with best practice guidelines provided by the Sec-
retary. 
SEC. 102. NATIONAL PUBLIC EDUCATION CAMPAIGN. 
(a) NATIONAL PUBLIC EDUCATION CAMPAIGN.— 
(1) IN GENERAL.—Not later than January 1, 
2024, the Secretary, acting through the Director of 
the Centers for Disease Control and Prevention and 
in consultation with public and private entities, 
shall, directly or through grants, contracts, or inter-
agency agreements, develop and implement a na-
tional campaign to inform the public of the impor-
tance of advance care planning and of an individ-
ual’s right to direct and participate in health care 
decisions affecting such individual. 
(2) CONTENT OF EDUCATIONAL CAMPAIGN.— 
The national public education campaign established 
under paragraph (1) shall— 
(A) employ the use of various media, in-
cluding social media platforms and televised 
public service announcements; 
(B) provide culturally and linguistically ap-
propriate information; 
(C) be conducted continuously over a pe-
riod of not less than 5 years; 
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(D) identify and promote the advance care 
planning information available on the Internet 
Websites of the Department of Health and 
Human Service’s National Clearinghouse for 
Long-Term Care Information, the Administra-
tion for Children and Families, the Administra-
tion for Community Living, and the Centers for 
Medicare & Medicaid Services; 
(E) address the importance of individuals 
speaking to family members, health care prox-
ies, and qualified health care providers as part 
of an ongoing dialogue regarding health care 
choices; 
(F) address the need for individuals to use 
portable, interoperable, and accessible methods 
to communicate their health care decisions 
through a variety of means, using legally effec-
tuated documents that express their health care 
decisions in the form of advance directives (in-
cluding living wills, orders for life-sustaining 
treatment, and durable powers of attorney for 
health care); 
(G) raise public awareness regarding the 
availability of hospice and palliative care and 
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the quality of life benefits of early use of such 
services; 
(H) encourage individuals to speak with 
qualified health care professionals about their 
options and intentions for end-of-life care; and 
(I) adhere to evidence-based research on 
the most effective ways to communicate the ne-
cessity and benefits of advance care planning. 
(3) EVALUATION.—Not later than July 1, 
2026, the Secretary shall report to the appropriate 
committees of Congress on the effectiveness of the 
public education campaign under this section, and 
include in such report any recommendations that the 
Secretary determines appropriate regarding the need 
for continuation of legislative or administrative 
changes to facilitate changing public awareness, atti-
tudes, and behaviors regarding advance care plan-
ning. 
(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums 
as may be necessary to carry out this section. 
(b) REPEAL.—Section 4751(d) of the Omnibus 
Budget Reconciliation Act of 1990 (42 U.S.C. 1396a note; 
Public Law 101–508) is repealed. 
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Subtitle B—Provider Education 
SEC. 111. PUBLIC PROVIDER ADVANCE CARE PLANNING 
WEBSITE. 
(a) DEVELOPMENT.—Not later than January 1, 
2025, the Secretary, acting through the Administrator of 
the Centers for Medicare & Medicaid Services and the Di-
rector of the Agency for Healthcare Research and Quality, 
shall establish an, or expand upon an existing, internet 
website for providers under Medicare, Medicaid, CHIP, 
the Indian Health Service (including contract providers), 
and other qualified health care providers, including quali-
fied health care providers receiving assistance under the 
Older Americans Act of 1965 (42 U.S.C. 3002 et seq.) 
to serve older individuals, on each individual’s right to 
make decisions concerning medical care, including the 
right to accept or refuse medical or surgical treatment, 
and engage in advance care planning. 
(b) MAINTENANCE.—The internet website described 
in subsection (a) shall be maintained and publicized by 
the Secretary on an ongoing basis. 
(c) CONTENT.—The internet website shall include 
content, tools, and resources necessary to do the following: 
(1) Inform qualified health care providers and 
certified chaplains about the advance directive re-
quirements under the health care programs de-
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scribed in subsection (a) and State and Federal laws 
and regulations related to advance care planning. 
(2) Educate qualified health care providers and 
certified chaplains about advance care planning 
quality improvement activities. 
(3) Provide assistance to qualified health care 
providers to— 
(A) integrate advance care planning docu-
ments into electronic health records; and 
(B) develop and disseminate advance care 
planning informational materials for patients. 
(4) Inform qualified health care providers about 
advance care planning continuing education require-
ments and opportunities. 
(5) Encourage qualified health care providers to 
discuss advance care planning with patients of all 
ages, as appropriate. 
(6) Assist qualified health care providers and 
certified chaplains in understanding the continuum 
of end-of-life care services and supports available to 
patients, including palliative care and hospice. 
(7) Inform qualified health care providers of 
best practices for discussing end-of-life care with pa-
tients who have a serious or terminal diagnosis or 
prognosis and their loved ones. 
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SEC. 112. ADVANCE CARE CURRICULA PILOT PROGRAM. 
(a) IN GENERAL.—The Secretary, in consultation 
with appropriate professional associations, shall establish 
a pilot program by which the Secretary awards grants to 
eligible entities for purposes of supporting such entities 
in establishing end-of-life training requirements in the en-
tities’ applicable degree programs. 
(b) ELIGIBILITY.—To be eligible to participate in the 
pilot program under this section, an entity shall— 
(1) be a school of medicine, school of osteo-
pathic medicine, a physician assistant education pro-
gram (as defined in section 799B(3) of the Public 
Health Service Act (42 U.S.C. 295p(3))), a school of 
allied health (as defined in section 799B(4) of the 
Public Health Service Act (42 U.S.C. 295p(4))), a 
school of nursing, a school of social work, a graduate 
medical education program accredited by the Accred-
itation Council for Graduate Medical Education or 
the American Osteopathic Association, or other 
school, as the Secretary determines appropriate; 
(2) be staffed by teaching health professionals 
who have experience or training in palliative medi-
cine; 
(3) provide training in palliative medicine 
through a variety of service rotations, such as con-
sultation services, acute care services, extended care 
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facilities, ambulatory care and comprehensive eval-
uation units, hospice, home health, and community 
care programs; 
(4) develop specific performance-based meas-
ures to evaluate the competency of trainees; and 
(5) ensure that by not later than the end of the 
2-year period beginning on the date of enactment of 
this Act, professionals who are applicable faculty at 
the entity, or others as determined appropriate by 
the Secretary, shall be offered retraining in hospice 
and palliative medicine. 
(c) TRAINING.—Eligible entities participating in the 
pilot program under this section shall require minimum 
training for trainees that includes— 
(1) training in how to discuss and help patients 
and their loved ones with advance care planning; 
(2) with respect to trainees who will work with 
children, specialized pediatric training; 
(3) training in the continuum of end-of-life 
services and supports, including palliative care and 
hospice; 
(4) training in how to discuss end-of-life care 
with dying patients and their loved ones; 
(5) medical and legal issues training associated 
with end of life care; 
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(6) training in linguistic and cultural com-
petency; and 
(7) in the case of a graduate medical education 
program accredited by the Accreditation Council for 
Graduate Medical Education or the American Osteo-
pathic Association, a longitudinal component of at 
least 6 months. 
(d) REPORTS.—Each recipient of a grant under this 
section shall report to the Secretary on the outcomes of 
the program within 18 months of receipt of the final allot-
ment of grant funds. Not later than 1 year after receipt 
of all such reports, the Secretary shall submit to Congress 
a report compiling such results from all grant recipients. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section. 
SEC. 113. DEVELOPMENT OF CORE END-OF-LIFE CARE 
QUALITY 
MEASURES 
ACROSS 
EACH 
REL-
EVANT PROVIDER SETTING. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity (in this section referred to as the ‘‘Director’’) and in 
consultation with the Administrator of the Centers for 
Medicare & Medicaid Services, shall require the develop-
ment of specific end-of-life quality measures for each rel-
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evant qualified health care provider setting, as identified 
by the Director, in accordance with the requirements of 
subsection (b). 
(b) REQUIREMENTS.—For purposes of subsection 
(a), the requirements specified in this subsection are the 
following: 
(1) Selection of the specific measure or meas-
ures for an identified provider setting shall be based 
on an assessment of what is likely to have the great-
est positive impact on quality of end-of-life care in 
that setting, and made in consultation with affected 
providers, patients, and private organizations, that 
have developed such measures. 
(2) The measures may be structure-oriented, 
process-oriented, or outcome-oriented, as determined 
appropriate by the Director, and shall be patient-ori-
ented. 
(3) The Director shall ensure that reporting re-
quirements related to such measures— 
(A) are imposed consistently with other ap-
plicable laws and regulations, and in a manner 
that takes into account existing measures, the 
needs of patient populations, the specific serv-
ices provided, and the potential administrative 
burden to providers; and 
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(B) include demographic information to ac-
count for race, ethnicity, age, and gender, and 
other appropriate categories. 
(4) Not later than— 
(A) January 1, 2024, the Secretary shall 
disseminate the reporting requirements to all 
affected providers and provide for a 60-day pe-
riod for public comment; and 
(B) January 1, 2026, initial reporting by 
health care providers relating to the measures 
shall begin. 
SEC. 
114. 
CONTINUING 
EDUCATION 
FOR 
QUALIFIED 
HEALTH CARE PROVIDERS. 
(a) IN GENERAL.—Not later than January 1, 2024, 
the Secretary, acting through the Administrator of the 
Health Resources and Services Administration, shall de-
velop or enhance new and existing curricula on advance 
care planning and end-of-life care for continuing education 
that States may adopt for qualified health care providers. 
(b) CONSULTATION.—In carrying out subsection (a), 
the Secretary, acting through the Administrator of the 
Health Resources and Services Administration, may con-
sult with qualified health care providers, applicable profes-
sional clinician associations, institutions of higher edu-
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cation, State boards of medicine and nursing, and other 
professionals, as the Secretary determines appropriate. 
(c) CONTENT.—The continuing education curriculum 
developed or enhanced under subsection (a) shall, at a 
minimum, include— 
(1) a description of the meaning and impor-
tance of advance care planning; 
(2) a description of advance care planning doc-
uments, including living wills and durable powers of 
attorney, and the use of such directives; 
(3) the appropriate use of orders for scope of 
treatment; 
(4) counseling skills for when and how to intro-
duce and engage in advance care planning with pa-
tients and their loved ones; 
(5) palliative care principles and approaches to 
care; 
(6) the continuum of end-of-life services and 
supports, including palliative care and hospice; and 
(7) the importance of introducing palliative care 
and hospice early in illness in order to improve qual-
ity of life. 
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Subtitle C—Medicare Amendments 
SEC. 121. PERMANENT EXTENSION OF AUTHORIZATION 
FOR USE OF TELEHEALTH TO CONDUCT 
FACE-TO-FACE ENCOUNTER PRIOR TO RE-
CERTIFICATION OF ELIGIBILITY FOR HOS-
PICE CARE. 
Section 1814(a)(7)(D)(i)(II) of the Social Security 
Act (42 U.S.C. 1395f(a)(7)(D)(i)(II)) is amended by 
striking ‘‘during the emergency period’’ and all that fol-
lows through ‘‘ending on December 31, 2024’’ and insert-
ing the following: ‘‘during and after the emergency period 
described in section 1135(g)(1)(B)’’. 
SEC. 122. IMPROVEMENTS TO ADVANCE CARE PLANNING 
THROUGH TELEHEALTH. 
Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended— 
(1) in paragraph (4)(C)— 
(A) in clause (i), in the matter preceding 
subclause (I), by striking ‘‘and (7)’’ and insert-
ing ‘‘(7), and (10)’’; and 
(B) in clause (ii)(X), by inserting ‘‘or 
paragraph (10)’’ before the period; and 
(2) by adding at the end the following new 
paragraph: 
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‘‘(10) TREATMENT OF ADVANCE CARE PLAN-
NING SERVICES.—The geographic requirements de-
scribed in paragraph (4)(C)(i) shall not apply with 
respect to telehealth services furnished on or after 
January 1, 2024, for purposes of furnishing advance 
care planning services, as determined by the Sec-
retary.’’. 
TITLE II—REPORTS, RESEARCH, 
AND EVALUATIONS 
SEC. 201. STUDY AND REPORT BY THE SECRETARY RE-
GARDING THE ESTABLISHMENT AND IMPLE-
MENTATION OF A NATIONAL UNIFORM POL-
ICY ON ADVANCE DIRECTIVES. 
(a) STUDY.— 
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Office of the Assistant Secretary for 
Planning and Evaluation, shall conduct a study to 
evaluate the barriers to establishing and imple-
menting a national uniform policy on advance direc-
tives and what needs to be done to overcome those 
barriers. 
(2) MATTERS STUDIED.—The matters studied 
by the Secretary under paragraph (1) shall include 
issues concerning— 
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(A) family satisfaction that a patient’s 
wishes, as stated in the patient’s advance direc-
tive, were carried out; 
(B) the usability, accessibility, interoper-
ability, and portability of advance directives, in-
cluding cases involving the transfer of an indi-
vidual from one health care setting to another; 
(C) the feasibility of establishing an op-
tional, national advance directive form deemed 
valid by any health care entity or qualified 
health care provider participating in Medicare, 
Medicaid, or CHIP, regardless of State law; 
and 
(D) State variations in advance directive 
laws that are relevant to the establishment and 
implementation of a national uniform policy of 
advance directives. 
(b) REPORT TO CONGRESS.—Not later than 2 years 
after the date of enactment of this Act, the Secretary shall 
submit to Congress a report on the study conducted under 
subsection (a), together with recommendations for such 
legislation and administrative actions as the Secretary 
considers appropriate. 
(c) CONSULTATION.—In conducting the study and 
developing the report under this section, the Secretary 
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shall consult with relevant stakeholders and other inter-
ested parties. 
SEC. 202. GAO STUDY AND REPORT ON ESTABLISHMENT OF 
NATIONAL ADVANCE DIRECTIVE REGISTRY; 
OTHER STUDIES. 
(a) STUDY AND REPORT ON ESTABLISHMENT OF NA-
TIONAL ADVANCE DIRECTIVE REGISTRY.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study on the feasi-
bility of a national registry for advance directives, 
taking into consideration the constraints created by 
the privacy provisions enacted as a result of the 
Health Insurance Portability and Accountability Act 
of 1996 (Public Law 104–191). 
(2) REPORT.—Not later than 18 months after 
the date of enactment of this Act, the Comptroller 
General of the United States shall submit to Con-
gress a report on the study conducted under sub-
section (a) together with recommendations for such 
legislation and administrative action as the Comp-
troller General of the United States determines to be 
appropriate. 
(b) ONC STUDY.—The National Coordinator of the 
Office of the National Coordinator for Health Information 
Technology shall conduct a study on the feasibility and 
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impact on advance care planning of requiring that elec-
tronic health record vendors seeking certification have a 
prominent and easily visible field for storing and sharing 
advance care planning documents and related clinical 
notes. 
(c) ONC DEMONSTRATION PROGRAMS.—The Na-
tional Coordinator for Health Information Technology, in 
collaboration with the Director of the National Institute 
of Standards and Technology, shall initiate 2 demonstra-
tion programs to establish best practices and rec-
ommended standards to support— 
(1) usability, portability and interoperability of 
advance directives that are accessible to individuals, 
clinicians, and other authorized individuals; and 
(2) the use of electronic signatures, electronic 
authentication of witnesses, and electronic notariza-
tion to effectuate advance directives. 
(d) ADDITIONAL STUDY.—The Comptroller General 
of the United States shall conduct a study and submit a 
report to Congress on the incidence of health care, tests, 
surgeries, drugs, and other services paid provided by quali-
fied health care providers and paid for by the Federal Gov-
ernment or the patient and that were not the preference 
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of the patient or the authorized health care agent of the 
patient. 
Æ 
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