II 

114TH CONGRESS 

1ST SESSION S. 1549 

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 10, 2015 

Mr. WARNER (for himself, Mr. ISAKSON, Ms. BALDWIN, Mrs. CAPITO, Ms. 

COLLINS, and Ms. KLOBUCHAR) 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 2015’’. 

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. 


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Sec. 4. Quality measurement development. 

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

handbook. 

Sec. 6. Improvement of policies related to the use and portability of advance 

directives. 

Sec. 7. Additional requirements for facilities. 

Sec. 8. Grants for increasing public awareness of advance care planning and 

advanced illness care. 

Sec. 9. 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, 

19 health care services, and support from family care20 givers. 


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1 (5) The complexity of care needed by individ2 uals with advanced illness may result in uncoordi3 nated care, adverse health outcomes, frustration, 

4 wasted time, and undue emotional burdens on indi5 viduals and their family caregivers. 

6 (6) Numerous private sector leaders, including 

7 hospitals, health systems, home health agencies, hos8 pice programs, long-term care providers, employers, 

9 and other entities, have put in place innovative solu10 tions to provide more comprehensive and coordinated 

11 care for Americans living with advanced illness. 

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

13 standing Medicare care coordination benefits that 

14 offer a comprehensive set of services via an inter15 disciplinary team working to provide person- and 

16 family-centered care to the frailest and most vulner17 able individuals in our communities, can serve as a 

18 model for advanced illness care delivery. 

19 (8) Palliative care programs that serve patients 

20 beginning at diagnosis with advanced illness and 

21 provide care designed to reduce the symptom burden 

22 of illness can serve as a model for interdisciplinary 

23 team care planning based on the individual’s goals 

24 of care. 


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

2 the Nation’s largest purchaser of health care serv3 ices, must learn from these innovators and encour4 age health care providers to furnish more supportive 

5 and comprehensive advanced illness care to improve 

6 the efficacy and quality of health care delivered for 

7 generations of Americans to come. 

8 (10) Health care providers who serve individ9 uals with advanced illness face complicated care sys10 tems and legal concerns that may result in over- or 

11 under-treatment of individuals with advanced illness. 

12 (11) Individuals have the well-established right 

13 to accept or reject medical treatment that is offered, 

14 as well as the well-established right to document 

15 their preferences for how treatment decisions should 

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

17 ability to make health care decisions. 

18 (12) Too often, individuals with advanced ill19 ness do not understand the conditions they are fac20 ing or their treatment options, and they do not re21 ceive the information or support they need to evalu22 ate treatment options in light of their personal goals 

23 and values and to document treatment plans in a 

24 manner that allows providers and facilities to follow 

25 their plans. 


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1 (13) Providing quality services and planning 

2 support to individuals with advanced illness will pro3 tect and preserve their dignity. 

4 SEC. 3. IMPROVEMENT OF ADVANCED ILLNESS PLANNING 

5 AND COORDINATION. 

6 (a) MEDICARE COVERAGE OF PLANNING SERV7 ICES.— 

8 (1) COVERAGE.—Section 1861(s)(2) of the So9 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend10 ed— 

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

12 ‘‘and’’ at the end; 

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

14 ‘‘and’’ at the end; and 

15 (C) by inserting after subparagraph (FF) 

16 the following new paragraph: 

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

18 subsection (iii));’’. 

19 (2) SERVICES DESCRIBED.—Section 1861 of 

20 the Social Security Act (42 U.S.C. 1395x) is amend21 ed by adding at the end the following new sub22 section: 

23 ‘‘Planning Services 

24 ‘‘(iii)(1)(A) The term ‘planning services’ means a vol25 untary decisionmaking process that includes the elements 


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

2 services eligible individual by an applicable provider 

3 through an interdisciplinary team. 

4 ‘‘(B)(i) Except as provided in clause (ii), planning 

5 services may only be furnished to a planning services eligi6 ble individual under this title once in each 12-month pe7 riod. 

8 ‘‘(ii) The Secretary shall establish appropriate excep9 tions to the frequency limitation under clause (i), such as 

10 when there is a change in the individual’s medical condi11 tion. 

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

13 the following: 

14 ‘‘(i) One or more face-to-face encounters be15 tween one or more members of the interdisciplinary 

16 team and the individual and, at the individual’s dis17 cretion, family caregivers, or, for an individual who 

18 lacks decisionmaking capacity under State law, the 

19 individual’s legally authorized representative. 

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

21 typical trajectory of illnesses or conditions that af22 fect the individual, including foreseeable care deci23 sions that may need to be made at a future time 

24 when the individual is likely to be unable to make 


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1 decisions due to temporary or permanent cognitive 

2 incapacity. 

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

4 articulating goals of care, values, and preferences. 

5 ‘‘(iv) Providing the individual with and dis6 cussing information about the benefits and burdens 

7 of relevant ranges of treatment options available to 

8 the individual, including disease modifying or poten9 tially curative treatment, palliative care, which may 

10 be provided alone or in conjunction with disease 

11 modifying treatment, and, when the individual may 

12 be currently eligible or may become eligible for hos13 pice care due to disease progression. 

14 ‘‘(v) Assisting the individual in evaluating treat15 ment options and approaches to care to identify 

16 those that most closely align with the individual’s 

17 goals of care, values, and preferences. 

18 ‘‘(vi) Preparing, and sharing with relevant pro19 viders, documentation— 

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

21 care, preferences, and values, preferred deci22 sionmaking strategies, and a plan of care that 

23 is concrete and actionable; and 

24 ‘‘(II) that is in State or locally recognized 

25 forms that are used for the purpose of assuring 


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1 that providers can follow the plan across care 

2 settings, such as advance directives or portable 

3 treatment orders. 

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

5 and social service providers, who deliver care con6 sistent with the plan. 

7 ‘‘(viii) Providing culturally and educationally 

8 appropriate training for the individual and family 

9 caregivers to support their ability to carry out the 

10 plan. 

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

12 is impaired and another person or entity, such as an ap13 pointed agent, proxy, or surrogate, is exercising legal au14 thority under State law governing decisionmaking on be15 half of incapacitated individuals, the interdisciplinary 

16 team shall make a reasonable attempt to include the indi17 vidual in the planning process. 

18 ‘‘(3) For purposes of this subsection, the term ‘plan19 ning services eligible individual’ means an individual that 

20 meets at least one of the following criteria: 

21 ‘‘(A) The individual is diagnosed with meta22 static or locally advanced cancer. 

23 ‘‘(B) The individual is diagnosed with Alz24 heimer’s disease or another progressive dementia. 


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

2 neuromuscular disease. 

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

4 diabetes. 

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

6 kidney, liver, heart, gastrointestinal, cerebrovascular, 

7 or lung disease. 

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

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

10 dressing, eating, getting out of bed or a chair, mobil11 ity, and toileting) not associated with an acute or 

12 post-operative conditions that are caused by one or 

13 more serious or life threatening illnesses or frailty. 

14 ‘‘(G) The individual meets other criteria deter15 mined appropriate by the Secretary, including cri16 teria that are designed to identify individuals with a 

17 need for planning services due to a serious or life 

18 threatening illness or risk of decline in cognitive 

19 function over time. 

20 ‘‘(4) For purposes of this subsection, the term ‘appli21 cable provider’ means a hospice program (as defined in 

22 section 1861(dd)(2)) or other provider of services (as de23 fined in section 1861(u)) or supplier (as defined in section 

24 1861(d)) that— 


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1 ‘‘(A) furnishes planning services through an 

2 interdisciplinary team; and 

3 ‘‘(B) meets such other requirements the Sec4 retary may determine to be appropriate. 

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

6 ‘interdisciplinary team’ means a group that— 

7 ‘‘(i) includes the personnel described in sub8 section (dd)(2)(B)(i); 

9 ‘‘(ii) may include a chaplain, minister, or per10 sonal religious or spiritual advisor; 

11 ‘‘(iii) may include other direct care personnel; 

12 and 

13 ‘‘(iv) meets requirements that may be estab14 lished by the Secretary. 

15 ‘‘(B) An applicable provider furnishing planning serv16 ices to a planning services eligible individual shall offer 

17 to the individual (or the individual’s legally authorized rep18 resentative when the individual has been found to lack 

19 decisional capacity) the opportunity to select either a 

20 chaplain affiliated with the provider, a minister, or per21 sonal religious or spiritual advisor who can help to rep22 resent the individual’s goals, values, and preferences to 

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

24 authorized representative’s) request. 


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

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

3 that interdisciplinary team members (except for the cho4 sen chaplain, minister, or personal religious or spiritual 

5 advisor) have training and experience in delivering person6 directed planning services and in team-based delivery of 

7 services for individuals with dementing illness and individ8 uals with a serious or life threatening illness.’’. 

9 (3) PAYMENT UNDER PHYSICIAN FEE SCHED10 ULE.—Section 1848(j)(3) of the Social Security Act 

11 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

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

13 of the health risk assessment),’’. 

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

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

16 amended— 

17 (A) in paragraph (1)— 

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

19 ‘‘and’’ at the end; 

20 (ii) in subparagraph (P) by striking 

21 the semicolon at the end and inserting ‘‘, 

22 and’’; and 

23 (iii) by adding at the end the fol24 lowing new subparagraph: 


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

2 defined in section 1861(iii)(1)), which are fur3 nished more frequently than is covered under 

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

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

6 and inserting ‘‘(P), or (Q)’’. 

7 (5) EFFECTIVE DATE.—The amendments made 

8 by this subsection shall apply to services furnished 

9 on or after January 1, 2017. 

10 (b) ADVANCED ILLNESS CARE COORDINATION SERV11 ICES PROJECT.—Section 1115A(b)(2) of title XI of the 

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

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

14 the following new sentence: ‘‘The models selected 

15 under this subparagraph shall include the model de16 scribed in subparagraph (D) and such model shall be 

17 implemented by not later than December 31, 

18 2017.’’; and 

19 (2) by adding at the end the following new sub20 paragraph: 

21 ‘‘(D) ADVANCED ILLNESS CARE COORDINA22 TION SERVICES MODEL.— 

23 ‘‘(i) MODEL.— 

24 ‘‘(I) IN GENERAL.—The model 

25 described in this subparagraph is a 


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1 model under which payments are 

2 made to applicable providers that fur3 nish advanced illness care coordina4 tion services to eligible individuals. 

5 ‘‘(II) REQUIREMENT.—At least 

6 one applicable provider selected for 

7 participation under the model shall be 

8 a hospice program (as defined in sec9 tion 1861(dd)(2)). 

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

11 subparagraph, the term ‘applicable pro12 vider’ has the meaning given such term in 

13 section 1861(iii)(4). 

14 ‘‘(iii) ADVANCED ILLNESS CARE CO15 ORDINATION SERVICES.—In this subpara16 graph, the term ‘advanced illness care co17 ordination services’ means the following 

18 services: 

19 ‘‘(I) Planning services (as defined 

20 in section 1861(iii)). 

21 ‘‘(II) A multi-dimensional assess22 ment of the individual’s strengths and 

23 limitations. 


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1 ‘‘(III) An assessment of the indi2 vidual’s formal and informal supports, 

3 including family caregivers. 

4 ‘‘(IV) Comprehensive medication 

5 review and management (including, if 

6 appropriate, counseling and self-man7 agement support). 

8 ‘‘(V) In-home supportive services 

9 for the eligible individual and family 

10 caregivers consistent with the care 

11 plan. 

12 ‘‘(VI) 24-hour access to emer13 gency support in person or via tele14 phone or telemedicine with the indi15 vidual’s medical record and care plan 

16 available to the responder. 

17 ‘‘(VII) Coordination across 

18 health care and social service systems, 

19 including involvement of the inter20 disciplinary team to evaluate quality 

21 and address concerns over time. 

22 ‘‘(VIII) Such other services as 

23 specified by the Secretary. 


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

2 subparagraph, the term ‘eligible individual’ 

3 means an individual who— 

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

5 benefits under part A of title XVIII 

6 and enrolled under part B of such 

7 title, but not enrolled under part C of 

8 such title; and 

9 ‘‘(II) has the need for assistance 

10 with two or more activities of daily 

11 living (defined as bathing, dressing, 

12 eating, getting out of bed or a chair, 

13 mobility, and toileting) that is not as14 sociated with an acute or post-opera15 tive condition that is caused by one or 

16 more serious or life threatening condi17 tions or frailty.’’. 

18 SEC. 4. QUALITY MEASUREMENT DEVELOPMENT. 

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

20 Health Service Act (42 U.S.C. 299b–31(c)(2)) is amend21 ed— 

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

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

24 (2) by inserting after subparagraph (H) the fol25 lowing new subparagraphs: 


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1 ‘‘(I) the process of eliciting and docu2 menting patient (and, where relevant and ap3 propriate, family caregiver) goals, preferences, 

4 and values from the patient or from a legally 

5 authorized representative, including the articu6 lation of goals that accurately reflect how the 

7 patient wants to live; 

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

9 (and, where relevant, family caregiver10 centeredness), and accuracy of care plans, in11 cluding documentation of individual goals, pref12 erences, and values; 

13 ‘‘(K) agreement and consistency among— 

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

15 preferences; 

16 ‘‘(ii) any documented care plan; 

17 ‘‘(iii) the treatment delivered; and 

18 ‘‘(iv) outcomes of treatment;’’. 

19 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

20 are authorized to be appropriated to the Secretary of 

21 Health and Human Services to carry out the amendments 

22 made by this section, $5,000,000 for fiscal year 2016. 

23 Amounts appropriated under the preceding sentence shall 

24 remain available until expended. 


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1 SEC. 5. INCLUSION OF ADVANCE CARE PLANNING MATE2 RIALS IN THE MEDICARE & YOU HANDBOOK. 

3 (a) IN GENERAL.—Section 1804(a) of the Social Se4 curity Act (42 U.S.C. 1395b–2(a)) is amended— 

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

6 end; 

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

8 the end and inserting a semicolon; and 

9 (3) by inserting after paragraph (3) the fol10 lowing new paragraphs: 

11 ‘‘(4) information on— 

12 ‘‘(A) care planning; 

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

14 preferences should be considered in framing a 

15 care plan; and 

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

17 advanced illness, including disease modifying 

18 options, palliative care that supports individuals 

19 from the onset of advanced illness and can be 

20 provided at the same time as all other care 

21 types, and hospice care; and 

22 ‘‘(5) information on documentation options for 

23 care planning or advance care planning, including 

24 advance directives and portable treatment orders.’’. 


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

2 this section shall apply to notices distributed on or after 

3 January 1, 2017. 

4 SEC. 6. IMPROVEMENT OF POLICIES RELATED TO THE USE 

5 AND PORTABILITY OF ADVANCE DIRECTIVES. 

6 (a) MEDICARE.— 

7 (1) IN GENERAL.—Section 1866(f) of the Social 

8 Security Act (42 U.S.C. 1395cc(f)) is amended— 

9 (A) in paragraph (1)— 

10 (i) in subparagraph (A)(i)— 

11 (I) by inserting ‘‘relevant’’ after 

12 ‘‘rights under’’; and 

13 (II) by striking ‘‘of the State’’; 

14 (ii) by striking subparagraph (B); 

15 (iii) by redesignating subparagraphs 

16 (C), (D), and (E) as subparagraphs (G), 

17 (H), and (I), respectively; 

18 (iv) by inserting after subparagraph 

19 (A) the following new subparagraphs: 

20 ‘‘(B) to request and document in a prominent 

21 part of the individual’s current medical record the 

22 content of (or a copy of) an advance directive or 

23 portable treatment order; 


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1 ‘‘(C) to provide each individual with resources 

2 to assist them in understanding the information pro3 vided to them pursuant to subparagraph (A); 

4 ‘‘(D) in the case of an individual with decisional 

5 capacity under State law, to follow the individual’s 

6 current treatment instructions, as expressed in writ7 ing or through verbal or non-verbal communications; 

8 ‘‘(E) in the case of an individual who lacks 

9 decisional capacity— 

10 ‘‘(i) to follow treatment decisions in ac11 cordance with current advance directives and 

12 portable treatment orders that are valid under 

13 State law where the care is delivered and the 

14 instructions provided by legally authorized rep15 resentatives in accordance with State law; and 

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

17 directive or portable treatment order that is 

18 valid under State law where the care is deliv19 ered or instructions provided by a legally au20 thorized representative in accordance with State 

21 law, to deliver treatment based on credible evi22 dence of the individual’s treatment preferences, 

23 goals, and values, which evidence may include a 

24 current advance directive or portable treatment 

25 order executed in another State; 


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1 ‘‘(F) that specify conditions or circumstances 

2 under which an advance directive, portable treat3 ment order, or treatment directions from an indi4 vidual or legally authorized representative would not 

5 be followed;’’; 

6 (v) in subparagraph (H), as redesig7 nated by subparagraph (C), by striking 

8 ‘‘State law’’ and all that follows through 

9 ‘‘respecting’’ and inserting ‘‘this section 

10 and relevant State and Federal law re11 specting’’; 

12 (vi) in subparagraph (I), as redesig13 nated by subparagraph (C), by inserting 

14 ‘‘and portable treatment orders’’ before the 

15 period at the end; 

16 (vii) in the flush matter at the end, by 

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

18 (viii) by adding at the end the fol19 lowing new sentence: ‘‘Nothing in subpara20 graph (D) or (E) shall be construed to 

21 apply to a request or directive ordering a 

22 sterilization or abortion or ordering with23 drawal of treatment from a pregnant 

24 woman if continued treatment can reasonVerDate Sep 11 2014 06:13 Jun 11, 2015 Jkt 049200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S1549.IS S1549

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1 ably be expected to bring her child to live 

2 birth.’’; 

3 (B) by redesignating paragraphs (3) and 

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

5 (C) by inserting after paragraph (2) the 

6 following new paragraph: 

7 ‘‘(3) Nothing in this section shall be construed to pro8 hibit the application of a State law which allows for an 

9 objection on the basis of conscience for any health care 

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

11 of conscience cannot implement an advance directive or 

12 portable treatment order.’’; 

13 (D) in paragraph (4), as redesignated by 

14 paragraph (2)— 

15 (i) by striking ‘‘a written’’ and insert16 ing ‘‘an’’; 

17 (ii) by striking ‘‘State law’’ and in18 serting ‘‘State or Federal law’’; and 

19 (iii) by striking ‘‘of the State’’; 

20 (E) by redesignating paragraph (5), as re21 designated by paragraph (2), as paragraph (6); 

22 (F) by inserting after paragraph (4) the 

23 following new paragraph: 

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

25 order’ means a treatment order designed to document a 


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1 clinical process that includes shared, informed medical de2 cisionmaking, that reflects the individual’s goals of care 

3 and values, and that is designed to apply across care set4 tings, including the home.’’; and 

5 (G) by inserting after paragraph (6), as re6 designated by paragraph (6), the following new 

7 paragraph: 

8 ‘‘(7) Nothing in this subsection shall permit the Sec9 retary to seek civil penalties, including exclusion from par10 ticipation in the program under this title or the program 

11 under title XIX, against a provider or organization if the 

12 provider or organization— 

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

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

15 and values when addressing decisionmaking for an 

16 individual who lacks decisional capacity; or 

17 ‘‘(B) exercised its right of conscience in accord18 ance with paragraph (3).’’. 

19 (2) EFFECTIVE DATE.—The amendments made 

20 by paragraph (1) shall apply to provider agreements 

21 and contracts entered into, renewed, or extended 

22 under title XVIII of the Social Security Act on or 

23 after such date as the Secretary of Health and 

24 Human Services specifies, but in no case may such 


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1 date be later than 1 year after the date of the enact2 ment of this Act. 

3 (3) RULE OF CONSTRUCTION.—Nothing in the 

4 provisions of, or the amendments made by, this sub5 section shall be construed to require a provider of 

6 services or an organization to act in a manner con7 trary to its religious or moral convictions. 

8 (b) CLARIFICATION WITH RESPECT TO ADVANCE DI9 RECTIVES.—Paragraph (2) of section 7 of the Assisted 

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

11 14406) is amended to read as follows: 

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 individuals, such as 

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

20 SEC. 7. ADDITIONAL REQUIREMENTS FOR FACILITIES. 

21 (a) REQUIREMENTS.— 

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

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

24 amended— 


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

2 ‘‘and’’ at the end; 

3 (B) in subparagraph (W), as added by sec4 tion 3005(1)(C) of the Patient Protection and 

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

6 redesignating such subparagraph as subpara7 graph (X), moving such subparagraph to follow 

8 subparagraph (V), moving such subparagraph 2 

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

10 end and inserting a comma; 

11 (C) in subparagraph (W), as added by sec12 tion 6406(b)(3) of the Patient Protection and 

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

14 redesignating such subparagraph as subpara15 graph (Y), moving such subparagraph to follow 

16 subparagraph (X), as added by subparagraph 

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

18 left, and striking the period at the end and in19 serting ‘‘, and’’; and 

20 (D) by inserting after subparagraph (Y) 

21 the following new subparagraph: 

22 ‘‘(Z) in the case of hospitals, skilled nursing fa23 cilities, home health agencies, and hospice programs, 

24 to assure that documented care plans include any 

25 advance directives or portable treatment orders 


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1 made while the individual received care by the pro2 vider and that such plan is sent to the individual’s 

3 primary care provider upon discharge and any facil4 ity to which the individual is transferred.’’. 

5 (2) EFFECTIVE DATE.—The amendments made 

6 by this subsection shall apply to agreements entered 

7 into or renewed on or after January 1, 2017. 

8 (b) HHS STUDY AND REPORT.— 

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

10 Human Services shall conduct a study on the extent 

11 to which hospitals, skilled nursing facilities, hospice 

12 programs, home health agencies, and applicable pro13 viders of planning services under section 1861(iii) of 

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

15 work with individuals to— 

16 (A) engage in a care planning process; 

17 (B) thoroughly and completely document 

18 the care planning process in the medical record; 

19 (C) complete documents necessary to sup20 port the treatment and care plan, such as port21 able treatment orders and advance directives; 

22 (D) provide services and support that is 

23 free from discrimination based on advanced 

24 age, disability status, or advanced illness; and 


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1 (E) provide documentation necessary to 

2 carry out the treatment plan to— 

3 (i) subsequent providers or facilities; 

4 and 

5 (ii) the individual, their legally au6 thorized representatives, and, where appro7 priate and relevant, their family caregiver. 

8 (2) REPORT.—Not later than January 1, 2020, 

9 the Secretary of Health and Human Services shall 

10 submit to Congress a report on the study conducted 

11 under paragraph (1) together with recommendations 

12 for such legislation and administrative action as the 

13 Secretary determines to be appropriate. 

14 SEC. 8. GRANTS FOR INCREASING PUBLIC AWARENESS OF 

15 ADVANCE CARE PLANNING AND ADVANCED 

16 ILLNESS CARE. 

17 (a) MATERIAL AND RESOURCES DEVELOPMENT.— 

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

19 Human Services (in this section referred to as the 

20 ‘‘Secretary’’) is authorized to award grants to enti21 ties described in subsection (d) to develop online 

22 training modules, decision support tools, and in23 structional materials for individuals, family care24 givers, and health care providers that include— 


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1 (A) for healthy individuals, the importance 

2 of— 

3 (i) identifying an individual who will 

4 make treatment decisions in the event of 

5 future cognitive incapacity; 

6 (ii) discussing values and goals rel7 evant to catastrophic injury or illness; and 

8 (iii) completing an advance directive 

9 that— 

10 (I) appoints a surrogate; and 

11 (II) documents goals and values 

12 and other information that should be 

13 considered in making treatment deci14 sions; 

15 (B) for individuals with advanced illness, 

16 the importance of— 

17 (i) articulating goals of care; 

18 (ii) understanding prognosis and typ19 ical disease trajectory; 

20 (iii) evaluating treatment options in 

21 light of goals of care; 

22 (iv) developing a treatment plan; and 

23 (v) documenting the treatment plan 

24 on advance directives, portable treatment 

25 orders, and other documentation forms 


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1 used in the locality where the plan is to be 

2 executed; 

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

4 other advance directive forms and portable 

5 treatment orders; and 

6 (D) the range of services for individuals 

7 facing advanced illness, including planning serv8 ices, palliative care, and hospice care. 

9 (2) PERIOD.—Any grant awarded under para10 graph (1) shall be for a period of 3 years. 

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

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

14 to award grants to entities described in subsection 

15 (d) to establish and maintain a website and tele16 phone hotline to disseminate resources developed 

17 under subsection (a) and materials designed by the 

18 Department of Health and Human Services Center 

19 for Faith-Based and Neighborhood Partnerships for 

20 faith communities. 

21 (2) PERIOD.—Any grant awarded under para22 graph (1) shall be for a period of 5 years. 

23 (3) ABILITY TO SUSTAIN ACTIVITIES.—The 

24 Secretary shall take into account the ability of an 

25 entity to sustain the activities described in paraVerDate Sep 11 2014 06:13 Jun 11, 2015 Jkt 049200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S1549.IS S1549

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1 graph (1) beyond the 5-year grant period in deter2 mining whether to award a grant under paragraph 

3 (1) to the entity. 

4 (c) NATIONAL PUBLIC EDUCATION CAMPAIGN.— 

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

6 to award grants to entities described in subsection 

7 (d) to conduct a national public education campaign 

8 to raise public awareness of advance care planning 

9 and advanced illness care, including the availability 

10 of the resources created under subsections (a) and 

11 (b). 

12 (2) PERIOD.—Any grant awarded under para13 graph (1) shall be for a period of 5 years. 

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

15 subsection are public or private entities (including States 

16 or political subdivisions of a State, faith-based organiza17 tions, and religious educational institutions), or a consor18 tium of any such entities. 

19 (e) AUTHORIZATION OF APPROPRIATIONS.— 

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

21 appropriated to the Secretary— 

22 (A) for purposes of making grants under 

23 subsection (a), $5,000,000 for fiscal year 2017, 

24 to remain available until expended; 


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1 (B) for purposes of making grants under 

2 subsection (b), $5,000,000 for fiscal year 2017, 

3 to remain available until expended; and 

4 (C) for purposes of making grants under 

5 subsection (c), $5,000,000 for fiscal year 2017 

6 to remain available until expended. 

7 (2) LIMITATION.—None of the funds appro8 priated under paragraph (1) shall be used to— 

9 (A) develop a model advance directive; 

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

11 adjusted life year (or similar measure that dis12 counts the value of a life because of an individ13 ual’s disability); or 

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

15 advocates, promotes, or facilitates any item or 

16 procedure for which funding is unavailable 

17 under the Assisted Suicide Funding Restriction 

18 Act of 1997 (Public Law 105–12). 

19 SEC. 9. RULE OF CONSTRUCTION. 

20 Nothing in the provisions of, or the amendments 

21 made by, this Act shall be construed to limit the restric22 tions of, or to authorize the use of Federal funds for any 

23 service, material, or activity pertaining to an item or serv24 ice or procedure for which funds are unavailable under, 


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1 the Assisted Suicide Funding Restriction Act of 1997 

2 (Public Law 105–12). 

Æ 


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