II 

113TH CONGRESS 

2D SESSION S. 3009 

To improve end-of-life care. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 12, 2014 

Mr. BLUMENTHAL (for himself and Mr. ROCKEFELLER) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To improve end-of-life care. 

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 ‘‘Advance Planning and Compassionate Care Act of 

6 2014’’. 

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

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

TITLE I—ADVANCE CARE PLANNING 

Subtitle A—Consumer and Provider Education 

PART I—CONSUMER EDUCATION


tkelley on DSK3SPTVN1PROD with BILLS
2 

•S 3009 IS

SUBPART A—NATIONAL INITIATIVES

Sec. 101. Advance care planning telephone hotline. 

Sec. 102. Advance care planning information clearinghouses. 

Sec. 103. Advance care planning toolkit. 

Sec. 104. National public education campaign. 

Sec. 105. Update of Medicare and Social Security handbooks. 

Sec. 106. Authorization of appropriations. 

SUBPART B—STATE AND LOCAL INITIATIVES

Sec. 111. Financial assistance for advance care planning. 

Sec. 112. Grants for programs for orders regarding life sustaining treatment. 

PART II—PROVIDER EDUCATION

Sec. 121. Public provider advance care planning website. 

Sec. 122. Continuing education for physicians and nurses. 

Subtitle B—Portability of Advance Directives; Health Information Technology 

Sec. 131. Portability of advance directives. 

Sec. 132. State advance directive registries; driver’s license advance directive 

notation. 

Sec. 133. GAO study and report on establishment of national advance directive 

registry. 

Subtitle C—National Uniform Policy on Advance Care Planning 

Sec. 141. Study and report by the Secretary regarding the establishment and 

implementation of a national uniform policy on advance directives. 

TITLE II—COMPASSIONATE CARE 

Subtitle A—Workforce Development 

PART I—EDUCATION AND TRAINING

Sec. 201. National Geriatric and Palliative Care Services Corps. 

Sec. 202. Exemption of palliative medicine fellowship training from Medicare 

graduate medical education caps. 

Sec. 203. Medical school curricula. 

Subtitle B—Coverage Under Medicare, Medicaid, and CHIP 

PART I—COVERAGE OF ADVANCE CARE PLANNING

Sec. 211. Medicare, Medicaid, and CHIP coverage. 

PART II—HOSPICE

Sec. 221. Adoption of MedPAC hospice payment methodology recommendations. 

Sec. 222. Removing hospice inpatient days in setting per diem rates for critical 

access hospitals. 

Sec. 223. Hospice payments for dual eligible individuals residing in long-term 

care facilities. 


tkelley on DSK3SPTVN1PROD with BILLS
3 

•S 3009 IS

Sec. 224. Delineation of respective care responsibilities of hospice programs and 

long-term care facilities. 

Sec. 225. Adoption of MedPAC hospice program eligibility certification and recertification recommendations. 

Sec. 226. Concurrent care for children. 

Sec. 227. Making hospice a required benefit under Medicaid and CHIP. 

Sec. 228. Medicare Hospice payment model demonstration projects. 

Sec. 229. MedPAC studies and reports. 

Sec. 230. HHS Evaluations. 

Subtitle C—Quality Improvement 

Sec. 241. Patient satisfaction surveys. 

Sec. 242. Development of core end-of-life care quality measures across each relevant provider setting. 

Sec. 243. Accreditation of hospital-based palliative care programs. 

Sec. 244. Survey and data requirements for all Medicare participating hospice 

programs. 

Subtitle D—Additional Reports, Research, and Evaluations 

Sec. 251. National Center On Palliative and End-of-Life Care. 

Sec. 252. National Mortality Followback Survey. 

Sec. 253. Demonstration projects for use of telemedicine services in advance 

care planning. 

Sec. 254. Inspector General investigation of fraud and abuse. 

Sec. 255. GAO study and report on provider adherence to advance directives. 

1 SEC. 2. DEFINITIONS. 

2 In this Act: 

3 (1) ADVANCE CARE PLANNING.—The term ‘‘ad4 vance care planning’’ means the process of— 

5 (A) determining an individual’s priorities, 

6 values and goals for care in the future when the 

7 individual is no longer able to express his or her 

8 wishes; 

9 (B) engaging family members, health care 

10 proxies, and health care providers in an ongoing 

11 dialogue about— 

12 (i) the individual’s wishes for care; 


tkelley on DSK3SPTVN1PROD with BILLS
4 

•S 3009 IS

1 (ii) what the future may hold for peo2 ple with serious illnesses or injuries; 

3 (iii) how individuals, their health care 

4 proxies, and family members want their be5 liefs and preferences to guide care deci6 sions; and 

7 (iv) the steps that individuals and 

8 family members can take regarding, and 

9 the resources available to help with, fi10 nances, family matters, spiritual questions, 

11 and other issues that impact seriously ill or 

12 dying patients and their families; and 

13 (C) executing and updating advance direc14 tives and appointing a health care proxy. 

15 (2) ADVANCE DIRECTIVE.—The term ‘‘advance 

16 directive’’ means a living will, medical directive, 

17 health care power of attorney, durable power of at18 torney, or other written statement by a competent 

19 individual that is recognized under State law and in20 dicates the individual’s wishes regarding medical 

21 treatment in the event of future incompetence. Such 

22 term includes an advance health care directive and 

23 a health care directive recognized under State law. 


tkelley on DSK3SPTVN1PROD with BILLS
5 

•S 3009 IS

1 (3) CHIP.—The term ‘‘CHIP’’ means the pro2 gram established under title XXI of the Social Secu3 rity Act (42 U.S.C. 1397aa et seq.). 

4 (4) END-OF-LIFE-CARE.—The term ‘‘end-of-life 

5 care’’ means all aspects of care of a patient with a 

6 potentially fatal condition, and includes care that is 

7 focused on specific preparations for an impending 

8 death. 

9 (5) HEALTH CARE POWER OF ATTORNEY.—The 

10 term ‘‘health care power of attorney’’ means a legal 

11 document that identifies a health care proxy or deci12 sionmaker for a patient who has the authority to act 

13 on the patient’s behalf when the patient is unable to 

14 communicate his or her wishes for medical care on 

15 matters that the patient specifies when he or she is 

16 competent. Such term includes a durable power of 

17 attorney that relates to medical care. 

18 (6) LIVING WILL.—The term ‘‘living will’’ 

19 means a legal document— 

20 (A) used to specify the type of medical 

21 care (including any type of medical treatment, 

22 including life-sustaining procedures if that per23 son becomes permanently unconscious or is oth24 erwise dying) that an individual wants provided 

25 or withheld in the event the individual cannot 


tkelley on DSK3SPTVN1PROD with BILLS
6 

•S 3009 IS

1 speak for himself or herself and cannot express 

2 his or her wishes; and 

3 (B) that requires a physician to honor the 

4 provisions of upon receipt or to transfer the 

5 care of the individual covered by the document 

6 to another physician that will honor such provi7 sions. 

8 (7) MEDICAID.—The term ‘‘Medicaid’’ means 

9 the program established under title XIX of the So10 cial Security Act (42 U.S.C. 1396 et seq.). 

11 (8) MEDICARE.—The term ‘‘Medicare’’ means 

12 the program established under title XVIII of the So13 cial Security Act (42 U.S.C. 1395 et seq.). 

14 (9) ORDERS FOR LIFE-SUSTAINING TREAT15 MENT.—The term ‘‘orders for life-sustaining treat16 ment’’ means a process for focusing a patients’ val17 ues, goals, and preferences on current medical cir18 cumstances and to translate such into visible and 

19 portable medical orders applicable across care set20 tings, including home, long-term care, emergency 

21 medical services, and hospitals. 

22 (10) PALLIATIVE CARE.—The term ‘‘palliative 

23 care’’ means interdisciplinary care for individuals 

24 with a life-threatening illness or injury relating to 

25 pain and symptom management and psychological, 


tkelley on DSK3SPTVN1PROD with BILLS
7 

•S 3009 IS

1 social, and spiritual needs and that seeks to improve 

2 the quality of life for the individual and the individ3 ual’s family. 

4 (11) SECRETARY.—The term ‘‘Secretary’’ 

5 means the Secretary of Health and Human Services. 

6 TITLE I—ADVANCE CARE 

7 PLANNING 

8 Subtitle A—Consumer and 

9 Provider Education 

10 PART I—CONSUMER EDUCATION 

11 Subpart A—National Initiatives 

12 SEC. 101. ADVANCE CARE PLANNING TELEPHONE HOTLINE. 

13 (a) IN GENERAL.—Not later than January 1, 2016, 

14 the Secretary, acting through the Director of the Centers 

15 for Disease Control and Prevention, shall establish and op16 erate directly, or by grant, contract, or interagency agree17 ment, a 24-hour toll-free telephone hotline to provide con18 sumer information regarding advance care planning, in19 cluding— 

20 (1) an explanation of advanced care planning 

21 and its importance; 

22 (2) issues to be considered when developing an 

23 individual’s advance care plan; 

24 (3) how to establish an advance directive; 


tkelley on DSK3SPTVN1PROD with BILLS
8 

•S 3009 IS

1 (4) procedures to help ensure that an individ2 ual’s directives for end-of-life care are followed; 

3 (5) Federal and State-specific resources for as4 sistance with advance care planning; and 

5 (6) hospice and palliative care (including their 

6 respective purposes and services). 

7 (b) ESTABLISHMENT.—In carrying out the require8 ments under subsection (a), the Director of the Centers 

9 for Disease Control and Prevention may designate an ex10 isting 24-hour toll-free telephone hotline or, if no such 

11 service is available or appropriate, establish a new 24-hour 

12 toll-free telephone hotline. 

13 SEC. 102. ADVANCE CARE PLANNING INFORMATION CLEAR14 INGHOUSES. 

15 (a) EXPANSION OF NATIONAL CLEARINGHOUSE FOR

16 LONG-TERM CARE INFORMATION.— 

17 (1) DEVELOPMENT.—Not later than January 1, 

18 2015, the Secretary shall develop an online clearing19 house to provide comprehensive information regard20 ing advance care planning. 

21 (2) MAINTENANCE.—The advance care plan22 ning clearinghouse, which shall be clearly identifiable 

23 and available on the homepage of the Department of 

24 Health and Human Service’s National Clearinghouse 

25 for Long-Term Care Information website, shall be 


tkelley on DSK3SPTVN1PROD with BILLS
9 

•S 3009 IS

1 maintained and publicized by the Secretary on an 

2 ongoing basis. 

3 (3) CONTENT.—The advance care planning 

4 clearinghouse shall include— 

5 (A) any relevant content contained in the 

6 national public education campaign required 

7 under section 104; 

8 (B) content addressing— 

9 (i) an explanation of advanced care 

10 planning and its importance; 

11 (ii) issues to be considered when de12 veloping an individual’s advance care plan; 

13 (iii) how to establish an advance di14 rective; 

15 (iv) procedures to help ensure that an 

16 individual’s directives for end-of-life care 

17 are followed; and 

18 (v) hospice and palliative care (includ19 ing their respective purposes and services); 

20 (C) available Federal and State-specific re21 sources for assistance with advance care plan22 ning, including— 

23 (i) contact information for any State 

24 public health departments that are respon25 sible for issues regarding end-of-life care; 


tkelley on DSK3SPTVN1PROD with BILLS
10 

•S 3009 IS

1 (ii) contact information for relevant 

2 legal service organizations, including those 

3 funded under the Older Americans Act of 

4 1965 (42 U.S.C. 3001 et seq.); and 

5 (iii) advance directive forms for each 

6 State; and 

7 (D) any additional information, as deter8 mined by the Secretary. 

9 (b) ESTABLISHMENT OF PEDIATRIC ADVANCE CARE

10 PLANNING CLEARINGHOUSE.— 

11 (1) DEVELOPMENT.—Not later than January 1, 

12 2016, the Secretary, in consultation with the Assist13 ant Secretary for Children and Families of the De14 partment of Health and Human Services, shall de15 velop an online clearinghouse to provide comprehen16 sive information regarding pediatric advance care 

17 planning. 

18 (2) MAINTENANCE.—The pediatric advance 

19 care planning clearinghouse, which shall be clearly 

20 identifiable on the homepage of the Administration 

21 for Children and Families website, shall be main22 tained and publicized by the Secretary on an ongo23 ing basis. 

24 (3) CONTENT.—The pediatric advance care 

25 planning clearinghouse shall provide advance care 


tkelley on DSK3SPTVN1PROD with BILLS
11 

•S 3009 IS

1 planning information specific to children with life2 threatening illnesses or injuries and their families. 

3 SEC. 103. ADVANCE CARE PLANNING TOOLKIT. 

4 (a) DEVELOPMENT.—Not later than July 1, 2015, 

5 the Secretary, in consultation with the Director of the 

6 Centers for Disease Control and Prevention, shall develop 

7 an online advance care planning toolkit. 

8 (b) MAINTENANCE.—The advance care planning tool9 kit, which shall be available in English, Spanish, and any 

10 other languages that the Secretary deems appropriate, 

11 shall be maintained and publicized by the Secretary on an 

12 ongoing basis and made available on the websites of the 

13 following agencies: 

14 (1) The Centers for Disease Control and Pre15 vention. 

16 (2) The Department of Health and Human 

17 Service’s National Clearinghouse for Long-Term 

18 Care Information. 

19 (3) The Administration for Children and Fami20 lies. 

21 (c) CONTENT.—The advance care planning toolkit 

22 shall include content addressing— 

23 (1) common issues and questions regarding ad24 vance care planning, including individuals and re25 sources to contact for further inquiries; 


tkelley on DSK3SPTVN1PROD with BILLS
12 

•S 3009 IS

1 (2) advance directives and their uses, including 

2 living wills and durable powers of attorney; 

3 (3) the roles and responsibilities of a health 

4 care proxy; 

5 (4) Federal and State-specific resources to as6 sist individuals and their families with advance care 

7 planning, including— 

8 (A) the advance care planning toll-free 

9 telephone hotline established under section 101; 

10 (B) the advance care planning clearing11 houses established under section 102; 

12 (C) the advance care planning toolkit es13 tablished under this section; 

14 (D) available State legal service organiza15 tions to assist individuals with advance care 

16 planning, including those organizations that re17 ceive funding pursuant to the Older Americans 

18 Act of 1965 (42 U.S.C. 3001 et seq.); and 

19 (E) website links or addresses for State20 specific advance directive forms; and 

21 (5) any additional information, as determined 

22 by the Secretary. 

23 SEC. 104. NATIONAL PUBLIC EDUCATION CAMPAIGN. 

24 (a) NATIONAL PUBLIC EDUCATION CAMPAIGN.— 


tkelley on DSK3SPTVN1PROD with BILLS
13 

•S 3009 IS

1 (1) IN GENERAL.—Not later than January 1, 

2 2016, the Secretary, acting through the Director of 

3 the Centers for Disease Control and Prevention, 

4 shall, directly or through grants, contracts, or inter5 agency agreements, develop and implement a na6 tional campaign to inform the public of the impor7 tance of advance care planning and of an individ8 ual’s right to direct and participate in their health 

9 care decisions. 

10 (2) CONTENT OF EDUCATIONAL CAMPAIGN.— 

11 The national public education campaign established 

12 under paragraph (1) shall— 

13 (A) employ the use of various media, in14 cluding regularly televised public service an15 nouncements; 

16 (B) provide culturally and linguistically ap17 propriate information; 

18 (C) be conducted continuously over a pe19 riod of not less than 5 years; 

20 (D) identify and promote the advance care 

21 planning information available on the Depart22 ment of Health and Human Service’s National 

23 Clearinghouse for Long-Term Care Information 

24 website and Administration for Children and 

25 Families website, as well as any other relevant 


tkelley on DSK3SPTVN1PROD with BILLS
14 

•S 3009 IS

1 Federal or State-specific advance care planning 

2 resources; 

3 (E) raise public awareness of the con4 sequences that may result if an individual is no 

5 longer able to express or communicate their 

6 health care decisions; 

7 (F) address the importance of individuals 

8 speaking to family members, health care prox9 ies, and health care providers as part of an on10 going dialogue regarding their health care 

11 choices; 

12 (G) address the need for individuals to ob13 tain readily available legal documents that ex14 press their health care decisions through ad15 vance directives (including living wills, comfort 

16 care orders, and durable powers of attorney for 

17 health care); 

18 (H) raise public awareness regarding the 

19 availability of hospice and palliative care; and 

20 (I) encourage individuals to speak with 

21 their physicians about their options and inten22 tions for end-of-life care. 

23 (3) EVALUATION.— 

24 (A) IN GENERAL.—Not later than July 1, 

25 2018, the Secretary, acting through the DirecVerDate Sep 11 2014 19:41 Dec 16, 2014 Jkt 049200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S3009.IS S3009

tkelley on DSK3SPTVN1PROD with BILLS
15 

•S 3009 IS

1 tor of the Centers for Disease Control and Pre2 vention, shall conduct a nationwide survey to 

3 evaluate whether the national campaign con4 ducted under this subsection has achieved its 

5 goal of changing public awareness, attitudes, 

6 and behaviors regarding advance care planning. 

7 (B) BASELINE SURVEY.—In order to 

8 evaluate the effectiveness of the national cam9 paign, the Secretary shall conduct a baseline 

10 survey prior to implementation of the campaign. 

11 (C) REPORTING REQUIREMENT.—Not later 

12 than December 31, 2018, the Secretary shall 

13 report the findings of such survey, as well as 

14 any recommendations that the Secretary deter15 mines appropriate regarding the need for con16 tinuation or legislative or administrative 

17 changes to facilitate changing public awareness, 

18 attitudes, and behaviors regarding advance care 

19 planning, to the appropriate committees of the 

20 Congress. 

21 (b) REPEAL.—Section 4751(d) of the Omnibus 

22 Budget Reconciliation Act of 1990 (42 U.S.C. 1396a note; 

23 Public Law 101–508) is repealed. 


tkelley on DSK3SPTVN1PROD with BILLS
16 

•S 3009 IS

1 SEC. 105. UPDATE OF MEDICARE AND SOCIAL SECURITY 

2 HANDBOOKS. 

3 (a) MEDICARE & YOU HANDBOOK.— 

4 (1) IN GENERAL.—Not later than 60 days after 

5 the date of enactment of this Act, the Secretary 

6 shall update the online version of the ‘‘Plan Ahead 

7 for Long-Term Care’’ section of the Medicare & You 

8 Handbook to include— 

9 (A) an explanation of advance care plan10 ning and advance directives, including— 

11 (i) living wills; 

12 (ii) health care proxies; and 

13 (iii) after-death directives; 

14 (B) Federal and State-specific resources to 

15 assist individuals and their families with ad16 vance care planning, including— 

17 (i) the advance care planning toll-free 

18 telephone hotline established under section 

19 101; 

20 (ii) the advance care planning clear21 inghouses established under section 102; 

22 (iii) the advance care planning toolkit 

23 established under section 103; 

24 (iv) available State legal service orga25 nizations to assist individuals with advance 

26 care planning, including those organizaVerDate Sep 11 2014 19:41 Dec 16, 2014 Jkt 049200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S3009.IS S3009

tkelley on DSK3SPTVN1PROD with BILLS
17 

•S 3009 IS

1 tions that receive funding pursuant to the 

2 Older Americans Act of 1965 (42 U.S.C. 

3 3001 et seq.); and 

4 (v) website links or addresses for 

5 State-specific advance directive forms; and 

6 (C) any additional information, as deter7 mined by the Secretary. 

8 (2) UPDATE OF PAPER AND SUBSEQUENT

9 VERSIONS.—The Secretary shall include the infor10 mation described in paragraph (1) in all paper and 

11 electronic versions of the Medicare & You Handbook 

12 that are published on or after the date that is 60 

13 days after the date of enactment of this Act. 

14 (b) SOCIAL SECURITY HANDBOOK.—The Commis15 sioner of Social Security shall— 

16 (1) not later than 60 days after the date of en17 actment of this Act, update the online version of the 

18 Social Security Handbook for beneficiaries to include 

19 the information described in subsection (a)(1); and 

20 (2) include such information in all paper and 

21 online versions of such handbook that are published 

22 on or after the date that is 60 days after the date 

23 of enactment of this Act. 


tkelley on DSK3SPTVN1PROD with BILLS
18 

•S 3009 IS

1 SEC. 106. AUTHORIZATION OF APPROPRIATIONS. 

2 There is authorized to be appropriated for the period 

3 of fiscal years 2015 through 2019— 

4 (1) $195,000,000 to the Secretary to carry out 

5 sections 101, 102, 103, 104 and 105(a); and 

6 (2) $5,000,000 to the Commissioner of Social 

7 Security to carry out section 105(b). 

8 Subpart B—State and Local Initiatives 

9 SEC. 111. FINANCIAL ASSISTANCE FOR ADVANCE CARE 

10 PLANNING. 

11 (a) LEGAL ASSISTANCE FOR ADVANCE CARE PLAN12 NING.— 

13 (1) DEFINITION OF RECIPIENT.—Section 

14 1002(6) of the Legal Services Corporation Act (42 

15 U.S.C. 2996a(6)) is amended by striking ‘‘clause (A) 

16 of’’ and inserting ‘‘subparagraph (A) or (B) of’’. 

17 (2) ADVANCE CARE PLANNING.—Section 1006 

18 of the Legal Services Corporation Act (42 U.S.C. 

19 2996e) is amended— 

20 (A) in subsection (a)(1)— 

21 (i) by striking ‘‘title, and (B) to 

22 make’’ and inserting the following: ‘‘title; 

23 ‘‘(C) to make’’; and 

24 (ii) by inserting after subparagraph 

25 (A) the following: 


tkelley on DSK3SPTVN1PROD with BILLS
19 

•S 3009 IS

1 ‘‘(B) to provide financial assistance, and make 

2 grants and contracts, as described in subparagraph 

3 (A), on a competitive basis for the purpose of pro4 viding legal assistance in the form of advance care 

5 planning (as defined in section 3 of the Advance 

6 Planning and Compassionate Care Act of 2014, and 

7 including providing information about State-specific 

8 advance directives, as defined in that section) for eli9 gible clients under this title, including providing 

10 such planning to the family members of eligible cli11 ents and persons with power of attorney to make 

12 health care decisions for the clients; and’’; and 

13 (B) in subsection (b), by adding at the end 

14 the following: 

15 ‘‘(2) Advance care planning provided in accordance 

16 with subsection (a)(1)(B) shall not be construed to violate 

17 the Assisted Suicide Funding Restriction Act of 1997 (42 

18 U.S.C. 14401 et seq.).’’. 

19 (3) REPORTS.—Section 1008(a) of the Legal 

20 Services Corporation Act (42 U.S.C. 2996g(a)) is 

21 amended by adding at the end the following: ‘‘The 

22 Corporation shall require such a report, on an an23 nual basis, from each grantee, contractor, or other 

24 recipient of financial assistance under section 

25 1006(a)(1)(B).’’. 


tkelley on DSK3SPTVN1PROD with BILLS
20 

•S 3009 IS

1 (4) AUTHORIZATION OF APPROPRIATIONS.— 

2 Section 1010 of the Legal Services Corporation Act 

3 (42 U.S.C. 2996i) is amended— 

4 (A) in subsection (a)— 

5 (i) by striking ‘‘(a)’’ and inserting 

6 ‘‘(a)(1)’’; 

7 (ii) in the last sentence, by striking 

8 ‘‘Appropriations for that purpose’’ and in9 serting the following: 

10 ‘‘(3) Appropriations for a purpose described in para11 graph (1) or (2)’’; and 

12 (iii) by inserting before paragraph (3) 

13 (as designated by clause (ii)) the following: 

14 ‘‘(2) There are authorized to be appropriated to carry 

15 out section 1006(a)(1)(B), $10,000,000 for each of fiscal 

16 years 2015, 2016, 2017, 2018, and 2019.’’; and 

17 (B) in subsection (d), by striking ‘‘sub18 section (a)’’ and inserting ‘‘subsection (a)(1)’’. 

19 (5) EFFECTIVE DATE.—This subsection and the 

20 amendments made by this subsection take effect 

21 July 1, 2015. 

22 (b) STATE HEALTH INSURANCE ASSISTANCE PRO23 GRAMS.— 

24 (1) IN GENERAL.—The Secretary shall use 

25 amounts made available under paragraph (3) to 


tkelley on DSK3SPTVN1PROD with BILLS
21 

•S 3009 IS

1 award grants to States for State health insurance 

2 assistance programs receiving assistance under sec3 tion 4360 of the Omnibus Budget Reconciliation Act 

4 of 1990 to provide advance care planning services to 

5 Medicare beneficiaries, personal representatives of 

6 such beneficiaries, and the families of such bene7 ficiaries. Such services shall include information re8 garding State-specific advance directives and ways to 

9 discuss individual care wishes with health care pro10 viders. 

11 (2) REQUIREMENTS.— 

12 (A) AWARD OF GRANTS.—In making 

13 grants under this subsection for a fiscal year, 

14 the Secretary shall satisfy the following require15 ments: 

16 (i) Two-thirds of the total amount of 

17 funds available under paragraph (3) for a 

18 fiscal year shall be allocated among those 

19 States approved for a grant under this sec20 tion that have adopted the Uniform 

21 Health-Care Decisions Act drafted by the 

22 National Conference of Commissioners on 

23 Uniform State Laws and approved and 

24 recommended for enactment by all States 


tkelley on DSK3SPTVN1PROD with BILLS
22 

•S 3009 IS

1 at the annual conference of such commis2 sioners in 1993. 

3 (ii) One-third of the total amount of 

4 funds available under paragraph (3) for a 

5 fiscal year shall be allocated among those 

6 States approved for a grant under this sec7 tion that have adopted a uniform form for 

8 orders regarding life sustaining treatment 

9 as defined in section 1861(hhh)(5) of the 

10 Social Security Act (as amended by section 

11 211 of this Act) or a comparable approach 

12 to advance care planning. 

13 (B) WORK PLAN; REPORT.—As a condition 

14 of being awarded a grant under this subsection, 

15 a State shall submit the following to the Sec16 retary: 

17 (i) An approved plan for expending 

18 grant funds. 

19 (ii) For each fiscal year for which the 

20 State is paid grant funds under this sub21 section, an annual report regarding the use 

22 of the funds, including the number of 

23 Medicare beneficiaries served and their sat24 isfaction with the services provided. 


tkelley on DSK3SPTVN1PROD with BILLS
23 

•S 3009 IS

1 (C) LIMITATION.—No State shall be paid 

2 funds from a grant made under this subsection 

3 prior to July 1, 2015. 

4 (3) AUTHORIZATION OF APPROPRIATIONS.— 

5 There is authorized to be appropriated to the Sec6 retary to the Centers for Medicare & Medicaid Serv7 ices Program Management Account, $12,000,000 for 

8 each of fiscal years 2015 through 2019 for purposes 

9 of awarding grants to States under paragraph (1). 

10 (c) MEDICAID TRANSFORMATION GRANTS FOR AD11 VANCE CARE PLANNING.—Section 1903(z) of the Social 

12 Security Act (42 U.S.C. 1396b(z)) is amended— 

13 (1) in paragraph (2), by adding at the end the 

14 following new subparagraph: 

15 ‘‘(G) Methods for improving the effective16 ness and efficiency of medical assistance pro17 vided under this title by making available to in18 dividuals enrolled in the State plan or under a 

19 waiver of such plan information regarding ad20 vance care planning (as defined in section 3 of 

21 the Advance Planning and Compassionate Care 

22 Act of 2014), including at time of enrollment or 

23 renewal of enrollment in the plan or waiver, 

24 through providers, and through such other inVerDate Sep 11 2014 19:41 Dec 16, 2014 Jkt 049200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S3009.IS S3009

tkelley on DSK3SPTVN1PROD with BILLS
24 

•S 3009 IS

1 novative means as the State determines appro2 priate.’’; 

3 (2) in paragraph (3), by adding at the end the 

4 following new subparagraph: 

5 ‘‘(D) WORK PLAN REQUIRED FOR AWARD

6 OF ADVANCE CARE PLANNING GRANTS.—Pay7 ment to a State under this subsection to adopt 

8 the innovative methods described in paragraph 

9 (2)(G) is conditioned on the State submitting to 

10 the Secretary an approved plan for expending 

11 the funds awarded to the State under this sub12 section.’’; and 

13 (3) in paragraph (4)— 

14 (A) in subparagraph (A)— 

15 (i) in clause (i), by striking ‘‘and’’ at 

16 the end; 

17 (ii) in clause (ii), by striking the pe18 riod at the end and inserting ‘‘; and’’; and 

19 (iii) by inserting after clause (ii), the 

20 following new clause: 

21 ‘‘(iii) $20,000,000 for each of fiscal 

22 years 2015 through 2019.’’; and 

23 (B) by striking subparagraph (B), and in24 serting the following: 


tkelley on DSK3SPTVN1PROD with BILLS
25 

•S 3009 IS

1 ‘‘(B) ALLOCATION OF FUNDS.—The Sec2 retary shall specify a method for allocating the 

3 funds made available under this subsection 

4 among States awarded a grant for fiscal year 

5 2015, 2016, 2017, 2018, or 2019. Such method 

6 shall provide that— 

7 ‘‘(i) 100 percent of such funds for 

8 each of fiscal years 2015 through 2019 

9 shall be awarded to States that design pro10 grams to adopt the innovative methods de11 scribed in paragraph (2)(G); and 

12 ‘‘(ii) in no event shall a payment to a 

13 State awarded a grant under this sub14 section for fiscal year 2015 be made prior 

15 to July 1, 2015.’’. 

16 (d) ADVANCE CARE PLANNING COMMUNITY TRAIN17 ING GRANTS.— 

18 (1) IN GENERAL.—The Secretary shall use 

19 amounts made available under paragraph (3) to 

20 award grants to area agencies on aging (as defined 

21 in section 102 of the Older Americans Act of 1965 

22 (42 U.S.C. 3002)). 

23 (2) REQUIREMENTS.— 

24 (A) USE OF FUNDS.—Funds awarded to 

25 an area agency on aging under this subsection 


tkelley on DSK3SPTVN1PROD with BILLS
26 

•S 3009 IS

1 shall be used to provide advance care planning 

2 education and training opportunities for local 

3 aging service providers and organizations. 

4 (B) WORK PLAN; REPORT.—As a condition 

5 of being awarded a grant under this subsection, 

6 an area agency on aging shall submit the fol7 lowing to the Secretary: 

8 (i) An approved plan for expending 

9 grant funds. 

10 (ii) For each fiscal year for which the 

11 agency is paid grant funds under this sub12 section, an annual report regarding the use 

13 of the funds, including the number of 

14 Medicare beneficiaries served and their sat15 isfaction with the services provided. 

16 (C) LIMITATION.—No area agency on 

17 aging shall be paid funds from a grant made 

18 under this subsection prior to July 1, 2015. 

19 (3) AUTHORIZATION OF APPROPRIATIONS.— 

20 There is authorized to be appropriated to the Sec21 retary to the Centers for Medicare & Medicaid Serv22 ices Program Management Account, $12,000,000 for 

23 each of fiscal years 2015 through 2019 for purposes 

24 of awarding grants to area agencies on aging under 

25 paragraph (1). 


tkelley on DSK3SPTVN1PROD with BILLS
27 

•S 3009 IS

1 (e) NONDUPLICATION OF ACTIVITIES.—The Sec2 retary shall establish procedures to ensure that funds 

3 made available under grants awarded under this section 

4 or pursuant to amendments made by this section supple5 ment, not supplant, existing Federal funding, and that 

6 such funds are not used to duplicate activities carried out 

7 under such grants or under other Federally funded pro8 grams. 

9 SEC. 112. GRANTS FOR PROGRAMS FOR ORDERS REGARD10 ING LIFE SUSTAINING TREATMENT. 

11 (a) IN GENERAL.—The Secretary shall make grants 

12 to eligible entities for the purpose of— 

13 (1) establishing new programs for orders re14 garding life sustaining treatment in States or local15 ities; 

16 (2) expanding or enhancing an existing pro17 gram for orders regarding life sustaining treatment 

18 in States or localities; or 

19 (3) providing a clearinghouse of information on 

20 programs for orders for life sustaining treatment 

21 and consultative services for the development or en22 hancement of such programs. 

23 (b) AUTHORIZED ACTIVITIES.—Activities funded 

24 through a grant under this section for an area may in25 clude— 


tkelley on DSK3SPTVN1PROD with BILLS
28 

•S 3009 IS

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

2 includes home care, hospice, long-term care, commu3 nity and assisted living residences, skilled nursing 

4 facilities, inpatient rehabilitation facilities, hospitals, 

5 and emergency medical services within the area; 

6 (2) securing consultative services and advice 

7 from institutions with experience in developing and 

8 managing such programs; and 

9 (3) expanding an existing program for orders 

10 regarding life sustaining treatment to serve more pa11 tients or enhance the quality of services, including 

12 educational services for patients and patients’ fami13 lies or training of health care professionals. 

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

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

16 funds appropriated to carry out this section for each fiscal 

17 year— 

18 (1) at least two-thirds are used for establishing 

19 or developing new programs for orders regarding life 

20 sustaining treatment; and 

21 (2) one-third is used for expanding or enhanc22 ing existing programs for orders regarding life sus23 taining treatment. 

24 (d) DEFINITIONS.—In this section: 

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


tkelley on DSK3SPTVN1PROD with BILLS
29 

•S 3009 IS

1 (A) an academic medical center, a medical 

2 school, a State health department, a State med3 ical association, a multi-State taskforce, a hos4 pital, or a health system capable of admin5 istering a program for orders regarding life sus6 taining treatment for a State or locality; or 

7 (B) any other health care agency or entity 

8 as the Secretary determines appropriate. 

9 (2) The term ‘‘order regarding life sustaining 

10 treatment’’ has the meaning given such term in sec11 tion 1861(hhh)(5) of the Social Security Act, as 

12 added by section 211. 

13 (3) The term ‘‘program for orders regarding 

14 life sustaining treatment’’ means, with respect to an 

15 area, a program that supports the active use of or16 ders regarding life sustaining treatment in the area. 

17 (e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

18 out this section, there are authorized to be appropriated 

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

20 2014 through 2019. 

21 PART II—PROVIDER EDUCATION 

22 SEC. 121. PUBLIC PROVIDER ADVANCE CARE PLANNING 

23 WEBSITE. 

24 (a) DEVELOPMENT.—Not later than January 1, 

25 2015, the Secretary, acting through the Administrator of 


tkelley on DSK3SPTVN1PROD with BILLS
30 

•S 3009 IS

1 the Centers for Medicare & Medicaid Services and the Di2 rector of the Agency for Healthcare Research and Quality, 

3 shall establish a website for providers under Medicare, 

4 Medicaid, the Children’s Health Insurance Program, the 

5 Indian Health Service (include contract providers) and 

6 other public health providers on each individual’s right to 

7 make decisions concerning medical care, including the 

8 right to accept or refuse medical or surgical treatment, 

9 and the existence of advance directives. 

10 (b) MAINTENANCE.—The website, shall be main11 tained and publicized by the Secretary on an ongoing 

12 basis. 

13 (c) CONTENT.—The website shall include content, 

14 tools, and resources necessary to do the following: 

15 (1) Inform providers about the advance direc16 tive requirements under the health care programs 

17 described in subsection (a) and other State and Fed18 eral laws and regulations related to advance care 

19 planning. 

20 (2) Educate providers about advance care plan21 ning quality improvement activities. 

22 (3) Provide assistance to providers to— 

23 (A) integrate advance directives into elec24 tronic health records, including oral directives; 

25 and 


tkelley on DSK3SPTVN1PROD with BILLS
31 

•S 3009 IS

1 (B) develop and disseminate advance care 

2 planning informational materials for their pa3 tients. 

4 (4) Inform providers about advance care plan5 ning continuing education requirements and oppor6 tunities. 

7 (5) Encourage providers to discuss advance 

8 care planning with their patients of all ages. 

9 (6) Assist providers’ understanding of the con10 tinuum of end-of-life care services and supports 

11 available to patients, including palliative care and 

12 hospice. 

13 (7) Inform providers of best practices for dis14 cussing end-of-life care with dying patients and their 

15 loved ones. 

16 SEC. 122. CONTINUING EDUCATION FOR PHYSICIANS AND 

17 NURSES. 

18 (a) IN GENERAL.—Not later than January 1, 2017, 

19 the Secretary, acting through the Director of Health Re20 sources and Services Administration, shall develop, in con21 sultation with health care providers and State boards of 

22 medicine and nursing, a curriculum for continuing edu23 cation that States may adopt for physicians and nurses 

24 on advance care planning and end-of-life care. 

25 (b) CONTENT.— 


tkelley on DSK3SPTVN1PROD with BILLS
32 

•S 3009 IS

1 (1) IN GENERAL.—The continuing education 

2 curriculum developed under subsection (a) for physi3 cians and nurses shall, at a minimum, include— 

4 (A) a description of the meaning and im5 portance of advance care planning; 

6 (B) a description of advance directives, in7 cluding living wills and durable powers of attor8 ney, and the use of such directives; 

9 (C) palliative care principles and ap10 proaches to care; and 

11 (D) the continuum of end-of-life services 

12 and supports, including palliative care and hos13 pice. 

14 (2) ADDITIONAL CONTENT FOR PHYSICIANS.— 

15 The continuing education curriculum for physicians 

16 developed under subsection (a) shall include instruc17 tion on how to conduct advance care planning with 

18 patients and their loved ones. 

19 Subtitle B—Portability of Advance 

20 Directives; Health Information 

21 Technology 

22 SEC. 131. PORTABILITY OF ADVANCE DIRECTIVES. 

23 (a) MEDICARE.—Section 1866(f) of the Social Secu24 rity Act (42 U.S.C. 1395cc(f)) is amended— 

25 (1) in paragraph (1)— 


tkelley on DSK3SPTVN1PROD with BILLS
33 

•S 3009 IS

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

2 ‘‘and if presented by the individual, to include 

3 the content of such advance directive in a 

4 prominent part of such record’’ before the semi5 colon at the end; 

6 (B) in subparagraph (D), by striking 

7 ‘‘and’’ after the semicolon at the end; 

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

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

10 (D) by inserting after subparagraph (E) 

11 the following new subparagraph: 

12 ‘‘(F) to provide each individual with the oppor13 tunity to discuss issues relating to the information 

14 provided to that individual pursuant to subpara15 graph (A) with an appropriately trained profes16 sional.’’; and 

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

18 paragraph: 

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

20 of the State in which such advance directive is presented 

21 by an adult individual to a provider of services, a Medicare 

22 Advantage organization, or a prepaid or eligible organiza23 tion shall be given the same effect by that provider or or24 ganization as an advance directive validly executed under 


tkelley on DSK3SPTVN1PROD with BILLS
34 

•S 3009 IS

1 the law of the State in which it is presented would be given 

2 effect. 

3 ‘‘(B)(i) The definition of an advanced directive shall 

4 also include actual knowledge of instructions made while 

5 an individual was able to express the wishes of such indi6 vidual with regard to health care. 

7 ‘‘(ii) For purposes of clause (i), the term ‘actual 

8 knowledge’ means the possession of information of an indi9 vidual’s wishes communicated to the health care provider 

10 orally or in writing by the individual, the individual’s med11 ical power of attorney representative, the individual’s 

12 health care surrogate, or other individuals resulting in the 

13 health care provider’s personal cognizance of these wishes. 

14 Other forms of imputed knowledge are not actual knowl15 edge. 

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

17 any State law to the extent such law is inconsistent with 

18 such provisions. The provisions of this paragraph shall not 

19 preempt any State law that provides for greater port20 ability, more deference to a patient’s wishes, or more lati21 tude in determining a patient’s wishes.’’. 

22 (b) MEDICAID.—Section 1902(w) of the Social Secu23 rity Act (42 U.S.C. 1396a(w)) is amended— 

24 (1) in paragraph (1)— 

25 (A) in subparagraph (B)— 


tkelley on DSK3SPTVN1PROD with BILLS
35 

•S 3009 IS

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

2 medical record’’ and inserting ‘‘in a promi3 nent part of the individual’s current med4 ical record’’; and 

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

6 the individual, to include the content of 

7 such advance directive in a prominent part 

8 of such record’’ before the semicolon at the 

9 end; 

10 (B) in subparagraph (D), by striking 

11 ‘‘and’’ after the semicolon at the end; 

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

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

14 (D) by inserting after subparagraph (E) 

15 the following new subparagraph: 

16 ‘‘(F) to provide each individual with the oppor17 tunity to discuss issues relating to the information 

18 provided to that individual pursuant to subpara19 graph (A) with an appropriately trained profes20 sional.’’; and 

21 (2) by adding at the end the following para22 graph: 

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

24 of the State in which such advance directive is presented 

25 by an adult individual to a provider or organization shall 


tkelley on DSK3SPTVN1PROD with BILLS
36 

•S 3009 IS

1 be given the same effect by that provider or organization 

2 as an advance directive validly executed under the law of 

3 the State in which it is presented would be given effect. 

4 ‘‘(B)(i) The definition of an advance directive shall 

5 also include actual knowledge of instructions made while 

6 an individual was able to express the wishes of such indi7 vidual with regard to health care. 

8 ‘‘(ii) For purposes of clause (i), the term ‘actual 

9 knowledge’ means the possession of information of an indi10 vidual’s wishes communicated to the health care provider 

11 orally or in writing by the individual, the individual’s med12 ical power of attorney representative, the individual’s 

13 health care surrogate, or other individuals resulting in the 

14 health care provider’s personal cognizance of these wishes. 

15 Other forms of imputed knowledge are not actual knowl16 edge. 

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

18 any State law to the extent such law is inconsistent with 

19 such provisions. The provisions of this paragraph shall not 

20 preempt any State law that provides for greater port21 ability, more deference to a patient’s wishes, or more lati22 tude in determining a patient’s wishes.’’. 

23 (c) CHIP.—Section 2107(e)(1) of the Social Security 

24 Act (42 U.S.C. 1397gg(e)(1)) is amended— 


tkelley on DSK3SPTVN1PROD with BILLS
37 

•S 3009 IS

1 (1) by redesignating subparagraphs (G) 

2 through (O) as subparagraphs (H) through (P), re3 spectively; and 

4 (2) by inserting after subparagraph (F) the fol5 lowing: 

6 ‘‘(G) Section 1902(w) (relating to advance 

7 directives).’’. 

8 (d) STUDY AND REPORT REGARDING IMPLEMENTA9 TION.— 

10 (1) STUDY.—The Secretary shall conduct a 

11 study regarding the implementation of the amend12 ments made by subsections (a) and (b). 

13 (2) REPORT.—Not later than 18 months after 

14 the date of enactment of this Act, the Secretary 

15 shall submit to Congress a report on the study con16 ducted under paragraph (1), together with rec17 ommendations for such legislation and administra18 tive actions as the Secretary considers appropriate. 

19 (e) EFFECTIVE DATES.— 

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

21 the amendments made by subsections (a), (b), and 

22 (c) shall apply to provider agreements and contracts 

23 entered into, renewed, or extended under title XVIII 

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

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


tkelley on DSK3SPTVN1PROD with BILLS
38 

•S 3009 IS

1 U.S.C. 1396 et seq.) and State child health plans 

2 under title XXI of such Act (42 U.S.C. 1397aa et 

3 seq.), on or after such date as the Secretary speci4 fies, but in no case may such date be later than 1 

5 year after the date of enactment of this Act. 

6 (2) EXTENSION OF EFFECTIVE DATE FOR

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

8 plan under title XIX of the Social Security Act or 

9 a State child health plan under title XXI of such 

10 Act which the Secretary determines requires State 

11 legislation in order for the plan to meet the addi12 tional requirements imposed by the amendments 

13 made by subsections (b) and (c), the State plan shall 

14 not be regarded as failing to comply with the re15 quirements of such title solely on the basis of its 

16 failure to meet these additional requirements before 

17 the first day of the first calendar quarter beginning 

18 after the close of the first regular session of the 

19 State legislature that begins after the date of enact20 ment of this Act. For purposes of the previous sen21 tence, in the case of a State that has a 2-year legis22 lative session, each year of the session is considered 

23 to be a separate regular session of the State legisla24 ture. 


tkelley on DSK3SPTVN1PROD with BILLS
39 

•S 3009 IS

1 SEC. 132. STATE ADVANCE DIRECTIVE REGISTRIES; DRIV2 ER’S LICENSE ADVANCE DIRECTIVE NOTA3 TION. 

4 Part P of title III of the Public Health Service Act 

5 (42 U.S.C. 280g) is amended by inserting after section 

6 399S the following new sections: 

7 ‘‘SEC. 399S–1. STATE ADVANCE DIRECTIVE REGISTRIES. 

8 ‘‘(a) STATE ADVANCE DIRECTIVE REGISTRY.—In 

9 this section, the term ‘State advance directive registry’ 

10 means a secure, electronic database that— 

11 ‘‘(1) is available free of charge to residents of 

12 a State; and 

13 ‘‘(2) stores advance directive documents and 

14 makes such documents accessible to medical service 

15 providers in accordance with Federal and State pri16 vacy laws. 

17 ‘‘(b) GRANT PROGRAM.—Beginning on July 1, 2015, 

18 the Secretary, acting through the Director of the Centers 

19 for Disease Control and Prevention, shall award grants 

20 on a competitive basis to eligible entities to establish and 

21 operate, directly or indirectly (by competitive grant or 

22 competitive contract), State advance directive registries. 

23 ‘‘(c) ELIGIBLE ENTITIES.— 

24 ‘‘(1) IN GENERAL.—To be eligible to receive a 

25 grant under this section, an entity shall— 

26 ‘‘(A) be a State department of health; and 


tkelley on DSK3SPTVN1PROD with BILLS
40 

•S 3009 IS

1 ‘‘(B) submit to the Director an application 

2 at such time, in such manner, and containing— 

3 ‘‘(i) a plan for the establishment and 

4 operation of a State advance directive reg5 istry; and 

6 ‘‘(ii) such other information as the Di7 rector may require. 

8 ‘‘(2) NO REQUIREMENT OF NOTATION MECHA9 NISM.—The Secretary shall not require that an enti10 ty establish and operate a driver’s license advance 

11 directive notation mechanism for State residents 

12 under section 399V to be eligible to receive a grant 

13 under this section. 

14 ‘‘(d) ANNUAL REPORT.—For each year for which an 

15 entity receives an award under this section, such entity 

16 shall submit an annual report to the Director on the use 

17 of the funds received pursuant to such award, including 

18 the number of State residents served through the registry. 

19 ‘‘(e) AUTHORIZATION.—There is authorized to be ap20 propriated to carry out this section $20,000,000 for fiscal 

21 year 2015 and each fiscal year thereafter. 

22 ‘‘SEC. 399S–2. DRIVER’S LICENSE ADVANCE DIRECTIVE NO23 TATION. 

24 ‘‘(a) IN GENERAL.—Beginning July 1, 2015, the Sec25 retary, acting through the Director of the Centers for DisVerDate Sep 11 2014 19:41 Dec 16, 2014 Jkt 049200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S3009.IS S3009

tkelley on DSK3SPTVN1PROD with BILLS
41 

•S 3009 IS

1 ease Control and Prevention, shall award grants on a com2 petitive basis to States to establish and operate a mecha3 nism for a State resident with a driver’s license to include 

4 a notice of the existence of an advance directive for such 

5 resident on such license. 

6 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

7 under this section, a State shall— 

8 ‘‘(1) establish and operate a State advance di9 rective registry under section 399S–1; and 

10 ‘‘(2) submit to the Director an application at 

11 such time, in such manner, and containing— 

12 ‘‘(A) a plan that includes a description of 

13 how the State will— 

14 ‘‘(i) disseminate information about ad15 vance directives at the time of driver’s li16 cense application or renewal; 

17 ‘‘(ii) enable each State resident with a 

18 driver’s license to include a notice of the 

19 existence of an advance directive for such 

20 resident on such license in a manner con21 sistent with the notice on such a license in22 dicating a driver’s intent to be an organ 

23 donor; and 

24 ‘‘(iii) coordinate with the State de25 partment of health to ensure that, if a 


tkelley on DSK3SPTVN1PROD with BILLS
42 

•S 3009 IS

1 State resident has an advance directive no2 tice on his or her driver’s license, the exist3 ence of such advance directive is included 

4 in the State registry established under sec5 tion 399S–1; and 

6 ‘‘(B) any other information as the Director 

7 may require. 

8 ‘‘(c) ANNUAL REPORT.—For each year for which a 

9 State receives an award under this section, such State 

10 shall submit an annual report to the Director on the use 

11 of the funds received pursuant to such award, including 

12 the number of State residents served through the mecha13 nism. 

14 ‘‘(d) AUTHORIZATION.—There is authorized to be ap15 propriated to carry out this section $50,000,000 for fiscal 

16 year 2015 and each fiscal year thereafter.’’. 

17 SEC. 133. GAO STUDY AND REPORT ON ESTABLISHMENT OF 

18 NATIONAL ADVANCE DIRECTIVE REGISTRY. 

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

20 States shall conduct a study on the feasibility of a national 

21 registry for advance directives, taking into consideration 

22 the constraints created by the privacy provisions enacted 

23 as a result of the Health Insurance Portability and Ac24 countability Act of 1996 (Public Law 104–191). 


tkelley on DSK3SPTVN1PROD with BILLS
43 

•S 3009 IS

1 (b) REPORT.—Not later than 18 months after the 

2 date of enactment of this Act, the Comptroller General 

3 of the United States shall submit to Congress a report 

4 on the study conducted under subsection (a) together with 

5 recommendations for such legislation and administrative 

6 action as the Comptroller General of the United States 

7 determines to be appropriate. 

8 Subtitle C—National Uniform 

9 Policy on Advance Care Planning 

10 SEC. 141. STUDY AND REPORT BY THE SECRETARY RE11 GARDING THE ESTABLISHMENT AND IMPLE12 MENTATION OF A NATIONAL UNIFORM POL13 ICY ON ADVANCE DIRECTIVES. 

14 (a) STUDY.— 

15 (1) IN GENERAL.—The Secretary, acting 

16 through the Office of the Assistant Secretary for 

17 Planning and Evaluation, shall conduct a thorough 

18 study of all matters relating to the establishment 

19 and implementation of a national uniform policy on 

20 advance directives for individuals receiving items and 

21 services under titles XVIII, XIX, or XXI of the So22 cial Security Act (42 U.S.C. 1395 et seq., 1396 et 

23 seq., or 1397aa et seq.). 


tkelley on DSK3SPTVN1PROD with BILLS
44 

•S 3009 IS

1 (2) MATTERS STUDIED.—The matters studied 

2 by the Secretary under paragraph (1) shall include 

3 issues concerning— 

4 (A) family satisfaction that a patient’s 

5 wishes, as stated in the patient’s advance direc6 tive, were carried out; 

7 (B) the portability of advance directives, 

8 including cases involving the transfer of an in9 dividual from 1 health care setting to another; 

10 (C) immunity from civil liability and crimi11 nal responsibility for health care providers that 

12 follow the instructions in an individual’s ad13 vance directive that was validly executed in, and 

14 consistent with the laws of, the State in which 

15 it was executed; 

16 (D) conditions under which an advance di17 rective is operative; 

18 (E) revocation of an advance directive by 

19 an individual; 

20 (F) the criteria used by States for deter21 mining that an individual has a terminal condi22 tion; 

23 (G) surrogate decisionmaking regarding 

24 end-of-life care; 


tkelley on DSK3SPTVN1PROD with BILLS
45 

•S 3009 IS

1 (H) the provision of adequate palliative 

2 care (as defined in paragraph (3)), including 

3 pain management; 

4 (I) adequate and timely referrals to hos5 pice care programs; and 

6 (J) the end-of-life care needs of children 

7 and their families. 

8 (3) PALLIATIVE CARE.—For purposes of para9 graph (2)(H), the term ‘‘palliative care’’ means 

10 interdisciplinary care for individuals with a life11 threatening illness or injury relating to pain and 

12 symptom management and psychological, social, and 

13 spiritual needs and that seeks to improve the quality 

14 of life for the individual and the individual’s family. 

15 (b) REPORT TO CONGRESS.—Not later than 18 

16 months after the date of enactment of this Act, the Sec17 retary shall submit to Congress a report on the study con18 ducted under subsection (a), together with recommenda19 tions for such legislation and administrative actions as the 

20 Secretary considers appropriate. 

21 (c) CONSULTATION.—In conducting the study and 

22 developing the report under this section, the Secretary 

23 shall consult with the Uniform Law Commissioners, and 

24 other interested parties. 


tkelley on DSK3SPTVN1PROD with BILLS
46 

•S 3009 IS

1 TITLE II—COMPASSIONATE 

2 CARE 

3 Subtitle A—Workforce 

4 Development 

5 PART I—EDUCATION AND TRAINING 

6 SEC. 201. NATIONAL GERIATRIC AND PALLIATIVE CARE 

7 SERVICES CORPS. 

8 Section 331 of the Public Health Service Act (42 

9 U.S.C. 254d) is amended— 

10 (1) by redesignating subsection (j) as sub11 section (k); and 

12 (2) by inserting after subsection (i), the fol13 lowing: 

14 ‘‘(j) NATIONAL GERIATRIC AND PALLIATIVE CARE

15 SERVICES CORPS.— 

16 ‘‘(1) ESTABLISHMENT.—Not later than Janu17 ary 1, 2017, the Secretary shall establish within the 

18 National Health Service Corps a National Geriatric 

19 and Palliative Care Services Corps (referred to in 

20 this subsection as the ‘Corps’) which shall consist 

21 of— 

22 ‘‘(A) such officers of the Regular and Re23 serve Corps of the Service as the Secretary may 

24 designate; 


tkelley on DSK3SPTVN1PROD with BILLS
47 

•S 3009 IS

1 ‘‘(B) such civilian employees of the United 

2 States as the Secretary may appoint; and 

3 ‘‘(C) such other individuals who are not 

4 employees of the United States. 

5 ‘‘(2) DUTIES.—The Corps shall be utilized by 

6 the Secretary to provide geriatric and palliative care 

7 services within health professional shortage areas. 

8 ‘‘(3) APPLICATION OF PROVISIONS.—The loan9 forgiveness, scholarship, and direct financial incen10 tives programs provided for under this section shall 

11 apply to physicians, nurses, and other health profes12 sionals (as identified by the Secretary) with respect 

13 to the training necessary to enable such individuals 

14 to become geriatric or palliative care specialists and 

15 provide geriatric and palliative care services in 

16 health professional shortage areas. 

17 ‘‘(4) REPORT.—Not later than 6 months prior 

18 to the date on which the Secretary establishes the 

19 Corps under paragraph (1), the Secretary shall sub20 mit to Congress a report concerning the organization 

21 of the Corps, the application process for membership 

22 in the Corps, and the funding necessary for the 

23 Corps (targeted by profession and by specializa24 tion).’’. 


tkelley on DSK3SPTVN1PROD with BILLS
48 

•S 3009 IS

1 SEC. 202. EXEMPTION OF PALLIATIVE MEDICINE FELLOW2 SHIP TRAINING FROM MEDICARE GRADUATE 

3 MEDICAL EDUCATION CAPS. 

4 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec5 tion 1886(h)(4)(F) of the Social Security Act (42 U.S.C. 

6 1395ww(h)(4)(F)) is amended— 

7 (1) in clause (i), by inserting ‘‘clause (iii) and’’ 

8 after ‘‘subject to’’; and 

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

10 clause: 

11 ‘‘(iii) INCREASE ALLOWED FOR PAL12 LIATIVE MEDICINE FELLOWSHIP TRAIN13 ING.—For cost reporting periods beginning 

14 on or after January 1, 2016, in applying 

15 clause (i), there shall not be taken into ac16 count full-time equivalent residents in the 

17 field of allopathic or osteopathic medicine 

18 who are in palliative medicine fellowship 

19 training that is approved by the Accredita20 tion Council for Graduate Medical Edu21 cation.’’. 

22 (b) INDIRECT MEDICAL EDUCATION.—Section 

23 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

24 1395ww(d)(5)(B)) is amended— 

25 (1) by redesignating the second clause (x), as 

26 added by section 5505(b) of the Patient Protection 


tkelley on DSK3SPTVN1PROD with BILLS
49 

•S 3009 IS

1 and Affordable Care Act (Public Law 111–148), as 

2 clause (xi) and moving such clause 4 ems to the left, 

3 and realigning the left margins of subclauses (II) 

4 and (III) of such clause and items (aa), (bb), (cc), 

5 and (dd) of subclause (II) of such clause appro6 priately; and 

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

8 clause: 

9 ‘‘(xii) Clause (iii) of subsection (h)(4)(F) shall 

10 apply to clause (v) in the same manner and for the 

11 same period as such clause (iii) applies to clause (i) 

12 of such subsection.’’. 

13 SEC. 203. MEDICAL SCHOOL CURRICULA. 

14 (a) IN GENERAL.—The Secretary, in consultation 

15 with the Association of American Medical Colleges, shall 

16 establish guidelines for the imposition by medical schools 

17 of a minimum amount of end-of-life training as a require18 ment for obtaining a Doctor of Medicine degree in the field 

19 of allopathic or osteopathic medicine. 

20 (b) TRAINING.—Under the guidelines established 

21 under subsection (a), minimum training shall include— 

22 (1) training in how to discuss and help patients 

23 and their loved ones with advance care planning; 


tkelley on DSK3SPTVN1PROD with BILLS
50 

•S 3009 IS

1 (2) with respect to students and trainees who 

2 will work with children, specialized pediatric train3 ing; 

4 (3) training in the continuum of end-of-life 

5 services and supports, including palliative care and 

6 hospice; 

7 (4) training in how to discuss end-of-life care 

8 with dying patients and their loved ones; and 

9 (5) medical and legal issues training. 

10 (c) DISTRIBUTION.—Not later than January 1, 2016, 

11 the Secretary shall disseminate the guidelines established 

12 under subsection (a) to medical schools. 

13 (d) COMPLIANCE.—Effective beginning not later than 

14 July 1, 2017, a medical school that is receiving Federal 

15 assistance shall be required to implement the guidelines 

16 established under subsection (a). A medical school that the 

17 Secretary determines is not implementing such guidelines 

18 shall not be eligible for Federal assistance. 

19 Subtitle B—Coverage Under 

20 Medicare, Medicaid, and CHIP 

21 PART I—COVERAGE OF ADVANCE CARE 

22 PLANNING 

23 SEC. 211. MEDICARE, MEDICAID, AND CHIP COVERAGE. 

24 (a) MEDICARE.— 


tkelley on DSK3SPTVN1PROD with BILLS
51 

•S 3009 IS

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

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

3 (A) in subsection (s)(2)— 

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

5 subparagraph (EE); 

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

7 subparagraph (FF); and 

8 (iii) by adding at the end the fol9 lowing new subparagraph: 

10 ‘‘(GG) advance care planning consultation 

11 (as defined in subsection (iii)(1));’’; and 

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

13 subsection: 

14 ‘‘Advance Care Planning Consultation 

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

16 ‘advance care planning consultation’ means a consultation 

17 between the individual and a practitioner described in 

18 paragraph (2) regarding advance care planning, if, subject 

19 to subparagraphs (A) and (B) of paragraph (3), the indi20 vidual involved has not had such a consultation within the 

21 last 5 years. Such consultation shall include the following: 

22 ‘‘(A) An explanation by the practitioner of ad23 vance care planning, including key questions and 

24 considerations, important steps, and suggested peo25 ple to talk to. 


tkelley on DSK3SPTVN1PROD with BILLS
52 

•S 3009 IS

1 ‘‘(B) An explanation by the practitioner of ad2 vance directives, including living wills and durable 

3 powers of attorney, and their uses. 

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

5 role and responsibilities of a health care proxy. 

6 ‘‘(D) The provision by the practitioner of a list 

7 of national and State-specific resources to assist con8 sumers and their families with advance care plan9 ning, including the national toll-free hotline, the ad10 vance care planning clearinghouses, and State legal 

11 service organizations (including those funded 

12 through the Older Americans Act). 

13 ‘‘(E) An explanation by the practitioner of the 

14 continuum of end-of-life services and supports avail15 able, including palliative care and hospice, and bene16 fits for such services and supports that are available 

17 under this title. 

18 ‘‘(F)(i) Subject to clause (ii), an explanation of 

19 orders regarding life sustaining treatment or similar 

20 orders, which shall include— 

21 ‘‘(I) the reasons why the development of 

22 such an order is beneficial to the individual and 

23 the individual’s family and the reasons why 

24 such an order should be updated periodically as 

25 the health of the individual changes; 


tkelley on DSK3SPTVN1PROD with BILLS
53 

•S 3009 IS

1 ‘‘(II) the information needed for an indi2 vidual or legal surrogate to make informed deci3 sions regarding the completion of such an 

4 order; and 

5 ‘‘(III) the identification of resources that 

6 an individual may use to determine the require7 ments of the State in which such individual re8 sides so that the treatment wishes of that indi9 vidual will be carried out if the individual is un10 able to communicate those wishes, including re11 quirements regarding the designation of a sur12 rogate decisionmaker (also known as a health 

13 care proxy). 

14 ‘‘(ii) The Secretary may limit the requirement 

15 for explanations under clause (i) to consultations 

16 furnished in States, localities, or other geographic 

17 areas in which orders described in such clause have 

18 been widely adopted. 

19 ‘‘(2) A practitioner described in this paragraph is— 

20 ‘‘(A) a physician (as defined in subsection 

21 (r)(1)); and 

22 ‘‘(B) a nurse practitioner or physician’s assist23 ant who has the authority under State law to sign 

24 orders for life sustaining treatments. 


tkelley on DSK3SPTVN1PROD with BILLS
54 

•S 3009 IS

1 ‘‘(3)(A) An initial preventive physical examination 

2 under subsection (ww), including any related discussion 

3 during such examination, shall not be considered an ad4 vance care planning consultation for purposes of applying 

5 the 5-year limitation under paragraph (1). 

6 ‘‘(B) An advance care planning consultation with re7 spect to an individual shall be conducted more frequently 

8 than provided under paragraph (1) if there is a significant 

9 change in the health condition of the individual, including 

10 diagnosis of a chronic, progressive, life-limiting disease, a 

11 life-threatening or terminal diagnosis or life-threatening 

12 injury, or upon admission to a skilled nursing facility, a 

13 long-term care facility (as defined by the Secretary), or 

14 a hospice program. 

15 ‘‘(4) A consultation under this subsection may in16 clude the formulation of an order regarding life sustaining 

17 treatment or a similar order. 

18 ‘‘(5)(A) For purposes of this section, the term ‘order 

19 regarding life sustaining treatment’ means, with respect 

20 to an individual, an actionable medical order relating to 

21 the treatment of that individual that— 

22 ‘‘(i) is signed and dated by a physician (as de23 fined in subsection (r)(1)) or another health care 

24 professional (as specified by the Secretary and who 

25 is acting within the scope of the professional’s auVerDate Sep 11 2014 19:41 Dec 16, 2014 Jkt 049200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S3009.IS S3009

tkelley on DSK3SPTVN1PROD with BILLS
55 

•S 3009 IS

1 thority under State law in signing such an order) 

2 and is in a form that permits it to stay with the pa3 tient and be followed by health care professionals 

4 and providers across the continuum of care, includ5 ing home care, hospice, long-term care, community 

6 and assisted living residences, skilled nursing facili7 ties, inpatient rehabilitation facilities, hospitals, and 

8 emergency medical services; 

9 ‘‘(ii) effectively communicates the individual’s 

10 preferences regarding life sustaining treatment, in11 cluding an indication of the treatment and care de12 sired by the individual; 

13 ‘‘(iii) is uniquely identifiable and standardized 

14 within a given locality, region, or State (as identified 

15 by the Secretary); 

16 ‘‘(iv) is portable across care settings; and 

17 ‘‘(v) may incorporate any advance directive (as 

18 defined in section 1866(f)(3)) if executed by the in19 dividual. 

20 ‘‘(B) The level of treatment indicated under subpara21 graph (A)(ii) may range from an indication for full treat22 ment to an indication to limit some or all or specified 

23 interventions. Such indicated levels of treatment may in24 clude indications respecting, among other items— 


tkelley on DSK3SPTVN1PROD with BILLS
56 

•S 3009 IS

1 ‘‘(i) the intensity of medical intervention if the 

2 patient is pulseless, apneic, or has serious cardiac or 

3 pulmonary problems; 

4 ‘‘(ii) the individual’s desire regarding transfer 

5 to a hospital or remaining at the current care set6 ting; 

7 ‘‘(iii) the use of antibiotics; and 

8 ‘‘(iv) the use of artificially administered nutri9 tion and hydration.’’. 

10 (2) PAYMENT.—Section 1848(j)(3) of the So11 cial Security Act (42 U.S.C. 1395w–4(j)(3)) is 

12 amended by inserting ‘‘(2)(GG),’’ after ‘‘(including 

13 administration of the health risk assessment),’’. 

14 (3) 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: 


tkelley on DSK3SPTVN1PROD with BILLS
57 

•S 3009 IS

1 ‘‘(Q) in the case of advance care planning con2 sultations (as defined in section 1861(iii)(1)), which 

3 are performed more frequently than is covered under 

4 such section;’’; and 

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

6 and inserting ‘‘(P), or (Q)’’. 

7 (4) EFFECTIVE DATE.—The amendments made 

8 by this subsection shall apply to consultations fur9 nished on or after January 1, 2016. 

10 (b) MEDICAID.— 

11 (1) MANDATORY BENEFIT.—Section 

12 1902(a)(10)(A) of the Social Security Act (42 

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

14 preceding clause (i) by striking ‘‘and (28)’’ and in15 serting ‘‘(28), and (29)’’. 

16 (2) MEDICAL ASSISTANCE.—Section 1905 of 

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

18 (A) in subsection (a)— 

19 (i) in paragraph (28), by striking 

20 ‘‘and’’ at the end; 

21 (ii) by redesignating paragraph (29) 

22 as paragraph (30); and 

23 (iii) by inserting after paragraph (28) 

24 the following new paragraph: 


tkelley on DSK3SPTVN1PROD with BILLS
58 

•S 3009 IS

1 ‘‘(29) advance care planning consultations (as 

2 defined in subsection (ee));’’; and 

3 (B) by adding at the end the following: 

4 ‘‘(ee)(1) For purposes of subsection (a)(29), the term 

5 ‘advance care planning consultation’ means a consultation 

6 between the individual and a practitioner described in 

7 paragraph (2) regarding advance care planning, if, subject 

8 to paragraph (3), the individual involved has not had such 

9 a consultation within the last 5 years. Such consultation 

10 shall include the following: 

11 ‘‘(A) An explanation by the practitioner of ad12 vance care planning, including key questions and 

13 considerations, important steps, and suggested peo14 ple to talk to. 

15 ‘‘(B) An explanation by the practitioner of ad16 vance directives, including living wills and durable 

17 powers of attorney, and their uses. 

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

19 role and responsibilities of a health care proxy. 

20 ‘‘(D) The provision by the practitioner of a list 

21 of national and State-specific resources to assist con22 sumers and their families with advance care plan23 ning, including the national toll-free hotline, the ad24 vance care planning clearinghouses, and State legal 


tkelley on DSK3SPTVN1PROD with BILLS
59 

•S 3009 IS

1 service organizations (including those funded 

2 through the Older Americans Act). 

3 ‘‘(E) An explanation by the practitioner of the 

4 continuum of end-of-life services and supports avail5 able, including palliative care and hospice, and bene6 fits for such services and supports that are available 

7 under this title. 

8 ‘‘(F)(i) Subject to clause (ii), an explanation of 

9 orders for life sustaining treatments or similar or10 ders, which shall include— 

11 ‘‘(I) the reasons why the development of 

12 such an order is beneficial to the individual and 

13 the individual’s family and the reasons why 

14 such an order should be updated periodically as 

15 the health of the individual changes; 

16 ‘‘(II) the information needed for an indi17 vidual or legal surrogate to make informed deci18 sions regarding the completion of such an 

19 order; and 

20 ‘‘(III) the identification of resources that 

21 an individual may use to determine the require22 ments of the State in which such individual re23 sides so that the treatment wishes of that indi24 vidual will be carried out if the individual is un25 able to communicate those wishes, including reVerDate Sep 11 2014 19:41 Dec 16, 2014 Jkt 049200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\S3009.IS S3009

tkelley on DSK3SPTVN1PROD with BILLS
60 

•S 3009 IS

1 quirements regarding the designation of a sur2 rogate decisionmaker (also known as a health 

3 care proxy). 

4 ‘‘(ii) The Secretary may limit the requirement 

5 for explanations under clause (i) to consultations 

6 furnished in States, localities, or other geographic 

7 areas in which orders described in such clause have 

8 been widely adopted. 

9 ‘‘(2) A practitioner described in this paragraph is— 

10 ‘‘(A) a physician (as defined in section 

11 1861(r)(1)); and 

12 ‘‘(B) a nurse practitioner or physician’s assist13 ant who has the authority under State law to sign 

14 orders for life sustaining treatments. 

15 ‘‘(3) An advance care planning consultation with re16 spect to an individual shall be conducted more frequently 

17 than provided under paragraph (1) if there is a significant 

18 change in the health condition of the individual including 

19 diagnosis of a chronic, progressive, life-limiting disease, a 

20 life-threatening or terminal diagnosis or life-threatening 

21 injury, or upon admission to a nursing facility, a long22 term care facility (as defined by the Secretary), or a hos23 pice program. 


tkelley on DSK3SPTVN1PROD with BILLS
61 

•S 3009 IS

1 ‘‘(4) A consultation under this subsection may in2 clude the formulation of an order regarding life sustaining 

3 treatment or a similar order. 

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

5 regarding life sustaining treatment’ has the meaning given 

6 that term in section 1861(iii)(5).’’. 

7 (c) CHIP.— 

8 (1) CHILD HEALTH ASSISTANCE.—Section 

9 2110(a) of the Social Security Act (42 U.S.C. 

10 1397jj) is amended— 

11 (A) by redesignating paragraph (28) as 

12 paragraph (29); and 

13 (B) by inserting after paragraph (27), the 

14 following: 

15 ‘‘(28) Advance care planning consultations (as 

16 defined in section 1905(ee)).’’. 

17 (2) MANDATORY COVERAGE.— 

18 (A) IN GENERAL.—Section 2103 of such 

19 Act (42 U.S.C. 1397cc), is amended— 

20 (i) in subsection (a), in the matter 

21 preceding paragraph (1), by striking ‘‘and 

22 (7)’’ and inserting ‘‘(7), and (9)’’; and 

23 (ii) in subsection (c), by adding at the 

24 end the following: 


tkelley on DSK3SPTVN1PROD with BILLS
62 

•S 3009 IS

1 ‘‘(9) END-OF-LIFE CARE.—The child health as2 sistance provided to a targeted low-income child 

3 shall include coverage of advance care planning con4 sultations (as defined in section 1905(ee) and at the 

5 same payment rate as the rate that would apply to 

6 such a consultation under the State plan under title 

7 XIX).’’. 

8 (B) CONFORMING AMENDMENT.—Section 

9 2102(a)(7)(B) of such Act (42 U.S.C. 

10 1397bb(a)(7)(B)) is amended by striking ‘‘sec11 tion 2103(c)(5)’’ and inserting ‘‘paragraphs (5) 

12 and (9) of section 2103(c)’’. 

13 (d) DEFINITION OF ADVANCE DIRECTIVE UNDER

14 MEDICARE, MEDICAID, AND CHIP.— 

15 (1) MEDICARE.—Section 1866(f)(3) of the So16 cial Security Act (42 U.S.C. 1395cc(f)(3)) is amend17 ed by striking ‘‘means’’ and all that follows through 

18 the period and inserting ‘‘means a living will, med19 ical directive, health care power of attorney, durable 

20 power of attorney, or other written statement by a 

21 competent individual that is recognized under State 

22 law and indicates the individual’s wishes regarding 

23 medical treatment in the event of future incom24 petence. Such term includes an advance health care 


tkelley on DSK3SPTVN1PROD with BILLS
63 

•S 3009 IS

1 directive and a health care directive recognized 

2 under State law.’’. 

3 (2) MEDICAID AND CHIP.—Section 1902(w)(4) 

4 of such Act (42 U.S.C. 1396a(w)(4)) is amended by 

5 striking ‘‘means’’ and all that follows through the 

6 period and inserting ‘‘means a living will, medical di7 rective, health care power of attorney, durable power 

8 of attorney, or other written statement by a com9 petent individual that is recognized under State law 

10 and indicates the individual’s wishes regarding med11 ical treatment in the event of future incompetence. 

12 Such term includes an advance health care directive 

13 and a health care directive recognized under State 

14 law.’’. 

15 (e) EFFECTIVE DATE.—The amendments made by 

16 this section take effect January 1, 2015. 

17 PART II—HOSPICE 

18 SEC. 221. ADOPTION OF MEDPAC HOSPICE PAYMENT METH19 ODOLOGY RECOMMENDATIONS. 

20 Section 1814(i) of the Social Security Act (42 U.S.C. 

21 1395f(i)) is amended by adding at the end the following 

22 new paragraph: 

23 ‘‘(8)(A) The Secretary shall conduct an evalua24 tion of the recommendations of the Medicare Pay25 ment Commission for reforming the hospice care 


tkelley on DSK3SPTVN1PROD with BILLS
64 

•S 3009 IS

1 benefit under this title that are contained in chapter 

2 6 of the Commission’s report entitled ‘Report to 

3 Congress: Medicare Payment Policy (March 2009)’, 

4 including the impact that such recommendations if 

5 implemented would have on access to care and the 

6 quality of care. In conducting such evaluation, the 

7 Secretary shall take into account data collected in 

8 accordance with section 263(b) of the Advance Plan9 ning and Compassionate Care Act of 2014. 

10 ‘‘(B) Based on the results of the examination 

11 conducted under subparagraph (A), the Secretary 

12 shall make appropriate refinements to the rec13 ommendations described in subparagraph (A). Such 

14 refinements shall take into account— 

15 ‘‘(i) the impact on patient populations with 

16 longer that average lengths of stay; 

17 ‘‘(ii) the impact on populations with short18 er that average lengths of stay; and 

19 ‘‘(iii) the utilization patterns of hospice 

20 providers in underserved areas, including rural 

21 hospices. 

22 ‘‘(C) Not later than January 1, 2018, the Sec23 retary shall submit to Congress a report that con24 tains a detailed description of— 


tkelley on DSK3SPTVN1PROD with BILLS
65 

•S 3009 IS

1 ‘‘(i) the refinements determined appro2 priate by the Secretary under subparagraph 

3 (B); 

4 ‘‘(ii) the revisions that the Secretary will 

5 implement through regulation under this title 

6 pursuant to subparagraph (D); and 

7 ‘‘(iii) the revisions that the Secretary de8 termines require additional legislative action by 

9 Congress. 

10 ‘‘(D)(i) The Secretary shall implement the rec11 ommendations described in subparagraph (A), as re12 fined under subparagraph (B). 

13 ‘‘(ii) Subject to clause (iii), the implementation 

14 of such recommendations shall apply to hospice care 

15 furnished on or after January 1, 2019. 

16 ‘‘(iii) The Secretary shall establish an appro17 priate transition to the implementation of such rec18 ommendations. 

19 ‘‘(E) For purposes of carrying out the provi20 sions of this paragraph, the Secretary shall provide 

21 for the transfer, from the Federal Hospital Insur22 ance Trust Fund under section 1817, of such sums 

23 as may be necessary to the Centers for Medicare & 

24 Medicaid Services Program Management Account.’’. 


tkelley on DSK3SPTVN1PROD with BILLS
66 

•S 3009 IS

1 SEC. 222. REMOVING HOSPICE INPATIENT DAYS IN SET2 TING PER DIEM RATES FOR CRITICAL AC3 CESS HOSPITALS. 

4 Section 1814(l) of the Social Security Act (42 U.S.C. 

5 1395f(l)), as amended by section 4102(b)(2) of the 

6 HITECH Act (Public Law 111–5), is amended by adding 

7 at the end the following new paragraph: 

8 ‘‘(6) For cost reporting periods beginning on or 

9 after January 1, 2016, the Secretary shall remove 

10 Medicare-certified hospice inpatient days from the 

11 calculation of per diem rates for inpatient critical ac12 cess hospital services.’’. 

13 SEC. 223. HOSPICE PAYMENTS FOR DUAL ELIGIBLE INDI14 VIDUALS RESIDING IN LONG-TERM CARE FA15 CILITIES. 

16 (a) IN GENERAL.—Section 1888 of the Social Secu17 rity Act (42 U.S.C. 1395yy) is amended by adding at the 

18 end the following new subsection: 

19 ‘‘(i) PAYMENTS FOR DUAL ELIGIBLE INDIVIDUALS

20 RESIDING IN LONG-TERM CARE FACILITIES.—For cost 

21 reporting periods beginning on or after January 1, 2016, 

22 the Secretary, acting through the Administrator of the 

23 Centers for Medicare & Medicaid Services, shall establish 

24 procedures under which payments for room and board 

25 under the State Medicaid plan with respect to an applica26 ble individual are made directly to the long-term care facilVerDate Sep 11 2014 19:41 Dec 16, 2014 Jkt 049200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\S3009.IS S3009

tkelley on DSK3SPTVN1PROD with BILLS
67 

•S 3009 IS

1 ity (as defined by the Secretary for purposes of title XIX) 

2 the individual is a resident of. For purposes of the pre3 ceding sentence, the term ‘applicable individual’ means an 

4 individual who is entitled to or enrolled for benefits under 

5 part A or enrolled for benefits under part B and is eligible 

6 for medical assistance for hospice care under a State plan 

7 under title XIX.’’. 

8 (b) STATE PLAN REQUIREMENT.— 

9 (1) IN GENERAL.—Section 1902(a) of the So10 cial Security Act (42 U.S.C. 1396a(a)) is amend11 ed— 

12 (A) in paragraph (74), by striking ‘‘and’’ 

13 at the end; 

14 (B) in paragraph (80), by striking ‘‘and’’ 

15 at the end; 

16 (C) in paragraph (81), by striking the pe17 riod at the end and inserting ‘‘; and’’; and 

18 (D) by inserting after paragraph (81) the 

19 following new paragraph: 

20 ‘‘(82) provide that the State will make pay21 ments for room and board with respect to applicable 

22 individuals in accordance with section 1888(i).’’. 

23 (2) EFFECTIVE DATE.— 


tkelley on DSK3SPTVN1PROD with BILLS
68 

•S 3009 IS

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

2 subparagraph (B), the amendments made by 

3 paragraph (1) take effect on January 1, 2016. 

4 (B) EXTENSION OF EFFECTIVE DATE FOR

5 STATE LAW AMENDMENT.—In the case of a 

6 State plan under title XIX of the Social Secu7 rity Act (42 U.S.C. 1396 et seq.) which the 

8 Secretary determines requires State legislation 

9 in order for the plan to meet the additional re10 quirements imposed by the amendments made 

11 by paragraph (1), the State plan shall not be 

12 regarded as failing to comply with the require13 ments of such title solely on the basis of its fail14 ure to meet these additional requirements be15 fore the first day of the first calendar quarter 

16 beginning after the close of the first regular 

17 session of the State legislature that begins after 

18 the date of enactment of this Act. For purposes 

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

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

21 of the session is considered to be a separate 

22 regular session of the State legislature. 


tkelley on DSK3SPTVN1PROD with BILLS
69 

•S 3009 IS

1 SEC. 224. DELINEATION OF RESPECTIVE CARE RESPON2 SIBILITIES OF HOSPICE PROGRAMS AND 

3 LONG-TERM CARE FACILITIES. 

4 Section 1888 of the Social Security Act (42 U.S.C. 

5 1395yy), as amended by section 223(a), is amended by 

6 adding at the end the following new subsection: 

7 ‘‘(j) DELINEATION OF RESPECTIVE CARE RESPON8 SIBILITIES OF HOSPICE PROGRAMS AND LONG-TERM

9 CARE FACILITIES.—Not later than July 1, 2016, the Sec10 retary, acting through the Administrator of the Centers 

11 for Medicare & Medicaid Services, shall delineate and en12 force the respective care responsibilities of hospice pro13 grams and long-term care facilities (as defined by the Sec14 retary for purposes of title XIX) with respect to individ15 uals residing in such facilities who are furnished hospice 

16 care.’’. 

17 SEC. 225. ADOPTION OF MEDPAC HOSPICE PROGRAM ELI18 GIBILITY CERTIFICATION AND RECERTIFI19 CATION RECOMMENDATIONS. 

20 In accordance with the recommendations of the Medi21 care Payment Advisory Commission contained in the 

22 March 2009 report entitled ‘‘Report to Congress: Medi23 care Payment Policy’’, section 1814(a)(7) of the Social Se24 curity Act (42 U.S.C. 1395f(a)(7)) is amended— 

25 (1) in subparagraph (C), by striking ‘‘and’’ at 

26 the end; and 


tkelley on DSK3SPTVN1PROD with BILLS
70 

•S 3009 IS

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

3 ‘‘(E) on or after January 1, 2016— 

4 ‘‘(i) a hospice physician or advance 

5 practice nurse visits the individual to de6 termine continued eligibility of the indi7 vidual for hospice care prior to the 180th8 day recertification and each subsequent re9 certification under subparagraph (A)(ii) 

10 and attests that such visit took place (in 

11 accordance with procedures established by 

12 the Secretary, in consultation with the Ad13 ministrator of the Centers for Medicare & 

14 Medicaid Services); and 

15 ‘‘(ii) any certification or recertification 

16 under subparagraph (A) includes a brief 

17 narrative describing the clinical basis for 

18 the individual’s prognosis (in accordance 

19 with procedures established by the Sec20 retary, in consultation with the Adminis21 trator of the Centers for Medicare & Med22 icaid Services); and’’. 


tkelley on DSK3SPTVN1PROD with BILLS
71 

•S 3009 IS

1 SEC. 226. CONCURRENT CARE FOR CHILDREN. 

2 (a) PERMITTING MEDICARE HOSPICE BENE3 FICIARIES 18 YEARS OF AGE OR YOUNGER TO RECEIVE

4 CURATIVE CARE.— 

5 (1) IN GENERAL.—Section 1812 of the Social 

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

7 (A) in subsection (a)(4), by inserting 

8 ‘‘(subject to the second sentence of subsection 

9 (d)(2)(A))’’ after ‘‘in lieu of certain other bene10 fits’’; and 

11 (B) in subsection (d)— 

12 (i) in paragraph (1), by inserting ‘‘ , 

13 subject to the second sentence of para14 graph (2)(A),’’ after ‘‘instead’’; and 

15 (ii) in paragraph (2)(A), by adding at 

16 the end the following new sentence: 

17 ‘‘Clause (ii)(I) shall not apply to an indi18 vidual who is 18 years of age or younger.’’ 

19 (2) CONFORMING AMENDMENT.—Section 

20 1862(a)(1)(C) of the Social Security Act (42 U.S.C. 

21 1395y(a)(1)(C)) is amended inserting ‘‘subject to 

22 the second sentence of section 1812(d)(2)(A),’’ after 

23 ‘‘hospice care,’’. 

24 (b) APPLICATION TO MEDICAID AND CHIP.— 

25 (1) MEDICAID.—Section 1905(o)(1)(A) of the 

26 Social Security Act (42 U.S.C. 1395d(o)(1)(A)) is 


tkelley on DSK3SPTVN1PROD with BILLS
72 

•S 3009 IS

1 amended by inserting ‘‘(subject, in the case of an in2 dividual who is a child, to the second sentence of 

3 such section)’’ after ‘‘section 1812(d)(2)(A)’’. 

4 (2) CHIP.—Section 2110(a)(23) of the Social 

5 Security Act (42 U.S.C. 1397jj(a)(23)) is amended 

6 by striking ‘‘(concurrent’’ and all that follows 

7 through the period and inserting ‘‘(concurrent, in 

8 the case of an individual who is a child, with care 

9 related to the treatment of the individual’s condition 

10 with respect to which a diagnosis of terminal illness 

11 has been made).’’. 

12 (c) EFFECTIVE DATE.—The amendments made by 

13 this section shall apply to items and services furnished on 

14 or after January 1, 2016. 

15 SEC. 227. MAKING HOSPICE A REQUIRED BENEFIT UNDER 

16 MEDICAID AND CHIP. 

17 (a) MANDATORY BENEFIT.— 

18 (1) MEDICAID.— 

19 (A) IN GENERAL.—Section 1902(a)(10)(A) 

20 of the Social Security Act (42 U.S.C. 

21 1396a(a)(10)(A)), as amended by section 

22 211(b)(1), is amended in the matter preceding 

23 clause (i) by inserting ‘‘(18),’’ after ‘‘(17),’’. 


tkelley on DSK3SPTVN1PROD with BILLS
73 

•S 3009 IS

1 (B) CONFORMING AMENDMENT.—Section 

2 1902(a)(10)(C) of such Act (42 U.S.C. 

3 1396a(a)(10)(C)) is amended— 

4 (i) in clause (iii)— 

5 (I) in subclause (I), by inserting 

6 ‘‘and hospice care’’ after ‘‘ambulatory 

7 services’’; and 

8 (II) in subclause (II), by insert9 ing ‘‘and hospice care’’ after ‘‘delivery 

10 services’’; and 

11 (ii) in clause (iv), by inserting ‘‘and 

12 (18)’’ after ‘‘(17)’’. 

13 (2) CHIP.—Section 2103(c)(9) of such Act (42 

14 U.S.C. 1397cc(c)(9)), as added by section 

15 211(c)(2)(A), is amended by inserting ‘‘and hospice 

16 care’’ before the period. 

17 (b) EFFECTIVE DATE.—The amendments made sub18 section (a) take effect on January 1, 2016. 

19 SEC. 228. MEDICARE HOSPICE PAYMENT MODEL DEM20 ONSTRATION PROJECTS. 

21 (a) ESTABLISHMENT.—Not later than July 1, 2017, 

22 the Secretary, acting through the Administrator of the 

23 Centers for Medicare & Medicaid Services and the Direc24 tor of the Agency for Healthcare Research and Quality, 

25 shall conduct demonstration projects to examine ways to 


tkelley on DSK3SPTVN1PROD with BILLS
74 

•S 3009 IS

1 improve how the Medicare hospice care benefit predicts 

2 disease trajectory. Projects shall include the following 

3 models: 

4 (1) Models that better and more appropriately 

5 care for, and transition as needed, patients in their 

6 last years of life who need palliative care, but do not 

7 qualify for hospice care under the Medicare hospice 

8 eligibility criteria. 

9 (2) Models that better and more appropriately 

10 care for long-term patients who are not recertified in 

11 hospice but still need palliative care. 

12 (3) Any other models determined appropriate 

13 by the Secretary. 

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 demonstration projects under this 

18 section. 

19 (c) REPORTS.—The Secretary shall submit to Con20 gress periodic reports on the demonstration projects con21 ducted under this section. 

22 SEC. 229. MEDPAC STUDIES AND REPORTS. 

23 (a) STUDY AND REPORT REGARDING AN ALTER24 NATIVE PAYMENT METHODOLOGY FOR HOSPICE CARE

25 UNDER THE MEDICARE PROGRAM.— 


tkelley on DSK3SPTVN1PROD with BILLS
75 

•S 3009 IS

1 (1) STUDY.—The Medicare Payment Advisory 

2 Commission (in this section referred to as the ‘‘Com3 mission’’) shall conduct a study on the establishment 

4 of a reimbursement system for hospice care fur5 nished under the Medicare program that is based on 

6 diagnoses. In conducting such study, the Commis7 sion shall use data collected under new provider data 

8 requirements. Such study shall include an analysis 

9 of the following: 

10 (A) Whether such a reimbursement system 

11 better meets patient needs and better cor12 responds with provider resource expenditures 

13 than the current system. 

14 (B) Whether such a reimbursement system 

15 improves quality, including facilitating stand16 ardization of care toward best practices and di17 agnoses-specific clinical pathways in hospice. 

18 (C) Whether such a reimbursement system 

19 could address concerns about the blanket 6- 

20 month terminal prognosis requirement in hos21 pice. 

22 (D) Whether such a reimbursement system 

23 is more cost effective than the current system. 

24 (E) Any other areas determined appro25 priate by the Commission. 


tkelley on DSK3SPTVN1PROD with BILLS
76 

•S 3009 IS

1 (2) REPORT.—Not later than June 15, 2018, 

2 the Commission shall submit to Congress a report 

3 on the study conducted under subsection (a) to4 gether with recommendations for such legislation 

5 and administrative action as the Commission deter6 mines appropriate. 

7 (b) STUDY AND REPORT REGARDING RURAL HOS8 PICE TRANSPORTATION COSTS UNDER THE MEDICARE

9 PROGRAM.— 

10 (1) STUDY.—The Commission shall conduct a 

11 study on rural Medicare hospice transportation mile12 age to determine potential Medicare reimbursement 

13 changes to account for potential higher costs. 

14 (2) REPORT.—Not later than June 15, 2018, 

15 the Commission shall submit to Congress a report 

16 on the study conducted under subsection (a) to17 gether with recommendations for such legislation 

18 and administrative action as the Commission deter19 mines appropriate. 

20 (c) EVALUATION OF REIMBURSEMENT DISINCEN21 TIVES TO ELECT MEDICARE HOSPICE WITHIN THE

22 MEDICARE SKILLED NURSING FACILITY BENEFIT.— 

23 (1) STUDY.—The Commission shall conduct a 

24 study to determine potential Medicare reimburse25 ment changes to remove Medicare reimbursement 


tkelley on DSK3SPTVN1PROD with BILLS
77 

•S 3009 IS

1 disincentives for patients in a skilled nursing facility 

2 who want to elect hospice. 

3 (2) REPORT.—Not later than June 15, 2018, 

4 the Commission shall submit to Congress a report 

5 on the study conducted under subsection (a) to6 gether with recommendations for such legislation 

7 and administrative action as the Commission deter8 mines appropriate. 

9 SEC. 230. HHS EVALUATIONS. 

10 (a) EVALUATION OF ACCESS TO HOSPICE AND HOS11 PITAL-BASED PALLIATIVE CARE.— 

12 (1) EVALUATION.—The Secretary, acting 

13 through the Administrator of the Health Resources 

14 and Services Administration, shall conduct an eval15 uation of geographic areas and populations under16 served by hospice and hospital-based palliative care 

17 to identify potential barriers to access. 

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

19 2017, the Secretary shall report to Congress, on the 

20 evaluation conducted under subsection (a) together 

21 with recommendations for such legislation and ad22 ministrative action as the Secretary determines ap23 propriate to address barriers to access to hospice 

24 and hospital-based palliative care. 


tkelley on DSK3SPTVN1PROD with BILLS
78 

•S 3009 IS

1 (b) EVALUATION OF AWARENESS AND USE OF HOS2 PICE RESPITE CARE UNDER MEDICARE, MEDICAID, AND

3 CHIP.— 

4 (1) EVALUATION.—The Secretary, acting 

5 through the Director of the Centers for Medicare 

6 and Medicaid Services, shall evaluate the awareness 

7 and use of hospice respite care by informal care8 givers of beneficiaries under Medicare, Medicaid, 

9 and CHIP. 

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

11 2015, the Secretary shall report to Congress, on the 

12 evaluation conducted under subsection (a) together 

13 with recommendations for such legislation and ad14 ministrative action as the Secretary determines ap15 propriate to increase awareness or use of hospice 

16 respite care under Medicare, Medicaid, and CHIP. 

17 Subtitle C—Quality Improvement 

18 SEC. 241. PATIENT SATISFACTION SURVEYS. 

19 Not later than January 1, 2017, the Secretary, acting 

20 through the Administrator of the Centers for Medicare & 

21 Medicaid Services, shall establish a mechanism for— 

22 (1) collecting information from patients (or 

23 their health care proxies or families members in the 

24 event patients are unable to speak for themselves) in 


tkelley on DSK3SPTVN1PROD with BILLS
79 

•S 3009 IS

1 relevant provider settings regarding their care at the 

2 end of life; and 

3 (2) incorporating such information in a timely 

4 manner into mechanisms used by the Administrator 

5 to provide quality of care information to consumers, 

6 including the Hospital Compare and Nursing Home 

7 Compare websites maintained by the Administrator. 

8 SEC. 242. DEVELOPMENT OF CORE END-OF-LIFE CARE 

9 QUALITY MEASURES ACROSS EACH REL10 EVANT PROVIDER SETTING. 

11 (a) IN GENERAL.—The Secretary, acting through the 

12 Administrator of the Agency for Healthcare Research and 

13 Quality (in this section referred to as the ‘‘Adminis14 trator’’) and in consultation with the Director of the Na15 tional Institutes of Health, shall require specific end-of16 life quality measures for each relevant provider setting, 

17 as identified by the Administrator, in accordance with the 

18 requirements of subsection (b). 

19 (b) REQUIREMENTS.—For purposes of subsection 

20 (a), the requirements specified in this subsection are the 

21 following: 

22 (1) Selection of the specific measure or meas23 ures for an identified provider setting shall be— 


tkelley on DSK3SPTVN1PROD with BILLS
80 

•S 3009 IS

1 (A) based on an assessment of what is 

2 likely to have the greatest positive impact on 

3 quality of end-of-life care in that setting; and 

4 (B) made in consultation with affected pro5 viders and public and private organizations, 

6 that have developed such measures. 

7 (2) The measures may be structure-oriented, 

8 process-oriented, or outcome-oriented, as determined 

9 appropriate by the Administrator. 

10 (3) The Administrator shall ensure that report11 ing requirements related to such measures are im12 posed consistent with other applicable laws and reg13 ulations, and in a manner that takes into account 

14 existing measures, the needs of patient populations, 

15 and the specific services provided. 

16 (4) Not later than— 

17 (A) April 1, 2016, the Secretary shall dis18 seminate the reporting requirements to all af19 fected providers; and 

20 (B) April 1, 2017, initial reporting relating 

21 to the measures shall begin. 

22 SEC. 243. ACCREDITATION OF HOSPITAL-BASED PALLIA23 TIVE CARE PROGRAMS. 

24 (a) IN GENERAL.—The Secretary, acting through the 

25 Director of the Agency for Healthcare Research and QualVerDate Sep 11 2014 19:41 Dec 16, 2014 Jkt 049200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\S3009.IS S3009

tkelley on DSK3SPTVN1PROD with BILLS
81 

•S 3009 IS

1 ity, shall designate a public or private agency, entity, or 

2 organization to develop requirements, standards, and pro3 cedures for accreditation of hospital-based palliative care 

4 programs. 

5 (b) REPORTING.—Not later than January 1, 2017, 

6 the Secretary shall prepare and submit a report to Con7 gress on the proposed accreditation process for hospital8 based palliative care programs. 

9 (c) ACCREDITATION.—Not later than July 1, 2017, 

10 the Secretary shall— 

11 (1) establish and promulgate standards and 

12 procedures for accreditation of hospital-based pallia13 tive care programs; and 

14 (2) designate an agency, entity, or organization 

15 that shall be responsible for certifying such pro16 grams in accordance with the standards established 

17 under paragraph (1). 

18 (d) DEFINITIONS.—For the purposes of this section: 

19 (1) The term ‘‘hospital-based palliative care 

20 program’’ means a hospital-based program that is 

21 comprised of an interdisciplinary team that special22 izes in providing palliative care services and con23 sultations in a variety of health care settings, includ24 ing hospitals, nursing homes, and home and commu25 nity-based services. 


tkelley on DSK3SPTVN1PROD with BILLS
82 

•S 3009 IS

1 (2) The term ‘‘interdisciplinary team’’ means a 

2 group of health care professionals (consisting of, at 

3 a minimum, a doctor, a nurse, and a social worker) 

4 that have received specialized training in palliative 

5 care. 

6 SEC. 244. SURVEY AND DATA REQUIREMENTS FOR ALL 

7 MEDICARE PARTICIPATING HOSPICE PRO8 GRAMS. 

9 (a) HOSPICE SURVEYS.—Section 1861(dd) of the So10 cial Security Act (42 U.S.C. 1395x(dd)) is amended by 

11 adding at the end the following new paragraph: 

12 ‘‘(6) In accordance with the recommendations of the 

13 Medicare Payment Advisory Commission contained in the 

14 March 2009 report entitled ‘Report to Congress: Medicare 

15 Payment Policy’, the Secretary shall establish, effective 

16 July 1, 2015, the following survey requirements for hos17 pice programs: 

18 ‘‘(A) Any hospice program seeking initial cer19 tification under this title on or after that date shall 

20 be subject to an initial survey by an appropriate 

21 State or local agency, or an approved accreditation 

22 agency, not later than 6 months after the program 

23 first seeks such certification. 

24 ‘‘(B) All hospice programs certified for partici25 pation under this title shall be subject to a standard 


tkelley on DSK3SPTVN1PROD with BILLS
83 

•S 3009 IS

1 survey by an appropriate State or local agency, or 

2 an approved accreditation agency, at least every 3 

3 years after initially being so certified.’’. 

4 (b) REQUIRED HOSPICE RESOURCE INPUTS DATA.— 

5 Section 1861(dd) of the Social Security Act (42 U.S.C. 

6 1395x(dd)), as amended by subsection (a), is amended— 

7 (1) in paragraph (2)— 

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

9 ‘‘and’’ at the end; 

10 (B) by redesignating subparagraph (G) as 

11 subparagraph (H); and 

12 (C) by inserting after subparagraph (F) 

13 the following new subparagraph: 

14 ‘‘(G) complies with the reporting requirements 

15 under paragraph (7); and’’; and 

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

17 paragraph: 

18 ‘‘(7)(A) In accordance with the recommenda19 tions of the Medicare Payment Advisory Commission 

20 for additional data (as contained in the March 2009 

21 report entitled ‘Report to Congress: Medicare Pay22 ment Policy’), beginning January 1, 2016, a hospice 

23 program shall report to the Secretary, in such form 

24 and manner, and at such intervals, as the Secretary 


tkelley on DSK3SPTVN1PROD with BILLS
84 

•S 3009 IS

1 shall require, the following data with respect to each 

2 patient visit: 

3 ‘‘(i) Visit type (such as admission, routine, 

4 emergency, education for family, other). 

5 ‘‘(ii) Visit length. 

6 ‘‘(iii) Professional or paraprofessional dis7 ciplines involved in the visit, including nurse, 

8 social worker, home health aide, physician, 

9 nurse practitioner, chaplain or spiritual coun10 selor, counselor, dietician, physical therapist, 

11 occupational therapist, speech language patholo12 gist, music or art therapist, and including be13 reavement and support services provided to a 

14 family after a patient’s death. 

15 ‘‘(iv) Drugs and other therapeutic inter16 ventions provided. 

17 ‘‘(v) Home medical equipment and other 

18 medical supplies provided. 

19 ‘‘(B) In collecting the data required under sub20 paragraph (A), the Secretary shall ensure that the 

21 data are reported in a manner that allows for sum22 marized cross-tabulations of the data by patients’ 

23 terminal diagnoses, lengths of stay, age, sex, and 

24 race.’’. 


tkelley on DSK3SPTVN1PROD with BILLS
85 

•S 3009 IS

1 Subtitle D—Additional Reports, 

2 Research, and Evaluations 

3 SEC. 251. NATIONAL CENTER ON PALLIATIVE AND END-OF4 LIFE CARE. 

5 Part E of title IV of the Public Health Service Act 

6 (42 U.S.C. 287 et seq.) is amended by adding at the end 

7 the following: 

8 ‘‘Subpart 7—National Center on Palliative and End9 of-Life Care 

10 ‘‘SEC. 485J. NATIONAL CENTER ON PALLIATIVE AND END11 OF-LIFE CARE. 

12 ‘‘(a) ESTABLISHMENT.—Not later than July 1, 2016, 

13 there shall be established within the National Institutes 

14 of Health, a National Center on Palliative and End-of15 Life Care (referred to in this section as the ‘Center’). 

16 ‘‘(b) PURPOSE.—The general purpose of the Center 

17 is to conduct and support research relating to palliative 

18 and end-of-life care interventions and approaches. 

19 ‘‘(c) ACTIVITIES.—The Center shall— 

20 ‘‘(1) develop and continuously update a re21 search agenda with the goal of— 

22 ‘‘(A) providing a better biomedical under23 standing of the end of life; and 

24 ‘‘(B) improving the quality of care and life 

25 at the end of life; and 


tkelley on DSK3SPTVN1PROD with BILLS
86 

•S 3009 IS

1 ‘‘(2) provide funding for peer-review-selected 

2 extra- and intra-mural research that includes the 

3 evaluation of existing, and the development of new, 

4 palliative and end-of-life care interventions and ap5 proaches.’’. 

6 SEC. 252. NATIONAL MORTALITY FOLLOWBACK SURVEY. 

7 (a) IN GENERAL.—Not later than December 31, 

8 2015, and annually thereafter, the Secretary, acting 

9 through the Director of the Centers for Disease Control 

10 and Prevention, shall renew and conduct the National 

11 Mortality Followback Survey (referred to in this section 

12 as the ‘‘Survey’’) to collect data on end-of-life care. 

13 (b) PURPOSE.—The purpose of the Survey shall be 

14 to gain a better understanding of current end-of-life care 

15 in the United States. 

16 (c) QUESTIONS.— 

17 (1) IN GENERAL.—In conducting the Survey, 

18 the Director of the Centers for Disease Control and 

19 Prevention shall, at a minimum, include the fol20 lowing questions with respect to the loved one of a 

21 respondent: 

22 (A) Did he or she have an advance direc23 tive, and if so, when it was completed. 


tkelley on DSK3SPTVN1PROD with BILLS
87 

•S 3009 IS

1 (B) Did he or she have an order for life2 sustaining treatment, and if so, when was it 

3 completed. 

4 (C) Did he or she have a durable power of 

5 attorney, and if so, when it was completed. 

6 (D) Had he or she discussed his or her 

7 wishes with loved ones, and if so, when. 

8 (E) Had he or she discussed his or her 

9 wishes with his or her physician, and if so, 

10 when. 

11 (F) In the opinion of the respondent, was 

12 he or she satisfied with the care he or she re13 ceived in the last year of life and in the last 

14 week of life. 

15 (G) Was he or she cared for by hospice, 

16 and if so, when. 

17 (H) Was he or she cared for by palliative 

18 care specialists, and if so, when. 

19 (I) Did he or she receive effective pain 

20 management (if needed). 

21 (J) What was the experience of the main 

22 caregiver (including if such caregiver was the 

23 respondent), and whether he or she received 

24 sufficient support in this role. 


tkelley on DSK3SPTVN1PROD with BILLS
88 

•S 3009 IS

1 (2) ADDITIONAL QUESTIONS.—Additional ques2 tions to be asked during the Survey shall be deter3 mined by the Director of the Centers for Disease 

4 Control and Prevention on an ongoing basis with 

5 input from relevant research entities. 

6 SEC. 253. DEMONSTRATION PROJECTS FOR USE OF TELE7 MEDICINE SERVICES IN ADVANCE CARE 

8 PLANNING. 

9 (a) IN GENERAL.—Not later than July 1, 2018, the 

10 Secretary shall establish a demonstration program to re11 imburse eligible entities for costs associated with the use 

12 of telemedicine services (including equipment and connec13 tion costs) to provide advance care planning consultations 

14 with geographically distant physicians and their patients. 

15 (b) DURATION.—The demonstration project under 

16 this section shall be conducted for at least a 3-year period. 

17 (c) DEFINITIONS.—For purposes of this section: 

18 (1) The term ‘‘eligible entity’’ means a physi19 cian or an advance practice nurse who provides serv20 ices pursuant to a hospital-based palliative care pro21 gram (as defined in section 262(d)(1)). 

22 (2) The term ‘‘geographically distant’’ has the 

23 meaning given that term by the Secretary for pur24 poses of conducting the demonstration program es25 tablished under this section. 


tkelley on DSK3SPTVN1PROD with BILLS
89 

•S 3009 IS

1 (3) The term ‘‘telemedicine services’’ means a 

2 service or consultation provided via telecommuni3 cation equipment that allows an eligible entity to ex4 change or discuss medical information with a patient 

5 or a health care professional at a separate location 

6 through real-time videoconferencing, or a similar for7 mat, for the purpose of providing health care diag8 nosis and treatment. 

9 (d) FUNDING.—There are authorized to be appro10 priated to the Secretary such sums as may be necessary 

11 to carry out this section. 

12 SEC. 254. INSPECTOR GENERAL INVESTIGATION OF FRAUD 

13 AND ABUSE. 

14 In accordance with the recommendations of the Medi15 care Payment Advisory Commission for additional data 

16 (as contained in the March 2009 report entitled ‘‘Report 

17 to Congress: Medicare Payment Policy’’), the Secretary 

18 shall direct the Office of the Inspector General of the De19 partment of Health and Human Services to investigate, 

20 not later than January 1, 2017, the following with respect 

21 to hospice benefit under Medicare, Medicaid, and CHIP: 

22 (1) The prevalence of financial relationships be23 tween hospices and long-term care facilities, such as 

24 nursing facilities and assisted living facilities, that 


tkelley on DSK3SPTVN1PROD with BILLS
90 

•S 3009 IS

1 may represent a conflict of interest and influence ad2 missions to hospice. 

3 (2) Differences in patterns of nursing home re4 ferrals to hospice. 

5 (3) The appropriateness of enrollment practices 

6 for hospices with unusual utilization patterns (such 

7 as high frequency of very long stays, very short 

8 stays, or enrollment of patients discharged from 

9 other hospices). 

10 (4) The appropriateness of hospice marketing 

11 materials and other admissions practices and poten12 tial correlations between length of stay and defi13 ciencies in marketing or admissions practices. 

14 SEC. 255. GAO STUDY AND REPORT ON PROVIDER ADHER15 ENCE TO ADVANCE DIRECTIVES. 

16 Not later than January 1, 2017, the Comptroller 

17 General of the United States shall conduct a study of the 

18 extent to which providers comply with advance directives 

19 under the Medicare and Medicaid programs and shall sub20 mit a report to Congress on the results of such study, to21 gether with such recommendations for administrative or 

22 legislative changes as the Comptroller General determines 

23 appropriate. 

Æ 


tkelley on DSK3SPTVN1PROD with BILLS