I 
111TH CONGRESS 
1ST SESSION H. R. 3253 
To amend titles XVIII and XIX of the Social Security Act to promote 
the use of advance directives, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 17, 2009 
Mr. LEVIN (for himself, Mr. BLUMENAUER, Mr. CASTLE, Mr. KIND, Mr. 
FARR, and Mr. COHEN) introduced the following bill; which was referred 
to the Committee on Energy and Commerce 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to promote the use of advance directives, and for other 
purposes. 
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 Directive Promotion 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. Improvement of policies related to the use and portability of advance 
directives. 
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Sec. 3. Medicare coverage of an end-of-life planning consultation as part of an 
initial preventive physical examination. 
Sec. 4. National information hotline for end-of-life decisionmaking and hospice 
care. 
Sec. 5. Increasing awareness of the importance of end-of-life planning. 
SEC. 2. IMPROVEMENT OF POLICIES RELATED TO THE USE 
AND PORTABILITY OF ADVANCE DIRECTIVES. 
(a) MEDICARE.—Section 1866(f) of the Social Secu-
rity Act (42 U.S.C. 1395cc(f)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (B), by inserting 
‘‘and if presented by the individual (or on be-
half of the individual), to include the content of 
such advance directive in a prominent part of 
such record’’ before the semicolon at the end; 
(B) in subparagraph (D), by striking 
‘‘and’’ after the semicolon at the end; 
(C) in subparagraph (E), by striking the 
period at the end and inserting ‘‘; and’’; and 
(D) by inserting after subparagraph (E) 
the following new subparagraph: 
‘‘(F) to provide each such individual with the 
opportunity to discuss issues relating to the informa-
tion provided to that individual pursuant to subpara-
graph (A) with an appropriately trained profes-
sional.’’; 
(2) in paragraph (3), by striking ‘‘a written’’ 
and inserting ‘‘an’’; and 
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(3) by adding at the end the following new 
paragraph: 
‘‘(5)(A) In addition to the requirements of paragraph 
(1), a provider of services shall give effect to a valid ad-
vance directive executed outside the State in which such 
directive is presented to the same extent as such provider 
would give effect to a valid advance directive executed 
under the law of the State in which it is presented. In 
the absence of knowledge to the contrary, such a provider 
may presume that such an advance directive executed out-
side the State in which it is presented is valid. Nothing 
in this paragraph shall be construed to authorize the ad-
ministration of health care treatment otherwise prohibited 
by the laws of the State in which the directive is presented. 
‘‘(B) The provisions of this paragraph shall preempt 
any State law to the extent such law is inconsistent with 
such provisions. The provisions of this paragraph shall not 
preempt any State law that provides for greater port-
ability, more deference to a patient’s wishes, or more lati-
tude in determining a patient’s wishes with respect to 
health care.’’. 
(b) MEDICAID.—Section 1902(w) of the Social Secu-
rity Act (42 U.S.C. 1396a(w)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (B)— 
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‘‘(6)(A) In addition to the requirements of paragraph 
(1), a provider shall give effect to a valid advance directive 
executed outside the State in which such directive is pre-
sented to the same extent as such provider would give ef-
fect to a valid advance directive executed under the law 
of the State in which it is presented. In the absence of 
knowledge to the contrary, such a provider may presume 
that such an advance directive executed outside the State 
in which it is presented is valid. Nothing in this paragraph 
shall be construed to authorize the administration of 
health care treatment otherwise prohibited by the laws of 
the State in which the directive is presented. 
‘‘(B) The provisions of this paragraph shall preempt 
any State law to the extent such law is inconsistent with 
such provisions. The provisions of this paragraph shall not 
preempt any State law that provides for greater port-
ability, more deference to a patient’s wishes, or more lati-
tude in determining a patient’s wishes with respect to 
health care.’’. 
(c) EFFECTIVE DATES.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by subsections (a) and (b) 
shall apply to provider agreements entered into, re-
newed, or extended under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.), and to State 
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plans under title XIX of such Act (42 U.S.C. 1396 
et seq.), on or after such date as the Secretary of 
Health and Human Services specifies, but in no case 
may such date be later than 1 year after the date 
of enactment of this Act. 
(2) EXTENSION
OF
EFFECTIVE
DATE
FOR 
STATE LAW AMENDMENT.—In the case of a State 
plan under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) which the Secretary of Health 
and Human Services determines requires State legis-
lation in order for the plan to meet the additional 
requirements imposed by the amendments made by 
subsection (b), the State plan shall not be regarded 
as failing to comply with the requirements of such 
title solely on the basis of its failure to meet these 
additional requirements before the first day of the 
first calendar quarter beginning after the close of 
the first regular session of the State legislature that 
begins after the date of enactment of this Act. For 
purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year 
of the session is considered to be a separate regular 
session of the State legislature. 
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SEC. 3. MEDICARE COVERAGE OF AN END-OF-LIFE PLAN-
NING CONSULTATION AS PART OF AN INITIAL 
PREVENTIVE PHYSICAL EXAMINATION. 
(a) IN GENERAL.—Section 1861(ww) of the Social 
Security Act (42 U.S.C. 1395x(ww)), as amended by sec-
tion 101(b)(1) of the Medicare Improvements for Patients 
and Providers Act of 2008 (Public Law 110–275), is 
amended by amending paragraph (3) to read as follows: 
‘‘(3) For purposes of paragraph (1), the term ‘end- 
of-life planning’ means a consultation between the physi-
cian and an individual regarding— 
‘‘(A) the importance of preparing advance di-
rectives in case an injury or illness causes the indi-
vidual to be unable to make health care decisions; 
‘‘(B) an explanation of what constitutes an ad-
vance directive, and the situations in which an ad-
vance directive is likely to be relied upon; 
‘‘(C) the reasons why the development of a 
comprehensive end-of-life plan is beneficial and the 
reasons why such a plan should be updated periodi-
cally as the health of the individual changes; 
‘‘(D) the identification of resources that an in-
dividual may use to determine the requirements of 
the State in which such individual resides so that 
the treatment wishes of that individual will be car-
ried out if the individual is unable to communicate 
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those wishes, including requirements regarding the 
designation of a surrogate decision maker (also 
known as a health care proxy); and 
‘‘(E) whether or not the physician is willing to 
follow the individual’s wishes as expressed in an ad-
vance directive.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to initial preventive physical exami-
nations furnished on or after January 1, 2010. 
SEC. 4. NATIONAL INFORMATION HOTLINE FOR END-OF- 
LIFE DECISIONMAKING AND HOSPICE CARE. 
The Secretary of Health and Human Services, acting 
through the Administrator of the Centers for Medicare & 
Medicaid Services, shall operate directly, or by grant, con-
tract, or interagency agreement, out of funds otherwise 
appropriated to the Secretary, a clearinghouse and a 24- 
hour toll-free telephone hotline in order to provide con-
sumer information about advance directives (as defined in 
section 1866(f)(3) of the Social Security Act (42 U.S.C. 
1395cc(f)(3)), as amended by section 2(a)), end-of-life de-
cisionmaking, and available end-of-life and hospice care 
services. In carrying out the preceding sentence, the Ad-
ministrator may designate an existing clearinghouse and 
24-hour toll-free telephone hotline or, if no such entity is 
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appropriate, may establish a new clearinghouse and a 24- 
hour toll-free telephone hotline. 
SEC. 5. INCREASING AWARENESS OF THE IMPORTANCE OF 
END-OF-LIFE PLANNING. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by adding at the end the following 
new part: 
‘‘PART S—PROGRAMS TO INCREASE AWARENESS 
OF ADVANCE DIRECTIVE PLANNING ISSUES 
‘‘SEC. 
399FF. 
ADVANCE 
DIRECTIVE 
EDUCATION 
CAM-
PAIGNS. 
‘‘(a) ADVANCE DIRECTIVE EDUCATION CAMPAIGN.— 
The Secretary shall, directly or through grants awarded 
under subsection (b), conduct a national public education 
campaign— 
‘‘(1) to raise public awareness of the impor-
tance of planning for care near the end of life; 
‘‘(2) to improve the public’s understanding of 
the various situations in which individuals may find 
themselves if they become unable to express their 
health care wishes; 
‘‘(3) to explain the need for readily available 
legal documents that express an individual’s wishes, 
through advance directives (including living wills, 
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comfort care orders, and durable powers of attorney 
for health care); and 
‘‘(4) to educate the public about the availability 
of hospice care and palliative care. 
‘‘(b) GRANTS.— 
‘‘(1) IN GENERAL.—The Secretary shall use at 
least 60 percent of the funds appropriated under 
subsection (c) for the purpose of awarding grants to 
public or nonprofit private entities (including States 
or political subdivisions of a State), or a consortium 
of any of such entities, for the purpose of conducting 
education campaigns under subsection (a). 
‘‘(2) PERIOD.—Any grant awarded under para-
graph (1) shall be for a period of 3 years. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$25,000,000.’’. 
Æ 
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