in an open and transparent manner and provide 
the opportunity for public comment on the ac-
tivities described in subparagraphs (B) and (C). 
(B) ESTABLISH STANDARDS FOR PATIENT 
DECISION AIDS.— 
(i) IN
GENERAL.—The entity shall 
synthesize evidence and convene a broad 
range of experts and key stakeholders to 
establish consensus-based standards, such 
as those developed by the International Pa-
tient Decision Aid Standard Collaboration, 
to determine which patient decision aids 
are high quality patient decision aids. 
(ii) DRAFT
OF
PROPOSED
STAND-
ARDS.—The entity shall make a draft of 
proposed standards available to the public. 
(iii) 60-DAY COMMENT PERIOD.—Be-
ginning on the date the entity makes a 
draft of the proposed standards available 
under clause (ii), the entity shall provide a 
60-day period for public comment on such 
draft. 
(iv) FINAL STANDARDS.— 
(I) IN GENERAL.—The standards 
established by the entity under this 
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subparagraph shall be adopted by the 
board of the entity. 
(II) PUBLIC AVAILABILITY.—The 
entity shall make such standards 
available to the public. 
(C) CERTIFY PATIENT DECISION AIDS.— 
The entity shall review patient decision aids 
and certify whether patient decision aids meet 
the standards established under subparagraph 
(B) and offer a balanced presentation of treat-
ment options from both the clinical and patient 
experience perspectives. In conducting such re-
view and certification, the entity shall give pri-
ority to the review and certification of patient 
decision aids for conditions identified in section 
5(g). 
(3) REPORT TO THE EXPERT PANEL.—The en-
tity shall submit to the expert panel established 
under subsection (b) a report on the standards es-
tablished for patient decision aids under paragraph 
(2)(B) and patient decision aids that are certified as 
meeting such standards under paragraph (2)(C). 
(4) 
REQUIREMENTS
DESCRIBED.—The 
fol-
lowing requirements are described in this paragraph: 
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(A) PRIVATE NONPROFIT.—The entity is a 
private nonprofit organization governed by a 
board. 
(B) EXPERIENCE.—The entity shall be 
able to demonstrate experience with— 
(i) consumer engagement; 
(ii) standard setting; 
(iii) health literacy; 
(iv) health care quality and safety 
issues; 
(v) certification processes; 
(vi) measure development; and 
(vii) evaluating health care quality. 
(C) MEMBERSHIP FEES.—If the entity re-
quires a membership fee for participation in the 
functions of the entity, such fees shall be rea-
sonable and adjusted based on the capacity of 
the potential member to pay the fee. In no case 
shall membership fees pose a barrier to the par-
ticipation of individuals or groups with low or 
nominal resources to participate in the func-
tions of the entity. 
(b) EXPERT PANEL.— 
(1) ESTABLISHMENT.—Not later than 120 days 
after the date of enactment of this Act, the Sec-
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retary shall establish an expert panel to make rec-
ommendations to the Secretary regarding which pa-
tient decision aids should be implemented, appro-
priate training for health care providers on patient 
decision aids and shared decision making, and ap-
propriate quality measures for use in the pilot pro-
gram under section 5 and under section 1899 of the 
Social Security Act, as added by section 6. 
(2) DUTIES.—The expert panel shall carry out 
the following duties: 
(A) Approve patient decision aids, from 
among those patient decision aids certified 
under paragraph (2)(C) of subsection (a) by the 
entity with a contract under such subsection, 
for use in the pilot program under section 5 
(including to the extent practicable, patient de-
cision aids for the medical care of the condi-
tions described in section 5(g) and under sec-
tion 1899 of the Social Security Act, as added 
by section 6. 
(B) Review current training curricula for 
health care providers on patient decision aids 
and shared decision making and recommend a 
training process for eligible providers partici-
pating in the pilot program under section 5 on 
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the use of such approved patient decision aids 
and shared decision making. 
(C) Review existing quality measures re-
garding patient knowledge, value concordance, 
and health outcomes that have been endorsed 
through a consensus-based process and rec-
ommend appropriate quality measures for selec-
tion under section 5(h)(1). 
(3) APPOINTMENT.—The expert panel shall be 
composed of 13 members appointed by the Secretary 
from among leading experts in shared decision mak-
ing of whom— 
(A) 2 shall be researchers; 
(B) 2 shall be primary care physicians; 
(C) 2 shall be from surgical specialties; 
(D) 2 shall be patient or consumer commu-
nity advocates; 
(E) 2 shall be nonphysician health care 
providers (such as nurses, nurse practitioners, 
and physician assistants); 
(F) 1 shall be from an integrated multispe-
cialty group practice; 
(G) 1 shall be from the National Cancer 
Institute; and 
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(H) 1 shall be from the Centers for Dis-
ease Control and Prevention. 
(4) REPORT.—Not later than 2 years after such 
date of enactment and each year thereafter until the 
date of the termination of the expert panel under 
paragraph (5), the expert panel shall submit to the 
Secretary a report on the patient decision aids ap-
proved under paragraph (2)(A), the training process 
recommended under paragraph (2)(B), the quality 
measures recommended under paragraph (2)(C), 
and recommendations on other conditions or medical 
care the Secretary may want to include in the pilot 
program under section 5. 
(5) TERMINATION.—The expert panel shall ter-
minate on such date as the Secretary determines ap-
propriate. 
(c) QUALITY MEASURE DEVELOPMENT.— 
(1) IN GENERAL.—Section 1890(b)(1)(A) of the 
Social Security Act (42 U.S.C. 1395aaa(b)(1)(A)) is 
amended— 
(A) in clause (ii), by striking ‘‘and’’ at the 
end; and 
(B) by adding at the end the following new 
clause: 
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‘‘(iv) that address conditions described 
in section 5(g) of the Empowering Medi-
care Patient Choices Act and regional 
practice variations under this title; and’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1890(d) of the Social Security Act (42 U.S.C. 
1395aaa(d)) is amended— 
(A) by inserting ‘‘(other than subsection 
(b)(1)(A)(iv))’’ after ‘‘this section’’; and 
(B) by adding at the end the following new 
sentence: ‘‘For provisions relating to funding 
for 
the 
duties 
described 
in 
subsection 
(b)(1)(A)(iv), see section 5(l) of the Empow-
ering Medicare Patient Choices Act.’’. 
SEC. 5. ESTABLISHMENT OF SHARED DECISION MAKING 
PILOT PROGRAM UNDER THE MEDICARE 
PROGRAM. 
(a) IN GENERAL.—Not later than 12 months after 
the date of enactment of this Act, the Secretary shall es-
tablish a pilot program to provide for the phased-in devel-
opment, implementation, and evaluation of shared decision 
making under the Medicare program using patient deci-
sion aids to meet the objective of improving the under-
standing by Medicare beneficiaries of their medical treat-
ment options, as compared to comparable Medicare bene-
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ficiaries who do not participate in a shared decision mak-
ing process using patient decision aids. 
(b) INITIAL IMPLEMENTATION (PHASE I).— 
(1) IN GENERAL.—During the initial implemen-
tation of the pilot program under this section (re-
ferred to in this section as ‘‘Phase I’’ of the pilot 
program), the Secretary shall enroll in the pilot pro-
gram not more than 15 eligible providers who have 
experience in implementing, and have invested in the 
necessary infrastructure to implement, shared deci-
sion making using patient decision aids for a period 
of 3 years. 
(2) APPLICATION.—An eligible provider seeking 
to participate in the pilot program during phase I 
shall submit to the Secretary an application at such 
time and containing such information as the Sec-
retary may require. 
(3) PREFERENCE.—In enrolling eligible pro-
viders in the pilot program during phase I, the Sec-
retary shall give preference to eligible providers 
that— 
(A) have documented experience in using 
patient decision aids for the conditions identi-
fied in subsection (g) and in using shared deci-
sion making; 
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(B) have the necessary information tech-
nology infrastructure to collect the information 
required by the Secretary for reporting pur-
poses; 
(C) are trained in how to use patient deci-
sion aids and shared decision making; and 
(D) would be eligible to receive financial 
assistance as a Shared Decision Making Re-
source Center under subsection (c). 
(c) SHARED DECISION MAKING RESOURCE CEN-
TERS.— 
(1) IN GENERAL.—The Secretary shall provide 
financial assistance for the establishment and sup-
port of Shared Decision Making Resource Centers 
(referred to in this section as ‘‘centers’’) to provide 
technical assistance to eligible providers and to de-
velop and disseminate best practices and other infor-
mation to support and accelerate adoption, imple-
mentation, and effective use of patient decision aids 
and shared decision making by eligible providers 
under the Medicare program. 
(2) AFFILIATION.—Centers shall be affiliated 
with a United States-based organization or group 
that applies for and is awarded financial assistance 
under this subsection. The Secretary shall provide fi-
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nancial assistance to centers under this subsection 
on the basis of merit. 
(3) OBJECTIVES.—The objective of a center is 
to enhance and promote the adoption of patient deci-
sion aids and shared decision making through— 
(A) providing assistance to eligible pro-
viders with the implementation and effective use 
of, and training on, patient decision aids; 
(B) the dissemination of best practices and 
research on the implementation and effective 
use of patient decision aids; and 
(C) providing assistance to eligible pro-
viders applying to participate or participating in 
phase II of the pilot program under this section 
or under section 1899 of the Social Security 
Act, as added by section 6. 
(4) REGIONAL ASSISTANCE.—Each center shall 
aim to provide assistance and education to all eligi-
ble providers in a region, including direct assistance 
to the following eligible providers: 
(A) Public or not-for-profit hospitals or 
critical access hospitals (as defined in section 
1861(mm)(1) of the Social Security Act (42 
U.S.C. 1395x(mm)(1)). 
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(B) Federally qualified health centers (as 
defined in section 1861(aa)(4) of the Social Se-
curity Act (42 U.S.C. 1395x(aa)(4)). 
(C) Entities that are located in a rural 
area or in an area that serves uninsured, under-
insured, and medically underserved individuals 
(regardless of whether such area is urban or 
rural). 
(D) Individual or small group practices (or 
a consortium thereof) that are primarily fo-
cused on primary care. 
(5) FINANCIAL ASSISTANCE.— 
(A) IN
GENERAL.—The Secretary may 
provide financial assistance for a period of 8 
years to any regional center established or sup-
ported under this subsection. 
(B) COST-SHARING REQUIREMENT.— 
(i) IN GENERAL.—Except as provided 
in clause (ii), the Secretary shall not pro-
vide as financial assistance under this sub-
section more than 50 percent of the capital 
and annual operating and maintenance 
funds required to establish and support 
such a center. 
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(ii) WAIVER
OF
COST-SHARING
RE-
QUIREMENT.—The Secretary may waive 
the limitation under clause (i) if the Sec-
retary determines that, as a result of na-
tional economic conditions, such limitation 
would be detrimental to the pilot program 
under this section. If the Secretary waives 
such limitation under the preceding sen-
tence, the Secretary shall submit to Con-
gress a report containing the Secretary’s 
justification for such waiver. 
(6) NOTICE
OF
PROGRAM
DESCRIPTION
AND 
AVAILABILITY OF FUNDS.—The Secretary shall pub-
lish in the Federal Register, not later than 12 
months after the date of the enactment of this Act, 
a draft description of a program for establishing and 
supporting regional centers under this subsection. 
Such draft description shall include the following: 
(A) A detailed explanation of the program 
and the program goals. 
(B) Procedures to be followed by appli-
cants for financial assistance. 
(C) Criteria for determining which appli-
cants are qualified to receive financial assist-
ance. 
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(D) Maximum support levels expected to 
be available to centers under the program. 
(7) APPLICATION REVIEW.—The Secretary shall 
review each application for financial assistance 
under this subsection based on merit. In making a 
decision whether to approve such application and 
provide financial assistance, the Secretary shall con-
sider at a minimum the merits of the application, in-
cluding those portions of the application regarding— 
(A) the ability of the applicant to provide 
assistance to particular categories of eligible 
providers with respect to the implementation 
and effective use of, and training on, patient 
decision aids; 
(B) the geographical diversity and extent 
of the service area of the applicant; and 
(C) the percentage of funding for the cen-
ter that would be provided as financial assist-
ance under this subsection and the amount of 
any funding or in-kind commitment from 
sources of funding in addition to the financial 
assistance provided under this subsection. 
(8) 
BIENNIAL
EVALUATION.—Each 
center 
which receives financial assistance under this sub-
section shall be evaluated biennially by an evaluation 
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panel appointed by the Secretary. Each such evalua-
tion panel shall be composed of private experts, none 
of whom shall be connected with the center involved, 
and officials of the Federal Government. Each eval-
uation panel shall measure the performance of the 
center involved against the objectives specified in 
paragraph (3). The Secretary shall not continue to 
provide financial assistance to a center under this 
subsection unless the most recent evaluation under 
this paragraph with respect to the center is overall 
positive. 
(d) EXPANDED IMPLEMENTATION (PHASE II).— 
(1) IN GENERAL.—Subject to paragraph (2), 
during the 3-year period beginning after the comple-
tion of phase I of the pilot program (referred to in 
this section as ‘‘phase II’’ of the pilot program), the 
Secretary shall enroll additional eligible providers to 
implement shared decision making using patient de-
cision aids under the pilot program under this sec-
tion. The Secretary may allow eligible providers to 
enroll in the pilot program on a regular basis during 
phase II. 
(2) CONTINGENCY.—The Secretary shall not 
implement phase II of the pilot program if the Sec-
retary finds, not later than 90 days after the date 
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of submittal of the interim report under subsection 
(i)(2)(A), that the continued implementation of 
shared decision making is not in the best interest of 
Medicare beneficiaries. 
(3) PREFERENCE.—In enrolling eligible pro-
viders in the pilot program during phase II, the Sec-
retary shall include, to the extent practicable, eligible 
providers that— 
(A) have or can acquire the infrastructure 
necessary to implement shared decision making 
supported by patient decision aids approved by 
the expert panel established under section 4(b) 
in a timely manner; or 
(B) have training in the use of patient de-
cision aids or will participate in training for 
health care professionals who will be involved in 
such use (as specified by the Secretary). 
(e) GUIDANCE.—The Secretary may, in consultation 
with the expert panel established under section 4(b), issue 
guidance to eligible providers participating in the pilot 
program under this section on the use of patient decision 
aids approved by the expert panel. 
(f) REQUIREMENTS.— 
(1) IMPLEMENTATION OF APPROVED PATIENT 
DECISION AIDS.— 
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(A) IN GENERAL.—During phase II of the 
pilot program under this section, an eligible 
provider participating in the pilot program shall 
incorporate 1 or more patient decision aids ap-
proved by the expert panel established under 
section 4(b) in furnishing items and services to 
Medicare beneficiaries with respect to 1 or more 
of the conditions identified in subsection (g), to-
gether with ongoing support involved in fur-
nishing such items and services. 
(B) DEFINED CLINICAL PROCESS.—During 
each phase of the pilot program under this sec-
tion, the eligible provider shall establish and im-
plement a defined clinical process under which, 
in the case of a Medicare beneficiary with 1 or 
more of such conditions, the eligible provider of-
fers the Medicare beneficiary shared decision 
making (supported by such a patient decision 
aid) and collects information on the quality of 
patient decision making with respect to the 
Medicare beneficiary. 
(2) FOLLOW-UP COUNSELING VISIT.— 
(A) IN GENERAL.—During each phase of 
the pilot program under this section, an eligible 
provider participating in the pilot program 
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under this section shall routinely schedule Medi-
care beneficiaries for a counseling visit after the 
viewing of such a patient decision aid to answer 
any questions the beneficiary may have with re-
spect to the medical care of the condition in-
volved and to assist the beneficiary in thinking 
through how their preferences and concerns re-
late to their medical care. 
(B) PAYMENT
FOR
FOLLOW-UP
COUN-
SELING
VISIT.—The Secretary shall establish 
procedures for making payments for such coun-
seling visits provided to Medicare beneficiaries 
during each phase of the pilot program under 
this section. Such procedures shall provide for 
the establishment— 
(i) of a code (or codes) to represent 
such services; and 
(ii) of a single payment amount for 
such service that includes the professional 
time of the health care provider and a por-
tion of the reasonable costs of the infra-
structure of the eligible provider. 
(C) LIMITATION.—In the case of an eligi-
ble provider that is a Medicare Advantage plan, 
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such eligible provider may not receive payment 
for such services. 
(3) WAIVER OF COINSURANCE.—The Secretary 
shall establish procedures under which an eligible 
provider participating in the pilot program under 
this section may, in the case of a low-income Medi-
care beneficiary (as determined by the Secretary), 
waive any coinsurance or copayment that would oth-
erwise apply for the follow-up counseling visit pro-
vided to such Medicare beneficiary under paragraph 
(2). 
(4) COSTS OF IMPLEMENTATION.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), during each phase of the pilot pro-
gram, an eligible provider participating in the 
pilot program shall be responsible for the costs 
of selecting, purchasing, and incorporating such 
patient decision aids into the group practice, re-
porting data on quality measures selected under 
subsection (h)(1), and recording outcomes 
under the pilot program. 
(B) FINANCIAL
SUPPORT.—During each 
such phase, the Secretary may, in addition to 
payments for counseling visits under paragraph 
(2), provide financial support to an eligible pro-
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vider participating in the pilot program to ac-
quire the infrastructure necessary to participate 
in the pilot program, including the development 
of clinical pathways to assure that Medicare 
beneficiaries have access to high-quality shared 
decision making, the reporting of data on qual-
ity measures selected under subsection (h)(1), 
and the recording of outcomes under the pilot 
program after phase I of the pilot program (as 
determined appropriate by the Secretary). 
(g) PREFERENCE SENSITIVE CARE DESCRIBED.— 
The patient decision aids approved under section 
4(b)(2)(A) shall, to the extent practicable, include patient 
decision aids for medical care of the following conditions: 
(1) Arthritis of the hip and knee. 
(2) Chronic back pain. 
(3) Chest pain (stable angina). 
(4) Enlarged prostate (benign prostatic hyper-
trophy, or BPH). 
(5) Early-stage prostate cancer. 
(6) Early-stage breast cancer. 
(7) End-of-life care. 
(8) Peripheral vascular disease. 
(9) Gall stones. 
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(10) Threat of stroke from carotid artery dis-
ease. 
(11) Any other condition the Secretary identi-
fies as appropriate. 
(h) QUALITY MEASURES.— 
(1) SELECTION.— 
(A) IN GENERAL.—During each phase of 
the pilot program, the Secretary shall measure 
the quality and implementation of shared deci-
sion making. For purposes of making such 
measurements, the Secretary shall select, from 
among those quality measures recommended by 
the expert panel under section 4(b)(2)(C), con-
sensus-based quality measures that assess 
Medicare beneficiaries’ knowledge of the options 
for medical treatment relevant to their medical 
condition, as well as the benefits and drawbacks 
of those medical treatment options, and the 
Medicare beneficiaries’ goals and concerns re-
garding their medical care. 
(B) RISK ADJUSTMENT.—In order to en-
sure accurate measurement across quality 
measures and eligible providers, the Secretary 
may risk adjust the quality measures selected 
under this paragraph to control for external 
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factors, such as cognitive impairment, demen-
tia, and literacy. 
(2) REPORTING DATA ON MEASURES.—During 
each such phase, an eligible provider participating in 
the pilot program shall report to the Secretary data 
on quality measures selected under paragraph (1) in 
accordance with procedures established by the Sec-
retary. 
(3) FEEDBACK
ON
MEASURES.—During each 
such phase, the Secretary shall provide confidential 
reports to eligible providers participating in the pilot 
program on the performance of the eligible provider 
on quality measures selected by the Secretary under 
paragraph (1), the aggregate performance of all eli-
gible providers participating in the pilot program, 
and any improvements in such performance. 
(i) EVALUATIONS AND REPORTS.— 
(1) INDEPENDENT
EVALUATION.—The Sec-
retary shall enter into a contract with an entity that 
has knowledge of shared decision making programs 
and demonstrated experience in the evaluation of 
such programs for the conduct of an independent 
evaluation of each phase of the pilot program under 
this section. 
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(2) REPORTS BY ENTITY CONDUCTING INDE-
PENDENT EVALUATION.— 
(A) INTERIM REPORT.—Not later than 2 
years after the implementation of phase I of the 
pilot program, the entity with a contract under 
paragraph (1) shall submit to the Secretary a 
report on the initial results of the independent 
evaluation conducted under such paragraph. 
(B) FINAL
REPORT.—Not later then 4 
years after the implementation of phase II of 
the pilot program, such entity shall submit to 
the Secretary a report on the final results of 
such independent evaluation. 
(C) CONTENTS OF REPORT.—Each report 
submitted under this paragraph shall— 
(i) include an assessment of— 
(I) quality measures selected 
under subsection (h)(1); 
(II) Medicare beneficiary and 
health care provider satisfaction under 
the applicable phase of the pilot pro-
gram; 
(III) utilization of medical serv-
ices for Medicare beneficiaries with 1 
or more of the conditions described in 
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subsection (g) and other Medicare 
beneficiaries as determined appro-
priate by the Secretary; 
(IV) appropriate utilization of 
shared decision making by eligible 
providers under the applicable phase 
of the pilot program; 
(V) savings to the Medicare pro-
gram under title XVIII of the Social 
Security Act; and 
(VI) the costs to eligible pro-
viders participating in the pilot pro-
gram of selecting, purchasing, and in-
corporating approved patient decision 
aids and meeting reporting require-
ments under the applicable phase of 
the pilot program; and 
(ii) identify the characteristics of indi-
vidual eligible providers that are most ef-
fective in implementing shared decision 
making under the applicable phase of the 
pilot program. 
(3) REPORT BY THE SECRETARY.—Not later 
than 12 months after the completion of phase II of 
the pilot program, the Secretary shall submit to 
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Congress a report on the pilot program that in-
cludes— 
(A) the results of the independent evalua-
tion conducted under paragraph (2); 
(B) an evaluation of the impact of the pilot 
program under this section, including the im-
pact— 
(i) of the use of patient decision aids 
approved by the expert panel established 
under section 4(b) for the medical care of 
the conditions described in subsection (g); 
(ii) on expenditures for such condi-
tions under the Medicare program, includ-
ing a comparison of such expenditures for 
such conditions where such patient deci-
sion aids were used to such expenditures 
for such conditions where such patient de-
cision aids were not used; and 
(iii) on Medicare beneficiaries, includ-
ing the understanding by beneficiaries of 
the options for medical care presented, 
concordance between beneficiary values 
and the medical care received, the mode of 
approved patient decision aid used (such as 
Internet, videos, and pamphlets), the tim-
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smartinez on PROD1PC64 with BILLS