I 
115TH CONGRESS 
1ST SESSION H. R. 3181 
To amend title XVIII of the Social Security Act to encourage Medicare 
beneficiaries to voluntarily adopt advance directives guiding the medical 
care they receive. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 11, 2017 
Mrs. BLACK (for herself, Mr. THOMPSON of California, Mr. COLLINS of New 
York, and Mr. WELCH) introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittee on Ways and Means, for a period to be subsequently 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 encourage 
Medicare beneficiaries to voluntarily adopt advance direc-
tives guiding the medical care they receive. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Choices Em-
powerment and Protection Act’’. 
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SEC. 2. MEDICARE ADVANCE DIRECTIVE CERTIFICATION 
PROGRAM. 
Part B of title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) is amended by adding at the end 
the following new section: 
‘‘MEDICARE ADVANCE DIRECTIVE CERTIFICATION 
PROGRAM 
‘‘SEC. 1849. (a) IN GENERAL.— 
‘‘(1) ESTABLISHMENT OF PROGRAM.—The Sec-
retary shall establish and implement an Advance Di-
rective Certification Program (in this section re-
ferred to as the ‘Program’) under which the Sec-
retary shall encourage eligible beneficiaries to adopt 
and maintain certified advance directives to guide 
the delivery of health care to such beneficiaries. The 
Secretary shall implement the Program not later 
than 3 years after the date of enactment of this sec-
tion. 
‘‘(2) DEFINITIONS.—In this section: 
‘‘(A) CERTIFIED
ADVANCE
DIRECTIVE.— 
The term ‘certified advance directive’ means 
any electronically stored statement by an eligi-
ble beneficiary who— 
‘‘(i) provides instructions that outline 
the kind of medical treatments and care 
that such beneficiary would want or not 
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want under particular conditions, and may 
also include the identification of a health 
care proxy or legal representative to make 
medical treatment decisions for the bene-
ficiary if the beneficiary becomes unable to 
make or communicate those decisions; 
‘‘(ii) is executed in accordance with 
the law governing advance directives of the 
State involved; and 
‘‘(iii) is offered by an entity that has 
received accreditation from the Secretary 
under this section. 
‘‘(B) ELIGIBLE BENEFICIARY.—The term 
‘eligible beneficiary’ means an individual en-
rolled under this part. 
‘‘(3) VOLUNTARY.—Participation in the Pro-
gram shall be voluntary with respect to the eligible 
beneficiary and an eligible beneficiary who has reg-
istered a certified advance directive under the Pro-
gram may terminate such directive at any time. 
Nothing in this section shall require an eligible bene-
ficiary to adopt or maintain a certified advance di-
rective. 
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‘‘(4) BEST PRACTICES.—In establishing and im-
plementing the Program, the Secretary shall con-
sider— 
‘‘(A) best practices within existing advance 
directive registry technologies, programs, and 
systems, including web-based or cloud-based ad-
vance directive technologies— 
‘‘(i) which may utilize time and date 
stamps, video, or other innovative meas-
ures to protect the authenticity, improve 
the quality, and enhance the security of 
such directives; and 
‘‘(ii) which may utilize secure email 
and messaging technologies and nationally 
recognized health care information tech-
nology standards to improve the accessi-
bility and interoperability of such direc-
tives; and 
‘‘(B) best practices for educating bene-
ficiaries on means for communicating bene-
ficiaries’ authenticated wishes to applicable 
family members, legal representatives, providers 
or health care proxies, including the use of 
email or other mail formats as well as access 
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