Federal regulations (concerning the privacy 
of individually identifiable health informa-
tion) promulgated under section 264(c) of 
the Health Insurance Portability and Ac-
countability Act of 1996 (42 U.S.C. 
1320d–2 note), subject to the access au-
thorized under subparagraph (D) and sub-
section (a)(8). 
‘‘(ii) ACCESS.—Such vendor or entity 
shall utilize standardized data protections 
and privacy standards, including the Fed-
eral regulations described in clause (i), to 
ensure that the content of an eligible bene-
ficiary’s advance directive is owned and 
maintained by the beneficiary and can only 
be accessed by those authorized to access 
the advance directive under subparagraph 
(D) and subsection (a)(8). 
‘‘(F) SECURITY
AND
TESTING.—The ad-
vance directive vendor or other entity providing 
an advance directive shall certify that— 
‘‘(i) all data management and data 
transfer elements involved in adopting, 
maintaining, and accessing the advance di-
rective have successfully passed rigorous 
VerDate Sep 11 2014 
22:09 Nov 21, 2015
Jkt 059200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H4059.IH
H4059
tkelley on DSK3SPTVN1PROD with BILLS
independent testing regarding standards of 
timeliness, accuracy, and efficiency; 
‘‘(ii) the data management and data 
transfer elements involved in adopting, 
maintaining, and accessing the advance di-
rective meet widely accepted industry secu-
rity standards; and 
‘‘(iii) the system that provides access 
to the advance directive has passed real- 
time tests simulating a realistic volume of 
beneficiaries and providers accessing ad-
vance directives simultaneously. 
‘‘(G) CERTIFIED ADVANCE DIRECTIVES.— 
The advance directive vendor or other entity 
providing an advance directive shall agree to 
offer certified advance directives (as defined in 
subsection (a)(2)(A)). 
‘‘(H) BENEFICIARY SURVEYS.— 
‘‘(i) IN GENERAL.—The advance di-
rective vendor or other entity providing an 
advance directive shall agree to administer 
annual beneficiary surveys on the informa-
tion described in clause (ii) and submit the 
results of such surveys to the Centers for 
Medicare & Medicaid Services. 
VerDate Sep 11 2014 
22:09 Nov 21, 2015
Jkt 059200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H4059.IH
H4059
tkelley on DSK3SPTVN1PROD with BILLS
‘‘(ii) INFORMATION.—The information 
described in this clause, with respect to an 
annual beneficiary survey and certified ad-
vance directive of a beneficiary, is the fol-
lowing: 
‘‘(I) Whether the beneficiary had 
to pay any third party for the cre-
ation, storage, or retrieval of the cer-
tified advance directive. 
‘‘(II) Whether the beneficiary 
had a health care encounter or emer-
gency that required the location, ac-
cess, retrieval, or consultation of the 
certified advance directive and if so, 
whether the certified advance directive 
was accessible in online and in near 
real-time, as required under this sec-
tion. 
‘‘(III) Whether the certified ad-
vance directive was actionable. 
‘‘(IV) Whether medical personnel 
followed the certified advance direc-
tive. 
‘‘(d) INCENTIVE.— 
VerDate Sep 11 2014 
22:09 Nov 21, 2015
Jkt 059200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H4059.IH
H4059
tkelley on DSK3SPTVN1PROD with BILLS
‘‘(1) IN GENERAL.—The Secretary shall make a 
one-time payment of the amount specified in para-
graph (2) to each eligible beneficiary who adopts a 
certified advance directive and registers such direc-
tive with the Program. 
‘‘(2) AMOUNT.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), the amount specified in this para-
graph is— 
‘‘(i) for a beneficiary who registers a 
certified advance directive with the Pro-
gram in 2015, $75; or 
‘‘(ii) for a beneficiary who registers a 
certified advance directive with the Pro-
gram in a subsequent year, the amount 
specified in this paragraph for the pre-
ceding year increased by the percentage in-
crease in the Chained Consumer Price 
Index for All Urban Consumers (as pub-
lished by the Bureau of Labor Statistics of 
the Department of Labor) over the pre-
ceding year. 
‘‘(B) ROUNDING.—If any amount deter-
mined under subparagraph (A) is not a multiple 
VerDate Sep 11 2014 
22:09 Nov 21, 2015
Jkt 059200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H4059.IH
H4059
tkelley on DSK3SPTVN1PROD with BILLS
of 10 cents, such amount shall be rounded to 
the nearest multiple of 10 cents. 
‘‘(3) ADMINISTRATION.—The Secretary shall, 
through a full notice and comment rulemaking proc-
ess, establish procedures for— 
‘‘(A) making the incentive payment di-
rectly to the eligible beneficiary or a personal 
account maintained by the beneficiary at a fi-
nancial institution that has been designated by 
the beneficiary, and ensuring that no other enti-
ty receives the payment on the beneficiary’s be-
half; and 
‘‘(B) ensuring that a beneficiary does not 
receive an incentive payment under this section 
more than once. 
‘‘(e) EDUCATION AND OUTREACH.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
for— 
‘‘(A) the inclusion of the statement set 
forth in paragraph (3) in the Medicare and You 
handbook under section 1804 and on a clear-
inghouse website linked to the Internet website 
of the Centers for Medicare & Medicaid Serv-
ices; 
VerDate Sep 11 2014 
22:09 Nov 21, 2015
Jkt 059200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H4059.IH
H4059
tkelley on DSK3SPTVN1PROD with BILLS
‘‘(B) the promotion of the benefits of elec-
tronic advance directives services, as they be-
come available, through the use of mass com-
munications and other means; 
‘‘(C) the inclusion, under the heading 
‘Statutory Advance Directive Forms’, of any 
relevant forms, whether mandatory or optional, 
specified in the statues or regulations of the 
States to be displayed on a clearinghouse 
website; 
‘‘(D) the inclusion, under the heading ‘Al-
ternative Advance Directive Forms,’ on a sepa-
rate clearinghouse website, and in accordance 
with paragraph (2)— 
‘‘(i) of other advance directive forms 
submitted to the Secretary by individuals 
and groups in an electronic format speci-
fied by the Secretary for which the submit-
ting entity includes, for each form sub-
mitted, an opinion by an attorney licensed 
to practice in the relevant State dem-
onstrating that the submitted form com-
plies with the law of that State; and 
‘‘(ii) of the following disclaimer, which 
shall be prominently posted on the website: 
VerDate Sep 11 2014 
22:09 Nov 21, 2015
Jkt 059200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H4059.IH
H4059
tkelley on DSK3SPTVN1PROD with BILLS