II 

113TH CONGRESS 

1ST SESSION S. 1439 

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 

AUGUST 1, 2013 

Mr. WARNER (for himself and Mr. ISAKSON) 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 ‘‘Care Planning Act of 2013’’. 

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. Improvement of advanced illness planning and coordination. 

Sec. 4. Quality measurement development. 


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Sec. 5. Inclusion of advance care planning materials in the Medicare & You 

handbook. 

Sec. 6. Care Planning Advisory Board. 

Sec. 7. Improvement of policies related to the use and portability of advance 

directives. 

Sec. 8. Additional requirements for facilities. 

Sec. 9. Grants for increasing public awareness of advance care planning and 

advanced illness care. 

Sec. 10. HHS study and report on the storage of advance directives. 

Sec. 11. GAO study and report on the provisions of, and amendments made by, 

this Act. 

Sec. 12. Consultation with the Care Planning Advisory Board. 

Sec. 13. 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 

6 72,000,000, or 1 in 5 Americans, over the next two 

7 decades. 

8 (2) Americans today are living longer and 

9 healthier lives than ever before in the history of the 

10 United States yet are also facing increased incidence 

11 of multiple serious conditions as aging progresses. 

12 (3) Americans with advanced illness face a com13 plicated and fragmented system of care delivery that 

14 puts them at risk for repeat hospitalizations, adverse 

15 drug reactions, and conflicting medical advice that 

16 may be overwhelming to individuals and families. 

17 (4) The progression of advanced illness leads to 

18 the need for increasingly intensive decision support, 


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1 health care services, and support from family care2 givers. 

3 (5) The complexity of care needed by individ4 uals with advanced illness may result in uncoordi5 nated care, adverse health outcomes, frustration, 

6 wasted time, and undue emotional burdens on indi7 viduals and their family caregivers. 

8 (6) Numerous private sector leaders, including 

9 hospitals, health systems, home health agencies, hos10 pice programs, long-term care providers, employers, 

11 and other entities, have put in place innovative solu12 tions to provide more comprehensive and coordinated 

13 care for Americans living with advanced illness. 

14 (7) Hospice programs, as one of the longest 

15 standing Medicare care coordination benefits that 

16 offer a comprehensive set of services via an inter17 disciplinary team working to provide person- and 

18 family-centered care to the frailest and most vulner19 able individuals in our communities, can serve as a 

20 model for advanced illness care delivery. 

21 (8) Palliative care programs that serve patients 

22 beginning at diagnosis with advanced illness and 

23 provide care designed to reduce the symptom burden 

24 of illness can serve as a model for interdisciplinary 


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1 team care planning based on the individual’s goals 

2 of care. 

3 (9) The Government of the United States, as 

4 the Nation’s largest purchaser of health care serv5 ices, must learn from these innovators and encour6 age health care providers to furnish more supportive 

7 and comprehensive advanced illness care to improve 

8 the efficacy and quality of health care delivered for 

9 generations of Americans to come. 

10 (10) Health care providers who serve individ11 uals with advanced illness face complicated care sys12 tems and legal concerns that may result in over- or 

13 under-treatment of individuals with advanced illness. 

14 (11) Individuals have the well-established right 

15 to accept or reject medical treatment that is offered, 

16 as well as the well-established right to document 

17 their preferences for how treatment decisions should 

18 be made if, at some point in the future, they lose the 

19 ability to make health care decisions. 

20 (12) Too often, individuals with advanced ill21 ness do not understand the conditions they are fac22 ing or their treatment options, and they do not re23 ceive the information or support they need to evalu24 ate treatment options in light of their personal goals 

25 and values and to document treatment plans in a 


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1 manner that allows providers and facilities to follow 

2 their plans. 

3 (13) Providing quality services and planning 

4 support to individuals with advanced illness will pro5 tect and preserve their dignity. 

6 SEC. 3. IMPROVEMENT OF ADVANCED ILLNESS PLANNING 

7 AND COORDINATION. 

8 (a) MEDICARE COVERAGE OF PLANNING SERV9 ICES.— 

10 (1) COVERAGE.—Section 1861(s)(2) of the So11 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend12 ed— 

13 (A) in subparagraph (EE), by striking 

14 ‘‘and’’ at the end; 

15 (B) in subparagraph (FF), by inserting 

16 ‘‘and’’ at the end; and 

17 (C) by inserting after subparagraph (FF) 

18 the following new paragraph: 

19 ‘‘(GG) planning services (as defined in 

20 subsection (iii));’’. 

21 (2) SERVICES DESCRIBED.—Section 1861 of 

22 the Social Security Act (42 U.S.C. 1395x) is amend23 ed by adding at the end the following new sub24 section: 


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1 ‘‘Planning Services 

2 ‘‘(iii)(1)(A) The term ‘planning services’ means a vol3 untary decisionmaking process that includes the elements 

4 described in paragraph (2) and is furnished to a planning 

5 services eligible individual by an applicable provider 

6 through an interdisciplinary team. 

7 ‘‘(B) Planning services may only be furnished to a 

8 planning services eligible individual under this title once 

9 in each 12-month period. 

10 ‘‘(2)(A) The elements described in this paragraph are 

11 the following: 

12 ‘‘(i) One or more face-to-face encounters be13 tween one or more members of the interdisciplinary 

14 team and the individual and, at the individual’s dis15 cretion, family caregivers, or, for an individual who 

16 lacks decisionmaking capacity under State law, the 

17 individual’s legally authorized representative. 

18 ‘‘(ii) The provision of information about the 

19 typical trajectory of illnesses or conditions that af20 fect the individual, including foreseeable care deci21 sions that may need to be made at a future time 

22 when the individual is likely to be unable to make 

23 decisions due to temporary or permanent cognitive 

24 incapacity. 


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1 ‘‘(iii) Assisting the individual in defining and 

2 articulating goals of care, values, and preferences. 

3 ‘‘(iv) Providing the individual with (and dis4 cussing) information about the benefits and burdens 

5 of a relevant range of treatment options available to 

6 the individual, including disease modifying or poten7 tially curative treatment, palliative care, which may 

8 be provided alone or in conjunction with disease 

9 modifying treatment, and, when the individual may 

10 be currently eligible or may become eligible for hos11 pice care due to disease progression, hospice care. 

12 An applicable provider shall present and discuss rel13 evant treatment options that may help the individual 

14 to achieve goals of care and may not exclude options 

15 based on an individual’s age, disability status, or the 

16 presence of advanced illness unless, in the provider’s 

17 clinical judgment, a treatment option will not 

18 achieve the outcome sought by the individual. 

19 ‘‘(v) Assisting the individual in evaluating treat20 ment options and approaches to care to identify 

21 those that most closely align with the individual’s 

22 goals of care, values, and preferences. 

23 ‘‘(vi) Preparing, and sharing with relevant pro24 viders, documentation— 


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1 ‘‘(I) that states the individual’s goals of 

2 care, preferences, and values, preferred deci3 sionmaking strategies, and a plan of care that 

4 is concrete, achievable, and actionable; and 

5 ‘‘(II) that is in a paper or electronic for6 mat, on State or locally recognized forms that 

7 are used for the purpose of assuring that pro8 viders can follow the plan across care settings, 

9 such as advance directives or portable treat10 ment orders. 

11 ‘‘(vii) Referrals to providers, including medical 

12 and social service providers, who deliver care con13 sistent with the plan. 

14 ‘‘(viii) Providing culturally and educationally 

15 appropriate training for the individual and family 

16 caregivers to support their ability to carry out the 

17 plan. 

18 ‘‘(B) Even when the individual’s decisional capacity 

19 is impaired and another person or entity, such as an ap20 pointed agent, proxy, or surrogate, is exercising legal au21 thority under State law governing decisionmaking on be22 half of incapacitated individuals, the interdisciplinary 

23 team shall make a reasonable attempt to include the indi24 vidual in the planning process. 


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1 ‘‘(3) For purposes of this subsection, the term ‘plan2 ning services eligible individual’ means an individual that 

3 meets at least one of the following criteria: 

4 ‘‘(A) The individual is diagnosed with meta5 static or locally advanced cancer. 

6 ‘‘(B) The individual is diagnosed with Alz7 heimer’s disease or another progressive dementia. 

8 ‘‘(C) The individual is diagnosed with late-stage 

9 neuromuscular disease. 

10 ‘‘(D) The individual is diagnosed with late-stage 

11 diabetes. 

12 ‘‘(E) The individual is diagnosed with late-stage 

13 kidney, liver, heart, gastrointestinal, cerebrovascular, 

14 or lung disease. 

15 ‘‘(F) The individual needs assistance with two 

16 or more activities of daily living (defined as bathing, 

17 dressing, eating, getting out of bed or a chair, mobil18 ity, and toileting) that are caused by one or more 

19 progressive illnesses. 

20 ‘‘(G) The individual meets other criteria deter21 mined appropriate by the Secretary, including cri22 teria that are designed to identify individuals with a 

23 need for planning services due to advancing illness 

24 or risk of decline in cognitive function over time. 


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1 ‘‘(4) For purposes of this subsection, the term ‘appli2 cable provider’ means a hospice program (as defined in 

3 section 1861(dd)(2)) or other provider of services (as de4 fined in section 1861(u)) or supplier (as defined in section 

5 1861(d)) that— 

6 ‘‘(A) furnishes planning services through an 

7 interdisciplinary team; and 

8 ‘‘(B) meets such other requirements the Sec9 retary may determine to be appropriate. 

10 ‘‘(5)(A) For purposes of this subsection, the term 

11 ‘interdisciplinary team’ means a group that— 

12 ‘‘(i) includes— 

13 ‘‘(I) a core team of a physician or an ad14 vance practice registered nurse, a social worker, 

15 a nurse; and, subject to subparagraph (B), a 

16 chaplain, a minister, or the individual’s per17 sonal religious or spiritual advisor; and 

18 ‘‘(II) when necessary to meet an individ19 ual’s planning needs, other professionals, which 

20 may include a pharmacist, a licensed clinical so21 cial worker, and a psychologist, either as ongo22 ing team members or who may be brought in as 

23 needed to address the individual’s planning 

24 needs; and 


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1 ‘‘(ii) meets requirements that may be estab2 lished by the Secretary. 

3 ‘‘(B) An applicable provider furnishing planning serv4 ices to a planning services eligible individual shall offer 

5 to the individual (or the individual’s legally authorized rep6 resentative when the individual has been found to lack 

7 decisional capacity) the opportunity to select either a 

8 chaplain affiliated with the provider, a minister, or per9 sonal religious or spiritual advisor who can help to rep10 resent the individual’s goals, values, and preferences to 

11 serve as a core team member at the individual’s (or legally 

12 authorized representative’s) request. 

13 ‘‘(C) The requirements established by the Secretary 

14 under subparagraph (A)(ii) shall include a requirement 

15 that interdisciplinary team members (except for the 

16 individuals’s chosen minister or personal religious or spir17 itual advisor) have training and experience in delivering 

18 person-directed planning services and in team-based deliv19 ery of services for individuals with dementing illness and 

20 individuals with advanced illness.’’. 

21 (3) PAYMENT UNDER PHYSICIAN FEE SCHED22 ULE.—Section 1848(j)(3) of the Social Security Act 

23 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

24 ‘‘(2)(GG),’’ after ‘‘(2)(FF) (including administration 

25 of the health risk assessment),’’. 


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1 (4) FREQUENCY LIMITATION.—Section 1862(a) 

2 of the Social Security Act (42 U.S.C. 1395y(a)) is 

3 amended— 

4 (A) in paragraph (1)— 

5 (i) in subparagraph (O), by striking 

6 ‘‘and’’ at the end; 

7 (ii) in subparagraph (P) by striking 

8 the semicolon at the end and inserting ‘‘, 

9 and’’; and 

10 (iii) by adding at the end the fol11 lowing new subparagraph: 

12 ‘‘(Q) in the case of planning services (as 

13 defined in section 1861(iii)(1)), which are fur14 nished more frequently than is covered under 

15 subparagraph (B) of such section;’’; and 

16 (B) in paragraph (7), by striking ‘‘or (P)’’ 

17 and inserting ‘‘(P), or (Q)’’. 

18 (5) EFFECTIVE DATE.—The amendments made 

19 by this subsection shall apply to services furnished 

20 on or after January 1, 2015. 

21 (b) MEDICAID COVERAGE OF PLANNING SERV22 ICES.— 

23 (1) IN GENERAL.—Section 1905(a) of the So24 cial Security Act (42 U.S.C. 1396d(a)) is amend25 ed— 


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1 (A) by redesignating paragraph (29) as 

2 paragraph (30); 

3 (B) in paragraph (28), by striking at the 

4 end ‘‘and’’; and 

5 (C) by inserting after paragraph (28) the 

6 following new paragraph: 

7 ‘‘(29) planning services (as defined in section 

8 1861(iii)); and’’. 

9 (2) CONFORMING AMENDMENT.—Section 

10 1902(a)(10)(A) of the Social Security Act (42 

11 U.S.C. 1396a(a)(10)(A)) is amended by striking 

12 ‘‘and (28)’’ and inserting ‘‘, (28), and (29)’’. 

13 (3) EFFECTIVE DATE.— 

14 (A) IN GENERAL.—Except as provided in 

15 subparagraph (B), the amendments made by 

16 paragraphs (1) and (2) take effect on January 

17 1, 2015. 

18 (B) EXTENSION OF EFFECTIVE DATE FOR

19 STATE LAW AMENDMENT.—In the case of a 

20 State plan under title XIX of the Social Secu21 rity Act (42 U.S.C. 1396 et seq.) which the 

22 Secretary determines requires State legislation 

23 in order for the plan to meet the additional re24 quirements imposed by the amendments made 

25 by paragraphs (1) and (2), the State plan shall 


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1 not be regarded as failing to comply with the 

2 requirements of such title solely on the basis of 

3 its failure to meet these additional requirements 

4 before the first day of the first calendar quarter 

5 beginning after the close of the first regular 

6 session of the State legislature that begins after 

7 the date of the enactment of this Act. For pur8 poses of the previous sentence, in the case of a 

9 State that has a 2-year legislative session, each 

10 year of the session is considered to be a sepa11 rate regular session of the State legislature. 

12 (c) ADVANCED ILLNESS CARE COORDINATION SERV13 ICES PROJECT.—Section 1115A(b)(2) of title XI of the 

14 Social Security Act (42 U.S.C. 1315a(b)(2)) is amended— 

15 (1) in subparagraph (A), by adding at the end 

16 the following new sentence: ‘‘The models selected 

17 under this subparagraph shall include the model de18 scribed in subparagraph (D) and such model shall be 

19 implemented by not later than December 31, 

20 2015.’’; and 

21 (2) by adding at the end the following new sub22 paragraph: 

23 ‘‘(D) ADVANCED ILLNESS CARE COORDINA24 TION SERVICES MODEL.— 

25 ‘‘(i) MODEL.— 


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1 ‘‘(I) IN GENERAL.—The model 

2 described in this subparagraph is a 

3 model under which payments are 

4 made to applicable providers that fur5 nish advanced illness care coordina6 tion services to eligible individuals. 

7 ‘‘(II) REQUIREMENT.—At least 

8 one applicable provider selected for 

9 participation under the model shall be 

10 a hospice program (as defined in sec11 tion 1861(dd)(2)). 

12 ‘‘(ii) APPLICABLE PROVIDER.—In this 

13 subparagraph, the term ‘applicable pro14 vider’ means a hospice program (as defined 

15 in section 1861(dd)(2)) or other provider 

16 of services (as defined in section 1861(u)) 

17 or supplier (as defined in section 1861(d)) 

18 that— 

19 ‘‘(I) furnishes advanced illness 

20 care coordination services through an 

21 interdisciplinary team (as defined in 

22 section 1861(iii)(5)); and 

23 ‘‘(II) meets such other require24 ments the Secretary may determine to 

25 be appropriate. 


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1 ‘‘(iii) ADVANCED ILLNESS CARE CO2 ORDINATION SERVICES.—In this subpara3 graph, the term ‘advanced illness care co4 ordination services’ means the following 

5 services: 

6 ‘‘(I) Planning services (as defined 

7 in section 1861(iii)). 

8 ‘‘(II) A multi-dimensional assess9 ment of the individual’s strengths and 

10 limitations. 

11 ‘‘(III) An assessment of the indi12 vidual’s formal and informal supports, 

13 including family caregivers. 

14 ‘‘(IV) Comprehensive medication 

15 review and management (including, if 

16 appropriate, counseling and self-man17 agement support). 

18 ‘‘(V) In-home supportive services 

19 for the eligible individual and family 

20 caregivers consistent with the care 

21 plan. 

22 ‘‘(VI) 24-hour access to emer23 gency support in person or via tele24 phone or telemedicine with the indiVerDate Mar 15 2010 00:16 Aug 08, 2013 Jkt 029200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S1439.IS S1439

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1 vidual’s medical record and care plan 

2 available to the responder. 

3 ‘‘(VII) Coordination across 

4 health care and social service systems, 

5 including involvement of the inter6 disciplinary team to evaluate quality 

7 and address concerns. 

8 ‘‘(VIII) Such other services as 

9 specified by the Secretary. 

10 ‘‘(iv) ELIGIBLE INDIVIDUAL.—In this 

11 subparagraph, the term ‘eligible individual’ 

12 means an individual who— 

13 ‘‘(I) is entitled to, or enrolled for, 

14 benefits under part A of title XVIII 

15 and enrolled under part B of such 

16 title, but not enrolled under part C of 

17 such title; and 

18 ‘‘(II) has the need for assistance 

19 with two or more activities of daily 

20 living (defined as bathing, dressing, 

21 eating, getting out of bed or a chair, 

22 mobility, and toileting) that are 

23 caused by one or more progressive 

24 conditions.’’. 


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1 SEC. 4. QUALITY MEASUREMENT DEVELOPMENT. 

2 (a) IN GENERAL.—Section 931(c)(2) of the Public 

3 Health Service Act (42 U.S.C. 299b–31(c)(2)) is amend4 ed— 

5 (1) by redesignating subparagraphs (I) and (J) 

6 as subparagraphs (L) and (M), respectively; and 

7 (2) by inserting after subparagraph (H) the fol8 lowing new subparagraphs: 

9 ‘‘(I) the process of eliciting and docu10 menting patient (and, where relevant and ap11 propriate, family caregiver) goals, preferences, 

12 and values from the patient or from a legally 

13 authorized representative, including the articu14 lation of goals that accurately reflect how the 

15 patient wants to live; 

16 ‘‘(J) the effectiveness, patient-centeredness 

17 (and, where relevant, family caregiver18 centeredness), and accuracy of care plans, in19 cluding documentation of individual goals, pref20 erences, and values; 

21 ‘‘(K) agreement and consistency among— 

22 ‘‘(i) the patient’s goals, values, and 

23 preferences; 

24 ‘‘(ii) any documented care plan; 

25 ‘‘(iii) the treatment delivered; and 

26 ‘‘(iv) outcomes of treatment;’’. 


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1 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to the Secretary of 

3 Health and Human Services to carry out the amendments 

4 made by this section, $5,000,000 for fiscal year 2014. 

5 Amounts appropriated under the preceding sentence shall 

6 remain available until expended. 

7 SEC. 5. INCLUSION OF ADVANCE CARE PLANNING MATE8 RIALS IN THE MEDICARE & YOU HANDBOOK. 

9 (a) IN GENERAL.—Section 1804(a) of the Social Se10 curity Act (42 U.S.C. 1395b–2(a)) is amended— 

11 (1) in paragraph (2), by striking ‘‘and’’ at the 

12 end; 

13 (2) in paragraph (3), by striking the period at 

14 the end and inserting a semicolon; and 

15 (3) by inserting after paragraph (3) the fol16 lowing new paragraphs: 

17 ‘‘(4) information on— 

18 ‘‘(A) care planning; 

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

20 preferences should be considered in framing a 

21 care plan; and 

22 ‘‘(C) a range of approaches for treating 

23 advanced illness, including disease modifying 

24 options, palliative care that supports individuals 

25 from the onset of advanced illness and can be 


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1 provided at the same time as all other care 

2 types, and hospice care; and 

3 ‘‘(5) information on documentation options for 

4 care planning or advance care planning, including 

5 advance directives and portable treatment orders.’’. 

6 (b) EFFECTIVE DATE.—The amendments made by 

7 this section shall apply to notices distributed on or after 

8 January 1, 2015. 

9 SEC. 6. CARE PLANNING ADVISORY BOARD. 

10 (a) ESTABLISHMENT.—The Secretary of Health and 

11 Human Services shall establish the Care Planning Advi12 sory Board (in this section referred to as the ‘‘Advisory 

13 Board’’). 

14 (b) MEMBERSHIP.— 

15 (1) IN GENERAL.—The Advisory Board shall be 

16 composed of 15 members, to be appointed not later 

17 than 30 days after the date of the enactment of this 

18 Act, as follows: 

19 (A) The President of the United States 

20 shall appoint 3 members. 

21 (B) The majority leader of the Senate shall 

22 appoint 3 members. 

23 (C) The minority leader of the Senate shall 

24 appoint 3 members. 


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1 (D) The Speaker of the House of Rep2 resentatives shall appoint 3 members. 

3 (E) The minority leader of the House of 

4 Representatives shall appoint 3 members. 

5 (2) REPRESENTATION.—The membership of the 

6 Advisory Board shall include individuals who (with a 

7 preference for individuals who also are members of 

8 the group they are appointed to represent)— 

9 (A) represent the interests of— 

10 (i) patient advocacy groups; 

11 (ii) older adults; 

12 (iii) individuals with cognitive or func13 tional limitations; 

14 (iv) family caregivers for individuals 

15 described in clause (ii) or (iii); 

16 (v) palliative care and hospice pro17 viders; 

18 (vi) researchers; 

19 (vii) ethicists; 

20 (viii) faith communities; 

21 (ix) health care providers; and 

22 (x) health care facilities; 

23 (B) have demonstrated experience in deal24 ing with issues related to health care decision25 making and health care policy; and 


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1 (C) represent the health care interests and 

2 needs of a variety of geographic areas and de3 mographic groups. 

4 (c) DUTIES.—The Advisory Board shall advise the 

5 Secretary on issues related to care planning, advanced ill6 ness coordination services, advance care planning, and 

7 documentation options, including how to— 

8 (1) assure that individuals with advanced illness 

9 receive person- and family-centered care; 

10 (2) assist individuals with advanced illness to 

11 develop a treatment plan that is formed around their 

12 goals, values, and preferences, that is informed by 

13 research on disease trajectory, and that includes a 

14 documented plan that is realistic, actionable, and 

15 concrete, and that may include the use of advance 

16 directives, portable treatment orders (where appro17 priate), or other forms used in the State or locality; 

18 (3) develop and monitor a demonstration pro19 gram that includes an optimal service array to sup20 port individuals with advanced illness with services 

21 designed to manage symptoms as illness progresses; 

22 (4) provide health care that is consistent with 

23 individuals’ current treatment preferences or, for 

24 those whose capacity to make decisions is impaired, 

25 with the individuals’ values and goals, and specific 


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1 directions documented in advance directives and 

2 portable treatment orders; 

3 (5) encourage provider participation in edu4 cational and training activities addressing care plan5 ning, advanced illness care, and advance care plan6 ning; 

7 (6) develop quality measures, including process, 

8 outcome, and experience measures, that applicable 

9 providers should report for planning services (as de10 fined in section 1861(iii) of the Social Security Act, 

11 as added by section 3); 

12 (7) determine the appropriate role for discharge 

13 planners in educating individuals and their families 

14 about care planning services, advance care planning, 

15 palliative care, hospice, advance directives, portable 

16 treatment orders, and other relevant services, sup17 ports, planning tools, and documentation options; 

18 (8) develop and promote best practices in com19 munications about advanced illness between pro20 viders, individuals, and family caregivers in different 

21 settings, including acute care hospitals; 

22 (9) evaluate the feasibility of replacing life ex23 pectancy in months with clinical criteria to deter24 mine eligibility for hospice care; and 


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1 (10) promote effective advance care planning 

2 and effective and appropriate use of portable treat3 ment orders. 

4 (d) APPLICATION OF FACA.—The Federal Advisory 

5 Committee Act (5 U.S.C. App.) shall apply to the Advisory 

6 Board. 

7 (e) PAY AND REIMBURSEMENT.— 

8 (1) NO COMPENSATION FOR MEMBERS OF ADVI9 SORY BOARD.—Except as provided in paragraph (2), 

10 a member of the Advisory Board may not receive 

11 pay, allowances, or benefits by reason of their serv12 ice on the Board. 

13 (2) TRAVEL EXPENSES.—Each member shall 

14 receive travel expenses, including per diem in lieu of 

15 subsistence under subchapter I of chapter 57 of title 

16 5, United States Code. 

17 (f) REPORT.—Not later than 3 years after the estab18 lishment of the Advisory Board, the Advisory Board shall 

19 submit to Congress a final report containing the findings 

20 and conclusions of the Advisory Board, together with rec21 ommendations for such legislation and administrative ac22 tions as the Advisory Board considers appropriate. 

23 (g) TERMINATION.—The Advisory Board shall termi24 nate 30 days after submitting the report under subsection 

25 (f). 


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1 (h) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated such sums as may be 

3 necessary to carry out this section. 

4 SEC. 7. IMPROVEMENT OF POLICIES RELATED TO THE USE 

5 AND PORTABILITY OF ADVANCE DIRECTIVES. 

6 (a) MEDICARE.—Section 1866(f) of the Social Secu7 rity Act (42 U.S.C. 1395cc(f)) is amended— 

8 (1) in paragraph (1)— 

9 (A) in subparagraph (A)(i), by striking 

10 ‘‘State law’’ and all that follows through ‘‘med11 ical care’’ and inserting ‘‘relevant State and 

12 Federal law (whether statutory or as recognized 

13 by the courts) to make decisions concerning 

14 medical care’’; 

15 (B) by striking subparagraph (B); 

16 (C) by redesignating subparagraphs (C), 

17 (D), and (E) as subparagraphs (G), (H), and 

18 (I), respectively; 

19 (D) by inserting after subparagraph (A) 

20 the following new subparagraphs: 

21 ‘‘(B) to document in a prominent part of the 

22 individual’s current medical record whether or not 

23 the individual has an advance directive or portable 

24 treatment order, to request a copy of the advance di25 rective or portable treatment order, as applicable, 


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1 and if received, to include the copy (or the content 

2 of the document or documents) in a prominent part 

3 of such record; 

4 ‘‘(C) to provide each individual with the oppor5 tunity to discuss the information provided pursuant 

6 to subparagraph (A) with an appropriately trained 

7 employee or volunteer of the provider or organiza8 tion; 

9 ‘‘(D) for an individual with decisional capacity 

10 under State law, to follow the individual’s current 

11 treatment instructions, as expressed in writing or 

12 through verbal or nonverbal communications; 

13 ‘‘(E) for an individual who lacks decisional ca14 pacity— 

15 ‘‘(i) to ensure that treatment decisions are 

16 made in accordance with current preferences, 

17 values, and goals of the individual, when pos18 sible to ascertain and follow, and in accordance 

19 with current advance directives and portable 

20 treatment orders that are valid under State law 

21 where the care is delivered, and instructions 

22 provided by legally authorized representatives in 

23 accordance with State and Federal law; 

24 ‘‘(ii) in the absence of a current advance 

25 directive or portable treatment order that is 


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1 valid under State law where the care is deliv2 ered, to deliver treatment based on credible evi3 dence of the individual’s treatment preferences, 

4 goals, and values, such as a current advance di5 rective or portable treatment order executed in 

6 another State or past statements about treat7 ment preferences; and 

8 ‘‘(iii) to reconcile actual or suspected dis9 crepancies among advance directives, portable 

10 treatment orders, and other evidence in accord11 ance with State law, and, where State law is si12 lent, to reconcile discrepancies in the manner 

13 most likely to deliver treatment that is con14 sistent with the individual’s treatment pref15 erences, goals, and values; 

16 ‘‘(F) that specify narrow, but potentially recur17 ring, conditions or circumstances under which an ad18 vance directive, portable treatment order, or treat19 ment directions from an individual or legally author20 ized representative would not be followed, such as— 

21 ‘‘(i) where the validity or authenticity of a 

22 document is in question; 

23 ‘‘(ii) where there is evidence that an indi24 vidual’s preferences changed after the individual 


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1 documented preferences in an advance directive 

2 or portable treatment order; 

3 ‘‘(iii) where the treatment sought by the 

4 individual is not medically indicated; and 

5 ‘‘(iv) because of conscience objections in 

6 accordance with paragraph (3);’’; 

7 (E) in subparagraph (H), as redesignated 

8 by subparagraph (C), by striking ‘‘State law’’ 

9 and all that follows through ‘‘respecting’’ and 

10 inserting ‘‘this section and relevant State and 

11 Federal law (whether statutory or as recognized 

12 by the courts) respecting’’; 

13 (F) in subparagraph (I), as redesignated 

14 by subparagraph (C), by inserting ‘‘and port15 able treatment orders’’ before the period at the 

16 end; 

17 (G) in the flush matter at the end, by 

18 striking ‘‘(C)’’ and inserting ‘‘(G)’’; and 

19 (H) by adding at the end the following new 

20 sentence: ‘‘Nothing in subparagraph (D) or (E) 

21 shall be construed to apply to sterilization or 

22 abortion.’’; 

23 (2) by redesignating paragraphs (3) and (4) as 

24 paragraphs (4) and (5), respectively; 


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1 (3) by inserting after paragraph (2) the fol2 lowing new paragraph: 

3 ‘‘(3) Nothing in this section shall be construed to pro4 hibit the application of a State law which allows for an 

5 objection on the basis of conscience for any health care 

6 provider or any agent of such provider which as a matter 

7 of conscience cannot implement an advance directive.’’; 

8 (4) in paragraph (4), as redesignated by para9 graph (2)— 

10 (A) by striking ‘‘written’’; 

11 (B) by striking ‘‘State law’’ and inserting 

12 ‘‘State or Federal law’’; and 

13 (C) by striking ‘‘of the State’’; 

14 (5) by redesignating paragraph (5), as redesig15 nated by paragraph (2), as paragraph (6); 

16 (6) by inserting after paragraph (4) the fol17 lowing new paragraph: 

18 ‘‘(5) In this subsection, the term ‘portable treatment 

19 order’ means a treatment order designed to document a 

20 clinical process that includes shared, informed medical de21 cisionmaking, that reflects the individual’s goals of care 

22 and values, and that is designed to apply across care set23 tings, including the home.’’; and 


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1 (7) by inserting after paragraph (6), as redesig2 nated by paragraph (6), the following new para3 graph: 

4 ‘‘(7) Nothing in this subsection shall permit the Sec5 retary to seek civil penalties, including exclusion from par6 ticipation in the program under this title or the program 

7 under title XIX, against an individual or entity if the indi8 vidual or entity— 

9 ‘‘(A) used reasonable efforts to deliver care that 

10 is consistent with an individual’s goals, preferences, 

11 and values when addressing decisionmaking for an 

12 individual who lacks decisional capacity; or 

13 ‘‘(B) declined to furnish care in accordance 

14 with paragraph (3).’’. 

15 (b) MEDICAID.—Section 1902(w) of the Social Secu16 rity Act (42 U.S.C. 1396a(w)) is amended— 

17 (1) in paragraph (1)— 

18 (A) in subparagraph (A)(i), by striking 

19 ‘‘State law’’ and all that follows through ‘‘med20 ical care’’ and inserting ‘‘relevant State and 

21 Federal law (whether statutory or as recognized 

22 by the courts) to make decisions concerning 

23 medical care’’; 

24 (B) by striking subparagraph (B); 


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1 (C) by redesignating subparagraphs (C), 

2 (D), and (E) as subparagraphs (F), (G), and 

3 (H), respectively; 

4 (D) by inserting after subparagraph (A) 

5 the following new subparagraphs: 

6 ‘‘(B) to document in a prominent part of the 

7 individual’s current medical record whether or not 

8 the individual has an advance directive or portable 

9 treatment order, to request a copy of the advance di10 rective and or portable treatment order, and if re11 ceived, to include the copy (or the content of the 

12 document or documents) in a prominent part of such 

13 record; 

14 ‘‘(C) to provide each individual with the oppor15 tunity to discuss the information provided pursuant 

16 to subparagraph (A) with an appropriately trained 

17 personnel of the provider or organization; 

18 ‘‘(D) for an individual with decisional capacity 

19 under State law, to follow the individual’s current 

20 treatment instructions, as expressed in writing or 

21 through verbal or non-verbal communications; 

22 ‘‘(E) for an individual who lacks decisional ca23 pacity— 

24 ‘‘(i) to ensure that treatment decisions are 

25 made in accordance with State law addressing 


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1 legally authorized representatives and advance 

2 directives; 

3 ‘‘(ii) in the absence of a current advance 

4 directive or portable treatment order, to deliver 

5 treatment based on credible evidence of the in6 dividual’s treatment preferences, goals, and val7 ues, such as an advance directive or portable 

8 treatment order executed in another State or 

9 past statements about treatment preferences; 

10 and 

11 ‘‘(iii) to reconcile actual or suspected dis12 crepancies among advance directives, portable 

13 treatment orders, and other evidence in accord14 ance with State law, and, where State law is si15 lent, to reconcile discrepancies in the manner 

16 most likely to deliver treatment that is con17 sistent with the individual’s treatment pref18 erences, goals, and values; 

19 ‘‘(F) that specify narrow, but potentially recur20 ring, conditions or circumstances under which an ad21 vance directive, portable treatment order, or treat22 ment directions from an individual or legally author23 ized representative would not be followed, such as— 

24 ‘‘(i) where the validity or authenticity of a 

25 document is in question; 


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1 ‘‘(ii) where there is evidence that an indi2 vidual’s preferences changed after the individual 

3 documented preferences in an advance directive 

4 or portable treatment order; 

5 ‘‘(iii) where the treatment sought by the 

6 individual is not medically indicated; and 

7 ‘‘(iv) because of conscience objections in 

8 accordance with paragraph (3);’’; 

9 (E) in subparagraph (H), as redesignated 

10 by subparagraph (C), by striking ‘‘State law’’ 

11 and all that follows through ‘‘respecting’’ and 

12 inserting ‘‘this section and relevant State and 

13 Federal law (whether statutory or as recognized 

14 by the courts) respecting’’; 

15 (F) in subparagraph (I), as redesignated 

16 by subparagraph (C), by inserting ‘‘and port17 able treatment orders’’ before the period at the 

18 end; 

19 (G) in the flush matter at the end, by 

20 striking ‘‘(C)’’ and inserting ‘‘(G)’’; and 

21 (H) by adding at the end the following new 

22 sentence: ‘‘Nothing in subparagraph (D) or (E) 

23 shall be construed to apply to sterilization or 

24 abortion.’’; and 

25 (2) in paragraph (4)— 


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1 (A) by striking ‘‘written’’; 

2 (B) by striking ‘‘State law’’ and inserting 

3 ‘‘State or Federal law’’; and 

4 (C) by striking ‘‘of the State’’; 

5 (3) by redesignating paragraph (5) as para6 graph (6); 

7 (4) by inserting after paragraph (4) the fol8 lowing new paragraph: 

9 ‘‘(5) In this subsection, the term ‘portable treatment 

10 order’ means a treatment order designed to document a 

11 clinical process that includes shared, informed medical de12 cisionmaking, that reflects the individual’s goals of care 

13 and values, and that is designed to apply across care set14 tings, including the home.’’; and 

15 (5) by inserting after paragraph (6), as redesig16 nated by paragraph (3), the following new para17 graph: 

18 ‘‘(7) Nothing in this subsection shall permit the Sec19 retary to seek civil penalties, including exclusion from par20 ticipation in the program under this title or the program 

21 under title XVIII, against an individual or entity if the 

22 individual or entity— 

23 ‘‘(A) used reasonable efforts to deliver care that 

24 is consistent with an individual’s goals, preferences, 


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1 and values when addressing decisionmaking for an 

2 individual who lacks decisional capacity; or 

3 ‘‘(B) declined to furnish care in accordance 

4 with paragraph (3).’’. 

5 (c) CLARIFICATION WITH RESPECT TO ADVANCE DI6 RECTIVES.—Section 7 of the Assisted Suicide Funding 

7 Restriction Act of 1997 (42 U.S.C. 14406) is amended— 

8 (1) in paragraph (1), by striking ‘‘or’’ at the 

9 end; and 

10 (2) by striking paragraph (2) and inserting the 

11 following: 

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

13 any employee of such a provider or organization, to 

14 follow or be bound by a request from an individual 

15 or legally authorized representative, an advance di16 rective, or a portable treatment order that directs 

17 the purposeful causing of, or the purposeful assist18 ing in causing, the death of any individual, such as 

19 by assisted suicide, euthanasia, or mercy killing; or 

20 ‘‘(3) to allow discrimination against or imposi21 tion of penalties on any provider or organization, or 

22 any employee of such a provider or organization, 

23 that refuses, for any reason, including an objection 

24 based on a religious, conscience, or moral objection, 

25 to inform, counsel, or in any way participate in the 


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1 purposeful causing of, or the purposeful assisting in 

2 causing, the death of any individual, such as by as3 sisted suicide, euthanasia, or mercy killing.’’. 

4 (d) EFFECTIVE DATES.— 

5 (1) IN GENERAL.—Subject to paragraph (2), 

6 the amendments made by subsections (a) and (b) 

7 shall apply to provider agreements and contracts en8 tered into, renewed, or extended under title XVIII of 

9 the Social Security Act (42 U.S.C. 1395 et seq.), 

10 and to State plans under title XIX of such Act (42 

11 U.S.C. 1396 et seq.), on or after such date as the 

12 Secretary of Health and Human Services specifies, 

13 but in no case may such date be later than 1 year 

14 after the date of the enactment of this Act. 

15 (2) EXTENSION OF EFFECTIVE DATE FOR

16 STATE LAW AMENDMENT.—In the case of a State 

17 plan under title XIX of the Social Security Act (42 

18 U.S.C. 1396 et seq.) which the Secretary of Health 

19 and Human Services determines requires State legis20 lation in order for the plan to meet the additional 

21 requirements imposed by the amendments made by 

22 subsection (b), the State plan shall not be regarded 

23 as failing to comply with the requirements of such 

24 title solely on the basis of its failure to meet these 

25 additional requirements before the first day of the 


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1 first calendar quarter beginning after the close of 

2 the first regular session of the State legislature that 

3 begins after the date of the enactment of this Act. 

4 For purposes of the previous sentence, in the case 

5 of a State that has a 2-year legislative session, each 

6 year of the session is considered to be a separate 

7 regular session of the State legislature. 

8 SEC. 8. ADDITIONAL REQUIREMENTS FOR FACILITIES. 

9 (a) REQUIREMENTS.— 

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

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

12 amended— 

13 (A) in subparagraph (V), by striking 

14 ‘‘and’’ at the end; 

15 (B) in subparagraph (W), as added by sec16 tion 3005(1)(C) of the Patient Protection and 

17 Affordable Care Act (Public Law 111–148), by 

18 redesignating such subparagraph as subpara19 graph (X), moving such subparagraph to follow 

20 subparagraph (V), moving such subparagraph 2 

21 ems to the left, and striking the period at the 

22 end and inserting a comma; 

23 (C) in subparagraph (W), as added by sec24 tion 6406(b)(3) of the Patient Protection and 

25 Affordable Care Act (Public Law 111–148), by 


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1 redesignating such subparagraph as subpara2 graph (Y), moving such subparagraph to follow 

3 subparagraph (X), as added by subparagraph 

4 (B), moving such subparagraph 2 ems to the 

5 left, and striking the period at the end and in6 serting ‘‘, and’’; and 

7 (D) by inserting after subparagraph (Y) 

8 the following new subparagraph: 

9 ‘‘(Z) in the case of hospitals, skilled nursing fa10 cilities, home health agencies, and hospice programs, 

11 to assure that appropriate documentation of care 

12 plans made while the individual received care by or 

13 through the provider (which may include advance di14 rectives, portable orders, or other locally appropriate 

15 documents) be completed prior to discharge to allow 

16 the plan to be carried out after discharge.’’. 

17 (2) EFFECTIVE DATE.—The amendments made 

18 by this subsection shall apply to agreements entered 

19 into or renewed on or after January 1, 2015. 

20 (b) HHS STUDY AND REPORT.— 

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

22 Human Services shall conduct a study on the extent 

23 to which hospitals, skilled nursing facilities, hospice 

24 programs, home health agencies, and applicable pro25 viders of planning services under section 1861(iii) of 


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1 the Social Security Act, as added by section 3(a), 

2 work with individuals to— 

3 (A) engage in a care planning process; 

4 (B) thoroughly and completely document 

5 the care planning process in the medical record; 

6 (C) complete documents necessary to sup7 port the treatment and care plan, such as port8 able treatment orders and advance directives; 

9 (D) provide services and support that is 

10 free from discrimination based on advanced 

11 age, disability status, or advanced illness; and 

12 (E) provide documentation necessary to 

13 carry out the treatment plan to— 

14 (i) subsequent providers or facilities; 

15 and 

16 (ii) the individual, their legally au17 thorized representatives, and, where appro18 priate and relevant, their family caregiver. 

19 (2) REPORT.—Not later than January 1, 2018, 

20 the Secretary of Health and Human Services shall 

21 submit to Congress a report on the study conducted 

22 under paragraph (1) together with recommendations 

23 for such legislation and administrative action as the 

24 Secretary determines to be appropriate. 


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1 SEC. 9. GRANTS FOR INCREASING PUBLIC AWARENESS OF 

2 ADVANCE CARE PLANNING AND ADVANCED 

3 ILLNESS CARE. 

4 (a) MATERIAL AND RESOURCES DEVELOPMENT.— 

5 (1) IN GENERAL.—The Secretary of Health and 

6 Human Services (in this section referred to as the 

7 ‘‘Secretary’’) is authorized to award grants to enti8 ties described in subsection (d) to develop online 

9 training modules, decision support tools, and in10 structional materials for individuals, family care11 givers, and health care providers that include— 

12 (A) for healthy individuals, the importance 

13 of— 

14 (i) identifying an individual who will 

15 make treatment decisions in the event of 

16 future cognitive incapacity; 

17 (ii) discussing values and goals rel18 evant to catastrophic injury or illness; and 

19 (iii) completing an advance directive 

20 that— 

21 (I) appoints a surrogate; and 

22 (II) documents goals and values 

23 and other information that should be 

24 considered in making treatment deci25 sions; 


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1 (B) for individuals with advanced illness, 

2 the importance of— 

3 (i) articulating goals of care; 

4 (ii) understanding prognosis and typ5 ical disease trajectory; 

6 (iii) evaluating treatment options in 

7 light of goals of care; 

8 (iv) developing a treatment plan; and 

9 (v) documenting the treatment plan 

10 on advance directives, portable treatment 

11 orders, and other documentation forms 

12 used in the locality where the plan is to be 

13 executed; 

14 (C) the role and effective use of State and 

15 other advance directive forms and portable 

16 treatment orders; and 

17 (D) the range of services for individuals 

18 facing advanced illness, including planning serv19 ices, palliative care, and hospice care. 

20 (2) PERIOD.—Any grant awarded under para21 graph (1) shall be for a period of 3 years. 

22 (b) ESTABLISHMENT AND MAINTENANCE OF WEB23 AND TELEPHONE-BASED RESOURCES.— 

24 (1) IN GENERAL.—The Secretary is authorized 

25 to award grants to entities described in subsection 


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1 (d) to establish and maintain a website and tele2 phone hotline to disseminate resources developed 

3 under subsection (a) and materials designed by the 

4 Department of Health and Human Services Center 

5 for Faith-Based and Neighborhood Partnerships for 

6 faith communities. 

7 (2) PERIOD.—Any grant awarded under para8 graph (1) shall be for a period of 5 years. 

9 (3) ABILITY TO SUSTAIN ACTIVITIES.—The 

10 Secretary shall take into account the ability of an 

11 entity to sustain the activities described in para12 graph (1) beyond the 5-year grant period in deter13 mining whether to award a grant under paragraph 

14 (1) to the entity. 

15 (c) NATIONAL PUBLIC EDUCATION CAMPAIGN.— 

16 (1) IN GENERAL.—The Secretary is authorized 

17 to award grants to entities described in subsection 

18 (d) to conduct a national public education campaign 

19 to raise public awareness of advance care planning 

20 and advanced illness care, including the availability 

21 of the resources created under subsections (a) and 

22 (b). 

23 (2) PERIOD.—Any grant awarded under para24 graph (1) shall be for a period of 5 years. 


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1 (d) ELIGIBLE ENTITIES.—Entities described in this 

2 subsection are public or private entities (including States 

3 or political subdivisions of a State, faith-based organiza4 tions, and religious educational institutions), or a consor5 tium of any such entities. 

6 (e) AUTHORIZATION OF APPROPRIATIONS.— 

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

8 appropriated to the Secretary— 

9 (A) for purposes of making grants under 

10 subsection (a), $5,000,000 for fiscal year 2015, 

11 to remain available until expended; 

12 (B) for purposes of making grants under 

13 subsection (b), $5,000,000 for fiscal year 2015, 

14 to remain available until expended; and 

15 (C) for purposes of making grants under 

16 subsection (c), $5,000,000 for fiscal year 2015 

17 to remain available until expended. 

18 (2) LIMITATION.—None of the funds appro19 priated under paragraph (1) shall be used to— 

20 (A) develop a model advance directive; 

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

22 adjusted life year (or similar measure that dis23 counts the value of a life because of an individ24 ual’s disability); or 


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

2 advocates, promotes, or facilitates any item or 

3 procedure for which funding is unavailable 

4 under the Assisted Suicide Funding Restriction 

5 Act of 1997 (Public Law 105–12). 

6 SEC. 10. HHS STUDY AND REPORT ON THE STORAGE OF AD7 VANCE DIRECTIVES. 

8 (a) STUDY.—The Secretary of Health and Human 

9 Services shall conduct a study on State and regional activi10 ties with respect to storing completed advance directives 

11 and portable treatment orders. Such study shall include 

12 an analysis of the practicality and feasibility of estab13 lishing a national registry for completed advance directives 

14 and portable treatment orders, taking into consideration 

15 the constraints created by the privacy provisions enacted 

16 as a result of the Health Insurance Portability and Ac17 countability Act of 1996 (Public Law 104–191). 

18 (b) REPORT.—Not later than January 1, 2017, the 

19 Secretary of Health and Human Services shall submit to 

20 Congress a report on the study conducted under sub21 section (a) together with recommendations for such legis22 lation and administrative action as the Secretary deter23 mines to be appropriate. 


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1 SEC. 11. GAO STUDY AND REPORT ON THE PROVISIONS OF, 

2 AND AMENDMENTS MADE BY, THIS ACT. 

3 (a) STUDY.—The Comptroller General of the United 

4 States (in this section referred to as the ‘‘Comptroller 

5 General’’) shall conduct a study on the provisions of, and 

6 amendments made by, this Act, including the quality (such 

7 as individual and family experience, individual under8 standing of treatment choices, and alignment among indi9 vidual goals, values, and preferences, the documented care 

10 plan, treatment delivered, and treatment outcomes) associ11 ated with such provisions and such amendments. 

12 (b) REPORT.—Not later than January 1, 2018, the 

13 Comptroller General shall submit to Congress a report 

14 containing the results of the study conducted under sub15 section (a), together with recommendations for such legis16 lation and administrative action as the Comptroller Gen17 eral determines appropriate. 

18 SEC. 12. CONSULTATION WITH THE CARE PLANNING ADVI19 SORY BOARD. 

20 The Secretary of Health and Human Services shall 

21 consult with the Care Planning Advisory Board estab22 lished under section 6 in order to ensure that every activ23 ity carried out under the provisions of, and amendments 

24 made by, this Act will help individuals to— 


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1 (1) receive education and care that is free from 

2 discrimination based on advanced age, disability sta3 tus, or presence of advanced illness; 

4 (2) develop plans and receive care that is con5 sistent with each individual’s goals, values and pref6 erences; and 

7 (3) receive an explanation of a range of per8 spectives on approaches for treating advanced ill9 ness, including disease modifying options, palliative 

10 care that supports individuals from the onset of ad11 vanced illness and can be provided at the same time 

12 as all other care types, and hospice care. 

13 SEC. 13. RULE OF CONSTRUCTION. 

14 Nothing in the provisions of, or the amendments 

15 made by, this Act shall be construed to limit the restric16 tions of, or to authorize the use of Federal funds for any 

17 service, material, or activity pertaining to an item or serv18 ice or procedure for which funds are unavailable under, 

19 the Assisted Suicide Funding Restriction Act of 1997 

20 (Public Law 105–12). 

Æ 


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