I 
115TH CONGRESS 
1ST SESSION H. R. 2797 
To amend title XVIII of the Social Security Act to provide for advanced 
illness care coordination services for Medicare beneficiaries, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 7, 2017 
Mr. BLUMENAUER (for himself and Mr. ROE of Tennessee) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for advanced illness care coordination services for Medi-
care beneficiaries, 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; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Patient Choice and Quality Care Act of 2017’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
Sec. 3. Advanced illness care and management model. 
Sec. 4. Quality measurement development and implementation. 
Sec. 5. Enhancing coverage of advance care planning services. 
Sec. 6. Advance care planning support tools. 
Sec. 7. Advance directives. 
Sec. 8. Additional requirements for facilities. 
Sec. 9. Grants for increasing public awareness and training. 
Sec. 10. Advance Care Planning Advisory Council. 
Sec. 11. Annual report on Medicare decedents. 
Sec. 12. Rule of construction. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) The population of the United States is esti-
mated to age rapidly, with the number of people over 
the age of 65 set to double to more than 98 million, 
or 1 in 5 Americans, by 2040. 
(2) As Americans live longer and healthier lives, 
they also face increased incidence of multiple serious 
or chronic progressive conditions and advanced ill-
ness as they age. 
(3) Americans with serious, chronic progressive, 
or advanced illness face a complicated and frag-
mented system of care delivery that puts them at 
risk for repeat hospitalizations, adverse drug reac-
tions, and conflicting medical advice that may be 
overwhelming to individuals and families. 
(4) The progression of serious, chronic progres-
sive, or advanced illness leads to the need for in-
creasingly intensive decision support, health care 
services, and support from family caregivers. 
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(5) The complexity of care needed by individ-
uals with serious, chronic progressive, or advanced 
illness may result in uncoordinated care, adverse 
health outcomes, frustration, wasted time, and 
undue emotional burdens on individuals and their 
family caregivers. 
(6) Numerous private sector leaders, including 
hospitals, health systems, home health agencies, hos-
pice programs, long-term care providers, employers, 
and other entities, have put in place innovative solu-
tions to provide more comprehensive and coordinated 
care for Americans living with serious, chronic pro-
gressive, or advanced illness. 
(7) Hospice and palliative care programs offer 
patients and families appropriate and patient-cen-
tered care, delivered by an interdisciplinary care 
team. These programs should serve as models for 
advanced illness care delivery. 
(8) Individuals have the well-established right 
to accept or reject medical treatment that is offered 
and all individuals should be afforded the oppor-
tunity to fully participate in decisions related to 
their health care. 
(9) Too often, individuals with serious, chronic 
progressive, or advanced illness do not understand 
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the conditions they are facing or their treatment op-
tions, and they do not receive the information or 
support they need to evaluate treatment options in 
light of their personal goals and values and to docu-
ment treatment plans in a manner that allows pro-
viders and facilities to follow their plans. 
(10) Providing high-quality advanced care plan-
ning services and supports to individuals with seri-
ous, chronic progressive, or advanced illness will pro-
tect and preserve their dignity and ensure care is 
aligned with an individual’s goals, values, and stated 
preferences. 
SEC. 3. ADVANCED ILLNESS CARE AND MANAGEMENT 
MODEL. 
Section 1115A of the Social Security Act (42 U.S.C. 
1315a) is amended— 
(1) in subsection (b)(2)(A), by adding at the 
end the following new sentence: ‘‘The models se-
lected under this subparagraph shall include the 
model described in subsection (h), which shall be im-
plemented by not later than 1 year after the date of 
the enactment of the Patient Choice and Quality 
Care Act of 2017.’’; and 
(2) by adding at the end the following new sub-
section: 
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‘‘(h) ADVANCED ILLNESS CARE AND MANAGEMENT 
MODEL.— 
‘‘(1) MODEL.— 
‘‘(A) IN GENERAL.—The model described 
in this subparagraph is a model under which 
payments are made under title XVIII to appli-
cable providers that furnish advanced illness 
care and management services, including care 
coordination and palliative care services, to eli-
gible individuals with serious, chronic progres-
sive, or advanced illness in order to test the use 
of targeted advanced illness management and 
early use of palliative care under the Medicare 
program. 
‘‘(B) VOLUNTARY.—Participation under 
the model shall be voluntary with respect to 
both eligible individuals and applicable pro-
viders. 
‘‘(C) REQUIREMENTS.— 
‘‘(i) HOSPICE
PROVIDER.—At least 
one applicable provider selected for partici-
pation under the model shall be a hospice 
program 
(as 
defined 
in 
section 
1861(dd)(2)). 
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‘‘(ii) COMPARISON.—The Secretary 
shall establish the model in such a manner 
as will permit the comparison of outcomes 
for eligible individuals participating under 
the model and eligible individuals who are 
not so participating. 
‘‘(iii) INCORPORATION INTO EXISTING 
MODELS.—In addition to operating the 
model independently, the Secretary shall 
incorporate the model into existing models 
related to the Medicare program, such as 
models involving accountable care organi-
zations, bundled payments, and value 
based purchasing arrangements, and other 
coordinated care models as the Secretary 
determines to be appropriate. 
‘‘(2) PAYMENTS.—Under the model, the Sec-
retary shall establish payment amounts for advanced 
illness care and management services that is tar-
geted to eligible individuals with a serious, chronic 
progressive, or advanced illness. The payments may 
include payments under a fee schedule, capitated 
payments, bundled payments, value-based pur-
chasing agreements, and other payment mechanisms 
determined appropriate by the Secretary. 
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‘‘(3) ADVANCED ILLNESS CARE AND MANAGE-
MENT SERVICES DEFINED.—In this subsection, the 
term ‘advanced illness care and management serv-
ices’ means the following services, as appropriate for 
the individual’s illness and stage of illness: 
‘‘(A) One or more face-to-face encounters 
between one or more members of the inter-
disciplinary team and the individual and, at the 
individual’s discretion, family caregivers, or, for 
an individual who lacks decisionmaking capacity 
under State law, the individual’s legally author-
ized representative. 
‘‘(B) The provision of information about 
the typical trajectory of illnesses or conditions 
that affect the individual, including foreseeable 
care decisions that may need to be made at a 
future time when the individual is likely to be 
unable to make decisions due to temporary or 
permanent cognitive or medical incapacity. 
‘‘(C) Assisting the individual in defining 
and articulating goals of care, values, and pref-
erences. 
‘‘(D) Providing the individual with and dis-
cussing information about the benefits and bur-
dens of relevant ranges of treatment options 
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available to the individual, including disease 
modifying or potentially curative treatment, pal-
liative care, which may be provided alone or in 
conjunction with disease modifying treatment, 
and, when the individual may be currently eligi-
ble or may become eligible for hospice care due 
to disease progression. 
‘‘(E) Assisting the individual in evaluating 
treatment options and approaches to care to 
identify those that most closely align with the 
individual’s goals of care, values, and pref-
erences. 
‘‘(F) Preparing, and sharing with relevant 
providers, documentation— 
‘‘(i) that states the individual’s goals 
of care, preferences, and values, preferred 
decisionmaking strategies, and a plan of 
care that is concrete and actionable; and 
‘‘(ii) that is in State or locally recog-
nized forms that are used for the purpose 
of assuring that providers can follow the 
plan across care settings, such as advance 
directives or portable treatment orders. 
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‘‘(G) Referrals to providers, including med-
ical and social service providers, who deliver 
care consistent with the plan. 
‘‘(H) Providing culturally and education-
ally appropriate training for the individual and 
family caregivers to support their ability to 
carry out the plan. 
‘‘(I) A multidimensional assessment of the 
individual’s strengths and limitations. 
‘‘(J) An assessment of the individual’s paid 
and unpaid supports, including family care-
givers. 
‘‘(K) Comprehensive medication review and 
management (including, if appropriate, coun-
seling and self-management support). 
‘‘(L) Visits to the patient in all sites of 
care (including the home, a hospital, and a 
nursing home) as needed to respond appro-
priately to problems and concerns. 
‘‘(M) Additional services, consistent with 
the care plan, that the interdisciplinary team 
believes would assist the eligible individual and 
family caregivers in more effectively managing 
their health condition. 
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‘‘(N) 24-Hour access to emergency support 
in person or via telephone or telemedicine with 
the individual’s medical record and care plan 
available to the responder. 
‘‘(O) Care coordination and communication 
across health care and social service settings 
and providers, including involvement of the 
interdisciplinary team to evaluate quality and 
address concerns over time. 
‘‘(P) Such other palliative and other serv-
ices that the Secretary determines appropriate. 
‘‘(4) APPLICABLE PROVIDER DEFINED.—In this 
subsection, the term ‘applicable provider’ means a 
hospice program (as defined in section 1861(dd)(2)) 
or other provider of services (as defined in section 
1861(u)) or supplier (as defined in section 1861(d)) 
that— 
‘‘(A) furnishes services through an inter-
disciplinary team; and 
‘‘(B) meets such other requirements the 
Secretary may determine to be appropriate. 
‘‘(5) ELIGIBLE INDIVIDUAL DEFINED.—In this 
subsection, the term ‘eligible individual’ means an 
individual who— 
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‘‘(A) is entitled to, or enrolled for, benefits 
under part A of title XVIII and enrolled under 
part B of such title, but not enrolled under part 
C of such title; 
‘‘(B) resides at home or in an institutional 
setting, whichever is consistent with their per-
sonal goals and preferences; and 
‘‘(C) meets at least one of the following: 
‘‘(i) The individual has the need for 
assistance with two or more activities of 
daily living (defined as bathing, dressing, 
eating, getting out of bed or a chair, mobil-
ity, and toileting) that is caused by one or 
more serious or life threatening conditions 
or frailty and that is not associated with 
an acute or post-operative condition. 
‘‘(ii) The individual is diagnosed with 
a serious, chronic progressive or advanced 
illness that— 
‘‘(I) has a strong negative impact 
on the individual’s quality of life and 
functioning in life roles, independent 
of its impact on mortality; or 
‘‘(II) is burdensome in symp-
toms, treatments or caregiver stress. 
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‘‘(iii) The individual is diagnosed 
with— 
‘‘(I) metastatic or locally ad-
vanced cancer; 
‘‘(II) Alzheimer’s disease or an-
other progressive dementia; 
‘‘(III) late-stage neuromuscular 
disease; 
‘‘(IV) late-stage diabetes; 
‘‘(V) 
late-stage 
kidney, 
liver, 
heart, 
gastrointestinal, 
cerebro-
vascular, or lung disease; or 
‘‘(VI) age-related physical debil-
ity. 
‘‘(iv) The individual meets other cri-
teria determined appropriate by the Sec-
retary. 
‘‘(6) INTERDISCIPLINARY TEAM.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), in this subsection, the term ‘inter-
disciplinary team’ means a group that— 
‘‘(i) includes at least— 
‘‘(I) one physician who is board 
certified in geriatrics, internal medi-
cine, or family medicine; 
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‘‘(II) 
one 
physician, 
advance 
practice registered nurse, or physician 
assistant, who is a palliative specialist 
(defined as having a certification in 
hospice and palliative care) or who 
has at least one year’s experience pro-
viding hospice or palliative care; 
‘‘(III) one nurse; and 
‘‘(IV) one social worker; 
‘‘(ii) may include a chaplain, minister, 
or pastoral counselor; 
‘‘(iii) may include other direct care 
personnel (including pharmacists, dieti-
cians, physical therapists, occupational 
therapists, and psychotherapists); and 
‘‘(iv) meets requirements that may be 
established by the Secretary. 
‘‘(B) ADDITIONAL MEMBER AT THE RE-
QUEST OF THE ELIGIBLE INDIVIDUAL.—An ap-
plicable provider shall offer to the eligible indi-
vidual (or the individual’s legally authorized 
representative when the individual has been 
found to lack decisional capacity) the oppor-
tunity to select either a chaplain affiliated with 
the applicable provider, a minister, or personal 
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religious or spiritual advisor who can help to 
represent the individual’s goals, values, and 
preferences to serve as a core interdisciplinary 
team member at the individual’s (or legally au-
thorized representative’s) request.’’. 
SEC. 4. QUALITY MEASUREMENT DEVELOPMENT AND IM-
PLEMENTATION. 
(a) FACILITATION
OF INCREASED COORDINATION 
AND ALIGNMENT BETWEEN THE PUBLIC AND PRIVATE 
SECTOR WITH RESPECT TO QUALITY MEASURES RE-
GARDING ADVANCED ILLNESS, PALLIATIVE, AND END-OF- 
LIFE CARE.— 
(1) IN GENERAL.—Section 1890(b) of the So-
cial Security Act (42 U.S.C. 1395aaa(b)) is amend-
ed by inserting after paragraph (3) the following 
new paragraph: 
‘‘(4) INCREASED
COORDINATION
AND
ALIGN-
MENT BETWEEN THE PUBLIC AND PRIVATE SECTOR 
WITH RESPECT TO QUALITY MEASURES REGARDING 
ADVANCED ILLNESS, PALLIATIVE, AND END-OF-LIFE 
CARE.— 
‘‘(A) IN GENERAL.—The entity shall facili-
tate increased coordination and alignment be-
tween the public and private sector with respect 
to quality measures regarding advanced illness, 
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palliative, and end-of-life care across the care 
settings and programs described in this section 
and across other services and care settings 
under this title, as appropriate. 
‘‘(B) ENVIRONMENTAL SCAN.—The entity 
shall conduct an environmental scan of meas-
ures, measure concepts, and preferred practices 
for advanced illness, palliative, and end-of-life 
care used in both the private and public sectors 
and from multiple settings of care. Such scan 
shall include a review of the following: 
‘‘(i) The process of eliciting and docu-
menting patient (and, where relevant and 
appropriate, family caregiver or legally au-
thorized representative) goals, preferences, 
and values regarding care and treatment, 
including the articulation of goals for end- 
of-life care that adequately reflect how the 
patient wants to live. 
‘‘(ii) 
The 
effectiveness, 
patient- 
centeredness (and, where relevant, family 
caregiver-centeredness), and adequacy of 
care plans, including documentation of in-
dividual goals, preferences, and values. 
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‘‘(iii) 
Agreement 
and 
consistency 
among— 
‘‘(I) the patient’s goals, pref-
erences, and values; 
‘‘(II) any documented care plan; 
and 
‘‘(III) the care delivered. 
‘‘(iv) Timely and appropriate referral 
to hospice care. 
‘‘(C) 
IDENTIFICATION
AND 
PRIORITIZATION
OF
MEASURES.—The entity 
shall, based on the scan conducted under sub-
paragraph (B), identify and prioritize measures, 
measure concepts, and preferred practices, that 
are aligned across settings of care, condition, 
and patient population. 
‘‘(D) REPORT.—Not later than 18 months 
after the date of enactment of this paragraph, 
the entity shall submit to the Secretary a report 
containing the findings of the entity with re-
spect to the environmental scan under subpara-
graph 
(B) 
and 
the 
identification 
and 
prioritization of measures, measure concepts, 
and preferred practices under subparagraph 
(C).’’. 
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(b) STUDY AND REPORT ON NIH DEVELOPMENT OF 
ADDITIONAL
MEASURES
RELATED
TO
CARE
PLAN-
NING.—Section 1890A of the Social Security Act (42 
U.S.C. 1395aaa–1) is amended by adding at the end the 
following new subsection: 
‘‘(g) STUDY AND REPORT ON NIH DEVELOPMENT 
OF ADDITIONAL MEASURES RELATED TO CARE PLAN-
NING.— 
‘‘(1) STUDY.—The Secretary, in consultation 
with the Palliative Care Research Cooperative 
Group, the National Institute of Nursing Research, 
and the Office of End-of-Life and Palliative Care 
Research of the National Institutes of Health shall 
conduct a study regarding the development of meas-
ures related to— 
‘‘(A) concordance of care between the 
wishes of an individual and the treatment re-
ceived by the individual, including documenta-
tion of such wishes in the medical record; 
‘‘(B) understanding the population with se-
rious, chronic progressive, or advanced illness 
that would benefit from palliative care and ad-
vance care planning services; and 
‘‘(C) appropriate transitions to hospice 
care. 
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‘‘(2) REPORT.—Not later than December 31, 
2019, the Secretary shall submit to Congress a re-
port containing the results of the study conducted 
under paragraph (1).’’. 
(c) MEDICARE PHYSICIAN FEE SCHEDULE.—Section 
1848(s)(1) of the Social Security Act (42 U.S.C. 1395w– 
4(s)(1)) is amended by adding at the end the following 
new subparagraph: 
‘‘(G) CLINICAL CARE MEASURES RELATING 
TO PALLIATIVE AND END-OF-LIFE CARE.—Be-
ginning after the completion of the environ-
mental scan under section 1890(b)(4)(B), with-
in one or more appropriate quality domains, the 
Secretary shall, in consultation with the entity 
with a contract under section 1890(a), establish 
appropriate clinical care measures relating to 
palliative and end-of-life care, including at least 
one measure for each of the areas studied 
under subparagraphs (A), (B), and (C) of sec-
tion 1890A(g)(1).’’. 
(d) POST-ACUTE CARE.—Section 1899B of the So-
cial Security Act (42 U.S.C. 1395lll) is amended— 
(1) in subsection (a)(2)(E)(i)— 
(A) in subclause (IV), by striking ‘‘and’’ at 
the end; 
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(B) in subclause (V), by striking the period 
at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(VI) with respect to the domain 
described in subsection (c)(1)(F) (re-
lating to end-of-life care)— 
‘‘(aa) for PAC providers de-
scribed in clauses (ii), (iii), and 
(iv) of paragraph (2)(A), October 
1, 2020; and 
‘‘(bb) for PAC providers de-
scribed in clauses (i) of such 
paragraph, January 1, 2021.’’; 
and 
(2) in subsection (c)(1), by adding at the end 
the following new subparagraph: 
‘‘(F) 
The 
effectiveness, 
patient- 
centeredness (and, where relevant, family care-
giver-centeredness), and adequacy of care plans 
and communications relating to such plans, in-
cluding— 
‘‘(i) documentation of a patient’s 
goals, preferences, and values; 
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‘‘(ii) agreement and consistency with 
respect to care among— 
‘‘(I) the patient’s goals, pref-
erences, and values; 
‘‘(II) any documented care plan; 
and 
‘‘(III) the care delivered; and 
‘‘(iii) timely and appropriate referral 
to hospice care.’’. 
(e) MEDICARE ADVANTAGE.—Section 1852(e)(3) of 
the Social Security Act (42 U.S.C. 1395w–22(e)(3)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(C) 
PALLIATIVE
AND
END-OF-LIFE 
CARE.—The Secretary, in consultation with the 
National Committee for Quality Assurance, 
shall prioritize the development of standards for 
palliative and end-of-life care, including transi-
tion to hospice care, with respect to Medicare 
Advantage organizations under this part for use 
under the quality improvement program under 
paragraph (1) that are the equivalent of such 
standards in quality programs applicable to 
providers of services and suppliers under the 
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original Medicare fee-for-service program under 
parts A and B.’’. 
(f) 
ALTERNATIVE
PAYMENT
MODELS.—Section 
1899(b)(3)(C) of the Social Security Act (42 U.S.C. 
1395jjj(b)(3)(C)) is amended— 
(1) by striking ‘‘STANDARDS.—The Secretary’’ 
and inserting ‘‘STANDARDS.— 
‘‘(i) IN
GENERAL.—The Secretary’’; 
and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) PALLIATIVE
AND
END-OF-LIFE 
CARE.—The Secretary, in consultation with 
the entity with a contract under section 
1890(a), shall ensure that quality perform-
ance standards established under this sub-
paragraph include measures that apply to 
palliative and end-of-life care, including 
transition to hospice care.’’. 
SEC. 5. ENHANCING COVERAGE OF ADVANCE CARE PLAN-
NING SERVICES. 
(a) DEFINITION.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended by adding at the 
end the following new subsection: 
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‘‘Advance Care Planning Services 
‘‘(jjj)(1) The term ‘advance care planning services’ 
means services identified as of the date of enactment of 
this subsection as Current Procedural Terminology (CPT) 
codes 99497 and 99498, and such codes as subsequently 
modified, that are furnished by a physician or other eligi-
ble practitioner (as determined by the Secretary). 
‘‘(2) For purposes of paragraph (1), the term ‘eligible 
practitioner’ includes, in addition to a practitioner eligible 
to bill such CPT codes as of the date of enactment of this 
subsection, an individual who— 
‘‘(A) is a clinical social worker (as defined in 
subsection (hh)(1)); and 
‘‘(B) possesses— 
‘‘(i) a relevant care planning certification; 
or 
‘‘(ii) experience providing care planning 
conversations or similar services, as defined by 
the Secretary, in the course of their work.’’. 
(b) NO APPLICATION OF COINSURANCE OR DEDUCT-
IBLE.— 
(1) AMOUNT.—Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)) is amended— 
(A) by striking ‘‘and (BB)’’ and inserting 
‘‘(BB)’’; and 
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(B) by inserting before the semicolon at 
the end the following: ‘‘, and (CC) with respect 
to advance care planning services (as defined in 
section 1861(jjj)(1)), the amounts paid shall be 
100 percent of the lesser of the actual charge 
for the services or the amount determined 
under the fee schedule established under section 
1848(b).’’. 
(2) WAIVER
OF
APPLICATION
OF
DEDUCT-
IBLE.—The first sentence of section 1833(b) of the 
Social Security Act (42 U.S.C. 1395l(b)) is amend-
ed— 
(A) by striking ‘‘and’’ before ‘‘(10)’’; and 
(B) by inserting before the period the fol-
lowing: ‘‘, and (11) such deductible shall not 
apply with respect to advance care planning 
services (as defined in section 1861(jjj)(1))’’. 
(c) EFFECTIVE DATE.—The amendment made by 
this subsection shall apply to advance care planning serv-
ices furnished on or after January 1, 2018. 
SEC. 6. ADVANCE CARE PLANNING SUPPORT TOOLS. 
(a) INCLUSION OF ADVANCE CARE PLANNING MATE-
RIALS IN THE MEDICARE & YOU HANDBOOK.— 
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(1) IN GENERAL.—Section 1804(a) of the So-
cial Security Act (42 U.S.C. 1395b–2(a)) is amend-
ed— 
(A) in paragraph (2), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (3), by striking the pe-
riod at the end and inserting a semicolon; and 
(C) by inserting after paragraph (3) the 
following new paragraphs: 
‘‘(4) information on— 
‘‘(A) care planning; 
‘‘(B) how individual goals, values, and 
preferences should be considered in framing a 
care plan; and 
‘‘(C) a range of approaches for treating se-
rious, chronic progressive, or advanced illness, 
including disease modifying options, palliative 
care that supports individuals from the onset of 
illness and can be provided at the same time as 
all other care types, and hospice care; and 
‘‘(5) information on documentation options for 
care planning or advance care planning, including 
advance directives and portable treatment orders.’’. 
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(2) EFFECTIVE DATE.—The amendments made 
by this section shall apply to notices distributed on 
or after January 1, 2018. 
(b) ADVANCE CARE PLANNING STANDARDS
FOR 
ELECTRONIC HEALTH RECORDS.— 
(1) IN
GENERAL.—Notwithstanding section 
3004(b)(3) of the Public Health Service Act (42 
U.S.C. 300jj–14(b)(3)), not later than 4 years after 
the date of the enactment of this Act, the Secretary 
of Health and Human Services shall adopt, by rule, 
standards for a qualified electronic health record (as 
defined in section 3000(13) of such Act (42 U.S.C. 
300jj(13))), with respect to organizing patient com-
munications with health care providers about care 
goals and to provide one-click access to the fol-
lowing: 
(A) 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 ap-
plicable. 
(B) The patient’s current order for life- 
sustaining treatment (described in section 
9(d)(3)(B)), as applicable. 
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(C) Documentation of advance care plan-
ning discussion between the patient and the 
provider. 
(2) TREATMENT OF STANDARDS.—A standard 
adopted under paragraph (1) shall be treated as a 
standard adopted under section 3004 of the Public 
Health Service Act (42 U.S.C. 300jj–14) for pur-
poses of certifying qualified electronic health records 
pursuant to section 3001(c)(5) of such Act (42 
U.S.C. 300jj–11(c)(5)). 
SEC. 7. ADVANCE DIRECTIVES. 
(a) PORTABILITY.—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 may 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. 
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‘‘(C) The provisions of this paragraph shall preempt 
any State law on advance directive portability to the extent 
such law is inconsistent with such provisions. 
‘‘(D) Nothing in the paragraph shall be construed 
to— 
‘‘(i) authorize the administration of health care 
treatment otherwise prohibited by the laws of the 
State in which the directive is presented; 
‘‘(ii) require a provider of services or an organi-
zation to act in a manner contrary to its religious 
or moral convictions; 
‘‘(iii) apply to a request or directive ordering a 
sterilization or abortion or ordering withdrawal of 
treatment from a pregnant woman if continued 
treatment can reasonably be expected to bring her 
child to live birth; 
‘‘(iv) prohibit the application of a State law 
which allows for an objection on the basis of con-
science for any health care provider or any agent of 
such provider which as a matter of conscience can-
not implement an advance directive or portable 
treatment order; or 
‘‘(v) permit the Secretary to seek civil penalties, 
including exclusion from participation in the pro-
gram under this title or the program under title 
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XIX, against a provider or organization if the pro-
vider or organization— 
‘‘(I) used reasonable efforts to deliver care 
that is consistent with an individual’s goals, 
preferences, and values when addressing deci-
sionmaking 
for 
an 
individual 
who 
lacks 
decisional capacity; or 
‘‘(II) exercised its right of conscience in 
accordance with clause (ii) or (iv).’’. 
(b) CLARIFICATION WITH RESPECT TO ADVANCE DI-
RECTIVES.—Paragraph (2) of section 7 of the Assisted 
Suicide Funding Restriction Act of 1997 (42 U.S.C. 
14406) is amended to read as follows: 
‘‘(2) to require any provider or organization, or 
any employee of such a provider or organization, to 
follow or be bound by a request from an individual 
or legally authorized representative, an advance di-
rective, or a portable treatment order that directs 
the purposeful causing of, or the purposeful assist-
ing in causing, the death of any individuals, such as 
by assisted suicide, euthanasia, or mercy killing.’’. 
(c) GAO STUDY ON HEALTH CARE DECISIONMAKING 
LAWS AND BARRIERS TO THE USE OF ADVANCE DIREC-
TIVES.— 
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(1) STUDY.—The Comptroller General of the 
United States shall conduct a study that examines 
the use, portability, and electronic storage of ad-
vance directives and that identifies barriers towards 
adopting, using, and following advance directives in 
the clinical setting. Such examination shall include 
issues that remain unresolved after the Stage 3 
Meaningful Use final rule, including barriers and so-
lutions to finding and accessing advance care plan-
ning documents, best practices for alerting eligible 
providers to the presence of an advance care plan, 
and best practices for transmitting advance care 
plans across sites of care. 
(2) REPORT.—Not later than 1 year after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report on the 
study conducted under paragraph (1) and shall in-
clude in the report such recommendations regarding 
improving advance health care planning as the 
Comptroller General deems appropriate. 
SEC. 8. ADDITIONAL REQUIREMENTS FOR FACILITIES. 
(a) REQUIREMENTS.— 
(1) IN GENERAL.—Section 1866(a)(1) of the 
Social Security Act (42 U.S.C. 1395cc(a)(1)) is 
amended— 
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(A) in subparagraph (Y), by striking the 
period at the end and inserting ‘‘; and’’; and 
(B) by inserting after subparagraph (Y) 
the following new subparagraph: 
‘‘(Z) in the case of hospitals, skilled nursing fa-
cilities, home health agencies, and hospice programs, 
to assure that documented care plans include any 
advance directives or portable treatment orders 
made while the individual received care by the pro-
vider and that such plan is sent to the individual’s 
primary care provider upon discharge and any facil-
ity to which the individual is transferred.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to agreements entered 
into or renewed on or after January 1, 2019. 
(b) HHS STUDY AND REPORT.— 
(1) STUDY.—The Secretary of Health and 
Human Services shall conduct a study on the extent 
to which hospitals, skilled nursing facilities, hospice 
programs, home health agencies, and providers of 
advance care planning services work with individuals 
to— 
(A) engage in a care planning process; 
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(B) thoroughly and completely document 
the care planning process in the medical record 
and to update the care plan on a regular basis; 
(C) complete documents necessary to sup-
port the treatment and care plan, such as port-
able treatment orders and advance directives; 
(D) provide services and support that are 
free from discrimination based on advanced 
age, disability status, or diagnosis, including se-
rious, chronic progressive, or advanced illness; 
and 
(E) provide documentation necessary to 
carry out the treatment plan to— 
(i) subsequent providers or facilities; 
and 
(ii) the individual, their legally au-
thorized representatives, and, where appro-
priate and relevant, their family caregiver. 
(2) REPORT.—Not later than January 1, 2021, 
the Secretary of Health and Human Services shall 
submit to Congress a report on the study conducted 
under paragraph (1) together with recommendations 
for such legislation and administrative action as the 
Secretary determines to be appropriate. 
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SEC. 9. GRANTS FOR INCREASING PUBLIC AWARENESS AND 
TRAINING. 
(a) MATERIAL AND RESOURCES DEVELOPMENT.— 
The Secretary of Health and Human Services (referred 
to in this section as the ‘‘Secretary’’), in consultation with 
the Advance Care Planning Advisory Council (established 
in section 10), may award grants to public or private enti-
ties (including, as appropriate, States, political subdivi-
sions of States, medical schools, nursing schools, health 
care systems, faith-based organizations, and religious edu-
cational institutions), or a consortium of any such entities, 
to develop online training modules, decision support tools, 
and instructional materials for individuals, family care-
givers, and health care providers that include— 
(1) with respect to healthy individuals, the im-
portance of— 
(A) identifying an individual who will make 
treatment decisions in the event of future cog-
nitive incapacity; 
(B) discussing values and goals relevant to 
serious injury or illness; and 
(C) completing an advance directive that— 
(i) appoints a surrogate; and 
(ii) documents goals and values and 
other information that should be consid-
ered in making treatment decisions; 
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(2) with respect to individuals with serious, 
chronic progressive, or advanced illness, the impor-
tance of— 
(A) articulating goals of care; 
(B) understanding prognosis and typical 
disease trajectory; 
(C) evaluating treatment options in light of 
goals of care; 
(D) developing a treatment plan; and 
(E) documenting the treatment plan on ad-
vance directives, portable treatment orders, and 
other documentation forms used in the locality 
where the plan is to be executed; 
(3) the role and effective use of State and other 
advance directive forms and portable treatment or-
ders; 
(4) the range of services for individuals facing 
serious, chronic progressive, or advanced illness, in-
cluding advance care planning services, palliative 
care, and hospice care; and 
(5) with respect to providers of advance care 
planning, advance illness care, hospice care, and pal-
liative care in hospital, hospice, home, community, 
and long-term care settings, material to assist in— 
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