ing of the delivery of such approved patient 
decision aid (such as the date of the initial 
diagnosis), and beneficiary and health care 
provider satisfaction with the shared deci-
sion making process; 
(C) an evaluation of which eligible pro-
viders are most effective at implementing pa-
tient decision aids and assisting Medicare bene-
ficiaries in making informed decisions on med-
ical care; and 
(D) recommendations for such legislation 
and administrative action as the Secretary de-
termines appropriate. 
(j) SAVINGS.— 
(1) IN GENERAL.—Subject to paragraph (2), 
not later than 2 years after the implementation of 
phase I of the pilot program, and annually there-
after for the duration of phase I and the first 2 
years of phase II, the Secretary shall determine if 
there were any savings to the Medicare program as 
a result of such implementation during the preceding 
year (or years, if applicable). In the case where the 
Secretary determines there were such savings, the 
Secretary shall use such savings as follows: 
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(A) Fifty percent of such savings shall be 
used to provide bonus payments to eligible pro-
viders participating in the pilot program who 
achieve high quality shared decision making (as 
measured by the level of participation of Medi-
care beneficiaries in the shared decision making 
process and high scores by the eligible provider 
on quality measures selected under subsection 
(h)(1)). 
(B) Twenty-five percent of such savings 
shall be placed in a Shared Decision Making 
Trust Fund established by the Secretary, which 
shall be used to expand participation in the 
pilot program to providers of services and sup-
pliers in additional settings (as determined ap-
propriate by the Secretary) by— 
(i) 
providing 
financial 
assistance 
under subsection (c); and 
(ii) providing for the development of 
quality measures not already selected 
under subsection (h)(1) to assess the im-
pact of shared decision making on the 
quality of patient care or the improvement 
of such quality measures already selected. 
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(C) Twenty-five percent of such savings 
shall be retained by the Medicare program. 
(2) RETENTION OF SAVINGS BY THE MEDICARE 
PROGRAM.—In the case where the Secretary deter-
mines there are savings to the Medicare program as 
a result of the implementation of the pilot program 
during a year (beginning with the third year of 
phase II), 100 percent of such savings shall be re-
tained by the Medicare program. 
(k) WAIVER.—The Secretary may waive such provi-
sions of titles XI and XVIII of the Social Security Act 
as may be necessary to carry out the pilot program under 
this section. 
(l) FUNDING.—For purposes of carrying out section 
4(a), implementing the pilot program under this section 
(including costs incurred in conducting the evaluation 
under 
subsection 
(i)), 
and 
carrying 
out 
section 
1890(b)(1)(A)(iv) of the Social Security Act, as added by 
section 4(c), the Secretary shall provide for the transfer 
from the Federal Hospital Insurance Trust Fund estab-
lished under section 1817 of the Social Security Act (42 
U.S.C. 1395i) to the Centers for Medicare & Medicaid 
Services Program Management Account of $300,000,000 
for the period of fiscal years 2010 through 2017. 
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SEC. 6. ESTABLISHMENT OF SHARED DECISION MAKING 
STANDARDS AND REQUIREMENTS IN MEDI-
CARE. 
Title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended by adding at the end the fol-
lowing new section: 
‘‘ESTABLISHMENT OF SHARED DECISION MAKING 
STANDARDS AND REQUIREMENTS 
‘‘SEC. 1899. (a) IN GENERAL.—Based on the find-
ings of phases I and II of the pilot program under section 
5 of the Empowering Medicare Patient Choices Act the 
Secretary shall promulgate regulations that— 
‘‘(1) specify for which preference sensitive con-
ditions beneficiaries should, subject to the suc-
ceeding provisions of this section, participate in 
shared decision making; 
‘‘(2) require providers of services and suppliers 
to make sure that beneficiaries receive patient deci-
sion aids as appropriate; and 
‘‘(3) specify a process for beneficiaries to elect 
not to use such patient decision aids. 
‘‘(b) PENALTY FOR NOT USING SHARED DECISION 
MAKING.—Notwithstanding any other provision of this 
title, the Secretary shall promulgate such regulations and 
issue such guidance as may be necessary to reduce by 20 
percent the amount of payment under this title that would 
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otherwise apply to an item or service specified by the Sec-
retary if the patient does not receive a patient decision 
aid prior to such item or service being furnished (except 
in the case where the beneficiary has elected not to use 
such patient decision aid under the process specified under 
subsection (a)(3)). 
‘‘(c) SECRETARIAL AUTHORITY TO WAIVE APPLICA-
TION OF THIS SECTION.—The Secretary may waive the 
application of this section to an item or service under this 
title if the Secretary determines either of the following: 
‘‘(1) Medical societies and others have estab-
lished evidence-based transparent standards incor-
porating patient decision aids and shared decision 
making into the standard of patient care for pref-
erence sensitive conditions. 
‘‘(2) Shared decision making is not in the best 
interest of beneficiaries.’’. 
Æ 
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