II 

112TH CONGRESS 

2D SESSION S. 3684 

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 

DECEMBER 17, 2012 

Mr. WARNER 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 ‘‘Senior Navigation and Planning Act of 2012’’. 

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. Medicare and Medicaid coverage of advanced illness care coordination 

services. 


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Sec. 4. Increasing awareness of the importance of advance care planning. 

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

handbook. 

Sec. 6. Senior Navigation Advisory Board. 

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

directives. 

Sec. 8. Additional requirements for facilities. 

Sec. 9. Incentives for accreditation and certification in hospice and palliative 

care. 

Sec. 10. Discharge checklist pilot program. 

Sec. 11. Web-based materials and grants. 

Sec. 12. HHS study and report on the storage of advanced directives. 

Sec. 13. GAO study and report on the provisions of, and amendments made by, 

this Act. 

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) Whereas the population of the United 

4 States is estimated to age rapidly, with the number 

5 of people over the age of 65 set to double to more 

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

7 two decades. 

8 (2) Whereas Americans today are living longer 

9 and healthier lives than ever before in the history of 

10 the United States yet are also facing increased inci11 dence of multiple chronic conditions as aging pro12 gresses. Advanced illness occurs when one or more 

13 conditions become serious enough that general 

14 health and functioning decline and quality of life in15 creasingly becomes the primary focus of care. 

16 (3) Whereas older Americans with advanced ill17 ness face an increasingly complicated and frag18 mented system of care delivery and are at greater 

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1 tions, and conflicting medical advice that may be 

2 overwhelming to individuals and families. 

3 (4) Whereas the progression of advanced illness 

4 over time leads to more intense needs that require 

5 greater time and assistance from that individual’s 

6 caregiver, be it a family member or a direct care 

7 worker and significantly increased medical needs, in8 cluding the need to see multiple specialists across 

9 the health care system, which often results in unco10 ordinated care, making individuals more prone to 

11 adverse health outcomes, increased frustration, and 

12 decreased satisfaction. 

13 (5) Whereas advanced illness imposes financial 

14 and emotional burdens on families, friends, and co15 workers, in addition to leading to billions per year 

16 in lost productivity due to caregivers having to take 

17 time off of work to care for frail and elderly loved 

18 ones. 

19 (6) Whereas numerous private sector leaders, 

20 including hospitals, health systems, home health 

21 agencies, hospice programs, long-term care pro22 viders, employers, and other entities, have put in 

23 place innovative solutions to providing more com24 prehensive and coordinated care for Americans living 

25 with advanced illness. 


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1 (7) Whereas hospice programs, as one of the 

2 longest standing Medicare care coordination benefits 

3 that entails administering a comprehensive set of 

4 services via an interdisciplinary team working to 

5 provide person-centered care to the frailest and most 

6 vulnerable individuals in our communities, can help 

7 serve as a model for advanced illness care delivery. 

8 (8) Whereas the Government of the United 

9 States, as the Nation’s largest purchaser of health 

10 care services, must learn from these innovators and 

11 encourage health care providers to furnish more sup12 portive and comprehensive advanced illness care co13 ordination services to improve individual’s experi14 ences and ensure a more sustainable system of care 

15 delivery for generations of Americans to come. 

16 SEC. 3. MEDICARE AND MEDICAID COVERAGE OF AD17 VANCED ILLNESS CARE COORDINATION 

18 SERVICES. 

19 (a) MEDICARE COVERAGE OF ADVANCED ILLNESS

20 CARE COORDINATION SERVICES.— 

21 (1) COVERAGE.—Section 1812(a)(5) of the So22 cial Security Act (42 U.S.C. 1395d(a)(5)) is amend23 ed to read as follows: 

24 ‘‘(5) for individuals with advanced illness (as 

25 determined under section 1861(iii)(2)) who have not 


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1 made an election under subsection (d)(1) to receive 

2 hospice care under this part, advanced illness care 

3 coordination services (as defined in section 

4 1861(iii)(1)).’’. 

5 (2) DEFINITION.—Section 1861 of the Social 

6 Security Act (42 U.S.C. 1395x) is amended by add7 ing at the end the following new subsection: 

8 ‘‘Advanced Illness Care Coordination Services 

9 ‘‘(iii)(1) The term ‘advanced illness care coordination 

10 services’ means the following services furnished to an indi11 vidual with advanced illness by an applicable provider: 

12 ‘‘(A) Palliative care consultation services. 

13 ‘‘(B) Person and family centered care planning 

14 services, including information on advance care plan15 ning. 

16 ‘‘(C) Medication management. 

17 ‘‘(D) Individual and family counseling services, 

18 including assistance with the identification of care 

19 options and the goals of care. 

20 ‘‘(E) Culturally and educationally appropriate 

21 family caregiver training and support services, in22 cluding respite services. 

23 ‘‘(F) Such other services the Secretary may 

24 specify. 


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1 ‘‘(2)(A) An individual is considered to have ‘advanced 

2 illness’ if the individual has a medical prognosis that the 

3 individual’s life expectancy is 18 months or less or meets 

4 other criteria specified by the Secretary in accordance with 

5 subparagraph (B). 

6 ‘‘(B) In specifying criteria under subparagraph (A), 

7 the Secretary shall consider— 

8 ‘‘(i) the severity of illness, including the diag9 nosis, stage, comorbidities, functional status, hos10 pitalization, and other objective factors determined 

11 appropriate by the Secretary; 

12 ‘‘(ii) the acuity of illness, as measured by the 

13 progression of illness and disability over the imme14 diately preceding 30- and 90-day periods; and 

15 ‘‘(iii) treatment response, such as, in the case 

16 of cancer, resistance to chemotherapy. 

17 ‘‘(3) For purposes of this subsection, the term ‘appli18 cable provider’ means— 

19 ‘‘(A) a hospice program (as defined in sub20 section (dd)(2)); or 

21 ‘‘(B) other provider of services or supplier spec22 ified by the Secretary. 

23 ‘‘(4) In the case of an applicable provider that is fur24 nishing advanced illness care coordination services to an 

25 individual who becomes eligible for hospice care under this 


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1 title, the applicable provider shall notify the individual of 

2 such eligibility.’’. 

3 (3) PAYMENT BASED ON THE PHYSICIAN FEE

4 SCHEDULE.—Section 1814(i)(4) of the Social Secu5 rity Act (42 U.S.C. 1395f(i)(4)) is amended to read 

6 as follows: 

7 ‘‘(4) The amount paid to an applicable provider with 

8 respect to advanced illness care coordination services (as 

9 defined in section 1861(iii)) for which payment may be 

10 made under this part shall be— 

11 ‘‘(A) with respect to such services furnished by 

12 a physician, an amount equal to the amount that 

13 would be paid for an equivalent physician’s service 

14 under the fee schedule established under section 

15 1848(b); 

16 ‘‘(B) with respect to such services, other than 

17 respite services, furnished by a non-physician practi18 tioner, an amount equal to the amount that would 

19 be paid for an equivalent service under section 

20 1833(a)(1)(O); and 

21 ‘‘(C) with respect to respite services, payment 

22 shall be at an appropriate rate to be determined by 

23 the Secretary’’. 


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1 (4) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply to services furnished 

3 on or after January 1, 2013. 

4 (b) MEDICAID COVERAGE OF ADVANCED ILLNESS

5 CARE COORDINATION SERVICES.— 

6 (1) IN GENERAL.—Section 1905(a) of the So7 cial Security Act (42 U.S.C. 1396d(a)) is amend8 ed— 

9 (A) by redesignating paragraph (29) as 

10 paragraph (30); 

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

12 end ‘‘and’’; and 

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

14 following new paragraph: 

15 ‘‘(29) advanced illness care coordination serv16 ices (as defined in section 1861(iii)) for individuals 

17 described in section 1812(a)(5); and’’. 

18 (2) CONFORMING AMENDMENT.—Section 

19 1902(a)(10)(A) of the Social Security Act (42 

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

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

22 (3) EFFECTIVE DATE.— 

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

24 subparagraph (B), the amendments made by 


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

2 1, 2013. 

3 (B) EXTENSION OF EFFECTIVE DATE FOR

4 STATE LAW AMENDMENT.—In the case of a 

5 State plan under title XIX of the Social Secu6 rity Act (42 U.S.C. 1396 et seq.) which the 

7 Secretary determines requires State legislation 

8 in order for the plan to meet the additional re9 quirements imposed by the amendments made 

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

11 not be regarded as failing to comply with the 

12 requirements of such title solely on the basis of 

13 its failure to meet these additional requirements 

14 before the first day of the first calendar quarter 

15 beginning after the close of the first regular 

16 session of the State legislature that begins after 

17 the date of enactment of this Act. For purposes 

18 of the previous sentence, in the case of a State 

19 that has a 2-year legislative session, each year 

20 of the session is considered to be a separate 

21 regular session of the State legislature. 

22 (c) EDUCATION ON ADVANCED ILLNESS CARE CO23 ORDINATION SERVICES.—The Secretary of Health and 

24 Human Services (in this section referred to as the ‘‘Sec25 retary’’) shall establish a program under which physicians 


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1 (as defined in subsection (r) of section 1861 of the Social 

2 Security Act (42 U.S.C. 1395x)) are educated on the cov3 erage of advanced illness care coordination services (as de4 fined in subsection (iii) of such section) under the Medi5 care and Medicaid programs under titles XVIII and XIX, 

6 respectively, of the Social Security Act (42 U.S.C. 1395 

7 et seq.; 1396 et seq.), including the importance of early 

8 intervention in providing such care to individuals. 

9 SEC. 4. INCREASING AWARENESS OF THE IMPORTANCE OF 

10 ADVANCE CARE PLANNING. 

11 Title III of the Public Health Service Act (42 U.S.C. 

12 241 et seq.) is amended by adding at the end the following 

13 new part: 

14 ‘‘PART W—PROGRAMS TO INCREASE AWARENESS 

15 OF ADVANCE CARE PLANNING ISSUES 

16 ‘‘SEC. 399OO. ADVANCE CARE PLANNING EDUCATION CAM17 PAIGNS AND INFORMATION PHONE LINE AND 

18 CLEARINGHOUSE. 

19 ‘‘(a) ADVANCE CARE PLANNING EDUCATION CAM20 PAIGN.—The Secretary shall, directly or through grants 

21 awarded under subsection (c), conduct a national public 

22 education campaign— 

23 ‘‘(1) to raise public awareness of the impor24 tance of planning for care throughout the life cycle 

25 and as illness progresses; 


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1 ‘‘(2) to explain the need for readily available 

2 legal documents and medical orders that express an 

3 individual’s wishes through— 

4 ‘‘(A) advance directives (including living 

5 wills, comfort care orders, and durable powers 

6 of attorney for health care); and 

7 ‘‘(B) other planning tools, such as Physi8 cian’s Orders for Life-Sustaining Treatment 

9 (POLST) or a State authorized portable order; 

10 and 

11 ‘‘(3) to educate the public about the availability 

12 of advanced illness care, palliative care, and hospice 

13 care. 

14 ‘‘(b) COMMUNICATIONS RESOURCES.—The Sec15 retary, directly or through grants awarded under sub16 section (c), shall provide for multiple, innovative commu17 nications resources, including a toll-free information tele18 phone line, that the public and health care professionals 

19 may access to find out about State-specific information re20 garding advance directives and end-of-life decisions. 

21 ‘‘(c) GRANTS.— 

22 ‘‘(1) IN GENERAL.—The Secretary shall use 

23 funds appropriated under subsection (d) for the pur24 pose of awarding grants to public or nonprofit pri25 vate entities (including States or political subdiviVerDate Mar 15 2010 03:45 Dec 20, 2012 Jkt 029200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3684.IS S3684

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1 sions of a State), or a consortium of any of such en2 tities, for the purpose of conducting education cam3 paigns under subsection (a). 

4 ‘‘(2) PERIOD.—Any grant awarded under para5 graph (1) shall be for a period of 3 years. 

6 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated— 

8 ‘‘(1) for purposes of carrying out subsection 

9 (b), $5,000,000 for fiscal year 2013 and each subse10 quent year; and 

11 ‘‘(2) for purposes of making grants under sub12 section (c), $10,000,000 for fiscal year 2013, to re13 main available until expended.’’. 

14 SEC. 5. INCLUSION OF ADVANCE CARE PLANNING MATE15 RIALS IN THE MEDICARE & YOU HANDBOOK. 

16 (a) IN GENERAL.—Section 1804(a) of the Social Se17 curity Act (42 U.S.C. 1395b–2(a)) is amended— 

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

19 end; 

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

21 the end and inserting ‘‘; and’’; and 

22 (3) by inserting after paragraph (3) the fol23 lowing new paragraph: 


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1 ‘‘(4) information on advanced illness care co2 ordination, palliative care, other end-of-life planning 

3 tools, and the hospice care benefit under this title.’’. 

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

5 this section shall apply to notices distributed on or after 

6 January 1, 2013. 

7 SEC. 6. SENIOR NAVIGATION ADVISORY BOARD. 

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

9 Human Services shall establish the Senior Navigation Ad10 visory Board (in this section referred to as the ‘‘Advisory 

11 Board’’). 

12 (b) MEMBERSHIP.—The Board shall be comprised of 

13 advocates, consumer representatives, researchers, govern14 ment officials, health care providers, ethicists, members of 

15 the faith-based community, family caregivers, medical pro16 viders, and other individuals with expertise in issues re17 lated to end-of-life care. 

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

19 Secretary on issues related to end-of-life care and advance 

20 care planning, including how to— 

21 (1) improve the quality of life for beneficiaries; 

22 (2) reduce current legal barriers to the enforce23 ment of advance directives; 


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1 (3) encourage provider participation in edu2 cational and training activities surrounding ad3 vanced illnesses and personal care planning; 

4 (4) develop quality and outcome measures that 

5 applicable programs should report for advanced ill6 ness care coordination services (as defined in section 

7 1861(iii) of the Social Security Act, as added by sec8 tion 3); 

9 (5) determine what information should be dis10 cussed in discharge planning; 

11 (6) enhance advance care planning; and 

12 (7) develop and sustain an optimal service array 

13 for implementing quality care coordination services. 

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

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

16 Board. 

17 (e) PAY AND REIMBURSEMENT.— 

18 (1) NO COMPENSATION FOR MEMBERS OF ADVI19 SORY BOARD.—Except as provided in paragraph (2), 

20 a member of the Advisory Board may not receive 

21 pay, allowances, or benefits by reason of their serv22 ice on the Board. 

23 (2) TRAVEL EXPENSES.—Each member shall 

24 receive travel expenses, including per diem in lieu of 


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1 subsistence under subchapter I of chapter 57 of title 

2 5, United States Code. 

3 (f) REPORT.—Not later than 3 years after the estab4 lishment of the Advisory Board, the Advisory Board shall 

5 submit to Congress a final report containing the findings 

6 and conclusions of the Advisory Board, together with rec7 ommendations for such legislation and administrative ac8 tions as the Advisory Board considers appropriate. 

9 (g) TERMINATION.—The Advisory Board shall termi10 nate 30 days after submitting the report under subsection 

11 (f). 

12 (h) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated such sums as may be 

14 necessary to carry out this section. 

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

16 AND PORTABILITY OF ADVANCED DIREC17 TIVES. 

18 (a) MEDICARE.—Section 1866(f) of the Social Secu19 rity Act (42 U.S.C. 1395cc(f)) is amended— 

20 (1) in paragraph (1)— 

21 (A) in subparagraph (B), by inserting 

22 ‘‘and if presented by the individual (or on be23 half of the individual), to include the content of 

24 such advance directive in a prominent part of 

25 such record’’ before the semicolon at the end; 


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1 (B) in subparagraph (D)— 

2 (i) by inserting ‘‘paragraph (5) and 

3 applicable’’ after ‘‘requirements of’’; and 

4 (ii) by striking ‘‘and’’ after the semi5 colon at the end; 

6 (C) in subparagraph (E), by striking the 

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

8 (D) by inserting after subparagraph (E) 

9 the following new subparagraph: 

10 ‘‘(F) to provide each individual with the oppor11 tunity to discuss issues relating to the information 

12 provided to that individual pursuant to subpara13 graph (A) with an appropriately trained profes14 sional.’’; 

15 (2) in paragraph (3), by striking ‘‘a written’’ 

16 and inserting ‘‘an’’; and 

17 (3) by adding at the end the following new 

18 paragraph: 

19 ‘‘(5)(A) An advance directive or State authorized 

20 portable order validly executed outside of the State in 

21 which the directive or order is presented shall be given 

22 effect by a provider of services or organization (as the case 

23 may be) to the same extent as an advance directive or 

24 order validly executed under the law of the State in which 

25 it is presented. 


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

2 a physician or other health care provider or a provider 

3 of services or organization may presume that a written 

4 advance health care directive or similar instrument or a 

5 State authorized portable order, regardless of where exe6 cuted, is valid. 

7 ‘‘(C) In the absence of a validly executed advance di8 rective or State authorized portable order, a provider of 

9 services or organization shall honor any authentic expres10 sion of an individual’s wishes with respect to health care. 

11 ‘‘(D) The provisions of this paragraph shall preempt 

12 any State law with respect to advance directive portability 

13 to the extent such law is inconsistent with such provisions. 

14 Nothing in this paragraph shall be construed to authorize 

15 the administration of health care treatment otherwise pro16 hibited by the laws of the State in which the directive is 

17 presented.’’. 

18 (b) MEDICAID.—Section 1902(w) of the Social Secu19 rity Act (42 U.S.C. 1396a(w)) is amended— 

20 (1) in paragraph (1)— 

21 (A) in subparagraph (B)— 

22 (i) by striking ‘‘in the individual’s 

23 medical record’’ and inserting ‘‘in a promi24 nent part of the individual’s current med25 ical record’’; and 


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1 (ii) by inserting ‘‘and if presented by 

2 the individual (or on behalf of the indi3 vidual), to include the content of such ad4 vance directive in a prominent part of such 

5 record’’ before the semicolon at the end; 

6 (B) in subparagraph (D)— 

7 (i) by inserting ‘‘paragraph (6) and 

8 applicable’’ after ‘‘requirements of’’; and 

9 (ii) by striking ‘‘and’’ after the semi10 colon at the end; 

11 (C) in subparagraph (E), by striking the 

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

13 (D) by inserting after subparagraph (E) 

14 the following new subparagraph: 

15 ‘‘(F) to provide each individual with the oppor16 tunity to discuss issues relating to the information 

17 provided to that individual pursuant to subpara18 graph (A) with an appropriately trained profes19 sional.’’; 

20 (2) in paragraph (4), by striking ‘‘a written’’ 

21 and inserting ‘‘an’’; and 

22 (3) by adding at the end the following para23 graph: 

24 ‘‘(6)(A) An advance directive or State authorized 

25 portable order validly executed outside of the State in 


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1 which the directive is presented shall be given effect by 

2 a provider of services or organization (as the case may 

3 be) to the same extent as an advance directive or order 

4 validly executed under the law of the State in which it 

5 is presented. 

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

7 a physician or other health care provider or a provider 

8 of services or organization may presume that a written 

9 advance health care directive or similar instrument or a 

10 State authorized portable order, regardless of where exe11 cuted, is valid. 

12 ‘‘(C) In the absence of a validly executed advance di13 rective or State authorized portable order, a provider of 

14 services or organization shall honor any authentic expres15 sion of an individual’s wishes with respect to health care. 

16 ‘‘(D) The provisions of this paragraph shall preempt 

17 any State law with respect to advance directive portability 

18 to the extent such law is inconsistent with such provisions. 

19 Nothing in this paragraph shall be construed to authorize 

20 the administration of health care treatment otherwise pro21 hibited by the laws of the State in which the directive is 

22 presented.’’. 

23 (c) EFFECTIVE DATES.— 

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

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


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1 shall apply to provider agreements and contracts en2 tered into, renewed, or extended under title XVIII of 

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

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

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

6 Secretary of Health and Human Services specifies, 

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

8 after the date of enactment of this Act. 

9 (2) EXTENSION OF EFFECTIVE DATE FOR

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

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

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

13 and Human Services determines requires State legis14 lation in order for the plan to meet the additional 

15 requirements imposed by the amendments made by 

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

17 as failing to comply with the requirements of such 

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

19 additional requirements before the first day of the 

20 first calendar quarter beginning after the close of 

21 the first regular session of the State legislature that 

22 begins after the date of enactment of this Act. For 

23 purposes of the previous sentence, in the case of a 

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


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1 of the session is considered to be a separate regular 

2 session of the State legislature. 

3 SEC. 8. ADDITIONAL REQUIREMENTS FOR FACILITIES. 

4 (a) REQUIREMENTS.— 

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

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

7 amended— 

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

9 ‘‘and’’ at the end; 

10 (B) in subparagraph (W), as added by sec11 tion 3005(1)(C) of the Patient Protection and 

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

13 redesignating such subparagraph as subpara14 graph (X), moving such subparagraph to follow 

15 subparagraph (V), moving such subparagraph 2 

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

17 end and inserting a comma; 

18 (C) in subparagraph (W), as added by sec19 tion 6406(b)(3) of the Patient Protection and 

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

21 redesignating such subparagraph as subpara22 graph (Y), moving such subparagraph to follow 

23 subparagraph (X), as added by subparagraph 

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


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1 left, and striking the period at the end and in2 serting ‘‘, and’’; and 

3 (D) by inserting after subparagraph (Y) 

4 the following new subparagraphs: 

5 ‘‘(Z) in the case of hospitals, skilled nursing fa6 cilities, home health agencies, and hospice programs, 

7 to provide an individual (and the caregivers and 

8 family of the individual, with the individual’s con9 sent, and the legal representative of the individual) 

10 who is receiving care by or through the provider with 

11 the opportunity to discuss the general course of 

12 treatment expected, the likely impact on length of 

13 life and function, and the procedures they should use 

14 to secure help if an unexpected situation arises, and 

15 ‘‘(AA) in the case of hospitals, skilled nursing 

16 facilities, home health agencies, hospice programs, 

17 and applicable providers of advanced illness care co18 ordination services (as defined in section 

19 1861(iii)(3)) to— 

20 ‘‘(i) provide for an assessment of each indi21 vidual (at the time of discharge from the pro22 vider) using an assessment instrument that is 

23 at least as informative as the continuity assess24 ment record and evaluation (CARE) instrument 


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1 developed by the Centers for Medicare & Med2 icaid Services; and 

3 ‘‘(ii) include the results of such assessment 

4 in the individual’s medical record.’’. 

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, 2014. 

8 (b) HHS STUDY AND REPORT ON APPROPRIATE AS9 SESSMENTS AT DISCHARGE.— 

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

11 Human Services shall conduct a study on the extent 

12 to which the assessment of individuals by hospitals, 

13 skilled nursing facilities, hospice programs, home 

14 health agencies, and applicable providers of ad15 vanced illness care coordination services under sec16 tion 1886(a)(1)(AA) of the Social Security Act, as 

17 added by subsection (a), accurately reflects the ac18 tual diagnosis and care plan, including care coordi19 nation, of the individual at the time of discharge. 

20 Such study shall include an analysis of how success21 ful the hospital, skilled nursing facility, hospice pro22 gram, home health agency, or applicable provider is 

23 in converting care goals and preferences expressed 

24 by the individual into a valid advance directive. 


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1 (2) REPORT.—Not later than January 1, 2016, 

2 the Secretary of Health and Human Services shall 

3 submit to Congress a report on the study conducted 

4 under paragraph (1) together with recommendations 

5 for such legislation and administrative action as the 

6 Secretary determines to be appropriate. 

7 SEC. 9. INCENTIVES FOR ACCREDITATION AND CERTIFI8 CATION IN HOSPICE AND PALLIATIVE CARE. 

9 (a) HOSPITALS.—Section 1886 of the Social Security 

10 Act (42 U.S.C. 1395ww) is amended by adding at the end 

11 the following new subsection: 

12 ‘‘(t) INCENTIVES FOR ACCREDITATION IN PALLIA13 TIVE CARE.— 

14 ‘‘(1) INCENTIVE PAYMENT.— 

15 ‘‘(A) IN GENERAL.—Subject to paragraph 

16 (3), with respect to inpatient hospital services 

17 and inpatient critical access hospital services 

18 furnished by an eligible hospital during a pay19 ment year, if the eligible hospital has in place 

20 an accredited palliative care program (as deter21 mined by the Secretary) with respect to such 

22 year and meets utilization criteria for such pro23 gram (as established by the Secretary) with re24 spect to such year, in addition to the amount 

25 otherwise paid under this section or section 


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1 1814, there shall also be paid to the eligible 

2 hospital, from the Federal Hospital Insurance 

3 Trust Fund established under section 1817, an 

4 amount equal to the applicable percent of the 

5 amount that would otherwise be paid under this 

6 section or section 1814 for such services for the 

7 hospital for such year. 

8 ‘‘(B) APPLICABLE PERCENT DEFINED.— 

9 The term ‘applicable percent’ means— 

10 ‘‘(i) for fiscal years 2013 through 

11 2018, 2 percent; and 

12 ‘‘(ii) for fiscal years 2019 through 

13 2022, 1 percent. 

14 ‘‘(C) FORM OF PAYMENT.—The payment 

15 under this paragraph for a payment year may 

16 be in the form of a single consolidated payment 

17 or in the form of such periodic installments as 

18 the Secretary may specify. 

19 ‘‘(2) INCENTIVE PAYMENT ADJUSTMENT.—Sub20 ject to paragraph (3), with respect to inpatient hos21 pital services and inpatient critical access hospital 

22 services furnished by an eligible hospital during a 

23 fiscal year after fiscal year 2022, if the eligible hos24 pital does not have in place an accredited palliative 

25 care program (as determined by the Secretary) with 


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1 respect to such fiscal year, the amount otherwise 

2 paid under this section or section 1814 for such 

3 services for the hospital for the year shall be reduced 

4 by 1 percent. 

5 ‘‘(3) EXCEPTION.—In the case of an eligible 

6 hospital with fewer than 50 beds, such hospital shall 

7 be deemed to meet the requirement in paragraphs 

8 (1)(A) and (2) if, in lieu of having in place an ac9 credited palliative care program, the hospital pro10 vides individuals and family members with access to 

11 a local or regional accredited palliative care team or 

12 program. 

13 ‘‘(4) DEFINITIONS.—In this subsection: 

14 ‘‘(A) ELIGIBLE HOSPITAL.—The term ‘eli15 gible hospital’ means— 

16 ‘‘(i) a hospital (as defined in section 

17 1861(e)); and 

18 ‘‘(ii) a critical access hospital (as de19 fined in section 1861(mm)(1)). 

20 ‘‘(B) PAYMENT YEAR.—The term ‘payment 

21 year’ means fiscal years 2013 through 2022. 

22 ‘‘(5) LIMITATIONS ON REVIEW.—There shall be 

23 no administrative or judicial review under section 

24 1869, section 1878, or otherwise, of— 


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1 ‘‘(A) the methodology and standards for 

2 determining payment amounts under paragraph 

3 (1) and payment adjustments under paragraph 

4 (2); 

5 ‘‘(B) the methodology and standards for 

6 determining whether the eligible hospital has in 

7 place an accredited palliative care program; and 

8 ‘‘(C) the application of the exception under 

9 paragraph (3).’’. 

10 (b) SKILLED NURSING FACILITIES.—Section 1888 of 

11 the Social Security Act (42 U.S.C. 1395yy) is amended 

12 by adding at the end the following new subsection: 

13 ‘‘(g) INCENTIVES FOR ACCREDITATION IN PALLIA14 TIVE CARE.— 

15 ‘‘(1) INCENTIVE PAYMENT.— 

16 ‘‘(A) IN GENERAL.—Subject to paragraph 

17 (3), with respect to covered skilled nursing fa18 cility services (as defined in subsection 

19 (e)(2)(A)) furnished by a skilled nursing facility 

20 during a payment year, if the facility has in 

21 place an accredited palliative care program (as 

22 determined by the Secretary) with respect to 

23 such year and meets utilization criteria for such 

24 program (as established by the Secretary) with 

25 respect to such year, in addition to the amount 


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1 otherwise paid under this subsection (e), there 

2 shall also be paid to the facility, from the Fed3 eral Hospital Insurance Trust Fund established 

4 under section 1817, an amount equal to the ap5 plicable percent of the amount that would oth6 erwise be paid under subsection (e) for such 

7 services for the facility for such year. 

8 ‘‘(B) DEFINITIONS.—In this subsection: 

9 ‘‘(i) APPLICABLE PERCENT.—The 

10 term ‘applicable percent’ means— 

11 ‘‘(I) for fiscal years 2013 

12 through 2018, 2 percent; and 

13 ‘‘(II) for fiscal years 2019 

14 through 2022, 1 percent. 

15 ‘‘(ii) PAYMENT YEAR.—The term 

16 ‘payment year’ means fiscal years 2013 

17 through 2022. 

18 ‘‘(C) FORM OF PAYMENT.—The payment 

19 under this paragraph for a payment year may 

20 be in the form of a single consolidated payment 

21 or in the form of such periodic installments as 

22 the Secretary may specify. 

23 ‘‘(2) INCENTIVE PAYMENT ADJUSTMENT.—Sub24 ject to paragraph (3), with respect to covered skilled 

25 nursing facility services (as defined in subsection 


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1 (e)(2)(A)) furnished by a skilled nursing facility dur2 ing a fiscal year after fiscal year 2022, if the facility 

3 does not have in place an accredited palliative care 

4 program (as determined by the Secretary) with re5 spect to such fiscal year, the amount otherwise paid 

6 under subsection (e) for such services for the facility 

7 for the year shall be reduced by 1 percent. 

8 ‘‘(3) EXCEPTION.—In the case of a skilled 

9 nursing facility with fewer than 60 beds, such facil10 ity shall be deemed to meet the requirement in para11 graphs (1)(A) and (2) if, in lieu of having in place 

12 an accredited palliative care program, the facility 

13 provides individuals and family members with access 

14 to a local or regional accredited palliative care team 

15 or program. 

16 ‘‘(4) LIMITATIONS ON REVIEW.—There shall be 

17 no administrative or judicial review under section 

18 1869, section 1878, or otherwise, of— 

19 ‘‘(A) the methodology and standards for 

20 determining payment amounts under paragraph 

21 (1) and payment adjustments under paragraph 

22 (2); 

23 ‘‘(B) the methodology and standards for 

24 determining whether the skilled nursing facility 


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1 has in place an accredited palliative care pro2 gram; and 

3 ‘‘(C) the application of the exception under 

4 paragraph (3).’’. 

5 (c) PHYSICIANS.—Section 1848 of the Social Security 

6 Act (42 U.S.C. 1395w–4) is amended by adding at the 

7 end the following new subsection: 

8 ‘‘(q) INCENTIVES FOR CERTIFICATION IN HOSPICE

9 AND PALLIATIVE CARE.— 

10 ‘‘(1) INCENTIVE PAYMENT.— 

11 ‘‘(A) IN GENERAL.—With respect to physi12 cian’s services furnished by a physician during 

13 a payment year, if the physician is certified in 

14 hospice and palliative care (as determined by 

15 the Secretary) with respect to such year, in ad16 dition to the amount otherwise paid under this 

17 part, there shall also be paid to the physician, 

18 from the Federal Supplementary Medical Insur19 ance Trust Fund established under section 

20 1841, an amount equal to the applicable per21 cent of the Secretary’s estimate (based on 

22 claims submitted not later than 2 months after 

23 the end of the payment year) of the allowed 

24 charges under this part for all covered profesVerDate Mar 15 2010 03:45 Dec 20, 2012 Jkt 029200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S3684.IS S3684

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1 sional services (as defined in subsection (k)(3)) 

2 furnished by the physician during such year. 

3 ‘‘(B) DEFINITIONS.—In this subsection: 

4 ‘‘(i) APPLICABLE PERCENT.—The 

5 term ‘applicable percent’ means— 

6 ‘‘(I) for 2013 through 2018, 2 

7 percent; and 

8 ‘‘(II) for 2019 through 2022, 1 

9 percent. 

10 ‘‘(ii) PAYMENT YEAR.—The term 

11 ‘payment year’ means 2013 through 2022. 

12 ‘‘(C) FORM OF PAYMENT.—The payment 

13 under this subsection for a payment year may 

14 be in the form of a single consolidated payment 

15 or in the form of such periodic installments as 

16 the Secretary may specify. 

17 ‘‘(2) LIMITATIONS ON REVIEW.—There shall be 

18 no administrative or judicial review under section 

19 1869, section 1878, or otherwise, of— 

20 ‘‘(A) the methodology and standards for 

21 determining payment amounts under paragraph 

22 (1); and 

23 ‘‘(B) the methodology and standards for 

24 determining whether the physician is certified 

25 in hospice and palliative care.’’. 


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1 SEC. 10. DISCHARGE CHECKLIST PILOT PROGRAM. 

2 (a) ESTABLISHMENT.—Not later than July 1, 2013, 

3 the Secretary of Health and Human Services (in this sec4 tion referred to as the ‘‘Secretary’’) shall conduct a pilot 

5 program under title XVIII of the Social Security Act to 

6 test the use of the Centers for Medicare and Medicaid 

7 Services’ discharge checklist included in the publication 

8 entitled ‘‘Planning for Your Discharge: A checklist for in9 dividuals and caregivers preparing to leave a hospital, 

10 nursing home, or other health care setting’’ and the con11 tinuity assessment record and evaluation (CARE) instru12 ment development by the Centers for Medicare and Med13 icaid Services. 

14 (b) WAIVER AUTHORITY.—The Secretary may waive 

15 compliance of such requirements of titles XI and XVIII 

16 of the Social Security Act as the Secretary determines nec17 essary to conduct the pilot program under this section. 

18 (c) REPORT.—Not later than 6 months after the com19 pletion of the pilot program under this section, the Sec20 retary shall submit to Congress a final report on the pilot 

21 program, together with recommendations for such legisla22 tion and administrative action as the Secretary determines 

23 appropriate. 

24 (d) FUNDING.—There are authorized to be appro25 priated such sums as may be necessary for purposes of 

26 conducting the pilot program under this section. 


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1 SEC. 11. WEB-BASED MATERIALS AND GRANTS. 

2 (a) WEB-BASED MATERIALS.—The Secretary of 

3 Health and Human Services (in this section referred to 

4 as the ‘‘Secretary’’) shall establish and maintain a Web 

5 site that provides information, online training, and in6 structional materials for entities, including faith-based or7 ganizations, on advance care planning, which shall include 

8 content addressing— 

9 (1) advance care planning, including common 

10 issues and questions regarding advance directives 

11 and their uses; 

12 (2) Physician Orders for Life-Sustaining Treat13 ment (POLST); 

14 (3) hospice benefits under Medicare, Medicaid, 

15 and the State Children’s Health Insurance Program 

16 established under the Social Security Act, including 

17 information on how hospice care is administered and 

18 provided to terminally ill individuals; 

19 (4) palliative care, including information on 

20 services that palliative care consultation teams and 

21 designated units provide for terminally ill individ22 uals; and 

23 (5) any additional information related to ad24 vanced progressive conditions and associated issues, 

25 as determined by the Secretary. 

26 (b) GRANTS.— 


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1 (1) HOSPICE CARE GRANT PROGRAM.— 

2 (A) GRANTS AUTHORIZED.—The Secretary 

3 is authorized to award grants to entities, in4 cluding faith-based organizations, to develop 

5 and provide services for terminally ill individ6 uals who are receiving hospice care in their own 

7 homes. 

8 (B) REQUIREMENTS.— 

9 (i) DURATION.—The grant program 

10 shall be conducted for a 5-year period, be11 ginning not later than January 1, 2013. 

12 (ii) AMOUNT OF GRANTS.—An entity 

13 may be awarded a grant under this para14 graph for a fiscal year that is not less than 

15 $5,000 and not more than $250,000. 

16 (iii) NUMBER OF GRANTS.—The Sec17 retary shall award grants under this para18 graph to not more than 100 entities. 

19 (C) ADDITIONAL MEDICAID FUNDS.—A 

20 State may elect to provide additional funds to 

21 recipients of a grant under this section, with 

22 such funds to be considered as amounts ex23 pended for the proper and efficient administra24 tion of the State plan under title XIX of the 

25 Social Security Act for purposes of the State 


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1 receiving payments under section 1903(a)(7) of 

2 that Act (42 U.S.C. 1396b(a)(7)). 

3 (D) USE OF FUNDS.—Grants awarded 

4 pursuant to this paragraph shall be used by en5 tities to develop and provide end-of-life support 

6 services for terminally ill individuals who are re7 ceiving care in their own homes, including— 

8 (i) support for family or other des9 ignated caregivers; and 

10 (ii) any additional information or ma11 terials relating to support services deter12 mined appropriate by the Secretary. 

13 (E) APPLICATION.—Each entity desiring a 

14 grant under this paragraph shall submit an ap15 plication to the Secretary at such time, in such 

16 manner, and accompanied by such information 

17 as the Secretary may reasonably require. 

18 (F) AUTHORIZATION OF APPROPRIA19 TIONS.—For the purpose of carrying out the 

20 grant program established under this para21 graph, there is authorized to be appropriated 

22 $15,000,000 for the period of fiscal years 2013 

23 through 2017. 

24 (2) ADVANCED ILLNESS CARE EDUCATIONAL

25 GRANT PROGRAM.— 


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1 (A) GRANTS AUTHORIZED.—The Secretary 

2 is authorized to award grants to entities, in3 cluding faith-based organizations and religious 

4 educational institutions, to develop and provide 

5 appropriate training and educational programs 

6 addressing the care of individuals with ad7 vanced illness. 

8 (B) REQUIREMENTS.— 

9 (i) DURATION.—The grant program 

10 shall be conducted for a 5-year period, be11 ginning not later than January 1, 2013. 

12 (ii) AMOUNT OF GRANTS.—An entity 

13 may be awarded a grant under this para14 graph for a fiscal year that is not less than 

15 $5,000, and not more than $50,000. 

16 (iii) NUMBER OF GRANTS.—The Sec17 retary shall award grants under this para18 graph to not more than 100 entities. 

19 (C) USE OF FUNDS.—Grants awarded pur20 suant to this paragraph shall be used by enti21 ties to develop appropriate training and edu22 cation programs addressing care of individuals 

23 with advanced illness and include such pro24 grams as part of their educational curriculum, 


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1 continuing education programs, or vocational 

2 training. 

3 (D) APPLICATION.—Each entity desiring a 

4 grant under this paragraph shall submit an ap5 plication to the Secretary at such time, in such 

6 manner, and accompanied by such information 

7 as the Secretary may reasonably require. 

8 (E) AUTHORIZATION OF APPROPRIA9 TIONS.—For the purpose of carrying out the 

10 grant program established under this para11 graph, there is authorized to be appropriated 

12 $10,000,000 for the period of fiscal years 2013 

13 through 2017. 

14 SEC. 12. HHS STUDY AND REPORT ON THE STORAGE OF AD15 VANCED DIRECTIVES. 

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

17 Services shall conduct a study on State and regional activi18 ties with respect to storing completed advance directives 

19 and Physician Orders for Life-Sustaining Treatment. 

20 Such study shall include an analysis of the practicality and 

21 feasibility of establishing a national registry for completed 

22 advance directives and Physician Orders for Life-Sus23 taining Treatment, taking into consideration the con24 straints created by the privacy provisions enacted as a reVerDate Mar 15 2010 03:45 Dec 20, 2012 Jkt 029200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S3684.IS S3684

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1 sult of the Health Insurance Portability and Account2 ability Act of 1996 (Public Law 104–191). 

3 (b) REPORT.—Not later than January 1, 2015, the 

4 Secretary of Health and Human Services shall submit to 

5 Congress a report on the study conducted under sub6 section (a) together with recommendations for such legis7 lation and administrative action as the Secretary deter8 mines to be appropriate. 

9 SEC. 13. GAO STUDY AND REPORT ON THE PROVISIONS OF, 

10 AND AMENDMENTS MADE BY, THIS ACT. 

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

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

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

14 amendments made by, this Act, including the quality and 

15 costs (such as individual and family experience, individual 

16 understanding of treatment choices, and any decrease in 

17 avoidable hospital admissions) associated with such provi18 sions and such amendments. 

19 (b) REPORT.—Not later than January 1, 2015, the 

20 Comptroller General shall submit to Congress a report 

21 containing the results of the study conducted under sub22 section (a), together with recommendations for such legis23 lation and administrative action as the Comptroller Gen24 eral determines appropriate. 

Æ 


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