I 
111TH CONGRESS 
1ST SESSION H. R. 2911 
To improve end-of-life care. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 17, 2009 
Mr. BLUMENAUER
(for himself, Ms. BALDWIN, Mr. LEVIN, and Mr. 
PASCRELL) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means and the Judiciary, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To improve end-of-life care. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Advance Planning and Compassionate Care Act of 
2009’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Definitions. 
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TITLE I—ADVANCE CARE PLANNING 
Subtitle A—Consumer and Provider Education 
PART I—CONSUMER EDUCATION 
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 direc-
tives. 
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 recommenda-
tions. 
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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. 
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 re-
certification 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 rel-
evant 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. 
SEC. 2. DEFINITIONS. 
In this Act: 
(1) ADVANCE CARE PLANNING.—The term ‘‘ad-
vance care planning’’ means the process of— 
(A) determining an individual’s priorities, 
values and goals for care in the future when the 
individual is no longer able to express his or her 
wishes; 
(B) engaging family members, health care 
proxies, and health care providers in an ongoing 
dialogue about— 
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(i) the individual’s wishes for care; 
(ii) what the future may hold for peo-
ple with serious illnesses or injuries; 
(iii) how individuals, their health care 
proxies, and family members want their be-
liefs and preferences to guide care deci-
sions; and 
(iv) the steps that individuals and 
family members can take regarding, and 
the resources available to help with, fi-
nances, family matters, spiritual questions, 
and other issues that impact seriously ill or 
dying patients and their families; and 
(C) executing and updating advance direc-
tives and appointing a health care proxy. 
(2) ADVANCE DIRECTIVE.—The term ‘‘advance 
directive’’ means a living will, medical directive, 
health care power of attorney, durable power of at-
torney, or other written statement by a competent 
individual that is recognized under State law and in-
dicates the individual’s wishes regarding medical 
treatment in the event of future incompetence. Such 
term includes an advance health care directive and 
a health care directive recognized under State law. 
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(3) CHIP.—The term ‘‘CHIP’’ means the pro-
gram established under title XXI of the Social Secu-
rity Act (42 U.S.C. 1397aa et seq.). 
(4) END-OF-LIFE-CARE.—The term ‘‘end-of-life 
care’’ means all aspects of care of a patient with a 
potentially fatal condition, and includes care that is 
focused on specific preparations for an impending 
death. 
(5) HEALTH CARE POWER OF ATTORNEY.—The 
term ‘‘health care power of attorney’’ means a legal 
document that identifies a health care proxy or deci-
sion maker for a patient who has the authority to 
act on the patient’s behalf when the patient is un-
able to communicate his or her wishes for medical 
care on matters that the patient specifies when he 
or she is competent. Such term includes a durable 
power of attorney that relates to medical care. 
(6) LIVING
WILL.—The term ‘‘living will’’ 
means a legal document— 
(A) used to specify the type of medical 
care (including any type of medical treatment, 
including life-sustaining procedures if that per-
son becomes permanently unconscious or is oth-
erwise dying) that an individual wants provided 
or withheld in the event the individual cannot 
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