tients or enhance the quality of services, including 
educational services for patients and patients’ fami-
lies, training of health care professionals, or estab-
lishing an orders for life-sustaining treatment reg-
istry; and 
(3) technical assistance and professional train-
ing. 
(c) DEFINITIONS.—In this section: 
(1) The term ‘‘eligible entity’’ includes— 
(A) an academic medical center, a medical 
school, a State health department, a State med-
ical association, a multistate task force, a hos-
pital, or a health system capable of admin-
istering a program for physician orders regard-
ing life-sustaining treatment for a State; or 
(B) any other health care agency or entity 
as the Secretary determines appropriate. 
(2) The term ‘‘program for orders for life-sus-
taining treatment’’ means a program that, regard-
less of its name— 
(A) implements a clinical process designed 
to facilitate shared, informed medical decision-
making and communication between health care 
professionals and patients with serious, progres-
sive illness or frailty and results in a set of 
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medical orders that are substantially consistent 
with the national standard and that— 
(i) are portable and honored across 
care settings; and 
(ii) address key medical decisions con-
sistent with the patient’s goals of care; and 
(B) is guided by a coalition of stake-
holders, such as patient advocacy groups and 
representatives from across the continuum of 
health care services, disability rights advocates, 
senior advocates, emergency medical services, 
long-term care, medical associations, hospitals, 
home health, hospice, nursing associations, the 
State agency responsible for senior and dis-
ability services, faith-based groups, and the 
State department of health. 
(3) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
$35,000,000 for the 5-fiscal-year period beginning with 
fiscal year 2017, to remain available until expended. 
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SEC. 4. ADVANCE CARE PLANNING STANDARDS FOR ELEC-
TRONIC HEALTH RECORDS. 
(a) 
IN
GENERAL.—Notwithstanding 
section 
3004(b)(3) of the Public Health Service Act (42 U.S.C. 
300jj–14(b)(3)), not later than 4 years after the date of 
the enactment of this Act, the Secretary of Health and 
Human Services shall adopt, by rule, standards for a 
qualified electronic health record (as defined in section 
3000(13) of such Act (42 U.S.C. 300jj(13)), with respect 
to organizing patient communications with health care 
providers about care goals and to provide one-click access 
to the following: 
(1) The patient’s current advance directive (as 
defined in section 1866(f)(3) of the Social Security 
Act (42 U.S.C. 1395cc(f)(3)), as applicable. 
(2) The patient’s current order for life-sus-
taining treatment (described in section 3(c)(2)(A)), 
as applicable. 
(3) Documentation of advance care planning 
discussion between the patient and the provider. 
(b) TREATMENT OF STANDARDS.—A standard adopt-
ed under subsection (a) shall be treated as a standard 
adopted under section 3004 of the Public Health Service 
Act (42 U.S.C. 300jj–14) for purposes of certifying quali-
fied electronic health records pursuant to section 
3001(c)(5) of such Act (42 U.S.C. 300jj–11(c)(5)). 
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SEC. 5. PORTABILITY OF ADVANCE DIRECTIVES. 
(a) IN GENERAL.—Section 1866(f) of the Social Se-
curity Act (42 U.S.C. 1395cc(f)) is amended by adding 
at the end the following new paragraph: 
‘‘(5)(A) An advance directive validly executed outside 
the State in which such directive is presented must be 
given effect by a provider of services or organization to 
the same extent as an advance directive validly executed 
under the law of the State in which it is presented. 
‘‘(B) In the absence of knowledge to the contrary, 
a physician or other health care provider or organization 
may presume that a written advance health care directive 
or similar instrument, regardless of where executed, is 
valid. 
‘‘(C) In the absence of a validly executed advance di-
rective, any authentic expression of a person’s wishes with 
respect to health care shall be honored. 
‘‘(D) The provisions of this paragraph shall preempt 
any State law on advance directive portability to the extent 
such law is inconsistent with such provisions. Nothing in 
the paragraph shall be construed to authorize the adminis-
tration of health care treatment otherwise prohibited by 
the laws of the State in which the directive is presented.’’. 
(b) GAO STUDY ON HEALTH CARE DECISIONMAKING 
LAWS AND BARRIERS TO THE USE OF ADVANCE DIREC-
TIVES.— 
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(1) STUDY.—The Comptroller General of the 
United States shall conduct a study that examines 
the use, portability, and electronic storage of ad-
vance directives and that identifies barriers towards 
adopting, using, and following advance directives in 
the clinical setting. Such examination shall include 
issues that remain unresolved after the Stage 3 
Meaningful Use final rule, including barriers and so-
lutions to finding and accessing advance care plan-
ning documents, best practices for alerting eligible 
providers to the presence of an advance care plan, 
and best practices for transmitting advance care 
plans across sites of care. 
(2) REPORT.—Not later than 1 year after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report on the 
study conducted under paragraph (1) and shall in-
clude in the report such recommendations regarding 
improving advance health care planning as the 
Comptroller General deems appropriate. 
SEC. 6. APPLICATION OF QUALITY MEASURES UNDER 
MEDICARE RELATING TO END-OF-LIFE CARE. 
(a) INCORPORATING
END-OF-LIFE
CARE
SUB-
DOMAINS WITHIN QUALITY DOMAINS UNDER MEDICARE 
PHYSICIAN FEE SCHEDULE.—Section 1848(s)(1) of the 
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