I 
113TH CONGRESS 
1ST SESSION H. R. 1173 
To amend the Social Security Act to provide for coverage of voluntary advance 
care planning consultation under Medicare and Medicaid, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 14, 2013 
Mr. BLUMENAUER (for himself, Mr. HANNA, Mr. ROE of Tennessee, Mr. 
REED, Ms. SCHWARTZ, Mr. KIND, Mr. GEORGE MILLER of California, 
Mr. MCDERMOTT, Mr. BERA of California, Ms. SCHAKOWSKY, and Mrs. 
CAPPS) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To amend the Social Security Act to provide for coverage 
of voluntary advance care planning consultation under 
Medicare and Medicaid, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Personalize Your Care Act of 2013’’. 
(b) FINDINGS.—Congress finds the following: 
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(1) All individuals should be afforded the oppor-
tunity to fully participate in decisions related to 
their health care or the care of a person for whom 
they are the proxy or surrogate. 
(2) Every individual’s values and goals should 
be identified, understood, and respected. Particular 
attention should be paid to populations which have 
not regularly had the opportunity to express their 
choices or preferences. 
(3) Advance care planning plays a valuable role 
in achieving quality care by informing physicians 
and family members of an individual’s treatment 
preferences should he or she become unable to direct 
care. 
(4) Early advance care planning is ideal be-
cause a person’s ability to make decisions may di-
minish over time and the person may suddenly lose 
the capability to participate in their health care deci-
sions. 
(5) Advance directives (such as living wills and 
durable powers of attorney for health care) must be 
prepared while individuals have the capacity to com-
plete them and only apply to future medical cir-
cumstances when decisionmaking capacity is lost. An 
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individual can change or revoke an advance directive 
at any time. 
(6) Physician orders for life-sustaining treat-
ment complement advance directives by providing a 
process to focus patients’ values, goals, and pref-
erences on current medical circumstances and to 
translate them into visible and portable medical or-
ders applicable across care settings. A patient (or 
proxy or surrogate) can change or revoke a physi-
cian order for life-sustaining treatment at any time. 
(7) Advance care planning should be routinely 
conducted in community and clinical practices. Care 
plans should be periodically revisited to reflect a per-
son’s changes in values and perceptions at different 
stages and circumstances of life. This shared deci-
sionmaking and collaborative planning between the 
patient (or proxy or surrogate) and the clinician of 
their choice will lead to more person-centered, cul-
turally appropriate care. 
(8) Effective, respectful, and culturally com-
petent advance care planning requires recognition 
that both overtreatment and undertreatment may be 
concerns of individuals contemplating future care. 
(9) More should be done within local health sys-
tems to establish specific policies and programs to 
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assist people with sensory, mental, and other disabil-
ities in order to maximize the degree to which they 
are active participants in the decisions related to 
their health care, including training health care pro-
viders to be aware of augmentative communication 
devices and how to communicate with people with 
developmental, psychiatric, speech, and sensory dis-
abilities. 
(10) Studies funded by the Agency for 
Healthcare Research and Quality have shown that 
individuals who talked with their families or physi-
cians about their preferences for care had less fear 
and anxiety, felt they had more ability to influence 
and direct their medical care, believed that their 
physicians had a better understanding of their wish-
es, and indicated a greater understanding and com-
fort level than they had before the discussion. Pa-
tients who had advance planning discussions with 
their physicians continued to discuss and talk about 
these concerns with their families. Such discussions 
enabled patients and families to reconcile any dif-
ferences about care and could help the family and 
physician come to agreement if they should need to 
make decisions for the patient. 
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(11) A decade of research has demonstrated 
that physician orders for life-sustaining treatment 
effectively convey patient preferences and guide med-
ical personnel toward medical treatment aligned with 
patient wishes. Programs for these orders have de-
veloped locally on a statewide or communitywide 
basis and have different program names, forms, and 
policies, but all follow the principle of patient-cen-
tered care. 
(12) According to research published in the Ar-
chives of Internal Medicine, between 65 and 76 per-
cent of physicians whose patients had an advance di-
rective were not aware that it existed. 
(13) Including completed advance care planning 
documents within a patient’s electronic health record 
can increase the likelihood these documents are kept 
up-to-date and available at the right place at the 
right time. 
(c) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; findings; table of contents. 
Sec. 2. Voluntary advance care planning consultation coverage under Medicare 
and Medicaid. 
Sec. 3. Grants for programs for physician orders for life-sustaining treatment. 
Sec. 4. Advance care planning standards for electronic health records. 
Sec. 5. Portability of advance directives. 
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SEC. 2. VOLUNTARY ADVANCE CARE PLANNING CONSULTA-
TION COVERAGE UNDER MEDICARE AND 
MEDICAID. 
(a) MEDICARE.— 
(1) IN GENERAL.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended— 
(A) in subsection (s)(2)— 
(i) by striking ‘‘and’’ at the end of 
subparagraph (EE); 
(ii) by adding ‘‘and’’ at the end of 
subparagraph (FF); and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(GG) voluntary advance care planning 
consultation (as defined in subsection (iii)(1));’’; 
and 
(B) by adding at the end the following new 
subsection: 
‘‘Voluntary Advance Care Planning Consultation 
‘‘(iii)(1) Subject to paragraphs (3) and (4), the term 
‘voluntary advance care planning consultation’ means an 
optional consultation between the individual and a practi-
tioner described in paragraph (2) regarding advance care 
planning. Such consultation may include the following, as 
specified by the Secretary: 
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‘‘(A) An explanation by the practitioner of ad-
vance care planning and the uses of advance direc-
tives. 
‘‘(B) An explanation by the practitioner of the 
role and responsibilities of a proxy or surrogate. 
‘‘(C) An explanation by the practitioner of the 
services and supports available under this title dur-
ing chronic and serious illness, including palliative 
care, home care, long-term care, and hospice care. 
‘‘(D) An explanation by the practitioner of phy-
sician orders for life-sustaining treatment or similar 
orders in States where such orders or similar orders 
exist. 
‘‘(E) Facilitation by the practitioner of shared 
decisionmaking with the patient (or proxy or surro-
gate) which may include— 
‘‘(i) use of decision aids and patient sup-
port tools; 
‘‘(ii) the provision of patient-centered, 
easy-to-understand information about advance 
care planning or disease-specific care planning; 
and 
‘‘(iii) the incorporation of patient pref-
erences and values into the medical plan, an ad-
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vance directive, and a physician order for life- 
sustaining treatment as appropriate. 
‘‘(2) A practitioner described in this paragraph is a 
physician (as defined in subsection (r)(1)), nurse practi-
tioner, or physician assistant. 
‘‘(3) Payment may not be made under this title for 
a voluntary advance care planning consultation furnished 
more often than once every 5 years unless there is a sig-
nificant change in the health, health-related condition, or 
care setting of the individual. 
‘‘(4) For purposes of this section, the term ‘physician 
order for life-sustaining treatment’ means, with respect to 
an individual, an actionable medical order relating to the 
treatment of that individual that effectively communicates 
the individual’s preferences regarding life-sustaining treat-
ment, is in a form that is sanctioned or approved under 
State law or regulation or is widely recognized by health 
care providers in the State, and permits it to be followed 
by health care professionals across the continuum of care. 
Such an order may be changed or revoked by the indi-
vidual (or proxy or surrogate) at any time.’’. 
(2) CONSTRUCTION.—The voluntary advance 
care planning consultation described in section 
1861(iii) of the Social Security Act, as added by 
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paragraph (1), shall be completely optional. Nothing 
in this section shall— 
(A) require an individual to complete an 
advance directive or a physician order for life- 
sustaining treatment; 
(B) require an individual to consent to re-
strictions on the amount, duration, or scope of 
medical benefits an individual is entitled to re-
ceive under this title; or 
(C) violate the Assisted Suicide Funding 
Restriction Act of 1997 (Public Law 105–12) 
by encouraging the promotion of suicide or as-
sisted suicide. 
(3) PAYMENT.—Section 1848(j)(3) of such Act 
(42 U.S.C. 1395w–4(j)(3)) is amended by inserting 
‘‘(2)(GG),’’ before ‘‘(3),’’. 
(4) FREQUENCY LIMITATION.—Section 1862(a) 
of such Act (42 U.S.C. 1395y(a)) is amended— 
(A) in paragraph (1)— 
(i) in subparagraph (O), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (P) by striking 
the semicolon at the end and inserting ‘‘, 
and’’; and 
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(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(Q) in the case of voluntary advance care 
planning consultations (as defined in paragraph 
(1) of section 1861(iii)), which are performed 
more frequently than is covered under such sec-
tion;’’; and 
(B) in paragraph (7), by striking ‘‘or (P)’’ 
and inserting ‘‘(P), or (Q)’’. 
(5) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to consultations fur-
nished on or after January 1, 2014. 
(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 (28)’’ and in-
serting ‘‘, (28), and (29)’’. 
(2) MEDICAL ASSISTANCE.—Section 1905(a) of 
such Act (42 U.S.C. 1396d(a)) is amended— 
(A) by striking ‘‘and’’ at the end of para-
graph (28); 
(B) by redesignating paragraph (29) as 
paragraph (30); and 
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(C) by inserting after paragraph (28) the 
following new paragraph: 
‘‘(29) voluntary advance care planning con-
sultation (as defined in section 1861(iii)(1)); and’’. 
(c) DEFINITION
OF ADVANCE DIRECTIVE UNDER 
MEDICARE AND MEDICAID.— 
(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 and in-
serting the following: ‘‘means a living will, medical 
directive, health care power of attorney, durable 
power of attorney for health care, advance health 
care directive, health care directive, or other state-
ment that is recorded and completed in a manner 
recognized under State law by an individual with ca-
pacity to make health care decisions and that indi-
cates the individual’s wishes regarding medical treat-
ment in the event of future incapacity of the indi-
vidual to make health care decisions.’’. 
(2) MEDICAID.—Section 1902(w)(4) of such 
Act (42 U.S.C. 1396a(w)(4)) is amended by striking 
‘‘means’’ and all that follows and inserting the fol-
lowing: ‘‘means a living will, medical directive, 
health care power of attorney, durable power of at-
torney for health care, advance health care directive, 
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health care directive, or other statement that is re-
corded and completed in a manner recognized under 
State law by an individual with capacity to make 
health care decisions and that indicates the individ-
ual’s wishes regarding medical treatment in the 
event of future incapacity of the individual to make 
health care decisions.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section take effect on January 1, 2014. 
SEC. 3. GRANTS FOR PROGRAMS FOR PHYSICIAN ORDERS 
FOR LIFE-SUSTAINING TREATMENT. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall make grants to eligible entities for 
the purpose of— 
(1) establishing statewide programs for physi-
cian orders for life-sustaining treatment; or 
(2) expanding or enhancing existing programs 
for physician orders for life-sustaining treatment. 
(b) AUTHORIZED
ACTIVITIES.—Activities funded 
through a grant under this section for an area may in-
clude— 
(1) developing such a program for the area that 
includes hospitals, home care, hospice, long-term 
care, community and assisted living residences, 
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skilled nursing facilities, and emergency medical 
services within a State; and 
(2) expanding an existing program for physi-
cian orders regarding life-sustaining treatment to 
serve more patients or enhance the quality of serv-
ices, including educational services for patients and 
patients’ families, training of health care profes-
sionals, or establishing a physician orders for life- 
sustaining treatment registry. 
(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 one-half are used for establishing 
new programs for physician orders regarding life- 
sustaining treatment; and 
(2) remaining funds are to be used for expand-
ing or enhancing existing programs for physician or-
ders regarding life-sustaining treatment. 
(d) DEFINITIONS.—In this section: 
(1) The term ‘‘eligible entity’’ includes— 
(A) an academic medical center, a medical 
school, a State health department, a State med-
ical association, a multistate task force, a hos-
pital, or a health system capable of admin-
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istering a program for physician orders regard-
ing life-sustaining treatment for a State; or 
(B) any other health care agency or entity 
as the Secretary determines appropriate. 
(2) The term ‘‘physician order for life-sus-
taining treatment’’ has the meaning given such term 
in section 1861(iii)(4) of the Social Security Act, as 
added by section 2. 
(3) The term ‘‘program for physician orders for 
life-sustaining treatment’’ means a program that— 
(A) supports the active use of physician or-
ders for life-sustaining treatment in the State; 
and 
(B) is guided by a coalition of stakeholders 
that includes patient advocacy groups and rep-
resentatives from across the continuum of 
health care services, such as disability rights 
advocates, senior advocates, emergency medical 
services, long-term care, medical associations, 
hospitals, home health, hospice, the State agen-
cy responsible for senior and disability services, 
and the State department of health. 
(4) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
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(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 
2014 through 2019. 
SEC. 4. ADVANCE CARE PLANNING STANDARDS FOR ELEC-
TRONIC HEALTH RECORDS. 
Notwithstanding section 3004(b)(3) of the Public 
Health Service Act (42 U.S.C. 300jj–14(b)(3)), not later 
than January 1, 2015, the Secretary of Health and 
Human Services shall adopt, by rule, standards for a 
qualified electronic health record (as defined in section 
3000(13) of such Act (42 U.S.C. 300jj(13)), with respect 
to patient communications with a health care provider 
about values and goals of care, to adequately display the 
following: 
(1) The patient’s current advance directive (as 
defined in section 1866(f)(3) of the Social Security 
Act (42 U.S.C. 1395cc(f)(3)), as applicable. 
(2) The patient’s current physician order for 
life-sustaining treatment (as defined in section 
1861(iii)(4) of the Social Security Act (42 U.S.C. 
1395x(iii)(4)), as applicable. 
A standard adopted under this section shall be treated as 
a standard adopted under section 3004 of the Public 
Health Service Act (42 U.S.C. 300jj–14) for purposes of 
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certifying qualified electronic health records pursuant to 
section 3001(c)(5) of such Act (42 U.S.C. 300jj– 
11(c)(5)). 
SEC. 5. PORTABILITY OF ADVANCE DIRECTIVES. 
(a) IN GENERAL.—Section 1866(f) of the Social Se-
curity Act (42 U.S.C. 1395cc(f)) is amended by adding 
at the end the following new paragraph: 
‘‘(5)(A) An advance directive validly executed outside 
the State in which such directive is presented must be 
given effect by a provider of services or organization to 
the same extent as an advance directive validly executed 
under the law of the State in which it is presented. 
‘‘(B) In the absence of knowledge to the contrary, 
a physician or other health care provider or organization 
may presume that a written advance health care directive 
or similar instrument, regardless of where executed, is 
valid. 
‘‘(C) In the absence of a validly executed advance di-
rective, any authentic expression of a person’s wishes with 
respect to health care shall be honored. 
‘‘(D) The provisions of this paragraph shall preempt 
any State law on advance directive portability to the extent 
such law is inconsistent with such provisions. Nothing in 
the paragraph shall be construed to authorize the adminis-
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tration of health care treatment otherwise prohibited by 
the laws of the State in which the directive is presented.’’. 
(b) MEDICAID.—Section 1902(w) of the Social Secu-
rity Act (42 U.S.C. 1396a(w)) is amended by adding at 
the end the following new paragraph: 
‘‘(6)(A) An advance directive validly executed outside 
the State in which such directive is presented must be 
given effect by a provider or organization to the same ex-
tent as an advance directive validly executed under the law 
of the State in which it is presented. 
‘‘(B) In the absence of knowledge to the contrary, 
a physician, other health care provider, or organization 
may presume that a written advance health care directive 
or similar instrument, regardless of where executed, is 
valid. 
‘‘(C) In the absence of a validly executed advance di-
rective, any authentic expression of a person’s wishes with 
respect to health care shall be honored. 
‘‘(D) The provisions of this paragraph shall preempt 
any State law on advance directive portability to the extent 
such law is inconsistent with such provisions. Nothing in 
the paragraph shall be construed to authorize the adminis-
tration of health care treatment otherwise prohibited by 
the laws of the State in which the directive is presented.’’. 
Æ 
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