I 
111TH CONGRESS 
1ST SESSION H. R. 3172 
To amend title XVIII of the Social Security Act to provide for advanced 
illness care management services for Medicare beneficiaries, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 10, 2009 
Ms. BALDWIN (for herself and Mr. TANNER) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for advanced illness care management services for Medi-
care beneficiaries, 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 
‘‘Senior Navigation and Planning Act of 2009’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
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Sec. 2. Medicare and Medicaid coverage of advanced illness care management 
services. 
Sec. 3. Increasing awareness of the importance of end-of-life planning. 
Sec. 4. Inclusion of end-of-life planning materials in the Medicare & You hand-
book. 
Sec. 5. Senior Navigation Advisory Board. 
Sec. 6. Requirement for physicians and nurse practitioners to provide certain 
Medicare beneficiaries with information on advance directives 
and other end-of-life planning tools. 
Sec. 7. Improvement of policies related to the use and portability of advance 
directives. 
Sec. 8. Additional requirements for facilities. 
Sec. 9. Requirement for Medicare providers to honor written orders for medical 
care. 
Sec. 10. Incentives for accreditation and certification in hospice and palliative 
care. 
Sec. 11. Discharge checklist pilot program. 
Sec. 12. Office of Medicare/Medicaid Integration. 
Sec. 13. Web-based materials and grants. 
Sec. 14. HHS study and report on the storage of advance directives. 
Sec. 15. GAO study and report on the provisions of, and amendments made by, 
this Act. 
SEC. 2. MEDICARE AND MEDICAID COVERAGE OF AD-
VANCED ILLNESS CARE MANAGEMENT SERV-
ICES. 
(a) MEDICARE COVERAGE OF ADVANCED ILLNESS 
CARE MANAGEMENT SERVICES.— 
(1) COVERAGE.—Section 1812(a)(5) of the So-
cial Security Act (42 U.S.C. 1395d(a)(5)) is amend-
ed to read as follows: 
‘‘(5) for individuals who have a life expectancy 
of 18 months or less and who have not made an 
election under subsection (d)(1) to receive hospice 
care under this part, advanced illness care manage-
ment services (as defined in section 1861(hhh)).’’. 
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(2) DEFINITION.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended by add-
ing at the end the following new subsection: 
‘‘Advanced Illness Care Management Services 
‘‘(hhh)(1) The term ‘advanced illness care manage-
ment services’ means the following services furnished to 
an individual by a hospice program, as defined in sub-
section (dd)(2): 
‘‘(A) Palliative care consultation services. 
‘‘(B) Care planning services. 
‘‘(C) Counseling of individual and family mem-
bers. 
‘‘(D) Discussions regarding the availability of 
supportive services (including information on ad-
vance care planning). 
‘‘(E) Patient-centered care. 
‘‘(F) Family conference services. 
‘‘(G) Respite services. 
‘‘(H) Onsite caregiver training. 
‘‘(I) Such other services as may be appropriate 
under a hospice model of care. 
‘‘(2) For purposes of paragraph (1)(F), the term 
‘family conference services’ means a family conference 
held by a hospice program (as so defined) for the indi-
vidual and the family members of the individual, including 
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services for the facilitation and provision of adequate fol-
low-up to such family conference, which includes addi-
tional collaboration and coordination with the hospice phy-
sician or other hospice personnel to clarify and put into 
action the goals of care as outlined by the individual and 
the family members of the individual. 
‘‘(3)(A) For purposes of paragraph (1)(G), the term 
‘respite services’ means the provision of additional hours 
of care to individuals who are unable to perform 2 or more 
activities of daily living. Such services shall be targeted 
toward furnishing services to the individual and providing 
the caregivers of the individual a needed break outside of 
the home of the individual. 
‘‘(B) For purposes of subparagraph (A), the Sec-
retary shall establish, on an annual basis, a minimum and 
maximum number of hours (not to exceed 16 hours each 
month) for which respite services may be provided to indi-
viduals eligible to receive such services. 
‘‘(C) In subparagraph (A), the term ‘activities of 
daily living’ means bathing, transferring, toileting, and 
feeding. 
‘‘(4) For purposes of paragraph (1)(H), the term ‘on-
site caregiver training’ means training provided to the 
caregivers of an individual, which is focused on training 
such caregivers to provide effective personal and technical 
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care to individuals, with an emphasis on what the care-
giver can expect with the disease process of the individual 
or the needs of the individual at the end of life. Such train-
ing shall be pragmatic and easily understood by non- 
health professionals as well as culturally and educationally 
appropriate. 
‘‘(5) In the case of a hospice program that is fur-
nishing advanced illness care management services to an 
individual who becomes eligible for hospice care under this 
title, the hospice program shall notify the individual of 
such eligibility.’’. 
(3) PAYMENT BASED ON THE PHYSICIAN FEE 
SCHEDULE.—Section 1814(i)(4) of the Social Secu-
rity Act (42 U.S.C. 1395f(i)(4)) is amended to read 
as follows: 
‘‘(4) The amount paid to a hospice program with re-
spect to the advanced illness care management services (as 
defined in section 1861(hhh)) for which payment may be 
made under this part shall be— 
‘‘(A) with respect to such services, other than 
respite services, furnished by a hospice physician, an 
amount equal to the amount that would be paid for 
an equivalent physician consultation under the fee 
schedule established under section 1848(b); 
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‘‘(B) with respect to such services, other than 
respite services, furnished by other hospice per-
sonnel, an amount equal to 85 percent of such fee 
schedule amount; and 
‘‘(C) with respect to respite services, payment 
shall be at an appropriate rate to be determined by 
the Secretary’’. 
(4) 
CONFORMING
AMENDMENTS.—Section 
1862(a) of the Social Security Act (42 U.S.C. 
1395y(a)) is amended— 
(A) in paragraph (1)— 
(i) by striking ‘‘and’’ at the end of 
subparagraph (N); 
(ii) by striking the semicolon at the 
end of subparagraph (O) and inserting ‘‘, 
and’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(P) in the case of advanced illness care 
management services which are respite services 
(as defined in section 1861(hhh)(3)), which are 
performed more frequently than is provided 
under clause (ii) of such section;’’; and 
(B) in paragraph (7), by striking ‘‘or (K)’’ 
and inserting ‘‘(K), or (P)’’. 
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(5) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to services furnished 
on or after January 1, 2011. 
(b) MEDICAID COVERAGE OF ADVANCED ILLNESS 
CARE MANAGEMENT SERVICES.— 
(1) IN GENERAL.—Section 1905(a) of the So-
cial Security Act (42 U.S.C. 1396d(a)) is amend-
ed— 
(A) by redesignating paragraph (28) as 
paragraph (29); 
(B) in paragraph (27), by striking at the 
end ‘‘and’’; and 
(C) by inserting after paragraph (27) the 
following new paragraph: 
‘‘(28) advanced illness care management serv-
ices (as defined in section 1861(hhh)) for individuals 
described in section 1812(a)(5); and’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1902(a)(10)(A) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)) is amended by striking 
‘‘and (21)’’ and inserting ‘‘, (21), and (28)’’. 
(3) EFFECTIVE DATE.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the amendments made by 
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paragraphs (1) and (2) take effect on January 
1, 2011. 
(B) EXTENSION OF EFFECTIVE DATE FOR 
STATE
LAW
AMENDMENT.—In the case of a 
State plan under title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.) which the 
Secretary determines requires State legislation 
in order for the plan to meet the additional re-
quirements imposed by the amendments made 
by paragraph (1), the State plan shall not be 
regarded as failing to comply with the require-
ments of such title solely on the basis of its fail-
ure to meet these additional requirements be-
fore 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. 
(c) EDUCATION ON ADVANCED ILLNESS CARE MAN-
AGEMENT
SERVICES.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall establish a program under which physicians 
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(as defined in subsection (r) of section 1861 of the Social 
Security Act (42 U.S.C. 1395x)) are educated on the cov-
erage of advanced illness care management services (as de-
fined in subsection (hhh) of such section) under the Medi-
care and Medicaid programs under titles XVIII and XIX, 
respectively, of the Social Security Act (42 U.S.C. 1395 
et seq.; 1396 et seq.), including the importance of early 
intervention in providing such care to individuals. 
SEC. 3. 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 CARE PLANNING ISSUES 
‘‘SEC. 399GG. ADVANCE CARE PLANNING EDUCATION CAM-
PAIGNS AND INFORMATION PHONE LINE AND 
CLEARINGHOUSE. 
‘‘(a) ADVANCE CARE PLANNING EDUCATION CAM-
PAIGN.—The Secretary shall, directly or through grants 
awarded under subsection (c), conduct a national public 
education campaign— 
‘‘(1) to raise public awareness of the impor-
tance of planning for care near the end of life; 
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