speak for himself or herself and cannot express 
his or her wishes; and 
(B) that requires a physician to honor the 
provisions of upon receipt or to transfer the 
care of the individual covered by the document 
to another physician that will honor such provi-
sions. 
(7) MEDICAID.—The term ‘‘Medicaid’’ means 
the program established under title XIX of the So-
cial Security Act (42 U.S.C. 1396 et seq.). 
(8) MEDICARE.—The term ‘‘Medicare’’ means 
the program established under title XVIII of the So-
cial Security Act (42 U.S.C. 1395 et seq.). 
(9) ORDERS
FOR
LIFE-SUSTAINING
TREAT-
MENT.—The term ‘‘orders for life-sustaining treat-
ment’’ means a process for focusing a patients’ val-
ues, goals, and preferences on current medical cir-
cumstances and to translate such into visible and 
portable medical orders applicable across care set-
tings, including home, long-term care, emergency 
medical services, and hospitals. 
(10) PALLIATIVE CARE.—The term ‘‘palliative 
care’’ means interdisciplinary care for individuals 
with a life-threatening illness or injury relating to 
pain and symptom management and psychological, 
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social, and spiritual needs and that seeks to improve 
the quality of life for the individual and the individ-
ual’s family. 
(11) 
SECRETARY.—The 
term 
‘‘Secretary’’ 
means the Secretary of Health and Human Services. 
TITLE I—ADVANCE CARE 
PLANNING 
Subtitle A—Consumer and 
Provider Education 
PART I—CONSUMER EDUCATION 
Subpart A—National Initiatives 
SEC. 101. ADVANCE CARE PLANNING TELEPHONE HOTLINE. 
(a) IN GENERAL.—Not later than January 1, 2011, 
the Secretary, acting through the Director of the Centers 
for Disease Control and Prevention, shall establish and op-
erate directly, or by grant, contract, or interagency agree-
ment, a 24-hour toll-free telephone hotline to provide con-
sumer information regarding advance care planning, in-
cluding— 
(1) an explanation of advanced care planning 
and its importance; 
(2) issues to be considered when developing an 
individual’s advance care plan; 
(3) how to establish an advance directive; 
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(4) procedures to help ensure that an individ-
ual’s directives for end-of-life care are followed; 
(5) Federal and State-specific resources for as-
sistance with advance care planning; and 
(6) hospice and palliative care (including their 
respective purposes and services). 
(b) ESTABLISHMENT.—In carrying out the require-
ments under subsection (a), the Director of the Centers 
for Disease Control and Prevention may designate an ex-
isting 24-hour toll-free telephone hotline or, if no such 
service is available or appropriate, establish a new 24-hour 
toll-free telephone hotline. 
SEC. 102. ADVANCE CARE PLANNING INFORMATION CLEAR-
INGHOUSES. 
(a) EXPANSION OF NATIONAL CLEARINGHOUSE FOR 
LONG-TERM CARE INFORMATION.— 
(1) DEVELOPMENT.—Not later than January 1, 
2010, the Secretary shall develop an online clearing-
house to provide comprehensive information regard-
ing advance care planning. 
(2) MAINTENANCE.—The advance care plan-
ning clearinghouse, which shall be clearly identifiable 
and available on the homepage of the Department of 
Health and Human Service’s National Clearinghouse 
for Long-Term Care Information website, shall be 
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maintained and publicized by the Secretary on an 
ongoing basis. 
(3) CONTENT.—The advance care planning 
clearinghouse shall include— 
(A) any relevant content contained in the 
national public education campaign required 
under section 104; 
(B) content addressing— 
(i) an explanation of advanced care 
planning and its importance; 
(ii) issues to be considered when de-
veloping an individual’s advance care plan; 
(iii) how to establish an advance di-
rective; 
(iv) procedures to help ensure that an 
individual’s directives for end-of-life care 
are followed; and 
(v) hospice and palliative care (includ-
ing their respective purposes and services); 
(C) available Federal and State-specific re-
sources for assistance with advance care plan-
ning, including— 
(i) contact information for any State 
public health departments that are respon-
sible for issues regarding end-of-life care; 
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(ii) contact information for relevant 
legal service organizations, including those 
funded under the Older Americans Act of 
1965 (42 U.S.C. 3001 et seq.); and 
(iii) advance directive forms for each 
State; and 
(D) any additional information, as deter-
mined by the Secretary. 
(b) ESTABLISHMENT OF PEDIATRIC ADVANCE CARE 
PLANNING CLEARINGHOUSE.— 
(1) DEVELOPMENT.—Not later than January 1, 
2011, the Secretary, in consultation with the Assist-
ant Secretary for Children and Families of the De-
partment of Health and Human Services, shall de-
velop an online clearinghouse to provide comprehen-
sive information regarding pediatric advance care 
planning. 
(2) MAINTENANCE.—The pediatric advance 
care planning clearinghouse, which shall be clearly 
identifiable on the homepage of the Administration 
for Children and Families website, shall be main-
tained and publicized by the Secretary on an ongo-
ing basis. 
(3) CONTENT.—The pediatric advance care 
planning clearinghouse shall provide advance care 
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planning information specific to children with life- 
threatening illnesses or injuries and their families. 
SEC. 103. ADVANCE CARE PLANNING TOOLKIT. 
(a) DEVELOPMENT.—Not later than July 1, 2010, 
the Secretary, in consultation with the Director of the 
Centers for Disease Control and Prevention, shall develop 
an online advance care planning toolkit. 
(b) MAINTENANCE.—The advance care planning tool-
kit, which shall be available in English, Spanish, and any 
other languages that the Secretary deems appropriate, 
shall be maintained and publicized by the Secretary on an 
ongoing basis and made available on the following 
websites: 
(1) The Centers for Disease Control and Pre-
vention. 
(2) The Department of Health and Human 
Service’s National Clearinghouse for Long-Term 
Care Information. 
(3) The Administration for Children and Fami-
lies. 
(c) CONTENT.—The advance care planning toolkit 
shall include content addressing— 
(1) common issues and questions regarding ad-
vance care planning, including individuals and re-
sources to contact for further inquiries; 
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(2) advance directives and their uses, including 
living wills and durable powers of attorney; 
(3) the roles and responsibilities of a health 
care proxy; 
(4) Federal and State-specific resources to as-
sist individuals and their families with advance care 
planning, including— 
(A) the advance care planning toll-free 
telephone hotline established under section 101; 
(B) the advance care planning clearing-
houses established under section 102; 
(C) the advance care planning toolkit es-
tablished under this section; 
(D) available State legal service organiza-
tions to assist individuals with advance care 
planning, including those organizations that re-
ceive funding pursuant to the Older Americans 
Act of 1965 (42 U.S.C. 3001 et seq.); and 
(E) website links or addresses for State- 
specific advance directive forms; and 
(5) any additional information, as determined 
by the Secretary. 
SEC. 104. NATIONAL PUBLIC EDUCATION CAMPAIGN. 
(a) NATIONAL PUBLIC EDUCATION CAMPAIGN.— 
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(1) IN GENERAL.—Not later than January 1, 
2011, the Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, 
shall, directly or through grants, contracts, or inter-
agency agreements, develop and implement a na-
tional campaign to inform the public of the impor-
tance of advance care planning and of an individ-
ual’s right to direct and participate in their health 
care decisions. 
(2) CONTENT OF EDUCATIONAL CAMPAIGN.— 
The national public education campaign established 
under paragraph (1) shall— 
(A) employ the use of various media, in-
cluding regularly televised public service an-
nouncements; 
(B) provide culturally and linguistically ap-
propriate information; 
(C) be conducted continuously over a pe-
riod of not less than 5 years; 
(D) identify and promote the advance care 
planning information available on the Depart-
ment of Health and Human Service’s National 
Clearinghouse for Long-Term Care Information 
website and Administration for Children and 
Families website, as well as any other relevant 
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Federal or State-specific advance care planning 
resources; 
(E) raise public awareness of the con-
sequences that may result if an individual is no 
longer able to express or communicate their 
health care decisions; 
(F) address the importance of individuals 
speaking to family members, health care prox-
ies, and health care providers as part of an on-
going dialogue regarding their health care 
choices; 
(G) address the need for individuals to ob-
tain readily available legal documents that ex-
press their health care decisions through ad-
vance directives (including living wills, comfort 
care orders, and durable powers of attorney for 
health care); 
(H) raise public awareness regarding the 
availability of hospice and palliative care; and 
(I) encourage individuals to speak with 
their physicians about their options and inten-
tions for end-of-life care. 
(3) EVALUATION.— 
(A) IN GENERAL.—Not later than July 1, 
2013, the Secretary, acting through the Direc-
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tor of the Centers for Disease Control and Pre-
vention, shall conduct a nationwide survey to 
evaluate whether the national campaign con-
ducted under this subsection has achieved its 
goal of changing public awareness, attitudes, 
and behaviors regarding advance care planning. 
(B) BASELINE
SURVEY.—In order to 
evaluate the effectiveness of the national cam-
paign, the Secretary shall conduct a baseline 
survey prior to implementation of the campaign. 
(C) REPORTING REQUIREMENT.—Not later 
than December 31, 2013, the Secretary shall 
report the findings of such survey, as well as 
any recommendations that the Secretary deter-
mines appropriate regarding the need for con-
tinuation 
or 
legislative 
or 
administrative 
changes to facilitate changing public awareness, 
attitudes, and behaviors regarding advance care 
planning, to the appropriate committees of the 
Congress. 
(b) REPEAL.—Section 4751(d) of the Omnibus 
Budget Reconciliation Act of 1990 (42 U.S.C. 1396a note; 
Public Law 101–508) is repealed. 
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SEC. 105. UPDATE OF MEDICARE AND SOCIAL SECURITY 
HANDBOOKS. 
(a) MEDICARE & YOU HANDBOOK.— 
(1) IN GENERAL.—Not later than 60 days after 
the date of enactment of this Act, the Secretary 
shall update the online version of the ‘‘Planning 
Ahead’’ section of the Medicare & You Handbook to 
include— 
(A) an explanation of advance care plan-
ning and advance directives, including— 
(i) living wills; 
(ii) health care proxies; and 
(iii) after-death directives; 
(B) Federal and State-specific resources to 
assist individuals and their families with ad-
vance care planning, including— 
(i) the advance care planning toll-free 
telephone hotline established under section 
101; 
(ii) the advance care planning clear-
inghouses established under section 102; 
(iii) the advance care planning toolkit 
established under section 103; 
(iv) available State legal service orga-
nizations to assist individuals with advance 
care planning, including those organiza-
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tions that receive funding pursuant to the 
Older Americans Act of 1965 (42 U.S.C. 
3001 et seq.); and 
(v) website links or addresses for 
State-specific advance directive forms; and 
(C) any additional information, as deter-
mined by the Secretary. 
(2) UPDATE
OF
PAPER
AND
SUBSEQUENT 
VERSIONS.—The Secretary shall include the infor-
mation described in paragraph (1) in all paper and 
electronic versions of the Medicare & You Handbook 
that are published on or after the date that is 60 
days after the date of enactment of this Act. 
(b) SOCIAL SECURITY HANDBOOK.—The Commis-
sioner of Social Security shall— 
(1) not later than 60 days after the date of en-
actment of this Act, update the online version of the 
Social Security Handbook for beneficiaries to include 
the information described in subsection (a)(1); and 
(2) include such information in all paper and 
online versions of such handbook that are published 
on or after the date that is 60 days after the date 
of enactment of this Act. 
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SEC. 106. AUTHORIZATION OF APPROPRIATIONS. 
There is authorized to be appropriated for the period 
of fiscal years 2010 through 2014— 
(1) $195,000,000 to the Secretary to carry out 
sections 101, 102, 103, 104 and 105(a); and 
(2) $5,000,000 to the Commissioner of Social 
Security to carry out section 105(b). 
Subpart B—State and Local Initiatives 
SEC. 111. FINANCIAL ASSISTANCE FOR ADVANCE CARE 
PLANNING. 
(a) LEGAL ASSISTANCE FOR ADVANCE CARE PLAN-
NING.— 
(1) 
DEFINITION
OF
RECIPIENT.—Section 
1002(6) of the Legal Services Corporation Act (42 
U.S.C. 2996a(6)) is amended by striking ‘‘clause (A) 
of’’ and inserting ‘‘subparagraph (A) or (B) of’’. 
(2) ADVANCE CARE PLANNING.—Section 1006 
of the Legal Services Corporation Act (42 U.S.C. 
2996e) is amended— 
(A) in subsection (a)(1)— 
(i) by striking ‘‘title, and (B) to 
make’’ and inserting the following: ‘‘title; 
‘‘(C) to make’’; and 
(ii) by inserting after subparagraph 
(A) the following: 
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‘‘(B) to provide financial assistance, and make 
grants and contracts, as described in subparagraph 
(A), on a competitive basis for the purpose of pro-
viding legal assistance in the form of advance care 
planning (as defined in section 3 of the Advance 
Planning and Compassionate Care Act of 2009, and 
including providing information about State-specific 
advance directives, as defined in that section) for eli-
gible clients under this title, including providing 
such planning to the family members of eligible cli-
ents and persons with power of attorney to make 
health care decisions for the clients; and’’; and 
(B) in subsection (b), by adding at the end 
the following: 
‘‘(2) Advance care planning provided in accordance 
with subsection (a)(1)(B) shall not be construed to violate 
the Assisted Suicide Funding Restriction Act of 1997 (42 
U.S.C. 14401 et seq.).’’. 
(3) REPORTS.—Section 1008(a) of the Legal 
Services Corporation Act (42 U.S.C. 2996g(a)) is 
amended by adding at the end the following: ‘‘The 
Corporation shall require such a report, on an an-
nual basis, from each grantee, contractor, or other 
recipient of financial assistance under section 
1006(a)(1)(B).’’. 
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(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
Section 1010 of the Legal Services Corporation Act 
(42 U.S.C. 2996i) is amended— 
(A) in subsection (a)— 
(i) by striking ‘‘(a)’’ and inserting 
‘‘(a)(1)’’; 
(ii) in the last sentence, by striking 
‘‘Appropriations for that purpose’’ and in-
serting the following: 
‘‘(3) Appropriations for a purpose described in para-
graph (1) or (2)’’; and 
(iii) by inserting before paragraph (3) 
(as designated by clause (ii)) the following: 
‘‘(2) There are authorized to be appropriated to carry 
out section 1006(a)(1)(B), $10,000,000 for each of fiscal 
years 2010, 2011, 2012, 2013, and 2014.’’; and 
(B) in subsection (d), by striking ‘‘sub-
section (a)’’ and inserting ‘‘subsection (a)(1)’’. 
(5) EFFECTIVE DATE.—This subsection and the 
amendments made by this subsection take effect 
July 1, 2010. 
(b) STATE HEALTH INSURANCE ASSISTANCE PRO-
GRAMS.— 
(1) IN
GENERAL.—The Secretary shall use 
amounts made available under paragraph (3) to 
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award grants to States for State health insurance 
assistance programs receiving assistance under sec-
tion 4360 of the Omnibus Budget Reconciliation Act 
of 1990 to provide advance care planning services to 
Medicare beneficiaries, personal representatives of 
such beneficiaries, and the families of such bene-
ficiaries. Such services shall include information re-
garding State-specific advance directives and ways to 
discuss individual care wishes with health care pro-
viders. 
(2) REQUIREMENTS.— 
(A) AWARD
OF
GRANTS.—In making 
grants under this subsection for a fiscal year, 
the Secretary shall satisfy the following require-
ments: 
(i) Two-thirds of the total amount of 
funds available under paragraph (3) for a 
fiscal year shall be allocated among those 
States approved for a grant under this sec-
tion that have adopted the Uniform 
Health-Care Decisions Act drafted by the 
National Conference of Commissioners on 
Uniform State Laws and approved and 
recommended for enactment by all States 
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at the annual conference of such commis-
sioners in 1993. 
(ii) One-third of the total amount of 
funds available under paragraph (3) for a 
fiscal year shall be allocated among those 
States approved for a grant under this sec-
tion that have adopted a uniform form for 
orders regarding life sustaining treatment 
as defined in section 1861(hhh)(5) of the 
Social Security Act (as amended by section 
211 of this Act) or a comparable approach 
to advance care planning. 
(B) WORK PLAN; REPORT.—As a condition 
of being awarded a grant under this subsection, 
a State shall submit the following to the Sec-
retary: 
(i) An approved plan for expending 
grant funds. 
(ii) For each fiscal year for which the 
State is paid grant funds under this sub-
section, an annual report regarding the use 
of the funds, including the number of 
Medicare beneficiaries served and their sat-
isfaction with the services provided. 
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(C) LIMITATION.—No State shall be paid 
funds from a grant made under this subsection 
prior to July 1, 2010. 
(3) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to the Sec-
retary to the Centers for Medicare & Medicaid Serv-
ices Program Management Account, $12,000,000 for 
each of fiscal years 2010 through 2014 for purposes 
of awarding grants to States under paragraph (1). 
(c) MEDICAID TRANSFORMATION GRANTS FOR AD-
VANCE CARE PLANNING.—Section 1903(z) of the Social 
Security Act (42 U.S.C. 1396b(z)) is amended— 
(1) in paragraph (2), by adding at the end the 
following new subparagraph: 
‘‘(G) Methods for improving the effective-
ness and efficiency of medical assistance pro-
vided under this title by making available to in-
dividuals enrolled in the State plan or under a 
waiver of such plan information regarding ad-
vance care planning (as defined in section 3 of 
the Advance Planning and Compassionate Care 
Act of 2009), including at time of enrollment or 
renewal of enrollment in the plan or waiver, 
through providers, and through such other in-
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novative means as the State determines appro-
priate.’’; 
(2) in paragraph (3), by adding at the end the 
following new subparagraph: 
‘‘(D) WORK PLAN REQUIRED FOR AWARD 
OF ADVANCE CARE PLANNING GRANTS.—Pay-
ment to a State under this subsection to adopt 
the innovative methods described in paragraph 
(2)(G) is conditioned on the State submitting to 
the Secretary an approved plan for expending 
the funds awarded to the State under this sub-
section.’’; and 
(3) in paragraph (4)— 
(A) in subparagraph (A)— 
(i) in clause (i), by striking ‘‘and’’ at 
the end; 
(ii) in clause (ii), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(iii) by inserting after clause (ii), the 
following new clause: 
‘‘(iii) $20,000,000 for each of fiscal 
years 2010 through 2014.’’; and 
(B) by striking subparagraph (B), and in-
serting the following: 
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‘‘(B) ALLOCATION OF FUNDS.—The Sec-
retary shall specify a method for allocating the 
funds made available under this subsection 
among States awarded a grant for fiscal year 
2010, 2011, 2012, 2013, or 2014. Such method 
shall provide that— 
‘‘(i) 100 percent of such funds for 
each of fiscal years 2010 through 2014 
shall be awarded to States that design pro-
grams to adopt the innovative methods de-
scribed in paragraph (2)(G); and 
‘‘(ii) in no event shall a payment to a 
State awarded a grant under this sub-
section for fiscal year 2010 be made prior 
to July 1, 2010.’’. 
(d) ADVANCE CARE PLANNING COMMUNITY TRAIN-
ING GRANTS.— 
(1) IN
GENERAL.—The Secretary shall use 
amounts made available under paragraph (3) to 
award grants to area agencies on aging (as defined 
in section 102 of the Older Americans Act of 1965 
(42 U.S.C. 3002)). 
(2) REQUIREMENTS.— 
(A) USE OF FUNDS.—Funds awarded to 
an area agency on aging under this subsection 
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shall be used to provide advance care planning 
education and training opportunities for local 
aging service providers and organizations. 
(B) WORK PLAN; REPORT.—As a condition 
of being awarded a grant under this subsection, 
an area agency on aging shall submit the fol-
lowing to the Secretary: 
(i) An approved plan for expending 
grant funds. 
(ii) For each fiscal year for which the 
agency is paid grant funds under this sub-
section, an annual report regarding the use 
of the funds, including the number of 
Medicare beneficiaries served and their sat-
isfaction with the services provided. 
(C) LIMITATION.—No area agency on 
aging shall be paid funds from a grant made 
under this subsection prior to July 1, 2010. 
(3) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to the Sec-
retary to the Centers for Medicare & Medicaid Serv-
ices Program Management Account, $12,000,000 for 
each of fiscal years 2010 through 2014 for purposes 
of awarding grants to area agencies on aging under 
paragraph (1). 
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(e) NONDUPLICATION
OF ACTIVITIES.—The Sec-
retary shall establish procedures to ensure that funds 
made available under grants awarded under this section 
or pursuant to amendments made by this section supple-
ment, not supplant, existing Federal funding, and that 
such funds are not used to duplicate activities carried out 
under such grants or under other federally funded pro-
grams. 
SEC. 112. GRANTS FOR PROGRAMS FOR ORDERS REGARD-
ING LIFE SUSTAINING TREATMENT. 
(a) IN GENERAL.—The Secretary shall make grants 
to eligible entities for the purpose of— 
(1) establishing new programs for orders re-
garding life sustaining treatment in States or local-
ities; 
(2) expanding or enhancing an existing pro-
gram for orders regarding life sustaining treatment 
in States or localities; or 
(3) providing a clearinghouse of information on 
programs for orders for life sustaining treatment 
and consultative services for the development or en-
hancement of such programs. 
(b) AUTHORIZED
ACTIVITIES.—Activities funded 
through a grant under this section for an area may in-
clude— 
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(1) developing such a program for the area that 
includes home care, hospice, long-term care, commu-
nity and assisted living residences, skilled nursing 
facilities, inpatient rehabilitation facilities, hospitals, 
and emergency medical services within the area; 
(2) securing consultative services and advice 
from institutions with experience in developing and 
managing such programs; and 
(3) expanding an existing program for orders 
regarding life sustaining treatment to serve more pa-
tients or enhance the quality of services, including 
educational services for patients and patients’ fami-
lies or training of health care professionals. 
(c) DISTRIBUTION OF FUNDS.—In funding grants 
under this section, the Secretary shall ensure that, of the 
funds appropriated to carry out this section for each fiscal 
year— 
(1) at least two-thirds are used for establishing 
or developing new programs for orders regarding life 
sustaining treatment; and 
(2) one-third is used for expanding or enhanc-
ing existing programs for orders regarding life sus-
taining treatment. 
(d) DEFINITIONS.—In this section: 
(1) The term ‘‘eligible entity’’ includes— 
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(A) an academic medical center, a medical 
school, a State health department, a State med-
ical association, a multi-State taskforce, a hos-
pital, or a health system capable of admin-
istering a program for orders regarding life sus-
taining treatment for a State or locality; or 
(B) any other health care agency or entity 
as the Secretary determines appropriate. 
(2) The term ‘‘order regarding life sustaining 
treatment’’ has the meaning given such term in sec-
tion 1861(hhh)(5) of the Social Security Act, as 
added by section 211. 
(3) The term ‘‘program for orders regarding 
life sustaining treatment’’ means, with respect to an 
area, a program that supports the active use of or-
ders regarding life sustaining treatment in the area. 
(e) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for each of the fiscal years 
2009 through 2014. 
PART II—PROVIDER EDUCATION 
SEC. 121. PUBLIC PROVIDER ADVANCE CARE PLANNING 
WEBSITE. 
(a) DEVELOPMENT.—Not later than January 1, 
2010, the Secretary, acting through the Administrator of 
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the Centers for Medicare & Medicaid Services and the Di-
rector of the Agency for Healthcare Research and Quality, 
shall establish a website for providers under Medicare, 
Medicaid, the Children’s Health Insurance Program, the 
Indian Health Service (include contract providers) and 
other public health providers on each individual’s right to 
make decisions concerning medical care, including the 
right to accept or refuse medical or surgical treatment, 
and the existence of advance directives. 
(b) MAINTENANCE.—The website, shall be main-
tained and publicized by the Secretary on an ongoing 
basis. 
(c) CONTENT.—The website shall include content, 
tools, and resources necessary to do the following: 
(1) Inform providers about the advance direc-
tive requirements under the health care programs 
described in subsection (a) and other State and Fed-
eral laws and regulations related to advance care 
planning. 
(2) Educate providers about advance care plan-
ning quality improvement activities. 
(3) Provide assistance to providers to— 
(A) integrate advance directives into elec-
tronic health records, including oral directives; 
and 
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(B) develop and disseminate advance care 
planning informational materials for their pa-
tients. 
(4) Inform providers about advance care plan-
ning continuing education requirements and oppor-
tunities. 
(5) Encourage providers to discuss advance 
care planning with their patients of all ages. 
(6) Assist providers’ understanding of the con-
tinuum of end-of-life care services and supports 
available to patients, including palliative care and 
hospice. 
(7) Inform providers of best practices for dis-
cussing end-of-life care with dying patients and their 
loved ones. 
SEC. 122. CONTINUING EDUCATION FOR PHYSICIANS AND 
NURSES. 
(a) IN GENERAL.—Not later than January 1, 2012, 
the Secretary, acting through the Director of Health Re-
sources and Services Administration, shall develop, in con-
sultation with health care providers and State boards of 
medicine and nursing, a curriculum for continuing edu-
cation that States may adopt for physicians and nurses 
on advance care planning and end-of-life care. 
(b) CONTENT.— 
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(1) IN
GENERAL.—The continuing education 
curriculum developed under subsection (a) for physi-
cians and nurses shall, at a minimum, include— 
(A) a description of the meaning and im-
portance of advance care planning; 
(B) a description of advance directives, in-
cluding living wills and durable powers of attor-
ney, and the use of such directives; 
(C) palliative care principles and ap-
proaches to care; and 
(D) the continuum of end-of-life services 
and supports, including palliative care and hos-
pice. 
(2) ADDITIONAL CONTENT FOR PHYSICIANS.— 
The continuing education curriculum for physicians 
developed under subsection (a) shall include instruc-
tion on how to conduct advance care planning with 
patients and their loved ones. 
Subtitle B—Portability of Advance 
Directives; Health Information 
Technology 
SEC. 131. PORTABILITY OF ADVANCE DIRECTIVES. 
(a) MEDICARE.—Section 1866(f) of the Social Secu-
rity Act (42 U.S.C. 1395cc(f)) is amended— 
(1) in paragraph (1)— 
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(A) in subparagraph (B), by inserting 
‘‘and if presented by the individual, to include 
the content of such advance directive in a 
prominent part of such record’’ before the semi-
colon at the end; 
(B) in subparagraph (D), by striking 
‘‘and’’ after the semicolon at the end; 
(C) in subparagraph (E), by striking the 
period at the end and inserting ‘‘; and’’; and 
(D) by inserting after subparagraph (E) 
the following new subparagraph: 
‘‘(F) to provide each individual with the oppor-
tunity to discuss issues relating to the information 
provided to that individual pursuant to subpara-
graph (A) with an appropriately trained profes-
sional.’’; 
(2) in paragraph (3), by striking ‘‘a written’’ 
and inserting ‘‘an’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(5)(A) An advance directive validly executed outside 
of the State in which such advance directive is presented 
by an adult individual to a provider of services, a Medicare 
Advantage organization, or a prepaid or eligible organiza-
tion shall be given the same effect by that provider or or-
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ganization as an advance directive validly executed under 
the law of the State in which it is presented would be given 
effect. 
‘‘(B)(i) The definition of an advanced directive shall 
also include actual knowledge of instructions made while 
an individual was able to express the wishes of such indi-
vidual with regard to health care. 
‘‘(ii) For purposes of clause (i), the term ‘actual 
knowledge’ means the possession of information of an indi-
vidual’s wishes communicated to the health care provider 
orally or in writing by the individual, the individual’s med-
ical power of attorney representative, the individual’s 
health care surrogate, or other individuals resulting in the 
health care provider’s personal cognizance of these wishes. 
Other forms of imputed knowledge are not actual knowl-
edge. 
‘‘(C) The provisions of this paragraph shall preempt 
any State law to the extent such law is inconsistent with 
such provisions. The provisions of this paragraph shall not 
preempt any State law that provides for greater port-
ability, more deference to a patient’s wishes, or more lati-
tude in determining a patient’s wishes.’’. 
(b) MEDICAID.—Section 1902(w) of the Social Secu-
rity Act (42 U.S.C. 1396a(w)) is amended— 
(1) in paragraph (1)— 
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‘‘(6)(A) An advance directive validly executed outside 
of the State in which such advance directive is presented 
by an adult individual to a provider or organization shall 
be given the same effect by that provider or organization 
as an advance directive validly executed under the law of 
the State in which it is presented would be given effect. 
‘‘(B)(i) The definition of an advance directive shall 
also include actual knowledge of instructions made while 
an individual was able to express the wishes of such indi-
vidual with regard to health care. 
‘‘(ii) For purposes of clause (i), the term ‘actual 
knowledge’ means the possession of information of an indi-
vidual’s wishes communicated to the health care provider 
orally or in writing by the individual, the individual’s med-
ical power of attorney representative, the individual’s 
health care surrogate, or other individuals resulting in the 
health care provider’s personal cognizance of these wishes. 
Other forms of imputed knowledge are not actual knowl-
edge. 
‘‘(C) The provisions of this paragraph shall preempt 
any State law to the extent such law is inconsistent with 
such provisions. The provisions of this paragraph shall not 
preempt any State law that provides for greater port-
ability, more deference to a patient’s wishes, or more lati-
tude in determining a patient’s wishes.’’. 
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(c) CHIP.—Section 2107(e)(1) of the Social Security 
Act (42 U.S.C. 1397gg(e)(1)) is amended— 
(1) 
by 
redesignating 
subparagraphs 
(E) 
through (L) as subparagraphs (D) through (M), re-
spectively; and 
(2) by inserting after subparagraph (D) the fol-
lowing: 
‘‘(E) Section 1902(w) (relating to advance 
directives).’’. 
(d) STUDY AND REPORT REGARDING IMPLEMENTA-
TION.— 
(1) STUDY.—The Secretary shall conduct a 
study regarding the implementation of the amend-
ments made by subsections (a) and (b). 
(2) REPORT.—Not later than 18 months after 
the date of enactment of this Act, the Secretary 
shall submit to Congress a report on the study con-
ducted under paragraph (1), together with rec-
ommendations for such legislation and administra-
tive actions as the Secretary considers appropriate. 
(e) EFFECTIVE DATES.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by subsections (a), (b), and 
(c) shall apply to provider agreements and contracts 
entered into, renewed, or extended under title XVIII 
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of the Social Security Act (42 U.S.C. 1395 et seq.), 
and to State plans under title XIX of such Act (42 
U.S.C. 1396 et seq.) and State child health plans 
under title XXI of such Act (42 U.S.C. 1397aa et 
seq.), on or after such date as the Secretary speci-
fies, but in no case may such date be later than 1 
year after the date of enactment of this Act. 
(2) EXTENSION
OF
EFFECTIVE
DATE
FOR 
STATE LAW AMENDMENT.—In the case of a State 
plan under title XIX of the Social Security Act or 
a State child health plan under title XXI of such 
Act which the Secretary determines requires State 
legislation in order for the plan to meet the addi-
tional requirements imposed by the amendments 
made by subsections (b) and (c), the State plan shall 
not be regarded as failing to comply with the re-
quirements of such title solely on the basis of its 
failure to meet these additional requirements before 
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 enact-
ment of this Act. For purposes of the previous sen-
tence, in the case of a State that has a 2-year legis-
lative session, each year of the session is considered 
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to be a separate regular session of the State legisla-
ture. 
SEC. 132. STATE ADVANCE DIRECTIVE REGISTRIES; DRIV-
ER’S LICENSE ADVANCE DIRECTIVE NOTA-
TION. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g) is amended— 
(1) by redesignating section 399R (as inserted 
by section 2 of Public Law 110–373) as section 
399S; 
(2) by redesignating section 399R (as inserted 
by section 3 of Public Law 110–374) as section 
399T; and 
(3) by adding at the end the following: 
‘‘SEC. 399U. STATE ADVANCE DIRECTIVE REGISTRIES. 
‘‘(a) STATE ADVANCE DIRECTIVE REGISTRY.—In 
this section, the term ‘State advance directive registry’ 
means a secure, electronic database that— 
‘‘(1) is available free of charge to residents of 
a State; and 
‘‘(2) stores advance directive documents and 
makes such documents accessible to medical service 
providers in accordance with Federal and State pri-
vacy laws. 
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‘‘(b) GRANT PROGRAM.—Beginning on July 1, 2010, 
the Secretary, acting through the Director of the Centers 
for Disease Control and Prevention, shall award grants 
on a competitive basis to eligible entities to establish and 
operate, directly or indirectly (by competitive grant or 
competitive contract), State advance directive registries. 
‘‘(c) ELIGIBLE ENTITIES.— 
‘‘(1) IN GENERAL.—To be eligible to receive a 
grant under this section, an entity shall— 
‘‘(A) be a State department of health; and 
‘‘(B) submit to the Director an application 
at such time, in such manner, and containing— 
‘‘(i) a plan for the establishment and 
operation of a State advance directive reg-
istry; and 
‘‘(ii) such other information as the Di-
rector may require. 
‘‘(2) NO REQUIREMENT OF NOTATION MECHA-
NISM.—The Secretary shall not require that an enti-
ty establish and operate a driver’s license advance 
directive notation mechanism for State residents 
under section 399V to be eligible to receive a grant 
under this section. 
‘‘(d) ANNUAL REPORT.—For each year for which an 
entity receives an award under this section, such entity 
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shall submit an annual report to the Director on the use 
of the funds received pursuant to such award, including 
the number of State residents served through the registry. 
‘‘(e) AUTHORIZATION.—There is authorized to be ap-
propriated to carry out this section $20,000,000 for fiscal 
year 2010 and each fiscal year thereafter. 
‘‘SEC. 399V. DRIVER’S LICENSE ADVANCE DIRECTIVE NOTA-
TION. 
‘‘(a) IN GENERAL.—Beginning July 1, 2010, the Sec-
retary, acting through the Director of the Centers for Dis-
ease Control and Prevention, shall award grants on a com-
petitive basis to States to establish and operate a mecha-
nism for a State resident with a driver’s license to include 
a notice of the existence of an advance directive for such 
resident on such license. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under this section, a State shall— 
‘‘(1) establish and operate a State advance di-
rective registry under section 399U; and 
‘‘(2) submit to the Director an application at 
such time, in such manner, and containing— 
‘‘(A) a plan that includes a description of 
how the State will— 
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‘‘(i) disseminate information about ad-
vance directives at the time of driver’s li-
cense application or renewal; 
‘‘(ii) enable each State resident with a 
driver’s license to include a notice of the 
existence of an advance directive for such 
resident on such license in a manner con-
sistent with the notice on such a license in-
dicating a driver’s intent to be an organ 
donor; and 
‘‘(iii) coordinate with the State de-
partment of health to ensure that, if a 
State resident has an advance directive no-
tice on his or her driver’s license, the exist-
ence of such advance directive is included 
in the State registry established under sec-
tion 399U; and 
‘‘(B) any other information as the Director 
may require. 
‘‘(c) ANNUAL REPORT.—For each year for which a 
State receives an award under this section, such State 
shall submit an annual report to the Director on the use 
of the funds received pursuant to such award, including 
the number of State residents served through the mecha-
nism. 
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‘‘(d) AUTHORIZATION.—There is authorized to be ap-
propriated to carry out this section $50,000,000 for fiscal 
year 2010 and each fiscal year thereafter.’’. 
SEC. 133. GAO STUDY AND REPORT ON ESTABLISHMENT OF 
NATIONAL ADVANCE DIRECTIVE REGISTRY. 
(a) STUDY.—The Comptroller General of the United 
States shall conduct a study on the feasibility of a national 
registry for advance directives, taking into consideration 
the constraints created by the privacy provisions enacted 
as a result of the Health Insurance Portability and Ac-
countability Act of 1996 (Public Law 104–191). 
(b) REPORT.—Not later than 18 months after the 
date of enactment of this Act, the Comptroller General 
of the United States shall submit to Congress a report 
on the study conducted under subsection (a) together with 
recommendations for such legislation and administrative 
action as the Comptroller General of the United States 
determines to be appropriate. 
Subtitle C—National Uniform 
Policy on Advance Care Planning 
SEC. 141. STUDY AND REPORT BY THE SECRETARY RE-
GARDING THE ESTABLISHMENT AND IMPLE-
MENTATION OF A NATIONAL UNIFORM POL-
ICY ON ADVANCE DIRECTIVES. 
(a) STUDY.— 
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(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Office of the Assistant Secretary for 
Planning and Evaluation, shall conduct a thorough 
study of all matters relating to the establishment 
and implementation of a national uniform policy on 
advance directives for individuals receiving items and 
services under titles XVIII, XIX, or XXI of the So-
cial Security Act (42 U.S.C. 1395 et seq.; 1396 et 
seq.; 1397aa et seq.). 
(2) MATTERS STUDIED.—The matters studied 
by the Secretary under paragraph (1) shall include 
issues concerning— 
(A) family satisfaction that a patient’s 
wishes, as stated in the patient’s advance direc-
tive, were carried out; 
(B) the portability of advance directives, 
including cases involving the transfer of an in-
dividual from one health care setting to an-
other; 
(C) immunity from civil liability and crimi-
nal responsibility for health care providers that 
follow the instructions in an individual’s ad-
vance directive that was validly executed in, and 
consistent with the laws of, the State in which 
it was executed; 
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(D) conditions under which an advance di-
rective is operative; 
(E) revocation of an advance directive by 
an individual; 
(F) the criteria used by States for deter-
mining that an individual has a terminal condi-
tion; 
(G) surrogate decisionmaking regarding 
end-of-life care; 
(H) the provision of adequate palliative 
care (as defined in paragraph (3)), including 
pain management; 
(I) adequate and timely referrals to hos-
pice care programs; and 
(J) the end-of-life care needs of children 
and their families. 
(3) PALLIATIVE CARE.—For purposes of para-
graph (2)(H), the term ‘‘palliative care’’ means 
interdisciplinary care for individuals with a life- 
threatening illness or injury relating to pain and 
symptom management and psychological, social, and 
spiritual needs and that seeks to improve the quality 
of life for the individual and the individual’s family. 
(b) REPORT
TO CONGRESS.—Not later than 18 
months after the date of enactment of this Act, the Sec-
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retary shall submit to Congress a report on the study con-
ducted under subsection (a), together with recommenda-
tions for such legislation and administrative actions as the 
Secretary considers appropriate. 
(c) CONSULTATION.—In conducting the study and 
developing the report under this section, the Secretary 
shall consult with the Uniform Law Commissioners, and 
other interested parties. 
TITLE II—COMPASSIONATE 
CARE 
Subtitle A—Workforce 
Development 
PART I—EDUCATION AND TRAINING 
SEC. 201. NATIONAL GERIATRIC AND PALLIATIVE CARE 
SERVICES CORPS. 
Section 331 of the Public Health Service Act (42 
U.S.C. 254d) is amended— 
(1) by redesignating subsection (j) as sub-
section (k); and 
(2) by inserting after subsection (i), the fol-
lowing: 
‘‘(j) NATIONAL GERIATRIC AND PALLIATIVE CARE 
SERVICES CORPS.— 
‘‘(1) ESTABLISHMENT.—Not later than Janu-
ary 1, 2012, the Secretary shall establish within the 
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National Health Service Corps a National Geriatric 
and Palliative Care Services Corps (referred to in 
this subsection as the ‘Corps’) which shall consist 
of— 
‘‘(A) such officers of the Regular and Re-
serve Corps of the Service as the Secretary may 
designate; 
‘‘(B) such civilian employees of the United 
States as the Secretary may appoint; and 
‘‘(C) such other individuals who are not 
employees of the United States. 
‘‘(2) DUTIES.—The Corps shall be utilized by 
the Secretary to provide geriatric and palliative care 
services within health professional shortage areas. 
‘‘(3) APPLICATION OF PROVISIONS.—The loan- 
forgiveness, scholarship, and direct financial incen-
tives programs provided for under this section shall 
apply to physicians, nurses, and other health profes-
sionals (as identified by the Secretary) with respect 
to the training necessary to enable such individuals 
to become geriatric or palliative care specialists and 
provide geriatric and palliative care services in 
health professional shortage areas. 
‘‘(4) REPORT.—Not later than 6 months prior 
to the date on which the Secretary establishes the 
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Corps under paragraph (1), the Secretary shall sub-
mit to Congress a report concerning the organization 
of the Corps, the application process for membership 
in the Corps, and the funding necessary for the 
Corps (targeted by profession and by specializa-
tion).’’. 
SEC. 202. EXEMPTION OF PALLIATIVE MEDICINE FELLOW-
SHIP TRAINING FROM MEDICARE GRADUATE 
MEDICAL EDUCATION CAPS. 
(a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec-
tion 1886(h)(4)(F) of the Social Security Act (42 U.S.C. 
1395ww(h)(4)(F)) is amended— 
(1) in clause (i), by inserting ‘‘clause (iii) and’’ 
after ‘‘subject to’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(iii) INCREASE ALLOWED FOR PAL-
LIATIVE
MEDICINE
FELLOWSHIP
TRAIN-
ING.—For cost reporting periods beginning 
on or after January 1, 2011, in applying 
clause (i), there shall not be taken into ac-
count full-time equivalent residents in the 
field of allopathic or osteopathic medicine 
who are in palliative medicine fellowship 
training that is approved by the Accredita-
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tion Council for Graduate Medical Edu-
cation.’’. 
(b) 
INDIRECT
MEDICAL
EDUCATION.—Section 
1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(B)) is amended by adding at the end the 
following new clause: 
‘‘(x) Clause (iii) of subsection (h)(4)(F) shall 
apply to clause (v) in the same manner and for the 
same period as such clause (iii) applies to clause (i) 
of such subsection.’’. 
SEC. 203. MEDICAL SCHOOL CURRICULA. 
(a) IN GENERAL.—The Secretary, in consultation 
with the Association of American Medical Colleges, shall 
establish guidelines for the imposition by medical schools 
of a minimum amount of end-of-life training as a require-
ment for obtaining a Doctor of Medicine degree in the field 
of allopathic or osteopathic medicine. 
(b) TRAINING.—Under the guidelines established 
under subsection (a), minimum training shall include— 
(1) training in how to discuss and help patients 
and their loved ones with advance care planning; 
(2) with respect to students and trainees who 
will work with children, specialized pediatric train-
ing; 
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(3) training in the continuum of end-of-life 
services and supports, including palliative care and 
hospice; 
(4) training in how to discuss end-of-life care 
with dying patients and their loved ones; and 
(5) medical and legal issues training. 
(c) DISTRIBUTION.—Not later than January 1, 2011, 
the Secretary shall disseminate the guidelines established 
under subsection (a) to medical schools. 
(d) COMPLIANCE.—Effective beginning not later than 
July 1, 2012, a medical school that is receiving Federal 
assistance shall be required to implement the guidelines 
established under subsection (a). A medical school that the 
Secretary determines is not implementing such guidelines 
shall not be eligible for Federal assistance. 
Subtitle B—Coverage Under 
Medicare, Medicaid, and CHIP 
PART I—COVERAGE OF ADVANCE CARE 
PLANNING 
SEC. 211. MEDICARE, MEDICAID, AND CHIP COVERAGE. 
(a) MEDICARE.— 
(1) IN GENERAL.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended— 
(A) in subsection (s)(2)— 
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(i) by striking ‘‘and’’ at the end of 
subparagraph (DD); 
(ii) by adding ‘‘and’’ at the end of 
subparagraph (EE); and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(FF) advance care planning consultation 
(as defined in subsection (hhh)(1));’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘Advance Care Planning Consultation 
‘‘(hhh)(1) Subject to paragraphs (3) and (4), the 
term ‘advance care planning consultation’ means a con-
sultation between the individual and a practitioner de-
scribed in paragraph (2) regarding advance care planning, 
if, subject to subparagraphs (A) and (B) of paragraph (3), 
the individual involved has not had such a consultation 
within the last 5 years. Such consultation shall include the 
following: 
‘‘(A) An explanation by the practitioner of ad-
vance care planning, including key questions and 
considerations, important steps, and suggested peo-
ple to talk to. 
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‘‘(B) An explanation by the practitioner of ad-
vance directives, including living wills and durable 
powers of attorney, and their uses. 
‘‘(C) An explanation by the practitioner of the 
role and responsibilities of a health care proxy. 
‘‘(D) The provision by the practitioner of a list 
of national and State-specific resources to assist con-
sumers and their families with advance care plan-
ning, including the national toll-free hotline, the ad-
vance care planning clearinghouses, and State legal 
service 
organizations 
(including 
those 
funded 
through the Older Americans Act). 
‘‘(E) An explanation by the practitioner of the 
continuum of end-of-life services and supports avail-
able, including palliative care and hospice, and bene-
fits for such services and supports that are available 
under this title. 
‘‘(F)(i) Subject to clause (ii), an explanation of 
orders regarding life sustaining treatment or similar 
orders, which shall include— 
‘‘(I) the reasons why the development of 
such an order is beneficial to the individual and 
the individual’s family and the reasons why 
such an order should be updated periodically as 
the health of the individual changes; 
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‘‘(II) the information needed for an indi-
vidual or legal surrogate to make informed deci-
sions regarding the completion of such an 
order; and 
‘‘(III) the identification of resources that 
an individual may use to determine the require-
ments of the State in which such individual re-
sides so that the treatment wishes of that indi-
vidual will be carried out if the individual is un-
able to communicate those wishes, including re-
quirements regarding the designation of a sur-
rogate decision maker (also known as a health 
care proxy). 
‘‘(ii) The Secretary may limit the requirement 
for explanations under clause (i) to consultations 
furnished in States, localities, or other geographic 
areas in which orders described in such clause have 
been widely adopted. 
‘‘(2) A practitioner described in this paragraph is— 
‘‘(A) a physician (as defined in subsection 
(r)(1)); and 
‘‘(B) a nurse practitioner or physician’s assist-
ant who has the authority under State law to sign 
orders for life sustaining treatments. 
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‘‘(3)(A) An initial preventive physical examination 
under subsection (ww), including any related discussion 
during such examination, shall not be considered an ad-
vance care planning consultation for purposes of applying 
the 5-year limitation under paragraph (1). 
‘‘(B) An advance care planning consultation with re-
spect to an individual shall be conducted more frequently 
than provided under paragraph (1) if there is a significant 
change in the health condition of the individual, including 
diagnosis of a chronic, progressive, life-limiting disease, a 
life-threatening or terminal diagnosis or life-threatening 
injury, or upon admission to a skilled nursing facility, a 
long-term care facility (as defined by the Secretary), or 
a hospice program. 
‘‘(4) A consultation under this subsection may in-
clude the formulation of an order regarding life sustaining 
treatment or a similar order. 
‘‘(5)(A) For purposes of this section, the term ‘order 
regarding life sustaining treatment’ means, with respect 
to an individual, an actionable medical order relating to 
the treatment of that individual that— 
‘‘(i) is signed and dated by a physician (as de-
fined in subsection (r)(1)) or another health care 
professional (as specified by the Secretary and who 
is acting within the scope of the professional’s au-
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thority under State law in signing such an order) 
and is in a form that permits it to stay with the pa-
tient and be followed by health care professionals 
and providers across the continuum of care, includ-
ing home care, hospice, long-term care, community 
and assisted living residences, skilled nursing facili-
ties, inpatient rehabilitation facilities, hospitals, and 
emergency medical services; 
‘‘(ii) effectively communicates the individual’s 
preferences regarding life sustaining treatment, in-
cluding an indication of the treatment and care de-
sired by the individual; 
‘‘(iii) is uniquely identifiable and standardized 
within a given locality, region, or State (as identified 
by the Secretary); 
‘‘(iv) is portable across care settings; and 
‘‘(v) may incorporate any advance directive (as 
defined in section 1866(f)(3)) if executed by the in-
dividual. 
‘‘(B) The level of treatment indicated under subpara-
graph (A)(ii) may range from an indication for full treat-
ment to an indication to limit some or all or specified 
interventions. Such indicated levels of treatment may in-
clude indications respecting, among other items— 
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‘‘(i) the intensity of medical intervention if the 
patient is pulseless, apneic, or has serious cardiac or 
pulmonary problems; 
‘‘(ii) the individual’s desire regarding transfer 
to a hospital or remaining at the current care set-
ting; 
‘‘(iii) the use of antibiotics; and 
‘‘(iv) the use of artificially administered nutri-
tion and hydration.’’. 
(2) PAYMENT.—Section 1848(j)(3) of the So-
cial Security Act (42 U.S.C. 1395w–4(j)(3)) is 
amended by inserting ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’. 
(3) FREQUENCY LIMITATION.—Section 1862(a) 
of the Social Security Act (42 U.S.C. 1395y(a)(1)) 
is amended— 
(A) in paragraph (1)— 
(i) in subparagraph (N), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (O) by striking 
the semicolon at the end and inserting ‘‘, 
and’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(P) in the case of advance care planning con-
sultations (as defined in section 1861(hhh)(1)), 
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which are performed more frequently than is covered 
under such section;’’; and 
(B) in paragraph (7), by striking ‘‘or (K)’’ 
and inserting ‘‘(K), or (P)’’. 
(4) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to consultations fur-
nished on or after January 1, 2011. 
(b) MEDICAID.— 
(1) 
MANDATORY
BENEFIT.—Section 
1902(a)(10)(A) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)) is amended in the matter 
preceding clause (i) by striking ‘‘and (21)’’ and in-
serting ‘‘, (21), and (28)’’. 
(2) MEDICAL
ASSISTANCE.—Section 1905 of 
such Act (42 U.S.C. 1396d) is amended— 
(A) in subsection (a)— 
(i) in paragraph (27), by striking 
‘‘and’’ at the end; 
(ii) by redesignating paragraph (28) 
as paragraph (29); and 
(iii) by inserting after paragraph (27) 
the following new paragraph: 
‘‘(28) advance care planning consultations (as 
defined in subsection (y));’’; and 
(B) by adding at the end the following: 
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‘‘(y)(1) For purposes of subsection (a)(28), the term 
‘advance care planning consultation’ means a consultation 
between the individual and a practitioner described in 
paragraph (2) regarding advance care planning, if, subject 
to paragraph (3), the individual involved has not had such 
a consultation within the last 5 years. Such consultation 
shall include the following: 
‘‘(A) An explanation by the practitioner of ad-
vance care planning, including key questions and 
considerations, important steps, and suggested peo-
ple to talk to. 
‘‘(B) An explanation by the practitioner of ad-
vance directives, including living wills and durable 
powers of attorney, and their uses. 
‘‘(C) An explanation by the practitioner of the 
role and responsibilities of a health care proxy. 
‘‘(D) The provision by the practitioner of a list 
of national and State-specific resources to assist con-
sumers and their families with advance care plan-
ning, including the national toll-free hotline, the ad-
vance care planning clearinghouses, and State legal 
service 
organizations 
(including 
those 
funded 
through the Older Americans Act). 
‘‘(E) An explanation by the practitioner of the 
continuum of end-of-life services and supports avail-
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able, including palliative care and hospice, and bene-
fits for such services and supports that are available 
under this title. 
‘‘(F)(i) Subject to clause (ii), an explanation of 
orders for life sustaining treatments or similar or-
ders, which shall include— 
‘‘(I) the reasons why the development of 
such an order is beneficial to the individual and 
the individual’s family and the reasons why 
such an order should be updated periodically as 
the health of the individual changes; 
‘‘(II) the information needed for an indi-
vidual or legal surrogate to make informed deci-
sions regarding the completion of such an 
order; and 
‘‘(III) the identification of resources that 
an individual may use to determine the require-
ments of the State in which such individual re-
sides so that the treatment wishes of that indi-
vidual will be carried out if the individual is un-
able to communicate those wishes, including re-
quirements regarding the designation of a sur-
rogate decision maker (also known as a health 
care proxy). 
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‘‘(ii) The Secretary may limit the requirement 
for explanations under clause (i) to consultations 
furnished in States, localities, or other geographic 
areas in which orders described in such clause have 
been widely adopted. 
‘‘(2) A practitioner described in this paragraph is— 
‘‘(A) a physician (as defined in section 
1861(r)(1)); and 
‘‘(B) a nurse practitioner or physician’s assist-
ant who has the authority under State law to sign 
orders for life sustaining treatments. 
‘‘(3) An advance care planning consultation with re-
spect to an individual shall be conducted more frequently 
than provided under paragraph (1) if there is a significant 
change in the health condition of the individual including 
diagnosis of a chronic, progressive, life-limiting disease, a 
life-threatening or terminal diagnosis or life-threatening 
injury, or upon admission to a nursing facility, a long- 
term care facility (as defined by the Secretary), or a hos-
pice program. 
‘‘(4) A consultation under this subsection may in-
clude the formulation of an order regarding life sustaining 
treatment or a similar order. 
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‘‘(5) For purposes of this subsection, the term ‘orders 
regarding life sustaining treatment’ has the meaning given 
that term in section 1861(hhh)(5).’’. 
(c) CHIP.— 
(1) 
CHILD
HEALTH
ASSISTANCE.—Section 
2110(a) of the Social Security Act (42 U.S.C. 
1397jj) is amended— 
(A) by redesignating paragraph (28) as 
paragraph (29); and 
(B) by inserting after paragraph (27), the 
following: 
‘‘(28) Advance care planning consultations (as 
defined in section 1905(y)).’’. 
(2) MANDATORY COVERAGE.— 
(A) IN GENERAL.—Section 2103 of such 
Act (42 U.S.C. 1397cc), is amended— 
(i) in subsection (a), in the matter 
preceding paragraph (1), by striking ‘‘and 
(7)’’ and inserting ‘‘(7), and (9)’’; and 
(ii) in subsection (c), by adding at the 
end the following: 
‘‘(9) END-OF-LIFE CARE.—The child health as-
sistance provided to a targeted low-income child 
shall include coverage of advance care planning con-
sultations (as defined in section 1905(y) and at the 
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same payment rate as the rate that would apply to 
such a consultation under the State plan under title 
XIX).’’. 
(B) CONFORMING
AMENDMENT.—Section 
2102(a)(7)(B) 
of 
such 
Act 
(42 
U.S.C. 
1397bb(a)(7)(B)) is amended by striking ‘‘sec-
tion 2103(c)(5)’’ and inserting ‘‘paragraphs (5) 
and (9) of section 2103(c)’’. 
(d) DEFINITION OF ADVANCE DIRECTIVE UNDER 
MEDICARE, MEDICAID, AND CHIP.— 
(1) MEDICARE.—Section 1866(f)(3) of the So-
cial Security Act (42 U.S.C. 1395cc(f)(3)) is amend-
ed by striking ‘‘means’’ and all that follows through 
the period and inserting ‘‘means a living will, med-
ical directive, health care power of attorney, durable 
power of attorney, or other written statement by a 
competent individual that is recognized under State 
law and indicates the individual’s wishes regarding 
medical treatment in the event of future incom-
petence. Such term includes an advance health care 
directive and a health care directive recognized 
under State law.’’. 
(2) MEDICAID AND CHIP.—Section 1902(w)(4) 
of such Act (42 U.S.C. 1396a(w)(4)) is amended by 
striking ‘‘means’’ and all that follows through the 
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period and inserting ‘‘means a living will, medical di-
rective, health care power of attorney, durable power 
of attorney, or other written statement by a com-
petent individual that is recognized under State law 
and indicates the individual’s wishes regarding med-
ical treatment in the event of future incompetence. 
Such term includes an advance health care directive 
and a health care directive recognized under State 
law.’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section take effect January 1, 2010. 
PART II—HOSPICE 
SEC. 221. ADOPTION OF MEDPAC HOSPICE PAYMENT METH-
ODOLOGY RECOMMENDATIONS. 
Section 1814(i) of the Social Security Act (42 U.S.C. 
1395f(i)) is amended by adding at the end the following 
new paragraph: 
‘‘(6)(A) The Secretary shall conduct an evalua-
tion of the recommendations of the Medicare Pay-
ment Commission for reforming the hospice care 
benefit under this title that are contained in chapter 
6 of the Commission’s report entitled ‘Report to 
Congress: Medicare Payment Policy (March 2009)’, 
including the impact that such recommendations if 
implemented would have on access to care and the 
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quality of care. In conducting such evaluation, the 
Secretary shall take into account data collected in 
accordance with section 263(b) of the Advance Plan-
ning and Compassionate Care Act of 2009. 
‘‘(B) Based on the results of the examination 
conducted under subparagraph (A), the Secretary 
shall make appropriate refinements to the rec-
ommendations described in subparagraph (A). Such 
refinements shall take into account— 
‘‘(i) the impact on patient populations with 
longer that average lengths of stay; 
‘‘(ii) the impact on populations with short-
er that average lengths of stay; and 
‘‘(iii) the utilization patterns of hospice 
providers in underserved areas, including rural 
hospices. 
‘‘(C) Not later than January 1, 2013, the Sec-
retary shall submit to Congress a report that con-
tains a detailed description of— 
‘‘(i) the refinements determined appro-
priate by the Secretary under subparagraph 
(B); 
‘‘(ii) the revisions that the Secretary will 
implement through regulation under this title 
pursuant to subparagraph (D); and 
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‘‘(iii) the revisions that the Secretary de-
termines require additional legislative action by 
Congress. 
‘‘(D)(i) The Secretary shall implement the rec-
ommendations described in subparagraph (A), as re-
fined under subparagraph (B). 
‘‘(ii) Subject to clause (iii), the implementation 
of such recommendations shall apply to hospice care 
furnished on or after January 1, 2014. 
‘‘(iii) The Secretary shall establish an appro-
priate transition to the implementation of such rec-
ommendations. 
‘‘(E) For purposes of carrying out the provi-
sions of this paragraph, the Secretary shall provide 
for the transfer, from the Federal Hospital Insur-
ance Trust Fund under section 1817, of such sums 
as may be necessary to the Centers for Medicare & 
Medicaid Services Program Management Account.’’. 
SEC. 222. REMOVING HOSPICE INPATIENT DAYS IN SET-
TING PER DIEM RATES FOR CRITICAL AC-
CESS HOSPITALS. 
Section 1814(l) of the Social Security Act (42 U.S.C. 
1395f(l)), as amended by section 4102(b)(2) of the 
HITECH Act (Public Law 111–5), is amended by adding 
at the end the following new paragraph: 
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‘‘(6) For cost reporting periods beginning on or 
after January 1, 2011, the Secretary shall remove 
Medicare-certified hospice inpatient days from the 
calculation of per diem rates for inpatient critical ac-
cess hospital services.’’. 
SEC. 223. HOSPICE PAYMENTS FOR DUAL ELIGIBLE INDI-
VIDUALS RESIDING IN LONG-TERM CARE FA-
CILITIES. 
(a) IN GENERAL.—Section 1888 of the Social Secu-
rity Act (42 U.S.C. 1395yy) is amended by adding at the 
end the following new subsection: 
‘‘(f) PAYMENTS FOR DUAL ELIGIBLE INDIVIDUALS 
RESIDING IN LONG-TERM CARE FACILITIES.—For cost 
reporting periods beginning on or after January 1, 2011, 
the Secretary, acting through the Administrator of the 
Centers for Medicare & Medicaid Services, shall establish 
procedures under which payments for room and board 
under the State Medicaid plan with respect to an applica-
ble individual are made directly to the long-term care facil-
ity (as defined by the Secretary for purposes of title XIX) 
the individual is a resident of. For purposes of the pre-
ceding sentence, the term ‘applicable individual’ means an 
individual who is entitled to or enrolled for benefits under 
part A or enrolled for benefits under part B and is eligible 
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for medical assistance for hospice care under a State plan 
under title XIX.’’. 
(b) STATE PLAN REQUIREMENT.— 
(1) IN GENERAL.—Section 1902(a) of the So-
cial Security Act (42 U.S.C. 1396a(a)) is amend-
ed— 
(A) in paragraph (72), by striking ‘‘and’’ 
at the end; 
(B) in paragraph (73), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (73) the 
following new paragraph: 
‘‘(74) provide that the State will make pay-
ments for room and board with respect to applicable 
individuals in accordance with section 1888(f).’’. 
(2) EFFECTIVE DATE.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the amendments made by 
paragraph (1) 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-
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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. 
SEC. 224. DELINEATION OF RESPECTIVE CARE RESPON-
SIBILITIES 
OF 
HOSPICE 
PROGRAMS 
AND 
LONG-TERM CARE FACILITIES. 
Section 1888 of the Social Security Act (42 U.S.C. 
1395yy), as amended by section 223(a), is amended by 
adding at the end the following new subsection: 
‘‘(g) DELINEATION OF RESPECTIVE CARE RESPON-
SIBILITIES
OF HOSPICE PROGRAMS
AND LONG-TERM 
CARE FACILITIES.—Not later than July 1, 2011, the Sec-
retary, acting through the Administrator of the Centers 
for Medicare & Medicaid Services, shall delineate and en-
force the respective care responsibilities of hospice pro-
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grams and long-term care facilities (as defined by the Sec-
retary for purposes of title XIX) with respect to individ-
uals residing in such facilities who are furnished hospice 
care.’’. 
SEC. 225. ADOPTION OF MEDPAC HOSPICE PROGRAM ELI-
GIBILITY CERTIFICATION AND RECERTIFI-
CATION RECOMMENDATIONS. 
In accordance with the recommendations of the Medi-
care Payment Advisory Commission contained in the 
March 2009 report entitled ‘‘Report to Congress: Medi-
care Payment Policy’’, section 1814(a)(7) of the Social Se-
curity Act (42 U.S.C. 1395f(a)(7)) is amended— 
(1) in subparagraph (B), by striking ‘‘and’’ at 
the end; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) on or after January 1, 2011— 
‘‘(i) a hospice physician or advance 
practice nurse visits the individual to de-
termine continued eligibility of the indi-
vidual for hospice care prior to the 180th 
day recertification and each subsequent re-
certification under subparagraph (A)(ii) 
and attests that such visit took place (in 
accordance with procedures established by 
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the Secretary, in consultation with the Ad-
ministrator of the Centers for Medicare & 
Medicaid Services); and 
‘‘(ii) any certification or recertification 
under subparagraph (A) includes a brief 
narrative describing the clinical basis for 
the individual’s prognosis (in accordance 
with procedures established by the Sec-
retary, in consultation with the Adminis-
trator of the Centers for Medicare & Med-
icaid Services); and’’. 
SEC. 226. CONCURRENT CARE FOR CHILDREN. 
(a) 
PERMITTING
MEDICARE
HOSPICE
BENE-
FICIARIES 18 YEARS OF AGE OR YOUNGER TO RECEIVE 
CURATIVE CARE.— 
(1) IN GENERAL.—Section 1812 of the Social 
Security Act (42 U.S.C. 1395d) is amended— 
(A) in subsection (a)(4), by inserting 
‘‘(subject to the second sentence of subsection 
(d)(2)(A))’’ after ‘‘in lieu of certain other bene-
fits’’; and 
(B) in subsection (d)— 
(i) in paragraph (1), by inserting ‘‘ , 
subject to the second sentence of para-
graph (2)(A),’’ after ‘‘instead’’; and 
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(ii) in paragraph (2)(A), by adding at 
the end the following new sentence: 
‘‘Clause (ii)(I) shall not apply to an indi-
vidual who is 18 years of age or younger.’’ 
(2) 
CONFORMING
AMENDMENT.—Section 
1862(a)(1)(C) of the Social Security Act (42 U.S.C. 
1395y(a)(1)(C)) is amended inserting ‘‘subject to 
the second sentence of section 1812(d)(2)(A),’’ after 
‘‘hospice care,’’. 
(b) APPLICATION TO MEDICAID AND CHIP.— 
(1) MEDICAID.—Section 1905(o)(1)(A) of the 
Social Security Act (42 U.S.C. 1395d(o)(1)(A)) is 
amended by inserting ‘‘(subject, in the case of an in-
dividual who is a child, to the second sentence of 
such section)’’ after ‘‘section 1812(d)(2)(A)’’. 
(2) CHIP.—Section 2110(a)(23) of the Social 
Security Act (42 U.S.C. 1397jj(a)(23)) is amended 
by inserting ‘‘(concurrent, in the case of an indi-
vidual who is a child, with care related to the treat-
ment of the individual’s condition with respect to 
which a diagnosis of terminal illness has been 
made)’’ after ‘‘hospice care’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2011. 
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SEC. 227. MAKING HOSPICE A REQUIRED BENEFIT UNDER 
MEDICAID AND CHIP. 
(a) MANDATORY BENEFIT.— 
(1) MEDICAID.— 
(A) IN GENERAL.—Section 1902(a)(10)(A) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)), 
as 
amended 
by 
section 
211(b)(1), is amended in the matter preceding 
clause (i) by inserting ‘‘(18),’’ after ‘‘(17),’’. 
(B) CONFORMING
AMENDMENT.—Section 
1902(a)(10)(C) 
of 
such 
Act 
(42 
U.S.C. 
1396a(a)(10)(C)) is amended— 
(i) in clause (iii)— 
(I) in subclause (I), by inserting 
‘‘and hospice care’’ after ‘‘ambulatory 
services’’; and 
(II) in subclause (II), by insert-
ing ‘‘and hospice care’’ after ‘‘delivery 
services’’; and 
(ii) in clause (iv), by inserting ‘‘and 
(18)’’ after ‘‘(17)’’. 
(2) CHIP.—Section 2103(c)(9) of such Act (42 
U.S.C. 
1397cc(c)(9)), 
as 
added 
by 
section 
211(c)(2)(A), is amended by inserting ‘‘and hospice 
care’’ before the period. 
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(b) EFFECTIVE DATE.—The amendments made sub-
section (a) take effect on January 1, 2011. 
SEC. 228. MEDICARE HOSPICE PAYMENT MODEL DEM-
ONSTRATION PROJECTS. 
(a) ESTABLISHMENT.—Not later than July 1, 2012, 
the Secretary, acting through the Administrator of the 
Centers for Medicare & Medicaid Services and the Direc-
tor of the Agency for Healthcare Research and Quality, 
shall conduct demonstration projects to examine ways to 
improve how the Medicare hospice care benefit predicts 
disease trajectory. Projects shall include the following 
models: 
(1) Models that better and more appropriately 
care for, and transition as needed, patients in their 
last years of life who need palliative care, but do not 
qualify for hospice care under the Medicare hospice 
eligibility criteria. 
(2) Models that better and more appropriately 
care for long-term patients who are not recertified in 
hospice but still need palliative care. 
(3) Any other models determined appropriate 
by the Secretary. 
(b) WAIVER AUTHORITY.—The Secretary may waive 
compliance of such requirements of titles XI and XVIII 
of the Social Security Act as the Secretary determines nec-
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essary to conduct the demonstration projects under this 
section. 
(c) REPORTS.—The Secretary shall submit to Con-
gress periodic reports on the demonstration projects con-
ducted under this section. 
SEC. 229. MEDPAC STUDIES AND REPORTS. 
(a) STUDY AND REPORT REGARDING AN ALTER-
NATIVE PAYMENT METHODOLOGY FOR HOSPICE CARE 
UNDER THE MEDICARE PROGRAM.— 
(1) STUDY.—The Medicare Payment Advisory 
Commission (in this section referred to as the ‘‘Com-
mission’’) shall conduct a study on the establishment 
of a reimbursement system for hospice care fur-
nished under the Medicare program that is based on 
diagnoses. In conducting such study, the Commis-
sion shall use data collected under new provider data 
requirements. Such study shall include an analysis 
of the following: 
(A) Whether such a reimbursement system 
better meets patient needs and better cor-
responds with provider resource expenditures 
than the current system. 
(B) Whether such a reimbursement system 
improves quality, including facilitating stand-
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ardization of care toward best practices and di-
agnoses-specific clinical pathways in hospice. 
(C) Whether such a reimbursement system 
could address concerns about the blanket 6- 
month terminal prognosis requirement in hos-
pice. 
(D) Whether such a reimbursement system 
is more cost effective than the current system. 
(E) Any other areas determined appro-
priate by the Commission. 
(2) REPORT.—Not later than June 15, 2013, 
the Commission shall submit to Congress a report 
on the study conducted under subsection (a) to-
gether with recommendations for such legislation 
and administrative action as the Commission deter-
mines appropriate. 
(b) STUDY AND REPORT REGARDING RURAL HOS-
PICE TRANSPORTATION COSTS UNDER THE MEDICARE 
PROGRAM.— 
(1) STUDY.—The Commission shall conduct a 
study on rural Medicare hospice transportation mile-
age to determine potential Medicare reimbursement 
changes to account for potential higher costs. 
(2) REPORT.—Not later than June 15, 2013, 
the Commission shall submit to Congress a report 
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on the study conducted under subsection (a) to-
gether with recommendations for such legislation 
and administrative action as the Commission deter-
mines appropriate. 
(c) EVALUATION
OF REIMBURSEMENT DISINCEN-
TIVES TO ELECT MEDICARE HOSPICE WITHIN
THE 
MEDICARE SKILLED NURSING FACILITY BENEFIT.— 
(1) STUDY.—The Commission shall conduct a 
study to determine potential Medicare reimburse-
ment changes to remove Medicare reimbursement 
disincentives for patients in a skilled nursing facility 
who want to elect hospice. 
(2) REPORT.—Not later than June 15, 2013, 
the Commission shall submit to Congress a report 
on the study conducted under subsection (a) to-
gether with recommendations for such legislation 
and administrative action as the Commission deter-
mines appropriate. 
SEC. 230. HHS EVALUATIONS. 
(a) EVALUATION OF ACCESS TO HOSPICE AND HOS-
PITAL-BASED PALLIATIVE CARE.— 
(1) 
EVALUATION.—The 
Secretary, 
acting 
through the Administrator of the Health Resources 
and Services Administration, shall conduct an eval-
uation of geographic areas and populations under-
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served by hospice and hospital-based palliative care 
to identify potential barriers to access. 
(2) REPORT.—Not later than December 31, 
2012, the Secretary shall report to Congress, on the 
evaluation conducted under subsection (a) together 
with recommendations for such legislation and ad-
ministrative action as the Secretary determines ap-
propriate to address barriers to access to hospice 
and hospital-based palliative care. 
(b) EVALUATION OF AWARENESS AND USE OF HOS-
PICE RESPITE CARE UNDER MEDICARE, MEDICAID, AND 
CHIP.— 
(1) 
EVALUATION.—The 
Secretary, 
acting 
through the Director of the Centers for Medicare & 
Medicaid Services, shall evaluate the awareness and 
use of hospice respite care by informal caregivers of 
beneficiaries under Medicare, Medicaid, and CHIP. 
(2) REPORT.—Not later than December 31, 
2010, the Secretary shall report to Congress, on the 
evaluation conducted under subsection (a) together 
with recommendations for such legislation and ad-
ministrative action as the Secretary determines ap-
propriate to increase awareness or use of hospice 
respite care under Medicare, Medicaid, and CHIP. 
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Subtitle C—Quality Improvement 
SEC. 241. PATIENT SATISFACTION SURVEYS. 
Not later than January 1, 2012, the Secretary, acting 
through the Administrator of the Centers for Medicare & 
Medicaid Services, shall establish a mechanism for— 
(1) collecting information from patients (or 
their health care proxies or families members in the 
event patients are unable to speak for themselves) in 
relevant provider settings regarding their care at the 
end of life; and 
(2) incorporating such information in a timely 
manner into mechanisms used by the Administrator 
to provide quality of care information to consumers, 
including the Hospital Compare and Nursing Home 
Compare websites maintained by the Administrator. 
SEC. 242. DEVELOPMENT OF CORE END-OF-LIFE CARE 
QUALITY 
MEASURES 
ACROSS 
EACH 
REL-
EVANT PROVIDER SETTING. 
(a) IN GENERAL.—The Secretary, acting through the 
Administrator of the Agency for Healthcare Research and 
Quality (in this section referred to as the ‘‘Adminis-
trator’’) and in consultation with the Director of the Na-
tional Institutes of Health, shall require specific end-of- 
life quality measures for each relevant provider setting, 
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as identified by the Administrator, in accordance with the 
requirements of subsection (b). 
(b) REQUIREMENTS.—For purposes of subsection 
(a), the requirements specified in this subsection are the 
following: 
(1) Selection of the specific measure or meas-
ures for an identified provider setting shall be— 
(A) based on an assessment of what is 
likely to have the greatest positive impact on 
quality of end-of-life care in that setting; and 
(B) made in consultation with affected pro-
viders and public and private organizations, 
that have developed such measures. 
(2) The measures may be structure-oriented, 
process-oriented, or outcome-oriented, as determined 
appropriate by the Administrator. 
(3) The Administrator shall ensure that report-
ing requirements related to such measures are im-
posed consistent with other applicable laws and reg-
ulations, and in a manner that takes into account 
existing measures, the needs of patient populations, 
and the specific services provided. 
(4) Not later than— 
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(A) April 1, 2011, the Secretary shall dis-
seminate the reporting requirements to all af-
fected providers; and 
(B) April 1, 2012, initial reporting relating 
to the measures shall begin. 
SEC. 243. ACCREDITATION OF HOSPITAL-BASED PALLIA-
TIVE CARE PROGRAMS. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity, shall designate a public or private agency, entity, or 
organization to develop requirements, standards, and pro-
cedures for accreditation of hospital-based palliative care 
programs. 
(b) REPORTING.—Not later than January 1, 2012, 
the Secretary shall prepare and submit a report to Con-
gress on the proposed accreditation process for hospital- 
based palliative care programs. 
(c) ACCREDITATION.—Not later than July 1, 2012, 
the Secretary shall— 
(1) establish and promulgate standards and 
procedures for accreditation of hospital-based pallia-
tive care programs; and 
(2) designate an agency, entity, or organization 
that shall be responsible for certifying such pro-
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grams in accordance with the standards established 
under paragraph (1). 
(d) DEFINITIONS.—For the purposes of this section: 
(1) The term ‘‘hospital-based palliative care 
program’’ means a hospital-based program that is 
comprised of an interdisciplinary team that special-
izes in providing palliative care services and con-
sultations in a variety of health care settings, includ-
ing hospitals, nursing homes, and home and commu-
nity-based services. 
(2) The term ‘‘interdisciplinary team’’ means a 
group of health care professionals (consisting of, at 
a minimum, a doctor, a nurse, and a social worker) 
that have received specialized training in palliative 
care. 
SEC. 244. SURVEY AND DATA REQUIREMENTS FOR ALL 
MEDICARE PARTICIPATING HOSPICE PRO-
GRAMS. 
(a) HOSPICE SURVEYS.—Section 1861(dd) of the So-
cial Security Act (42 U.S.C. 1395x(dd)) is amended by 
adding at the end the following new paragraph: 
‘‘(6) In accordance with the recommendations of the 
Medicare Payment Advisory Commission contained in the 
March 2009 report entitled ‘Report to Congress: Medicare 
Payment Policy’, the Secretary shall establish, effective 
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July 1, 2010, the following survey requirements for hos-
pice programs: 
‘‘(A) Any hospice program seeking initial cer-
tification under this title on or after that date shall 
be subject to an initial survey by an appropriate 
State or local agency, or an approved accreditation 
agency, not later than 6 months after the program 
first seeks such certification. 
‘‘(B) All hospice programs certified for partici-
pation under this title shall be subject to a standard 
survey by an appropriate State or local agency, or 
an approved accreditation agency, at least every 3 
years after initially being so certified.’’. 
(b) REQUIRED HOSPICE RESOURCE INPUTS DATA.— 
Section 1861(dd) of the Social Security Act (42 U.S.C. 
1395x(dd)), as amended by subsection (a), is amended— 
(1) in paragraph (3)— 
(A) in subparagraph (F), by striking 
‘‘and’’ at the end; 
(B) by redesignating subparagraph (G) as 
subparagraph (H); and 
(C) by inserting after subparagraph (F) 
the following new subparagraph: 
‘‘(G) to comply with the reporting requirements 
under paragraph (7); and’’; and 
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(2) by adding at the end the following new 
paragraph: 
‘‘(7)(A) In accordance with the recommenda-
tions of the Medicare Payment Advisory Commission 
for additional data (as contained in the March 2009 
report entitled ‘Report to Congress: Medicare Pay-
ment Policy’), beginning January 1, 2011, a hospice 
program shall report to the Secretary, in such form 
and manner, and at such intervals, as the Secretary 
shall require, the following data with respect to each 
patient visit: 
‘‘(i) Visit type (such as admission, routine, 
emergency, education for family, other). 
‘‘(ii) Visit length. 
‘‘(iii) Professional or paraprofessional dis-
ciplines involved in the visit, including nurse, 
social worker, home health aide, physician, 
nurse practitioner, chaplain or spiritual coun-
selor, counselor, dietician, physical therapist, 
occupational therapist, speech language patholo-
gist, music or art therapist, and including be-
reavement and support services provided to a 
family after a patient’s death. 
‘‘(iv) Drugs and other therapeutic inter-
ventions provided. 
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‘‘(v) Home medical equipment and other 
medical supplies provided. 
‘‘(B) In collecting the data required under sub-
paragraph (A), the Secretary shall ensure that the 
data are reported in a manner that allows for sum-
marized cross-tabulations of the data by patients’ 
terminal diagnoses, lengths of stay, age, sex, and 
race.’’. 
Subtitle D—Additional Reports, 
Research, and Evaluations 
SEC. 251. NATIONAL CENTER ON PALLIATIVE AND END-OF- 
LIFE CARE. 
Part E of title IV of the Public Health Service Act 
(42 U.S.C. 287 et seq.) is amended by adding at the end 
the following: 
‘‘Subpart 7—National Center on Palliative and End- 
of-Life Care 
‘‘SEC. 485J. NATIONAL CENTER ON PALLIATIVE AND END- 
OF-LIFE CARE. 
‘‘(a) ESTABLISHMENT.—Not later than July 1, 2011, 
there shall be established within the National Institutes 
of Health, a National Center on Palliative and End-of- 
Life Care (referred to in this section as the ‘Center’). 
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‘‘(b) PURPOSE.—The general purpose of the Center 
is to conduct and support research relating to palliative 
and end-of-life care interventions and approaches. 
‘‘(c) ACTIVITIES.—The Center shall— 
‘‘(1) develop and continuously update a re-
search agenda with the goal of— 
‘‘(A) providing a better biomedical under-
standing of the end of life; and 
‘‘(B) improving the quality of care and life 
at the end of life; and 
‘‘(2) provide funding for peer-review-selected 
extra- and intra-mural research that includes the 
evaluation of existing, and the development of new, 
palliative and end-of-life care interventions and ap-
proaches.’’. 
SEC. 252. NATIONAL MORTALITY FOLLOWBACK SURVEY. 
(a) IN GENERAL.—Not later than December 31, 
2010, and annually thereafter, the Secretary, acting 
through the Director of the Centers for Disease Control 
and Prevention, shall renew and conduct the National 
Mortality Followback Survey (referred to in this section 
as the ‘‘Survey’’) to collect data on end-of-life care. 
(b) PURPOSE.—The purpose of the Survey shall be 
to gain a better understanding of current end-of-life care 
in the United States. 
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(c) QUESTIONS.— 
(1) IN GENERAL.—In conducting the Survey, 
the Director of the Centers for Disease Control and 
Prevention shall, at a minimum, include the fol-
lowing questions with respect to the loved one of a 
respondent: 
(A) Did he or she have an advance direc-
tive, and if so, when it was completed. 
(B) Did he or she have an order for life- 
sustaining treatment, and if so, when was it 
completed. 
(C) Did he or she have a durable power of 
attorney, and if so, when it was completed. 
(D) Had he or she discussed his or her 
wishes with loved ones, and if so, when. 
(E) Had he or she discussed his or her 
wishes with his or her physician, and if so, 
when. 
(F) In the opinion of the respondent, was 
he or she satisfied with the care he or she re-
ceived in the last year of life and in the last 
week of life. 
(G) Was he or she cared for by hospice, 
and if so, when. 
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(H) Was he or she cared for by palliative 
care specialists, and if so, when. 
(I) Did he or she receive effective pain 
management (if needed). 
(J) What was the experience of the main 
caregiver (including if such caregiver was the 
respondent), and whether he or she received 
sufficient support in this role. 
(2) ADDITIONAL QUESTIONS.—Additional ques-
tions to be asked during the Survey shall be deter-
mined by the Director of the Centers for Disease 
Control and Prevention on an ongoing basis with 
input from relevant research entities. 
SEC. 253. DEMONSTRATION PROJECTS FOR USE OF TELE-
MEDICINE 
SERVICES 
IN 
ADVANCE 
CARE 
PLANNING. 
(a) IN GENERAL.—Not later than July 1, 2013, the 
Secretary shall establish a demonstration program to re-
imburse eligible entities for costs associated with the use 
of telemedicine services (including equipment and connec-
tion costs) to provide advance care planning consultations 
with geographically distant physicians and their patients. 
(b) DURATION.—The demonstration project under 
this section shall be conducted for at least a 3-year period. 
(c) DEFINITIONS.—For purposes of this section: 
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(1) The term ‘‘eligible entity’’ means a physi-
cian or an advance practice nurse who provides serv-
ices pursuant to a hospital-based palliative care pro-
gram (as defined in section 262(d)(1)). 
(2) The term ‘‘geographically distant’’ has the 
meaning given that term by the Secretary for pur-
poses of conducting the demonstration program es-
tablished under this section. 
(3) The term ‘‘telemedicine services’’ means a 
service or consultation provided via telecommuni-
cation equipment that allows an eligible entity to ex-
change or discuss medical information with a patient 
or a health care professional at a separate location 
through real-time videoconferencing, or a similar for-
mat, for the purpose of providing health care diag-
nosis and treatment. 
(d) FUNDING.—There are authorized to be appro-
priated to the Secretary such sums as may be necessary 
to carry out this section. 
SEC. 254. INSPECTOR GENERAL INVESTIGATION OF FRAUD 
AND ABUSE. 
In accordance with the recommendations of the Medi-
care Payment Advisory Commission for additional data 
(as contained in the March 2009 report entitled ‘‘Report 
to Congress: Medicare Payment Policy’’), the Secretary 
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shall direct the Office of the Inspector General of the De-
partment of Health and Human Services to investigate, 
not later than January 1, 2012, the following with respect 
to hospice benefit under Medicare, Medicaid, and CHIP: 
(1) The prevalence of financial relationships be-
tween hospices and long-term care facilities, such as 
nursing facilities and assisted living facilities, that 
may represent a conflict of interest and influence ad-
missions to hospice. 
(2) Differences in patterns of nursing home re-
ferrals to hospice. 
(3) The appropriateness of enrollment practices 
for hospices with unusual utilization patterns (such 
as high frequency of very long stays, very short 
stays, or enrollment of patients discharged from 
other hospices). 
(4) The appropriateness of hospice marketing 
materials and other admissions practices and poten-
tial correlations between length of stay and defi-
ciencies in marketing or admissions practices. 
SEC. 255. GAO STUDY AND REPORT ON PROVIDER ADHER-
ENCE TO ADVANCE DIRECTIVES. 
Not later than January 1, 2012, the Comptroller 
General of the United States shall conduct a study of the 
extent to which providers comply with advance directives 
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under the Medicare and Medicaid programs and shall sub-
mit a report to Congress on the results of such study, to-
gether with such recommendations for administrative or 
legislative changes as the Comptroller General determines 
appropriate. 
Æ 
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