I 
109TH CONGRESS 
1ST SESSION H. R. 2058
To amend titles XVIII and XIX of the Social Security Act and title III 
of the Public Health Service Act to improve access to information about 
individuals’ health care options and legal rights for care near the end 
of life, to promote advance care planning and decisionmaking so that 
individuals’ wishes are known should they become unable to speak for 
themselves, to engage health care providers in disseminating information 
about and assisting in the preparation of advance directives, which in-
clude living wills and durable powers of attorney for health care, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 3, 2005
Mr. LEVIN (for himself, Mr. ABERCROMBIE, Mr. CARDIN, Mr. CASE, Mr. CAS-
TLE, Mr. CLEAVER, Mr. CUMMINGS, Ms. DELAURO, Mr. ENGEL, Mr. 
FARR, Mr. HOLDEN, Mr. KILDEE, Mr. KIND, Mr. KUCINICH, Mr. LEWIS 
of Georgia, Mrs. MALONEY, Mrs. MCCARTHY, Mr. MCDERMOTT, Mr. 
MCNULTY, Mr. MEEK of Florida, Mr. GEORGE MILLER of California, Mr. 
MOORE of Kansas, Mr. ROSS, Ms. SLAUGHTER, Mr. SNYDER, Mr. UDALL 
of Colorado, Ms. WASSERMAN SCHULTZ, Mr. WAXMAN, Mr. DAVIS of Illi-
nois, and Mr. OWENS) introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittee on Ways and Means, for a period to be subsequently determined 
by the Speaker, in each case for consideration of such provisions as fall 
within the jurisdiction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
and title III of the Public Health Service Act to improve 
access to information about individuals’ health care op-
tions and legal rights for care near the end of life, 
to promote advance care planning and decisionmaking
so that individuals’ wishes are known should they become 
unable to speak for themselves, to engage health care 
providers in disseminating information about and assist-
ing in the preparation of advance directives, which in-
clude living wills and durable powers of attorney for 
health care, 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 
‘‘Advance Directives Improvement and Education Act of 
2005’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows:
Sec. 1. Short title; table of contents. 
Sec. 2. Findings and purposes. 
Sec. 3. Medicare coverage of end-of-life planning consultations. 
Sec. 4. Improvement of policies related to the use and portability of advance 
directives. 
Sec. 5. Increasing awareness of the importance of end-of-life planning. 
Sec. 6. GAO studies and reports on end-of-life planning issues.
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) Every year 2,500,000 people die in the 
United States. Eighty percent of those people die in 
institutions such as hospitals, nursing homes, and 
other facilities. Chronic illnesses, such as cancer and 
heart disease, account for 2 out of every 3 deaths.
(2) In January 2004, a study published in the 
Journal of the American Medical Association con-
cluded that many people dying in institutions have 
unmet medical, psychological, and spiritual needs. 
Moreover, family members of decedents who received 
care at home with hospice services were more likely 
to report a favorable dying experience. 
(3) In 1997, the Supreme Court of the United 
States, in its decisions in Washington v. Glucksberg 
and Vacco v. Quill, reaffirmed the constitutional 
right of competent adults to refuse unwanted med-
ical treatment. In those cases, the Court stressed the 
use of advance directives as a means of safeguarding 
that right should those adults become incapable of 
deciding for themselves. 
(4) A study published in 2002 estimated that 
the overall prevalence of advance directives is be-
tween 15 and 20 percent of the general population, 
despite the passage of the Patient Self-Determina-
tion Act in 1990, which requires that health care 
providers tell patients about advance directives. 
(5) Competent adults should complete advance 
care plans stipulating their health care decisions in 
the event that they become unable to speak for 
themselves. Through the execution of advance direc-
tives, including living wills and durable powers of at-
torney for health care according to the laws of the 
State in which they reside, individuals can protect 
their right to express their wishes and have them re-
spected. 
(b) PURPOSES.—The purposes of this Act are to im-
prove access to information about individuals’ health care 
options and legal rights for care near the end of life, to 
promote advance care planning and decisionmaking so 
that individuals’ wishes are known should they become un-
able to speak for themselves, to engage health care pro-
viders in disseminating information about and assisting in 
the preparation of advance directives, which include living 
wills and durable powers of attorney for health care, and 
for other purposes. 
SEC. 3. MEDICARE COVERAGE OF END-OF-LIFE PLANNING 
CONSULTATIONS. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)), as amended by section 
642(a) of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (Public Law 108–173; 117 
Stat. 2322), is amended—
(1) in subparagraph (Y), by striking ‘‘and’’ at 
the end;
(2) in subparagraph (Z), by inserting ‘‘and’’ at 
the end; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(AA) end-of-life planning consultations (as de-
fined in subsection (bbb));’’. 
(b) SERVICES DESCRIBED.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x), as amended by sec-
tion 706(b) of the Medicare Prescription Drug, Improve-
ment, and Modernization Act of 2003 (Public Law 108–
173; 117 Stat. 2339), is amended by adding at the end 
the following new subsection: 
‘‘End-of-Life Planning Consultation 
‘‘(bbb) The term ‘end-of-life planning consultation’ 
means physicians’ services—
‘‘(1) consisting of a consultation between the 
physician and an individual regarding—
‘‘(A) the importance of preparing advance 
directives in case an injury or illness causes the 
individual to be unable to make health care de-
cisions; 
‘‘(B) the situations in which an advance di-
rective is likely to be relied upon; 
‘‘(C) the reasons that the development of a 
comprehensive end-of-life plan is beneficial and
the reasons that such a plan should be updated 
periodically as the health of the individual 
changes; 
‘‘(D) 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 (health care proxy); and 
‘‘(E) whether or not the physician is will-
ing to follow the individual’s wishes as ex-
pressed in an advance directive; and 
‘‘(2) that are furnished to an individual on an 
annual basis or immediately following any major 
change in an individual’s health condition that would 
warrant such a consultation (whichever comes 
first).’’. 
(c) WAIVER OF DEDUCTIBLE AND COINSURANCE.—
(1) DEDUCTIBLE.—The first sentence of sec-
tion 1833(b) of the Social Security Act (42 U.S.C. 
1395l(b)) is amended—
(A) by striking ‘‘and’’ before ‘‘(6)’’; and
(B) by inserting before the period at the 
end the following: ‘‘, and (7) such deductible 
shall not apply with respect to an end-of-life 
planning consultation (as defined in section 
1861(bbb))’’. 
(2) COINSURANCE.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended—
(A) in clause (N), by inserting ‘‘(or 100 
percent in the case of an end-of-life planning 
consultation, as defined in section 1861(bbb))’’ 
after ‘‘80 percent’’; and 
(B) in clause (O), by inserting ‘‘(or 100 
percent in the case of an end-of-life planning 
consultation, as defined in section 1861(bbb))’’ 
after ‘‘80 percent’’. 
(d) PAYMENT FOR PHYSICIANS’ SERVICES.—Section 
1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–
4(j)(3)), as amended by section 611(c) of the Medicare 
Prescription Drug, Improvement, and Modernization Act 
of 2003 (Public Law 108–173; 117 Stat. 2304), is amend-
ed by inserting ‘‘(2)(AA),’’ after ‘‘(2)(W),’’. 
(e) FREQUENCY LIMITATION.—Section 1862(a)(1) of 
the Social Security Act (42 U.S.C. 1395y(a)(1)), as 
amended by section 613(c) of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Pub-
lic Law 108–173; 117 Stat. 2306), is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (L); 
(2) by striking the semicolon at the end of sub-
paragraph (M) and inserting ‘‘, and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(N) in the case of end-of-life planning con-
sultations (as defined in section 1861(bbb)), which 
are performed more frequently than is covered under 
paragraph (2) of such section;’’. 
(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2006. 
SEC. 4. IMPROVEMENT OF POLICIES RELATED TO THE USE 
AND 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)—
(A) in subparagraph (B), by inserting 
‘‘and if presented by the individual (or on be-
half of the individual), to include the content of 
such advance directive in a prominent part of 
such record’’ before the semicolon 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) In addition to the requirements of paragraph 
(1), a provider of services, Medicare Advantage organiza-
tion, or prepaid or eligible organization (as the case may 
be) shall give effect to an advance directive executed out-
side the State in which such directive is presented, even 
one that does not appear to meet the formalities of execu-
tion, form, or language required by the State in which it 
is presented to the same extent as such provider or organi-
zation would give effect to an advance directive that meets 
such requirements, except that a provider or organization
may decline to honor such a directive if the provider or 
organization can reasonably demonstrate that it is not an 
authentic expression of the individual’s wishes concerning 
his or her health care. Nothing in this paragraph shall 
be construed to authorize the administration of medical 
treatment otherwise prohibited by the laws of the State 
in which the directive is presented. 
‘‘(B) 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)—
(A) in subparagraph (B)—
(i) by striking ‘‘in the individual’s 
medical record’’ and inserting ‘‘in a promi-
nent part of the individual’s current med-
ical record’’; and 
(ii) by inserting ‘‘and if presented by 
the individual (or on behalf of the indi-
vidual), to include the content of such ad-
vance directive in a prominent part of such 
record’’ before the semicolon 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 (4), by striking ‘‘a written’’ 
and inserting ‘‘an’’; and 
(3) by adding at the end the following para-
graph: 
‘‘(6)(A) In addition to the requirements of paragraph 
(1), a provider or organization (as the case may be) shall 
give effect to an advance directive executed outside the 
State in which such directive is presented, even one that 
does not appear to meet the formalities of execution, form, 
or language required by the State in which it is presented 
to the same extent as such provider or organization would 
give effect to an advance directive that meets such require-
ments, except that a provider or organization may decline 
to honor such a directive if the provider or organization 
can reasonably demonstrate that it is not an authentic ex-
pression of the individual’s wishes concerning his or her 
health care. Nothing in this paragraph shall be construed 
to authorize the administration of medical treatment oth-
erwise prohibited by the laws of the State in which the 
directive is presented. 
‘‘(B) 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.’’. 
(c) EFFECTIVE DATES.—
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by subsections (a) and (b) 
shall apply to provider agreements and contracts en-
tered into, renewed, or extended under title XVIII 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.), on or after such date as the 
Secretary of Health and Human Services specifies, 
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 (42 
U.S.C. 1396 et seq.) which the Secretary of Health 
and Human Services determines requires State legis-
lation in order for the plan to meet the additional 
requirements imposed by the amendments made by 
subsection (b), the State plan shall not be regarded 
as failing to comply with the requirements 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 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. 5. INCREASING AWARENESS OF THE IMPORTANCE OF 
END-OF-LIFE PLANNING. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by adding at the end the following 
new part:
‘‘PART R—PROGRAMS TO INCREASE AWARENESS 
OF ADVANCE DIRECTIVE PLANNING ISSUES 
‘‘SEC. 
399Z–1. 
ADVANCE 
DIRECTIVE 
EDUCATION 
CAM-
PAIGNS 
AND 
INFORMATION 
CLEARING-
HOUSES. 
‘‘(a) ADVANCE DIRECTIVE EDUCATION CAMPAIGN.—
The Secretary shall, directly or through grants awarded 
under subsection (c), conduct a national public education 
campaign—
‘‘(1) to raise public awareness of the impor-
tance of planning for care near the end of life; 
‘‘(2) to improve the public’s understanding of 
the various situations in which individuals may find 
themselves if they become unable to express their 
health care wishes; 
‘‘(3) to explain the need for readily available 
legal documents that express an individual’s wishes, 
through advance directives (including living wills, 
comfort care orders, and durable powers of attorney 
for health care); and 
‘‘(4) to educate the public about the availability 
of hospice care and palliative care. 
‘‘(b) INFORMATION
CLEARINGHOUSE.—The Sec-
retary, directly or through grants awarded under sub-
section (c), shall provide for the establishment of a na-
tional, toll-free, information clearinghouse as well as clear-
inghouses that the public may access to find out about 
State-specific information regarding advance directive and 
end-of-life decisions. 
‘‘(c) GRANTS.—
‘‘(1) IN GENERAL.—The Secretary shall use at 
least 60 percent of the funds appropriated under 
subsection (d) for the purpose of awarding grants to 
public or nonprofit private entities (including States 
or political subdivisions of a State), or a consortium 
of any of such entities, for the purpose of conducting 
education campaigns under subsection (a) and estab-
lishing information clearinghouses under subsection 
(b). 
‘‘(2) PERIOD.—Any grant awarded under para-
graph (1) shall be for a period of 3 years. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$25,000,000.’’. 
SEC. 6. GAO STUDIES AND REPORTS ON END-OF-LIFE PLAN-
NING ISSUES. 
(a) STUDY AND REPORT ON COMPLIANCE WITH AD-
VANCE DIRECTIVES
AND OTHER ADVANCE PLANNING 
DOCUMENTS.—
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study on the effective-
ness of advance directives in making patients’ wishes 
known and honored by health care providers. 
(2) REPORT.—Not later than the date that is 
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 paragraph (1) together with recommendations 
for such legislation and administrative action as the 
Comptroller General of the United States determines 
to be appropriate. 
(b) STUDY AND REPORT ON IMPLEMENTATION OF 
THE MEDICARE COVERAGE FOR END-OF-LIFE PLANNING 
CONSULTATIONS.—
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study on the imple-
mentation of the amendments made by section 3 (re-
lating to medicare coverage of end-of-life planning 
consultations). 
(2) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Comptroller Gen-
eral of the United States shall submit to Congress 
a report on the study conducted under paragraph 
(1) together with recommendations for such legisla-
tion and administrative action as the Comptroller
General of the United States determines to be ap-
propriate. 
(c) STUDY AND REPORT ON ESTABLISHMENT OF NA-
TIONAL ADVANCE DIRECTIVE REGISTRY.—
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study on the feasi-
bility 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 Accountability Act. 
(2) REPORT.—Not later than 18 months after 
the date of enactment of this Act, the Comptroller 
General of the United States shall submit to Con-
gress a report on the study conducted under para-
graph (1) together with recommendations for such 
legislation and administrative action as the Comp-
troller General of the United States determines to be 
appropriate.
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