1) MODEL.— 

6 ‘‘(A) IN GENERAL.—The model described 

7 in this subparagraph is a model under which 

8 payments are made under title XVIII to appli9 cable providers that furnish advanced illness 

10 care and management services, including care 

11 coordination and palliative care services, to eli12 gible individuals with serious, chronic progres13 sive, or advanced illness in order to test the use 

14 of targeted advanced illness management and 

15 early use of palliative care under the Medicare 

16 program. 

17 ‘‘(B) VOLUNTARY.—Participation under 

18 the model shall be voluntary with respect to 

19 both eligible individuals and applicable pro20 viders. 

21 ‘‘(C) REQUIREMENTS.— 

22 ‘‘(i) HOSPICE PROVIDER.—At least 

23 one applicable provider selected for partici24 pation under the model shall be a hospice 


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1 program (as defined in section 

2 1861(dd)(2)). 

3 ‘‘(ii) COMPARISON.—The Secretary 

4 shall establish the model in such a manner 

5 as will permit the comparison of outcomes 

6 for eligible individuals participating under 

7 the model and eligible individuals who are 

8 not so participating. 

9 ‘‘(iii) INCORPORATION INTO EXISTING

10 MODELS.—In addition to operating the 

11 model independently, the Secretary shall 

12 incorporate the model into existing models 

13 related to the Medicare program, such as 

14 models involving accountable care organi15 zations, bundled payments, and value 

16 based purchasing arrangements, and other 

17 coordinated care models as the Secretary 

18 determines to be appropriate. 

19 ‘‘(2) PAYMENTS.—Under the model, the Sec20 retary shall establish payment amounts for advanced 

21 illness care and management services that is tar22 geted to eligible individuals with a serious, chronic 

23 progressive, or advanced illness. The payments may 

24 include payments under a fee schedule, capitated 

25 payments, bundled payments, value-based purVerDate Sep 11 2014 00:31 Jun 17, 2017 Jkt 069000 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1334.IS S1334

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1 chasing agreements, and other payment mechanisms 

2 determined appropriate by the Secretary. 

3 ‘‘(3) ADVANCED ILLNESS CARE AND MANAGE4 MENT SERVICES DEFINED.—In this subsection, the 

5 term ‘advanced illness care and management serv6 ices’ means the following services, as appropriate for 

7 the individual’s illness and stage of illness: 

8 ‘‘(A) One or more face-to-face encounters 

9 between one or more members of the inter10 disciplinary team and the individual and, at the 

11 individual’s discretion, family caregivers, or, for 

12 an individual who lacks decisionmaking capacity 

13 under State law, the individual’s legally author14 ized representative. 

15 ‘‘(B) The provision of information about 

16 the typical trajectory of illnesses or conditions 

17 that affect the individual, including foreseeable 

18 care decisions that may need to be made at a 

19 future time when the individual is likely to be 

20 unable to make decisions due to temporary or 

21 permanent cognitive or medical incapacity. 

22 ‘‘(C) Assisting the individual in defining 

23 and articulating goals of care, values, and pref24 erences. 


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1 ‘‘(D) Providing the individual with and dis2 cussing information about the benefits and bur3 dens of relevant ranges of treatment options 

4 available to the individual, including disease 

5 modifying or potentially curative treatment, pal6 liative care, which may be provided alone or in 

7 conjunction with disease modifying treatment, 

8 and, when the individual may be currently eligi9 ble or may become eligible for hospice care due 

10 to disease progression. 

11 ‘‘(E) Assisting the individual in evaluating 

12 treatment options and approaches to care to 

13 identify those that most closely align with the 

14 individual’s goals of care, values, and pref15 erences. 

16 ‘‘(F) Preparing, and sharing with relevant 

17 providers, documentation— 

18 ‘‘(i) that states the individual’s goals 

19 of care, preferences, and values, preferred 

20 decisionmaking strategies, and a plan of 

21 care that is concrete and actionable; and 

22 ‘‘(ii) that is in State or locally recog23 nized forms that are used for the purpose 

24 of assuring that providers can follow the 


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1 plan across care settings, such as advance 

2 directives or portable treatment orders. 

3 ‘‘(G) Referrals to providers, including med4 ical and social service providers, who deliver 

5 care consistent with the plan. 

6 ‘‘(H) Providing culturally and education7 ally appropriate training for the individual and 

8 family caregivers to support their ability to 

9 carry out the plan. 

10 ‘‘(I) A multidimensional assessment of the 

11 individual’s strengths and limitations. 

12 ‘‘(J) An assessment of the individual’s paid 

13 and unpaid supports, including family care14 givers. 

15 ‘‘(K) Comprehensive medication review and 

16 management (including, if appropriate, coun17 seling and self-management support). 

18 ‘‘(L) Visits to the patient in all sites of 

19 care (including the home, a hospital, and a 

20 nursing home) as needed to respond appro21 priately to problems and concerns. 

22 ‘‘(M) Additional services, consistent with 

23 the care plan, that the interdisciplinary team 

24 believes would assist the eligible individual and 


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1 family caregivers in more effectively managing 

2 their health condition. 

3 ‘‘(N) 24-Hour access to emergency support 

4 in person or via telephone or telemedicine with 

5 the individual’s medical record and care plan 

6 available to the responder. 

7 ‘‘(O) Care coordination and communication 

8 across health care and social service settings 

9 and providers, including involvement of the 

10 interdisciplinary team to evaluate quality and 

11 address concerns over time. 

12 ‘‘(P) Such other palliative and other serv13 ices that the Secretary determines appropriate. 

14 ‘‘(4) APPLICABLE PROVIDER DEFINED.—In this 

15 subsection, the term ‘applicable provider’ means a 

16 hospice program (as defined in section 1861(dd)(2)) 

17 or other provider of services (as defined in section 

18 1861(u)) or supplier (as defined in section 1861(d)) 

19 that— 

20 ‘‘(A) furnishes services through an inter21 disciplinary team; and 

22 ‘‘(B) meets such other requirements the 

23 Secretary may determine to be appropriate. 


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1 ‘‘(5) ELIGIBLE INDIVIDUAL DEFINED.—In this 

2 subsection, the term ‘eligible individual’ means an 

3 individual who— 

4 ‘‘(A) is entitled to, or enrolled for, benefits 

5 under part A of title XVIII and enrolled under 

6 part B of such title, but not enrolled under part 

7 C of such title; 

8 ‘‘(B) resides at home or in an institutional 

9 setting, whichever is consistent with their per10 sonal goals and preferences; and 

11 ‘‘(C) meets at least one of the following: 

12 ‘‘(i) The individual has the need for 

13 assistance with two or more activities of 

14 daily living (defined as bathing, dressing, 

15 eating, getting out of bed or a chair, mobil16 ity, and toileting) that is caused by one or 

17 more serious or life threatening conditions 

18 or frailty and that is not associated with 

19 an acute or post-operative condition. 

20 ‘‘(ii) The individual is diagnosed with 

21 a serious, chronic progressive or advanced 

22 illness that— 

23 ‘‘(I) has a strong negative impact 

24 on the individual’s quality of life and 


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1 functioning in life roles, independent 

2 of its impact on mortality; or 

3 ‘‘(II) is burdensome in symp4 toms, treatments or caregiver stress. 

5 ‘‘(iii) The individual is diagnosed 

6 with— 

7 ‘‘(I) metastatic or locally ad8 vanced cancer; 

9 ‘‘(II) Alzheimer’s disease or an10 other progressive dementia; 

11 ‘‘(III) late-stage neuromuscular 

12 disease; 

13 ‘‘(IV) late-stage diabetes; 

14 ‘‘(V) late-stage kidney, liver, 

15 heart, gastrointestinal, cerebro16 vascular, or lung disease; or 

17 ‘‘(VI) age-related physical debil18 ity. 

19 ‘‘(iv) The individual meets other cri20 teria determined appropriate by the Sec21 retary. 

22 ‘‘(6) INTERDISCIPLINARY TEAM.— 

23 ‘‘(A) IN GENERAL.—Subject to subpara24 graph (B), in this subsection, the term ‘inter25 disciplinary team’ means a group that— 


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1 ‘‘(i) includes at least— 

2 ‘‘(I) one physician who is board 

3 certified in geriatrics, internal medi4 cine, or family medicine; 

5 ‘‘(II) one physician, advance 

6 practice registered nurse, or physician 

7 assistant, who is a palliative specialist 

8 (defined as having a certification in 

9 hospice and palliative care) or who 

10 has at least one year’s experience pro11 viding hospice or palliative care; 

12 ‘‘(III) one nurse; and 

13 ‘‘(IV) one social worker; 

14 ‘‘(ii) may include a chaplain, minister, 

15 or pastoral counselor; 

16 ‘‘(iii) may include other direct care 

17 personnel (including pharmacists, dieti18 cians, physical therapists, occupational 

19 therapists, and psychotherapists); and 

20 ‘‘(iv) meets requirements that may be 

21 established by the Secretary. 

22 ‘‘(B) ADDITIONAL MEMBER AT THE RE23 QUEST OF THE ELIGIBLE INDIVIDUAL.—An ap24 plicable provider shall offer to the eligible indi25 vidual (or the individual’s legally authorized 


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1 representative when the individual has been 

2 found to lack decisional capacity) the oppor3 tunity to select either a chaplain affiliated with 

4 the applicable provider, a minister, or personal 

5 religious or spiritual advisor who can help to 

6 represent the individual’s goals, values, and 

7 preferences to serve as a core interdisciplinary 

8 team member at the individual’s (or legally au9 thorized representative’s) request.’’. 

10 SEC. 4. QUALITY MEASUREMENT DEVELOPMENT AND IM11 PLEMENTATION. 

12 (a) FACILITATION OF INCREASED COORDINATION

13 AND ALIGNMENT BETWEEN THE PUBLIC AND PRIVATE

14 SECTOR WITH RESPECT TO QUALITY MEASURES RE15 GARDING ADVANCED ILLNESS, PALLIATIVE, AND END-OF16 LIFE CARE.— 

17 (1) IN GENERAL.—Section 1890(b) of the So18 cial Security Act (42 U.S.C. 1395aaa(b)) is amend19 ed by inserting after paragraph (3) the following 

20 new paragraph: 

21 ‘‘(4) INCREASED COORDINATION AND ALIGN22 MENT BETWEEN THE PUBLIC AND PRIVATE SECTOR

23 WITH RESPECT TO QUALITY MEASURES REGARDING

24 ADVANCED ILLNESS, PALLIATIVE, AND END-OF-LIFE

25 CARE.— 


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1 ‘‘(A) IN GENERAL.—The entity shall facili2 tate increased coordination and alignment be3 tween the public and private sector with respect 

4 to quality measures regarding advanced illness, 

5 palliative, and end-of-life care across the care 

6 settings and programs described in this section 

7 and across other services and care settings 

8 under this title, as appropriate. 

9 ‘‘(B) ENVIRONMENTAL SCAN.—The entity 

10 shall conduct an environmental scan of meas11 ures, measure concepts, and preferred practices 

12 for advanced illness, palliative, and end-of-life 

13 care used in both the private and public sectors 

14 and from multiple settings of care. Such scan 

15 shall include a review of the following: 

16 ‘‘(i) The process of eliciting and docu17 menting patient (and, where relevant and 

18 appropriate, family caregiver or legally au19 thorized representative) goals, preferences, 

20 and values regarding care and treatment, 

21 including the articulation of goals for end22 of-life care that adequately reflect how the 

23 patient wants to live. 

24 ‘‘(ii) The effectiveness, patient25 centeredness (and, where relevant, family 


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1 caregiver-centeredness), and adequacy of 

2 care plans, including documentation of in3 dividual goals, preferences, and values. 

4 ‘‘(iii) Agreement and consistency 

5 among— 

6 ‘‘(I) the patient’s goals, pref7 erences, and values; 

8 ‘‘(II) any documented care plan; 

9 and 

10 ‘‘(III) the care delivered. 

11 ‘‘(iv) Timely and appropriate referral 

12 to hospice care. 

13 ‘‘(C) IDENTIFICATION AND

14 PRIORITIZATION OF MEASURES.—The entity 

15 shall, based on the scan conducted under sub16 paragraph (B), identify and prioritize measures, 

17 measure concepts, and preferred practices, that 

18 are aligned across settings of care, condition, 

19 and patient population. 

20 ‘‘(D) REPORT.—Not later than 18 months 

21 after the date of enactment of this paragraph, 

22 the entity shall submit to the Secretary a report 

23 containing the findings of the entity with re24 spect to the environmental scan under subpara25 graph (B) and the identification and 


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1 prioritization of measures, measure concepts, 

2 and preferred practices under subparagraph 

3 (C).’’. 

4 (b) STUDY AND REPORT ON NIH DEVELOPMENT OF

5 ADDITIONAL MEASURES RELATED TO CARE PLAN6 NING.—Section 1890A of the Social Security Act (42 

7 U.S.C. 1395aaa–1) is amended by adding at the end the 

8 following new subsection: 

9 ‘‘(g) STUDY AND REPORT ON NIH DEVELOPMENT

10 OF ADDITIONAL MEASURES RELATED TO CARE PLAN11 NING.— 

12 ‘‘(1) STUDY.—The Secretary, in consultation 

13 with the Palliative Care Research Cooperative 

14 Group, the National Institute of Nursing Research, 

15 and the Office of End-of-Life and Palliative Care 

16 Research of the National Institutes of Health shall 

17 conduct a study regarding the development of meas18 ures related to— 

19 ‘‘(A) concordance of care between the 

20 wishes of an individual and the treatment re21 ceived by the individual, including documenta22 tion of such wishes in the medical record; 

23 ‘‘(B) understanding the population with se24 rious, chronic progressive, or advanced illness 


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1 that would benefit from palliative care and ad2 vance care planning services; and 

3 ‘‘(C) appropriate transitions to hospice 

4 care. 

5 ‘‘(2) REPORT.—Not later than December 31, 

6 2019, the Secretary shall submit to Congress a re7 port containing the results of the study conducted 

8 under paragraph (1).’’. 

9 (c) MEDICARE PHYSICIAN FEE SCHEDULE.—Section 

10 1848(s)(1) of the Social Security Act (42 U.S.C. 1395w– 

11 4(s)(1)) is amended by adding at the end the following 

12 new subparagraph: 

13 ‘‘(G) CLINICAL CARE MEASURES RELATING

14 TO PALLIATIVE AND END-OF-LIFE CARE.—Be15 ginning after the completion of the environ16 mental scan under section 1890(b)(4)(B), with17 in one or more appropriate quality domains, the 

18 Secretary shall, in consultation with the entity 

19 with a contract under section 1890(a), establish 

20 appropriate clinical care measures relating to 

21 palliative and end-of-life care, including at least 

22 one measure for each of the areas studied 

23 under subparagraphs (A), (B), and (C) of sec24 tion 1890A(g)(1).’’. 


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1 (d) POST-ACUTE CARE.—Section 1899B of the So2 cial Security Act (42 U.S.C. 1395lll) is amended— 

3 (1) in subsection (a)(2)(E)(i)— 

4 (A) in subclause (IV), by striking ‘‘and’’ at 

5 the end; 

6 (B) in subclause (V), by striking the period 

7 at the end and inserting ‘‘; and’’; and 

8 (C) by adding at the end the following new 

9 subclause: 

10 ‘‘(VI) with respect to the domain 

11 described in subsection (c)(1)(F) (re12 lating to end-of-life care)— 

13 ‘‘(aa) for PAC providers de14 scribed in clauses (ii), (iii), and 

15 (iv) of paragraph (2)(A), October 

16 1, 2020; and 

17 ‘‘(bb) for PAC providers de18 scribed in clauses (i) of such 

19 paragraph, January 1, 2021.’’; 

20 and 

21 (2) in subsection (c)(1), by adding at the end 

22 the following new subparagraph: 

23 ‘‘(F) The effectiveness, patient24 centeredness (and, where relevant, family care25 giver-centeredness), and adequacy of care plans 


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1 and communications relating to such plans, in2 cluding— 

3 ‘‘(i) documentation of a patient’s 

4 goals, preferences, and values; 

5 ‘‘(ii) agreement and consistency with 

6 respect to care among— 

7 ‘‘(I) the patient’s goals, pref8 erences, and values; 

9 ‘‘(II) any documented care plan; 

10 and 

11 ‘‘(III) the care delivered; and 

12 ‘‘(iii) timely and appropriate referral 

13 to hospice care.’’. 

14 (e) MEDICARE ADVANTAGE.—Section 1852(e)(3) of 

15 the Social Security Act (42 U.S.C. 1395w–22(e)(3)) is 

16 amended by adding at the end the following new subpara17 graph: 

18 ‘‘(C) PALLIATIVE AND END-OF-LIFE

19 CARE.—The Secretary, in consultation with the 

20 National Committee for Quality Assurance, 

21 shall prioritize the development of standards for 

22 palliative and end-of-life care, including transi23 tion to hospice care, with respect to Medicare 

24 Advantage organizations under this part for use 

25 under the quality improvement program under 


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1 paragraph (1) that are the equivalent of such 

2 standards in quality programs applicable to 

3 providers of services and suppliers under the 

4 original Medicare fee-for-service program under 

5 parts A and B.’’. 

6 (f) ALTERNATIVE PAYMENT MODELS.—Section 

7 1899(b)(3)(C) of the Social Security Act (42 U.S.C. 

8 1395jjj(b)(3)(C)) is amended— 

9 (1) by striking ‘‘STANDARDS.—The Secretary’’ 

10 and inserting ‘‘STANDARDS.— 

11 ‘‘(i) IN GENERAL.—The Secretary’’; 

12 and 

13 (2) by adding at the end the following new 

14 clause: 

15 ‘‘(ii) PALLIATIVE AND END-OF-LIFE

16 CARE.—The Secretary, in consultation with 

17 the entity with a contract under section 

18 1890(a), shall ensure that quality perform19 ance standards established under this sub20 paragraph include measures that apply to 

21 palliative and end-of-life care, including 

22 transition to hospice care.’’. 


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1 SEC. 5. ENHANCING COVERAGE OF ADVANCE CARE PLAN2 NING SERVICES. 

3 (a) DEFINITION.—Section 1861 of the Social Secu4 rity Act (42 U.S.C. 1395x) is amended by adding at the 

5 end the following new subsection: 

6 ‘‘Advance Care Planning Services 

7 ‘‘(jjj)(1) The term ‘advance care planning services’ 

8 means services identified as of the date of enactment of 

9 this subsection as Current Procedural Terminology (CPT) 

10 codes 99497 and 99498, and such codes as subsequently 

11 modified, that are furnished by a physician or other eligi12 ble practitioner (as determined by the Secretary). 

13 ‘‘(2) For purposes of paragraph (1), the term ‘eligible 

14 practitioner’ includes, in addition to a practitioner eligible 

15 to bill such CPT codes as of the date of enactment of this 

16 subsection, an individual who— 

17 ‘‘(A) is a clinical social worker (as defined in 

18 subsection (hh)(1)); and 

19 ‘‘(B) possesses— 

20 ‘‘(i) a relevant care planning certification; 

21 or 

22 ‘‘(ii) experience providing care planning 

23 conversations or similar services, as defined by 

24 the Secretary, in the course of their work.’’. 

25 (b) NO APPLICATION OF COINSURANCE OR DEDUCT26 IBLE.— 


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1 (1) AMOUNT.—Section 1833(a)(1) of the Social 

2 Security Act (42 U.S.C. 1395l(a)(1)) is amended— 

3 (A) by striking ‘‘and (BB)’’ and inserting 

4 ‘‘(BB)’’; and 

5 (B) by inserting before the semicolon at 

6 the end the following: ‘‘, and (CC) with respect 

7 to advance care planning services (as defined in 

8 section 1861(jjj)(1)), the amounts paid shall be 

9 100 percent of the lesser of the actual charge 

10 for the services or the amount determined 

11 under the fee schedule established under section 

12 1848(b).’’. 

13 (2) WAIVER OF APPLICATION OF DEDUCT14 IBLE.—The first sentence of section 1833(b) of the 

15 Social Security Act (42 U.S.C. 1395l(b)) is amend16 ed— 

17 (A) by striking ‘‘and’’ before ‘‘(10)’’; and 

18 (B) by inserting before the period the fol19 lowing: ‘‘, and (11) such deductible shall not 

20 apply with respect to advance care planning 

21 services (as defined in section 1861(jjj)(1))’’. 

22 (c) EFFECTIVE DATE.—The amendment made by 

23 this subsection shall apply to advance care planning serv24 ices furnished on or after January 1, 2018. 


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1 SEC. 6. ADVANCE CARE PLANNING SUPPORT TOOLS. 

2 (a) INCLUSION OF ADVANCE CARE PLANNING MATE3 RIALS IN THE MEDICARE & YOU HANDBOOK.— 

4 (1) IN GENERAL.—Section 1804(a) of the So5 cial Security Act (42 U.S.C. 1395b–2(a)) is amend6 ed— 

7 (A) in paragraph (2), by striking ‘‘and’’ at 

8 the end; 

9 (B) in paragraph (3), by striking the pe10 riod at the end and inserting a semicolon; and 

11 (C) by inserting after paragraph (3) the 

12 following new paragraphs: 

13 ‘‘(4) information on— 

14 ‘‘(A) care planning; 

15 ‘‘(B) how individual goals, values, and 

16 preferences should be considered in framing a 

17 care plan; and 

18 ‘‘(C) a range of approaches for treating se19 rious, chronic progressive, or advanced illness, 

20 including disease modifying options, palliative 

21 care that supports individuals from the onset of 

22 serious, chronic progressive, or advanced illness 

23 and can be provided at the same time as all 

24 other care types, and hospice care; and 


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1 ‘‘(5) information on documentation options for 

2 care planning or advance care planning, including 

3 advance directives and portable treatment orders.’’. 

4 (2) EFFECTIVE DATE.—The amendments made 

5 by this section shall apply to notices distributed on 

6 or after January 1, 2018. 

7 (b) ADVANCE CARE PLANNING STANDARDS FOR

8 ELECTRONIC HEALTH RECORDS.— 

9 (1) IN GENERAL.—Notwithstanding section 

10 3004(b)(3) of the Public Health Service Act (42 

11 U.S.C. 300jj–14(b)(3)), not later than 4 years after 

12 the date of the enactment of this Act, the Secretary 

13 of Health and Human Services shall adopt, by rule, 

14 standards for a qualified electronic health record (as 

15 defined in section 3000(13) of such Act (42 U.S.C. 

16 300jj(13)), with respect to organizing patient com17 munications with health care providers about care 

18 goals and to provide one-click access to the fol19 lowing: 

20 (A) The patient’s current advance directive 

21 (as defined in section 1866(f)(3) of the Social 

22 Security Act (42 U.S.C. 1395cc(f)(3)), as appli23 cable. 


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1 (B) The patient’s current order for life2 sustaining treatment (described in section 

3 9(d)(3)(B)), as applicable. 

4 (C) Documentation of advance care plan5 ning discussion between the patient and the 

6 provider. 

7 (2) TREATMENT OF STANDARDS.—A standard 

8 adopted under paragraph (1) shall be treated as a 

9 standard adopted under section 3004 of the Public 

10 Health Service Act (42 U.S.C. 300jj–14) for pur11 poses of certifying qualified electronic health records 

12 pursuant to section 3001(c)(5) of such Act (42 

13 U.S.C. 300jj–11(c)(5)). 

14 SEC. 7. ADVANCE DIRECTIVES. 

15 (a) PORTABILITY.—Section 1866(f) of the Social Se16 curity Act (42 U.S.C. 1395cc(f)) is amended by adding 

17 at the end the following new paragraph: 

18 ‘‘(5)(A) An advance directive validly executed outside 

19 the State in which such directive is presented may be given 

20 effect by a provider of services or organization to the same 

21 extent as an advance directive validly executed under the 

22 law of the State in which it is presented. 

23 ‘‘(B) In the absence of knowledge to the contrary, 

24 a physician or other health care provider or organization 

25 may presume that a written advance health care directive 


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1 or similar instrument, regardless of where executed, is 

2 valid. 

3 ‘‘(C) The provisions of this paragraph shall preempt 

4 any State law on advance directive portability to the extent 

5 such law is inconsistent with such provisions. 

6 ‘‘(D) Nothing in the paragraph shall be construed 

7 to— 

8 ‘‘(i) authorize the administration of health care 

9 treatment otherwise prohibited by the laws of the 

10 State in which the directive is presented; 

11 ‘‘(ii) require a provider of services or an organi12 zation to act in a manner contrary to its religious 

13 or moral convictions; 

14 ‘‘(iii) apply to a request or directive ordering a 

15 sterilization or abortion or ordering withdrawal of 

16 treatment from a pregnant woman if continued 

17 treatment can reasonably be expected to bring her 

18 child to live birth; 

19 ‘‘(iv) prohibit the application of a State law 

20 which allows for an objection on the basis of con21 science for any health care provider or any agent of 

22 such provider which as a matter of conscience can23 not implement an advance directive or portable 

24 treatment order; or 


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1 ‘‘(v) permit the Secretary to seek civil penalties, 

2 including exclusion from participation in the pro3 gram under this title or the program under title 

4 XIX, against a provider or organization if the pro5 vider or organization— 

6 ‘‘(I) used reasonable efforts to deliver care 

7 that is consistent with an individual’s goals, 

8 preferences, and values when addressing deci9 sionmaking for an individual who lacks 

10 decisional capacity; or 

11 ‘‘(II) exercised its right of conscience in 

12 accordance with clause (ii) or (iv).’’. 

13 (b) CLARIFICATION WITH RESPECT TO ADVANCE DI14 RECTIVES.—Paragraph (2) of section 7 of the Assisted 

15 Suicide Funding Restriction Act of 1997 (42 U.S.C. 

16 14406) is amended to read as follows: 

17 ‘‘(2) to require any provider or organization, or 

18 any employee of such a provider or organization, to 

19 follow or be bound by a request from an individual 

20 or legally authorized representative, an advance di21 rective, or a portable treatment order that directs 

22 the purposeful causing of, or the purposeful assist23 ing in causing, the death of any individuals, such as 

24 by assisted suicide, euthanasia, or mercy killing.’’. 


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1 (c) GAO STUDY ON HEALTH CARE DECISIONMAKING

2 LAWS AND BARRIERS TO THE USE OF ADVANCE DIREC3 TIVES.— 

4 (1) STUDY.—The Comptroller General of the 

5 United States shall conduct a study that examines 

6 the use, portability, and electronic storage of ad7 vance directives and that identifies barriers towards 

8 adopting, using, and following advance directives in 

9 the clinical setting. Such examination shall include 

10 issues that remain unresolved after the Stage 3 

11 Meaningful Use final rule, including barriers and so12 lutions to finding and accessing advance care plan13 ning documents, best practices for alerting eligible 

14 providers to the presence of an advance care plan, 

15 and best practices for transmitting advance care 

16 plans across sites of care. 

17 (2) REPORT.—Not later than 1 year after the 

18 date of the enactment of this Act, the Comptroller 

19 General shall submit to Congress a report on the 

20 study conducted under paragraph (1) and shall in21 clude in the report such recommendations regarding 

22 improving advance health care planning as the 

23 Comptroller General deems appropriate. 

24 SEC. 8. ADDITIONAL REQUIREMENTS FOR FACILITIES. 

25 (a) REQUIREMENTS.— 


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1 (1) IN GENERAL.—Section 1866(a)(1) of the 

2 Social Security Act (42 U.S.C. 1395cc(a)(1)) is 

3 amended— 

4 (A) in subparagraph (Y), by striking the 

5 period at the end and inserting ‘‘; and’’; and 

6 (B) by inserting after subparagraph (Y) 

7 the following new subparagraph: 

8 ‘‘(Z) in the case of hospitals, skilled nursing fa9 cilities, home health agencies, and hospice programs, 

10 to assure that documented care plans include any 

11 advance directives or portable treatment orders 

12 made while the individual received care by the pro13 vider and that such plan is sent to the individual’s 

14 primary care provider upon discharge and any facil15 ity to which the individual is transferred.’’. 

16 (2) EFFECTIVE DATE.—The amendments made 

17 by this subsection shall apply to agreements entered 

18 into or renewed on or after January 1, 2019. 

19 (b) HHS STUDY AND REPORT.— 

20 (1) STUDY.—The Secretary of Health and 

21 Human Services shall conduct a study on the extent 

22 to which hospitals, skilled nursing facilities, hospice 

23 programs, home health agencies, and providers of 

24 advance care planning services work with individuals 

25 to— 


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1 (A) engage in a care planning process; 

2 (B) thoroughly and completely document 

3 the care planning process in the medical record 

4 and to update the care plan on a regular basis; 

5 (C) complete documents necessary to sup6 port the treatment and care plan, such as port7 able treatment orders and advance directives; 

8 (D) provide services and support that are 

9 free from discrimination based on advanced 

10 age, disability status, or diagnosis, including se11 rious, chronic progressive, or advanced illness; 

12 and 

13 (E) provide documentation necessary to 

14 carry out the treatment plan to— 

15 (i) subsequent providers or facilities; 

16 and 

17 (ii) the individual, their legally au18 thorized representatives, and, where appro19 priate and relevant, their family caregiver. 

20 (2) REPORT.—Not later than January 1, 2021, 

21 the Secretary of Health and Human Services shall 

22 submit to Congress a report on the study conducted 

23 under paragraph (1) together with recommendations 

24 for such legislation and administrative action as the 

25 Secretary determines to be appropriate. 


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1 SEC. 9. GRANTS FOR INCREASING PUBLIC AWARENESS AND 

2 TRAINING. 

3 (a) MATERIAL AND RESOURCES DEVELOPMENT.— 

4 The Secretary of Health and Human Services (referred 

5 to in this section as the ‘‘Secretary’’), in consultation with 

6 the Advance Care Planning Advisory Council (established 

7 in section 10), may award grants to public or private enti8 ties (including, as appropriate, States, political subdivi9 sions of States, medical schools, nursing schools, health 

10 care systems, faith-based organizations, and religious edu11 cational institutions), or a consortium of any such entities, 

12 to develop online training modules, decision support tools, 

13 and instructional materials for individuals, family care14 givers, and health care providers that include— 

15 (1) with respect to healthy individuals, the im16 portance of— 

17 (A) identifying an individual who will make 

18 treatment decisions in the event of future cog19 nitive incapacity; 

20 (B) discussing values and goals relevant to 

21 serious injury or illness; and 

22 (C) completing an advance directive that— 

23 (i) appoints a surrogate; and 

24 (ii) documents goals and values and 

25 other information that should be consid26 ered in making treatment decisions; 


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1 (2) with respect to individuals with serious, 

2 chronic progressive, or advanced illness, the impor3 tance of— 

4 (A) articulating goals of care; 

5 (B) understanding prognosis and typical 

6 disease trajectory; 

7 (C) evaluating treatment options in light of 

8 goals of care; 

9 (D) developing a treatment plan; and 

10 (E) documenting the treatment plan on ad11 vance directives, portable treatment orders, and 

12 other documentation forms used in the locality 

13 where the plan is to be executed; 

14 (3) the role and effective use of State and other 

15 advance directive forms and portable treatment or16 ders; 

17 (4) the range of services for individuals facing 

18 serious, chronic progressive, or advanced illness, in19 cluding advance care planning services, palliative 

20 care, and hospice care; and 

21 (5) with respect to providers of advance care 

22 planning, advance illness care, hospice care, and pal23 liative care in hospital, hospice, home, community, 

24 and long-term care settings, material to assist in— 


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1 (A) developing and implementing programs 

2 and initiatives to train and educate individuals; 

3 (B) providing training and continuing edu4 cation to individuals who will provide advance 

5 care planning services or palliative care in the 

6 hospital, hospice, home, community, and long7 term care settings; and 

8 (C) developing curricula or teaching mate9 rials related to advance care planning or pallia10 tive care in such settings. 

11 (b) ESTABLISHMENT AND MAINTENANCE OF WEB12 AND TELEPHONE-BASED RESOURCES.— 

13 (1) IN GENERAL.—The Secretary may award 

14 grants to public or private entities (including States, 

15 political subdivisions of States, faith-based organiza16 tions, and religious educational institutions), or a 

17 consortium of any such entities, to establish and 

18 maintain an Internet website and telephone hotline 

19 to disseminate resources developed under subsection 

20 (a) and materials for faith communities designed by 

21 the Department of Health and Human Services Cen22 ter for Faith-Based and Neighborhood Partnerships. 

23 (2) ABILITY TO SUSTAIN ACTIVITIES.—In deter24 mining whether to award a grant under paragraph 

25 (1), the Secretary shall take into account the ability 


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1 of an entity to sustain the activities described in 

2 paragraph (1) beyond the initial grant period. 

3 (c) NATIONAL PUBLIC EDUCATION CAMPAIGN.—The 

4 Secretary may award grants to public or private entities 

5 (including States, political subdivisions of States, faith6 based organizations, and religious educational institu7 tions) to conduct a national public education campaign to 

8 raise public awareness of advance care planning and seri9 ous, chronic progressive, or advanced illness care, includ10 ing the availability of the resources created under this sec11 tion. 

12 (d) ORDERS FOR LIFE-SUSTAINING TREATMENT.— 

13 (1) IN GENERAL.—The Secretary may award 

14 grants to eligible entities for the purposes of car15 rying out the activities under paragraph (2). 

16 (2) AUTHORIZED ACTIVITIES.—Activities fund17 ed through a grant under this section for an area 

18 may include— 

19 (A) establishing and operating a National 

20 Resource Center on POLST Programs to pro21 vide— 

22 (i) technical assistance and profes23 sional training to programs for orders for 

24 life-sustaining treatment; 


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1 (ii) analysis and dissemination of best 

2 practices in implementing program for or3 ders for life-sustaining treatment; 

4 (iii) voluntary standards for the estab5 lishment and operation of program for or6 ders for life-sustaining treatment; and 

7 (iv) compilations and summaries of 

8 recently conducted research and other re9 sources relevant to program for orders for 

10 life-sustaining treatment; 

11 (B) developing such a program for the 

12 area that includes hospitals, home care, hospice, 

13 long-term care, community and assisted living 

14 residences, skilled nursing facilities, and emer15 gency medical services within a State; and 

16 (C) expanding an existing program for or17 ders regarding life-sustaining treatment to serve 

18 more patients or enhance the quality of serv19 ices, including educational services for patients 

20 and patients’ families, training of health care 

21 professionals, or establishing an orders for life22 sustaining treatment registry. 

23 (3) DEFINITIONS.—In this subsection— 

24 (A) the term ‘‘eligible entity’’ means— 


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1 (i) an academic medical center, a 

2 medical school, a State health department, 

3 a State medical association, a multistate 

4 task force, a hospital, or a health system 

5 capable of administering a program for 

6 physician orders regarding life-sustaining 

7 treatment for a State; or 

8 (ii) any other health care agency or 

9 entity as the Secretary determines appro10 priate; and 

11 (B) the term ‘‘program for orders for life12 sustaining treatment’’ means a program that, 

13 regardless of its name— 

14 (i) implements a clinical process de15 signed to facilitate shared, informed med16 ical decisionmaking and communication be17 tween health care professionals and pa18 tients with serious, progressive illness or 

19 frailty and results in a set of medical or20 ders that— 

21 (I) are consistent with the na22 tional standard as reflected by the 

23 National POLST Paradigm, rep24 resenting health care providers, orga25 nizations, and stakeholders; 


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1 (II) are portable and honored 

2 across care settings; and 

3 (III) address key medical deci4 sions consistent with the patient’s 

5 goals of care; and 

6 (ii) is guided by a coalition of stake7 holders, such as patient advocacy groups 

8 and representatives from across the con9 tinuum of health care services, disability 

10 rights advocates, senior advocates, emer11 gency medical services, long-term care, 

12 medical associations, hospitals, home 

13 health, hospice, palliative care, nursing as14 sociations, the State agency responsible for 

15 senior and disability services, faith-based 

16 groups, and the State department of 

17 health. 

18 (e) AUTHORIZATION OF APPROPRIATIONS.— 

19 (1) IN GENERAL.—There are authorized to be 

20 appropriated to the Secretary, for purposes of 

21 awarding grants under this section, $50,000,000 for 

22 the period of fiscal years 2018 through 2022. 

23 (2) LIMITATION.—None of the funds appro24 priated under paragraph (1) shall be used to— 

25 (A) develop a model advance directive; 


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1 (B) develop or employ a dollars-per-quality 

2 adjusted life year (or similar measure that dis3 counts the value of a life because of an individ4 ual’s disability); or 

5 (C) make a grant to a private entity that 

6 advocates, promotes, or facilitates any item or 

7 procedure for which funding is unavailable 

8 under the Assisted Suicide Funding Restriction 

9 Act of 1997 (Public Law 105–12). 

10 SEC. 10. ADVANCE CARE PLANNING ADVISORY COUNCIL. 

11 (a) ESTABLISHMENT.—Not later than 180 days after 

12 the date of the enactment of this Act, the Secretary of 

13 Health and Human Services (in this section referred to 

14 as the ‘‘Secretary’’) shall establish within the Office of the 

15 Secretary an advisory committee to be known as the Ad16 vance Care Planning Advisory Council (in this section re17 ferred to as the ‘‘Council’’). 

18 (b) DUTIES.— 

19 (1) MISSION.—The Council shall advise the 

20 Secretary regarding the compilation, development, 

21 and dissemination of resources for developed with 

22 grants awarded under section 9. 

23 (2) RESPONSIBILITIES.—Responsibilities of the 

24 council include the following: 


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1 (A) Ensuring that resources provided con2 tain unbiased information about the range of 

3 options available to individuals with serious, 

4 chronic progressive, advanced, or terminal ill5 ness, including information about conventional, 

6 curative treatments, palliative care, and hospice 

7 care. 

8 (B) Developing strategies for increasing 

9 public understanding about serious, chronic 

10 progressive, or advanced illness and the impor11 tant role advance care planning can play in doc12 umenting an individual’s wishes for medical 

13 care for loved ones in the event that the indi14 vidual cannot communicate such wishes. 

15 (C) Compiling information for dissemina16 tion regarding existing advance care planning 

17 models including POLST, advance directives, 

18 and healthcare proxies. 

19 (D) Promoting interagency coordination 

20 and minimizing overlap regarding advance care 

21 planning, including opportunities to coordinate 

22 efforts between the Federal agencies and exter23 nal stakeholders. 


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1 (E) Identifying and evaluating cross-cut2 ting issues such as pediatric end-of-life care and 

3 advance care planning access issues. 

4 (c) MEMBERSHIP.— 

5 (1) IN GENERAL.—The Council shall be com6 posed of up to 15 members appointed by the Sec7 retary from among qualified individuals who are not 

8 officers or employees of the Federal Government. 

9 (2) GROUPS.—The members of the Council 

10 shall include the following: 

11 (A) At least 3 members with clinical train12 ing and an expertise in palliative care, advanced 

13 illness, or end-of-life care. 

14 (B) At least 3 members from patient and 

15 family advocacy groups. 

16 (C) At least 3 members from religious or 

17 spiritual organizations. 

18 (D) Other members from interested stake19 holder groups with a proven expertise in pallia20 tive, chronic, advanced, or end-of-life care. 

21 (d) APPLICABILITY OF FACA.—The Council shall be 

22 treated as an advisory committee subject to the Federal 

23 Advisory Committee Act (5 U.S.C. App.). 


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1 SEC. 11. ANNUAL REPORT ON MEDICARE DECEDENTS. 

2 The Secretary of Health and Human Services shall 

3 issue for each fiscal year (beginning no later than fiscal 

4 year 2018) an annual report that analyzes the cir5 cumstances of Medicare beneficiaries who died during the 

6 fiscal year covered by such report. Such analysis shall in7 clude at least the following with respect to such decedents: 

8 (1) Information on the care or payor settings 

9 (such as under part A or part C of Medicare) at the 

10 time of death. 

11 (2) Information on the demographic character12 istics of such decedents. 

13 (3) Information on the geographic distribution 

14 of such decedents. 

15 (4) An evaluation of the Medicare claims data 

16 for such decedents for services furnished in the last 

17 year of life, including an analysis of the setting of 

18 care for decedents who had more than one chronic 

19 illness at the time of death. 

20 (5) Such other information as the Secretary 

21 deems appropriate. 

22 SEC. 12. RULE OF CONSTRUCTION. 

23 Nothing in the provisions of, or the amendments 

24 made by, this Act shall be construed to limit the restric25 tions of, or to authorize the use of Federal funds for any 

26 service, material, or activity pertaining to an item or servVerDate Sep 11 2014 00:31 Jun 17, 2017 Jkt 069000 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S1334.IS S1334

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1 ice or procedure for which funds are unavailable under, 

2 the Assisted Suicide Funding Restriction Act of 1997 

3 (Public Law 105–12). 

Æ 


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