I 

113TH CONGRESS 

1ST SESSION H. R. 1173 

To amend the Social Security Act to provide for coverage of voluntary advance 

care planning consultation under Medicare and Medicaid, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 14, 2013 

Mr. BLUMENAUER (for himself, Mr. HANNA, Mr. ROE of Tennessee, Mr. 

REED, Ms. SCHWARTZ, Mr. KIND, Mr. GEORGE MILLER of California, 

Mr. MCDERMOTT, Mr. BERA of California, Ms. SCHAKOWSKY, and Mrs. 

CAPPS) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend the Social Security Act to provide for coverage 

of voluntary advance care planning consultation under 

Medicare and Medicaid, 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; FINDINGS; TABLE OF CONTENTS. 

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

5 ‘‘Personalize Your Care Act of 2013’’. 

6 (b) FINDINGS.—Congress finds the following: 


smartinez on DSK6TPTVN1PROD with BILLS
2 

•HR 1173 IH

1 (1) All individuals should be afforded the oppor2 tunity to fully participate in decisions related to 

3 their health care or the care of a person for whom 

4 they are the proxy or surrogate. 

5 (2) Every individual’s values and goals should 

6 be identified, understood, and respected. Particular 

7 attention should be paid to populations which have 

8 not regularly had the opportunity to express their 

9 choices or preferences. 

10 (3) Advance care planning plays a valuable role 

11 in achieving quality care by informing physicians 

12 and family members of an individual’s treatment 

13 preferences should he or she become unable to direct 

14 care. 

15 (4) Early advance care planning is ideal be16 cause a person’s ability to make decisions may di17 minish over time and the person may suddenly lose 

18 the capability to participate in their health care deci19 sions. 

20 (5) Advance directives (such as living wills and 

21 durable powers of attorney for health care) must be 

22 prepared while individuals have the capacity to com23 plete them and only apply to future medical cir24 cumstances when decisionmaking capacity is lost. An 


smartinez on DSK6TPTVN1PROD with BILLS
3 

•HR 1173 IH

1 individual can change or revoke an advance directive 

2 at any time. 

3 (6) Physician orders for life-sustaining treat4 ment complement advance directives by providing a 

5 process to focus patients’ values, goals, and pref6 erences on current medical circumstances and to 

7 translate them into visible and portable medical or8 ders applicable across care settings. A patient (or 

9 proxy or surrogate) can change or revoke a physi10 cian order for life-sustaining treatment at any time. 

11 (7) Advance care planning should be routinely 

12 conducted in community and clinical practices. Care 

13 plans should be periodically revisited to reflect a per14 son’s changes in values and perceptions at different 

15 stages and circumstances of life. This shared deci16 sionmaking and collaborative planning between the 

17 patient (or proxy or surrogate) and the clinician of 

18 their choice will lead to more person-centered, cul19 turally appropriate care. 

20 (8) Effective, respectful, and culturally com21 petent advance care planning requires recognition 

22 that both overtreatment and undertreatment may be 

23 concerns of individuals contemplating future care. 

24 (9) More should be done within local health sys25 tems to establish specific policies and programs to 


smartinez on DSK6TPTVN1PROD with BILLS
4 

•HR 1173 IH

1 assist people with sensory, mental, and other disabil2 ities in order to maximize the degree to which they 

3 are active participants in the decisions related to 

4 their health care, including training health care pro5 viders to be aware of augmentative communication 

6 devices and how to communicate with people with 

7 developmental, psychiatric, speech, and sensory dis8 abilities. 

9 (10) Studies funded by the Agency for 

10 Healthcare Research and Quality have shown that 

11 individuals who talked with their families or physi12 cians about their preferences for care had less fear 

13 and anxiety, felt they had more ability to influence 

14 and direct their medical care, believed that their 

15 physicians had a better understanding of their wish16 es, and indicated a greater understanding and com17 fort level than they had before the discussion. Pa18 tients who had advance planning discussions with 

19 their physicians continued to discuss and talk about 

20 these concerns with their families. Such discussions 

21 enabled patients and families to reconcile any dif22 ferences about care and could help the family and 

23 physician come to agreement if they should need to 

24 make decisions for the patient. 


smartinez on DSK6TPTVN1PROD with BILLS
5 

•HR 1173 IH

1 (11) A decade of research has demonstrated 

2 that physician orders for life-sustaining treatment 

3 effectively convey patient preferences and guide med4 ical personnel toward medical treatment aligned with 

5 patient wishes. Programs for these orders have de6 veloped locally on a statewide or communitywide 

7 basis and have different program names, forms, and 

8 policies, but all follow the principle of patient-cen9 tered care. 

10 (12) According to research published in the Ar11 chives of Internal Medicine, between 65 and 76 per12 cent of physicians whose patients had an advance di13 rective were not aware that it existed. 

14 (13) Including completed advance care planning 

15 documents within a patient’s electronic health record 

16 can increase the likelihood these documents are kept 

17 up-to-date and available at the right place at the 

18 right time. 

19 (c) TABLE OF CONTENTS.—The table of contents of 

20 this Act is as follows: 

Sec. 1. Short title; findings; table of contents. 

Sec. 2. Voluntary advance care planning consultation coverage under Medicare 

and Medicaid. 

Sec. 3. Grants for programs for physician orders for life-sustaining treatment. 

Sec. 4. Advance care planning standards for electronic health records. 

Sec. 5. Portability of advance directives. 


smartinez on DSK6TPTVN1PROD with BILLS
6 

•HR 1173 IH

1 SEC. 2. VOLUNTARY ADVANCE CARE PLANNING CONSULTA2 TION COVERAGE UNDER MEDICARE AND 

3 MEDICAID. 

4 (a) MEDICARE.— 

5 (1) IN GENERAL.—Section 1861 of the Social 

6 Security Act (42 U.S.C. 1395x) is amended— 

7 (A) in subsection (s)(2)— 

8 (i) by striking ‘‘and’’ at the end of 

9 subparagraph (EE); 

10 (ii) by adding ‘‘and’’ at the end of 

11 subparagraph (FF); and 

12 (iii) by adding at the end the fol13 lowing new subparagraph: 

14 ‘‘(GG) voluntary advance care planning 

15 consultation (as defined in subsection (iii)(1));’’; 

16 and 

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

18 subsection: 

19 ‘‘Voluntary Advance Care Planning Consultation 

20 ‘‘(iii)(1) Subject to paragraphs (3) and (4), the term 

21 ‘voluntary advance care planning consultation’ means an 

22 optional consultation between the individual and a practi23 tioner described in paragraph (2) regarding advance care 

24 planning. Such consultation may include the following, as 

25 specified by the Secretary: 


smartinez on DSK6TPTVN1PROD with BILLS
7 

•HR 1173 IH

1 ‘‘(A) An explanation by the practitioner of ad2 vance care planning and the uses of advance direc3 tives. 

4 ‘‘(B) An explanation by the practitioner of the 

5 role and responsibilities of a proxy or surrogate. 

6 ‘‘(C) An explanation by the practitioner of the 

7 services and supports available under this title dur8 ing chronic and serious illness, including palliative 

9 care, home care, long-term care, and hospice care. 

10 ‘‘(D) An explanation by the practitioner of phy11 sician orders for life-sustaining treatment or similar 

12 orders in States where such orders or similar orders 

13 exist. 

14 ‘‘(E) Facilitation by the practitioner of shared 

15 decisionmaking with the patient (or proxy or surro16 gate) which may include— 

17 ‘‘(i) use of decision aids and patient sup18 port tools; 

19 ‘‘(ii) the provision of patient-centered, 

20 easy-to-understand information about advance 

21 care planning or disease-specific care planning; 

22 and 

23 ‘‘(iii) the incorporation of patient pref24 erences and values into the medical plan, an adVerDate Mar 14 2013 05:22 Mar 21, 2013 Jkt 029200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1173.IH H1173

smartinez on DSK6TPTVN1PROD with BILLS
8 

•HR 1173 IH

1 vance directive, and a physician order for life2 sustaining treatment as appropriate. 

3 ‘‘(2) A practitioner described in this paragraph is a 

4 physician (as defined in subsection (r)(1)), nurse practi5 tioner, or physician assistant. 

6 ‘‘(3) Payment may not be made under this title for 

7 a voluntary advance care planning consultation furnished 

8 more often than once every 5 years unless there is a sig9 nificant change in the health, health-related condition, or 

10 care setting of the individual. 

11 ‘‘(4) For purposes of this section, the term ‘physician 

12 order for life-sustaining treatment’ means, with respect to 

13 an individual, an actionable medical order relating to the 

14 treatment of that individual that effectively communicates 

15 the individual’s preferences regarding life-sustaining treat16 ment, is in a form that is sanctioned or approved under 

17 State law or regulation or is widely recognized by health 

18 care providers in the State, and permits it to be followed 

19 by health care professionals across the continuum of care. 

20 Such an order may be changed or revoked by the indi21 vidual (or proxy or surrogate) at any time.’’. 

22 (2) CONSTRUCTION.—The voluntary advance 

23 care planning consultation described in section 

24 1861(iii) of the Social Security Act, as added by 


smartinez on DSK6TPTVN1PROD with BILLS
9 

•HR 1173 IH

1 paragraph (1), shall be completely optional. Nothing 

2 in this section shall— 

3 (A) require an individual to complete an 

4 advance directive or a physician order for life5 sustaining treatment; 

6 (B) require an individual to consent to re7 strictions on the amount, duration, or scope of 

8 medical benefits an individual is entitled to re9 ceive under this title; or 

10 (C) violate the Assisted Suicide Funding 

11 Restriction Act of 1997 (Public Law 105–12) 

12 by encouraging the promotion of suicide or as13 sisted suicide. 

14 (3) PAYMENT.—Section 1848(j)(3) of such Act 

15 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

16 ‘‘(2)(GG),’’ before ‘‘(3),’’. 

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

18 of such Act (42 U.S.C. 1395y(a)) is amended— 

19 (A) in paragraph (1)— 

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

21 ‘‘and’’ at the end; 

22 (ii) in subparagraph (P) by striking 

23 the semicolon at the end and inserting ‘‘, 

24 and’’; and 


smartinez on DSK6TPTVN1PROD with BILLS
10 

•HR 1173 IH

1 (iii) by adding at the end the fol2 lowing new subparagraph: 

3 ‘‘(Q) in the case of voluntary advance care 

4 planning consultations (as defined in paragraph 

5 (1) of section 1861(iii)), which are performed 

6 more frequently than is covered under such sec7 tion;’’; and 

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

9 and inserting ‘‘(P), or (Q)’’. 

10 (5) EFFECTIVE DATE.—The amendments made 

11 by this subsection shall apply to consultations fur12 nished on or after January 1, 2014. 

13 (b) MEDICAID.— 

14 (1) MANDATORY BENEFIT.—Section 

15 1902(a)(10)(A) of the Social Security Act (42 

16 U.S.C. 1396a(a)(10)(A)) is amended, in the matter 

17 preceding clause (i), by striking ‘‘and (28)’’ and in18 serting ‘‘, (28), and (29)’’. 

19 (2) MEDICAL ASSISTANCE.—Section 1905(a) of 

20 such Act (42 U.S.C. 1396d(a)) is amended— 

21 (A) by striking ‘‘and’’ at the end of para22 graph (28); 

23 (B) by redesignating paragraph (29) as 

24 paragraph (30); and 


smartinez on DSK6TPTVN1PROD with BILLS
11 

•HR 1173 IH

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

2 following new paragraph: 

3 ‘‘(29) voluntary advance care planning con4 sultation (as defined in section 1861(iii)(1)); and’’. 

5 (c) DEFINITION OF ADVANCE DIRECTIVE UNDER

6 MEDICARE AND MEDICAID.— 

7 (1) MEDICARE.—Section 1866(f)(3) of the So8 cial Security Act (42 U.S.C. 1395cc(f)(3)) is amend9 ed by striking ‘‘means’’ and all that follows and in10 serting the following: ‘‘means a living will, medical 

11 directive, health care power of attorney, durable 

12 power of attorney for health care, advance health 

13 care directive, health care directive, or other state14 ment that is recorded and completed in a manner 

15 recognized under State law by an individual with ca16 pacity to make health care decisions and that indi17 cates the individual’s wishes regarding medical treat18 ment in the event of future incapacity of the indi19 vidual to make health care decisions.’’. 

20 (2) MEDICAID.—Section 1902(w)(4) of such 

21 Act (42 U.S.C. 1396a(w)(4)) is amended by striking 

22 ‘‘means’’ and all that follows and inserting the fol23 lowing: ‘‘means a living will, medical directive, 

24 health care power of attorney, durable power of at25 torney for health care, advance health care directive, 


smartinez on DSK6TPTVN1PROD with BILLS
12 

•HR 1173 IH

1 health care directive, or other statement that is re2 corded and completed in a manner recognized under 

3 State law by an individual with capacity to make 

4 health care decisions and that indicates the individ5 ual’s wishes regarding medical treatment in the 

6 event of future incapacity of the individual to make 

7 health care decisions.’’. 

8 (d) EFFECTIVE DATE.—The amendments made by 

9 this section take effect on January 1, 2014. 

10 SEC. 3. GRANTS FOR PROGRAMS FOR PHYSICIAN ORDERS 

11 FOR LIFE-SUSTAINING TREATMENT. 

12 (a) IN GENERAL.—The Secretary of Health and 

13 Human Services shall make grants to eligible entities for 

14 the purpose of— 

15 (1) establishing statewide programs for physi16 cian orders for life-sustaining treatment; or 

17 (2) expanding or enhancing existing programs 

18 for physician orders for life-sustaining treatment. 

19 (b) AUTHORIZED ACTIVITIES.—Activities funded 

20 through a grant under this section for an area may in21 clude— 

22 (1) developing such a program for the area that 

23 includes hospitals, home care, hospice, long-term 

24 care, community and assisted living residences, 


smartinez on DSK6TPTVN1PROD with BILLS
13 

•HR 1173 IH

1 skilled nursing facilities, and emergency medical 

2 services within a State; and 

3 (2) expanding an existing program for physi4 cian orders regarding life-sustaining treatment to 

5 serve more patients or enhance the quality of serv6 ices, including educational services for patients and 

7 patients’ families, training of health care profes8 sionals, or establishing a physician orders for life9 sustaining treatment registry. 

10 (c) DISTRIBUTION OF FUNDS.—In funding grants 

11 under this section, the Secretary shall ensure that, of the 

12 funds appropriated to carry out this section for each fiscal 

13 year— 

14 (1) at least one-half are used for establishing 

15 new programs for physician orders regarding life16 sustaining treatment; and 

17 (2) remaining funds are to be used for expand18 ing or enhancing existing programs for physician or19 ders regarding life-sustaining treatment. 

20 (d) DEFINITIONS.—In this section: 

21 (1) The term ‘‘eligible entity’’ includes— 

22 (A) an academic medical center, a medical 

23 school, a State health department, a State med24 ical association, a multistate task force, a hos25 pital, or a health system capable of adminVerDate Mar 14 2013 05:22 Mar 21, 2013 Jkt 029200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1173.IH H1173

smartinez on DSK6TPTVN1PROD with BILLS
14 

•HR 1173 IH

1 istering a program for physician orders regard2 ing life-sustaining treatment for a State; or 

3 (B) any other health care agency or entity 

4 as the Secretary determines appropriate. 

5 (2) The term ‘‘physician order for life-sus6 taining treatment’’ has the meaning given such term 

7 in section 1861(iii)(4) of the Social Security Act, as 

8 added by section 2. 

9 (3) The term ‘‘program for physician orders for 

10 life-sustaining treatment’’ means a program that— 

11 (A) supports the active use of physician or12 ders for life-sustaining treatment in the State; 

13 and 

14 (B) is guided by a coalition of stakeholders 

15 that includes patient advocacy groups and rep16 resentatives from across the continuum of 

17 health care services, such as disability rights 

18 advocates, senior advocates, emergency medical 

19 services, long-term care, medical associations, 

20 hospitals, home health, hospice, the State agen21 cy responsible for senior and disability services, 

22 and the State department of health. 

23 (4) The term ‘‘Secretary’’ means the Secretary 

24 of Health and Human Services. 


smartinez on DSK6TPTVN1PROD with BILLS
15 

•HR 1173 IH

1 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there are authorized to be appropriated 

3 such sums as may be necessary for each of the fiscal years 

4 2014 through 2019. 

5 SEC. 4. ADVANCE CARE PLANNING STANDARDS FOR ELEC6 TRONIC HEALTH RECORDS. 

7 Notwithstanding section 3004(b)(3) of the Public 

8 Health Service Act (42 U.S.C. 300jj–14(b)(3)), not later 

9 than January 1, 2015, the Secretary of Health and 

10 Human Services shall adopt, by rule, standards for a 

11 qualified electronic health record (as defined in section 

12 3000(13) of such Act (42 U.S.C. 300jj(13)), with respect 

13 to patient communications with a health care provider 

14 about values and goals of care, to adequately display the 

15 following: 

16 (1) The patient’s current advance directive (as 

17 defined in section 1866(f)(3) of the Social Security 

18 Act (42 U.S.C. 1395cc(f)(3)), as applicable. 

19 (2) The patient’s current physician order for 

20 life-sustaining treatment (as defined in section 

21 1861(iii)(4) of the Social Security Act (42 U.S.C. 

22 1395x(iii)(4)), as applicable. 

23 A standard adopted under this section shall be treated as 

24 a standard adopted under section 3004 of the Public 

25 Health Service Act (42 U.S.C. 300jj–14) for purposes of 


smartinez on DSK6TPTVN1PROD with BILLS
16 

•HR 1173 IH

1 certifying qualified electronic health records pursuant to 

2 section 3001(c)(5) of such Act (42 U.S.C. 300jj– 

3 11(c)(5)). 

4 SEC. 5. PORTABILITY OF ADVANCE DIRECTIVES. 

5 (a) IN GENERAL.—Section 1866(f) of the Social Se6 curity Act (42 U.S.C. 1395cc(f)) is amended by adding 

7 at the end the following new paragraph: 

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

9 the State in which such directive is presented must be 

10 given effect by a provider of services or organization to 

11 the same extent as an advance directive validly executed 

12 under the law of the State in which it is presented. 

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

14 a physician or other health care provider or organization 

15 may presume that a written advance health care directive 

16 or similar instrument, regardless of where executed, is 

17 valid. 

18 ‘‘(C) In the absence of a validly executed advance di19 rective, any authentic expression of a person’s wishes with 

20 respect to health care shall be honored. 

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

22 any State law on advance directive portability to the extent 

23 such law is inconsistent with such provisions. Nothing in 

24 the paragraph shall be construed to authorize the adminisVerDate Mar 14 2013 05:22 Mar 21, 2013 Jkt 029200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H1173.IH H1173

smartinez on DSK6TPTVN1PROD with BILLS
17 

•HR 1173 IH

1 tration of health care treatment otherwise prohibited by 

2 the laws of the State in which the directive is presented.’’. 

3 (b) MEDICAID.—Section 1902(w) of the Social Secu4 rity Act (42 U.S.C. 1396a(w)) is amended by adding at 

5 the end the following new paragraph: 

6 ‘‘(6)(A) An advance directive validly executed outside 

7 the State in which such directive is presented must be 

8 given effect by a provider or organization to the same ex9 tent as an advance directive validly executed under the law 

10 of the State in which it is presented. 

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

12 a physician, other health care provider, or organization 

13 may presume that a written advance health care directive 

14 or similar instrument, regardless of where executed, is 

15 valid. 

16 ‘‘(C) In the absence of a validly executed advance di17 rective, any authentic expression of a person’s wishes with 

18 respect to health care shall be honored. 

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

20 any State law on advance directive portability to the extent 

21 such law is inconsistent with such provisions. Nothing in 

22 the paragraph shall be construed to authorize the adminis23 tration of health care treatment otherwise prohibited by 

24 the laws of the State in which the directive is presented.’’. 

Æ 


smartinez on DSK6TPTVN1PROD with BILLS