through mobile devices (as defined by the Sec-
retary). 
‘‘(5) ENROLLMENT
AND
DISENROLLMENT.— 
The Secretary shall establish procedures for eligible 
beneficiaries to enroll and disenroll under the Pro-
gram. Such procedures shall ensure that enrollment 
and disenrollment is available through an online 
process. The Secretary shall also establish proce-
dures to ensure Program participants can update or 
amend an advance directive in a timely and secure 
manner. 
‘‘(6) STATE LAW.—This section shall in no way 
supercede, abrogate, or otherwise interfere with 
State law governing advance directives. Under the 
Program, the Secretary shall establish a process 
under which the Secretary is required to verify that 
digital advance directive vendors or other entities 
providing a digital advance directive participating in 
the program enable those using their services to 
complete advance directives that fully comply with 
the law governing advance directives of the State in-
volved. 
‘‘(7) DISPLAY
OF
STATUTORY
AND
ALTER-
NATIVE
ADVANCE
DIRECTIVE
FORMS.—Under the 
Program, the Centers for Medicare & Medicaid Serv-
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ices shall provide, through a clearinghouse website, 
links to statutory and alternative advance directive 
forms and a State-by-State index to such forms to 
allow a beneficiary to create, adopt, modify, and ter-
minate an advance directive with any content per-
mitted or required, and in any form authorized by 
a State, in accordance with the requirements of sub-
paragraphs (C) through (E) of subsection (e)(1) and 
subsection (e)(2). 
‘‘(8) ACCESS
IN
CASES
OF
DISPUTE
OVER 
TREATMENT.—Under the Program: 
‘‘(A) SPECIAL
ACCESS.—The Secretary 
shall establish a process whereby, with respect 
to a beneficiary with a certified advance direc-
tive, a person described in subparagraph (B) 
may obtain access to the beneficiary’s advance 
directive for the purposes of viewing and shar-
ing such advance directive when— 
‘‘(i) the provisions of the advance di-
rective have come into force under the ap-
plicable State’s law because the beneficiary 
has become incapable of making health 
care 
decisions 
or 
under 
other 
cir-
cumstances provided under State law; and 
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‘‘(ii) at least one person described in 
subparagraph (B) is questioning or dis-
puting the provision, withholding, or with-
drawal of medical treatment, food, or 
fluids with respect to the beneficiary. 
‘‘(B) INTERESTED INDIVIDUALS.—A per-
son described in this subparagraph, with re-
spect to a beneficiary, is— 
‘‘(i) any individual who is a member 
of any class of persons who, under the ap-
plicable State’s law, would potentially be 
eligible to serve as a health care decision 
maker for the beneficiary if an advance di-
rective had not been executed regardless of 
whether higher priority for such eligibility 
would be accorded to another individual or 
individuals; and 
‘‘(ii) if the applicable State’s law does 
not designate persons or classes of persons 
described in clause (i), any person related 
within the third degree of consanguinity or 
affinity to the beneficiary. 
‘‘(b) REGISTRATION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish procedures for an eligible beneficiary to register 
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such beneficiary’s adoption of a certified advance di-
rective under the Program. Such procedures shall 
ensure that registration is available through an on-
line process. The Secretary shall also establish pro-
cedures to ensure Program participants can update 
previously registered information that is no longer 
accurate and indicate that an advance directive has 
been terminated. 
‘‘(2) REQUIRED INFORMATION.—In addition to 
such other information as the Secretary may deem 
appropriate, an eligible beneficiary seeking to reg-
ister a certified advance directive under the Program 
shall indicate where the advance directive is main-
tained or how it may be accessed. 
‘‘(3) REGISTRATION PERIODS.—The procedures 
established under paragraph (1) shall provide that 
registration under the Program shall occur during— 
‘‘(A) an eligible beneficiary’s initial enroll-
ment under an MA plan under part C as de-
scribed in paragraph (1) of section 1851(e); 
and 
‘‘(B) the annual, coordinated election pe-
riod under paragraph (3) of such section. 
‘‘(4) PRIVACY AND SECURITY.— 
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‘‘(A) IN
GENERAL.—The Secretary shall 
ensure that all aspects of the registration sys-
tem comply with the Federal regulations (con-
cerning the privacy of individually identifiable 
health information) promulgated under section 
264(c) of the Health Insurance Portability and 
Accountability Act of 1996 subject to the access 
authorized under subsection (a)(8), in accord-
ance with subsection (c)(2)(E). 
‘‘(B) ACCESS.—The Secretary shall utilize 
standardized data protections and privacy 
standards, including the Federal regulations de-
scribed in paragraph (1), to ensure that the 
registration record of an eligible beneficiary can 
only be accessed by— 
‘‘(i) the beneficiary, through the proc-
ess established under paragraph (1); 
‘‘(ii) those authorized to access the 
advance directive under subsection (a)(8) 
and subsection (c)(2)(E); and 
‘‘(iii) providers of services and sup-
pliers 
participating 
under 
this 
title, 
through a process established by the Sec-
retary. 
‘‘(c) ACCREDITATION.— 
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‘‘(1) IN GENERAL.—Under the Program, the 
Secretary shall— 
‘‘(A) grant accreditation to advance direc-
tive vendors and other entities providing ad-
vance directives that meet the accreditation cri-
teria established under paragraph (2); and 
‘‘(B) establish a process whereby advance 
directive vendors and other entities providing 
advance directives may obtain accreditation 
under this subsection. 
‘‘(2) ACCREDITATION
CRITERIA.—The Sec-
retary, in consultation with the General Accounting 
Office, shall establish accreditation criteria for ad-
vance directive vendors and other entities providing 
advance directives that seek to offer advance direc-
tives to be certified under the Program. Such cri-
teria shall consist of the following: 
‘‘(A) PROCESS
FOR
ADOPTING
ADVANCE 
DIRECTIVE.—The advance directive vendor or 
other entity providing an advance directive shall 
allow a beneficiary to create, adopt, modify, and 
terminate an advance directive through an on-
line process. 
‘‘(B) VENDORS.—The advance directive 
vendor or other entity providing an advance di-
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rective shall comply with an annual quality re-
view to be conducted by the Secretary. 
‘‘(C) USE
OF
STATUTORY
AND
ALTER-
NATIVE ADVANCE DIRECTIVE FORMS.—The ad-
vance directive vendor or other entity providing 
an advance directive shall enable a beneficiary 
to access, complete, modify, and adopt any ad-
vance directive applicable to the State indicated 
by the beneficiary who is posted as provided 
under subparagraphs (C) through (E) of sub-
section (e)(1) and of subsection (e)(2). 
‘‘(D) ACCESS.—The advance directive ven-
dor or other entity providing an advance direc-
tive shall maintain advance directives in such a 
way that— 
‘‘(i) an eligible beneficiary who has 
adopted an advance directive with such 
vendor or entity and any family member, 
legal representative, or health care proxy 
legally designated by such beneficiary has 
direct, has near real-time online access to 
the beneficiary’s advance directive for pur-
poses of viewing and sharing such advance 
directive, including communication of the 
advance directive and corresponding bene-
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ficiary’s wishes using nationally recognized 
health care information technology data 
content and data transport standards spec-
ified by the Secretary; 
‘‘(ii) in the case of an eligible bene-
ficiary who has adopted an advance direc-
tive with such vendor or entity or any fam-
ily member, legal representative, or health 
care proxy legally designated by such bene-
ficiary who is unable or unwilling to use 
the online access under subparagraph (A), 
such individual is able to obtain a hard 
copy of the beneficiary’s advance directive 
for the purposes of viewing and sharing 
such advance directive; and 
‘‘(iii) providers of services and sup-
pliers participating under this title have 
near real-time online access to the advance 
directive of an eligible beneficiary who has 
adopted an advance directive with such 
vendor or entity, including communication 
of the advance directive and corresponding 
beneficiary’s wishes through secure email 
and messaging technologies and nationally 
recognized health care information tech-
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nology standards specified by the Secretary 
to improve the accessibility and interoper-
ability of such directives. 
‘‘(E) PRIVACY PROTECTIONS.— 
‘‘(i) IN GENERAL.—The advance di-
rective vendor or other entity providing an 
advance directive shall comply with the 
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). 
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‘‘(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 
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.— 
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‘‘(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. 
‘‘(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. 
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‘‘(III) Whether the certified ad-
vance directive was actionable. 
‘‘(IV) Whether medical personnel 
followed the certified advance direc-
tive. 
‘‘(d) INCENTIVE.— 
‘‘(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 2017, $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-
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