,,ii  #aac? ,,congress  #a/ ,session    
,s4 #adci  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,augu/ #a1 #bjac ,mr4  
,w>n] 7= himself & ,mr4 ,isakson7       
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = advanc$ illness c>e           
coord9ation s]vices = ,m$ic>e           
b5efici>ies1 & = o!r purposes4  #a4     
,%ort title2 table ( cont5ts  7a7 ,%ort 
title ,?is ,act may be cit$ z ! ,c>e    
,plann+ ,act ( #bjac4  7b7 ,table (     
cont5ts ,! table ( cont5ts ( ?is ,act is
 z foll[s3  ,sec4 #a4 ,%ort title2 table
 ( cont5ts4 ,sec4 #b4 ,f9d+s4 ,sec4 #c4 
,improvem5t ( advanc$ illness plann+ &  
coord9ation4 ,sec4 #d4 ,quality         
measurem5t developm5t4 ,sec4 #e4        
,inclusion ( advance c>e plann+ mat]ials
 9 ! ,m$ic>e  ,y h&book4 ,sec4 #f4 ,c>e 
,plann+ ,advisory ,bo>d4 ,sec4 #g4      
,improvem5t ( policies relat$ to ! use &
 portability ( advance directives4 ,sec4

 #h4 ,additional requirem5ts =          
facilities4 ,sec4 #i4 ,grants = increas+
 public aw>5ess ( advance c>e plann+ &  
advanc$ illness c>e4 ,sec4 #aj4 ,,hhs   
/udy & report on ! /orage ( advance     
directives4 ,sec4 #aa4 ,,gao /udy &     
report on ! provisions (1 & am5dm5ts    
made by1 ?is ,act4 ,sec4 #ab4           
,consultation ) ! ,c>e ,plann+ ,advisory
 ,bo>d4 ,sec4 #ac4 ,rule ( con/ruction4 
#b4 ,f9d+s ,congress makes ! foll[+     
f9d+s3  7#a7 ,! population ( ! ,unit$   
,/ates is e/imat$ to age rapidly1 ) !   
numb] ( p ov] ! age ( #fe set to d\ble  
to m ?an #gb1jjj1jjj1 or #a 9 #e        
,am]icans1 ov] ! next two decades4  7#b7
 ,am]icans today are liv+ long] &       
heal?i] lives ?an ev] be=e 9 ! hi/ory ( 
! ,unit$ ,/ates yet are also fac+       
increas$ incid5ce ( multiple s]i\s      
conditions z ag+ progresses4  7#c7      
,am]icans ) advanc$ illness face a      
complicat$ & fragm5t$ sy/em ( c>e       
deliv]y t puts !m at risk = repeat      
hospitalizations1 adv]se drug reactions1

 & conflict+ m$ical advice t may be     
ov]:elm+ to individuals & families4     
7#d7 ,! progression ( advanc$ illness   
leads to ! ne$ = increas+ly int5sive    
decision support1 heal? c>e s]vices1 &  
support f family c>egiv]s4  7#e7 ,!     
complexity ( c>e ne$$ by individuals )  
advanc$ illness may result 9 uncoord9at$
 c>e1 adv]se heal? outcomes1 fru/ration1
 wa/$ "t1 & undue emotional burd5s on   
individuals & _! family c>egiv]s4  7#f7 
,num]\s private sector lead]s1 includ+  
hospitals1 heal? sy/ems1 home heal?     
ag5cies1 hospice programs1 long-t]m c>e 
provid]s1 employ]s1 & o!r entities1 h   
put 9 place innovative solutions to     
provide m compreh5sive & coord9at$ c>e =
 ,am]icans liv+ ) advanc$ illness4  7#g7
 ,hospice programs1 z "o ( ! longe/ /&+ 
,m$ic>e c>e coord9ation b5efits t (f] a 
compreh5sive set ( s]vices via an       
int]discipl9>y team work+ to provide    
p]son- & family-c5t]$ c>e to ! fraile/ &
 mo/ vuln]able individuals 9 our        
communities1 c s]ve z a model = advanc$ 

illness c>e deliv]y4  7#h7 ,palliative  
c>e programs t s]ve pati5ts beg9n+ at   
diagnosis ) advanc$ illness & provide   
c>e design$ to r$uce ! symptom burd5 (  
illness c s]ve z a model =              
int]discipl9>y team c>e plann+ bas$ on !
 individual's goals ( c>e4  7#i7 ,!     
,gov]nm5t ( ! ,unit$ ,/ates1 z !        
,nation's l>ge/ pur*as] ( heal? c>e     
s]vices1 mu/ le>n f ^! innovators &     
enc\rage heal? c>e provid]s to furni% m 
supportive & compreh5sive advanc$       
illness c>e to improve ! efficacy &     
quality ( heal? c>e deliv]$ = g5]ations 
( ,am]icans to come4  7#aj7 ,heal? c>e  
provid]s :o s]ve individuals ) advanc$  
illness face complicat$ c>e sy/ems &    
legal conc]ns t may result 9 ov]- or    
"u-treatm5t ( individuals ) advanc$     
illness4  7#aa7 ,individuals h !        
well-e/abli%$ "r to accept or reject    
m$ical treatm5t t is (f]$1 z well z !   
well-e/abli%$ "r to docum5t _! pref]5ces
 = h[ treatm5t decisions %\ld be made   
if1 at "s po9t 9 ! future1 !y lose !    

ability to make heal? c>e decisions4    
7#ab7 ,too (t51 individuals ) advanc$   
illness d n und]/& ! conditions !y are  
fac+ or _! treatm5t options1 & !y d n   
receive ! in=mation or support !y ne$ to
 evaluate treatm5t options 9 light ( _! 
p]sonal goals & values & to docum5t     
treatm5t plans 9 a mann] t all[s        
provid]s & facilities to foll[ _! plans4
  7#ac7 ,provid+ quality s]vices &      
plann+ support to individuals ) advanc$ 
illness w protect & pres]ve _! dignity4 
#c4 ,improvem5t ( advanc$ illness plann+
 & coord9ation  7a7 ,m$ic>e cov]age (   
plann+ s]vices  7#a7 ,cov]age ,section  
#ahfa7s77#b7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciex7s77#b77 is am5d$--
  7,a7 9 subp>agraph 7,,ee71 by /rik+ & 
at ! end2  7,b7 9 subp>agraph 7,,ff71 by
 ins]t+ & at ! end2 &  7,c7 by ins]t+   
aft] subp>agraph 7,,ff7 ! foll[+ new    
p>agraph3  7,,gg7 plann+ s]vices 7z     
def9$ 9 subsection 7iii772  4  7#b7     
,s]vices describ$ ,section #ahfa ( !    
,social ,security ,act 7#db ,u4,s4,c4   

#aciex7 is am5d$ by add+ at ! end !     
foll[+ new subsection3  7iii7 ,plann+   
s]vices  7#a7 7,a7 ,! t]m plann+ s]vices
 means a volunt>y decisionmak+ process t
 includes ! elem5ts describ$ 9 p>agraph 
7#b7 & is furni%$ to a plann+ s]vices   
eligible individual by an applicable    
provid] ?r\gh an int]discipl9>y team4   
7,b7 ,plann+ s]vices may only be furni%$
 to a plann+ s]vices eligible individual
 "u ?is title once 9 ea* #ab-mon? p]iod4
  7#b7 7,a7 ,! elem5ts describ$ 9 ?is   
p>agraph are ! foll[+3  7i7 ,"o or m    
face-to-face enc\nt]s betwe5 "o or m    
memb]s ( ! int]discipl9>y team & !      
individual &1 at ! individual's         
discretion1 family c>egiv]s1 or1 = an   
individual :o lacks decisionmak+        
capacity "u ,/ate law1 ! individual's   
legally au?oriz$ repres5tative4  7ii7 ,!
 provision ( in=mation ab\t ! typical   
trajectory ( illnesses or conditions t  
affect ! individual1 includ+ =eseeable  
c>e decisions t may ne$ to be made at a 
future "t :5 ! individual is likely to  

be unable to make decisions due to      
tempor>y or p]man5t cognitive           
incapacity4  7iii7 ,assi/+ ! individual 
9 def9+ & articulat+ goals ( c>e1       
values1 & pref]5ces4  7iv7 ,provid+ !   
individual ) 7& discuss+7 in=mation ab\t
 ! b5efits & burd5s ( a relevant range (
 treatm5t options available to !        
individual1 includ+ disease modify+ or  
pot5tially curative treatm5t1 palliative
 c>e1 :i* may be provid$ alone or 9     
conjunction ) disease modify+ treatm5t1 
&1 :5 ! individual may be curr5tly      
eligible or may become eligible =       
hospice c>e due to disease progression1 
hospice c>e4 ,an applicable provid] %all
 pres5t & discuss relevant treatm5t     
options t may help ! individual to      
a*ieve goals ( c>e & may n exclude      
options bas$ on an individual's age1    
disability /atus1 or ! pres5ce ( advanc$
 illness unless1 9 ! provid]'s cl9ical  
judgm5t1 a treatm5t option w n a*ieve ! 
outcome s\ght by ! individual4  7v7     
,assi/+ ! individual 9 evaluat+ treatm5t

 options & approa*es to c>e to id5tify  
^? t mo/ closely align ) ! individual's 
goals ( c>e1 values1 & pref]5ces4  7vi7 
,prep>+1 & %>+ ) relevant provid]s1     
docum5tation--  7,i7 t /ates !          
individual's goals ( c>e1 pref]5ces1 &  
values1 pref]r$ decisionmak+ /rategies1 
& a plan ( c>e t is concrete1 a*ievable1
 & actionable2 &  7,,ii7 t is 9 a pap]  
or electronic =mat1 on ,/ate or locally 
recogniz$ =ms t are us$ = ! purpose (   
assur+ t provid]s c foll[ ! plan across 
c>e sett+s1 su* z advance directives or 
portable treatm5t ord]s4  7vii7         
,ref]rals to provid]s1 includ+ m$ical & 
social s]vice provid]s1 :o deliv] c>e   
consi/5t ) ! plan4  7viii7 ,provid+     
culturally & educationally appropriate  
tra9+ = ! individual & family c>egiv]s  
to support _! ability to c>ry out !     
plan4  7,b7 ,ev5 :5 ! individual's      
decisional capacity is impair$ & ano!r  
p]son or entity1 su* z an appo9t$ ag5t1 
proxy1 or surrogate1 is ex]cis+ legal   
au?ority "u ,/ate law gov]n+            

decisionmak+ on behalf ( incapacitat$   
individuals1 ! int]discipl9>y team %all 
make a reasonable attempt to include !  
individual 9 ! plann+ process4  7#c7 ,= 
purposes ( ?is subsection1 ! t]m plann+ 
s]vices eligible individual means an    
individual t meets at lea/ "o ( ! foll[+
 crit]ia3  7,a7 ,! individual is        
diagnos$ ) meta/atic or locally advanc$ 
canc]4  7,b7 ,! individual is diagnos$ )
 ,alzheim]'s disease or ano!r           
progressive dem5tia4  7,c7 ,! individual
 is diagnos$ ) late-/age neuromuscul>   
disease4  7,d7 ,! individual is diagnos$
 ) late-/age diabetes4  7,e7 ,!         
individual is diagnos$ ) late-/age      
kidney1 liv]1 he>t1 ga/ro9te/9al1       
c]ebrovascul>1 or lung disease4  7,f7 ,!
 individual ne$s assi/ance ) two or m   
activities ( daily liv+ 7def9$ z ba?+1  
dress+1 eat+1 gett+ out ( b$ or a *air1 
mobility1 & toilet+7 t are caus$ by "o  
or m progressive illnesses4  7,g7 ,!    
individual meets o!r crit]ia det]m9$    
appropriate by ! ,secret>y1 includ+     

crit]ia t are design$ to id5tify        
individuals ) a ne$ = plann+ s]vices due
 to advanc+ illness or risk ( decl9e 9  
cognitive function ov] "t4  7#d7 ,=     
purposes ( ?is subsection1 ! t]m        
applicable provid] means a hospice      
program 7z def9$ 9 section              
#ahfa7;dd77#b77 or o!r provid] ( s]vices
 7z def9$ 9 section #ahfa7u77 or suppli]
 7z def9$ 9 section #ahfa7;d77 t--  7,a7
 furni%es plann+ s]vices ?r\gh an       
int]discipl9>y team2 &  7,b7 meets su*  
o!r requirem5ts ! ,secret>y may det]m9e 
to be appropriate4  7#e7 7,a7 ,=        
purposes ( ?is subsection1 ! t]m        
int]discipl9>y team means a gr\p t--    
7i7 includes--  7,i7 a core team ( a    
physician or an advance practice regi/]$
 nurse1 a social work]1 a nurse2 &1     
subject to subp>agraph 7,b71 a *apla91 a
 m9i/]1 or ! individual's p]sonal       
religi\s or spiritual advisor2 &  7,,ii7
 :5 necess>y to meet an individual's    
plann+ ne$s1 o!r pr(essionals1 :i* may  
include a ph>maci/1 a lic5s$ cl9ical    

social work]1 & a psy*ologi/1 ei!r z    
ongo+ team memb]s or :o may be br\ght 9 
z ne$$ to address ! individual's plann+ 
ne$s2 &  7ii7 meets requirem5ts t may be
 e/abli%$ by ! ,secret>y4  7,b7 ,an     
applicable provid] furni%+ plann+       
s]vices to a plann+ s]vices eligible    
individual %all (f] to ! individual 7or 
! individual's legally au?oriz$         
repres5tative :5 ! individual has be5   
f\nd to lack decisional capacity7 !     
opportunity to select ei!r a *apla9     
affiliat$ ) ! provid]1 a m9i/]1 or      
p]sonal religi\s or spiritual advisor :o
 c help to repres5t ! individual's      
goals1 values1 & pref]5ces to s]ve z a  
core team memb] at ! individual's 7or   
legally au?oriz$ repres5tative's7       
reque/4  7,c7 ,! requirem5ts e/abli%$ by
 ! ,secret>y "u subp>agraph 7,a77ii7    
%all include a requirem5t t             
int]discipl9>y team memb]s 7except = !  
individuals's *os5 m9i/] or p]sonal     
religi\s or spiritual advisor7 h tra9+ &
 exp]i5ce 9 deliv]+ p]son-direct$ plann+

 s]vices & 9 team-bas$ deliv]y ( s]vices
 = individuals ) dem5t+ illness &       
individuals ) advanc$ illness4  4  7#c7 
,paym5t "u physician fee s*$ule ,section
 #ahdh7;j77#c7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77  
is am5d$ by ins]t+ 7#b77;,,gg71 aft]    
7#b77;,,ff7 7includ+ adm9i/ration ( !   
heal? risk assessm5t714  7#d7 ,frequ5cy 
limitation ,section #ahfb7;a7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciey7a77 is am5d$--  7,a7 9 p>agraph  
7#a7--  7i7 9 subp>agraph 7,o71 by /rik+
 & at ! end2  7ii7 9 subp>agraph 7,p7 by
 /rik+ ! semicolon at ! end & ins]t+ 1  
&2 &  7iii7 by add+ at ! end ! foll[+   
new subp>agraph3  7,q7 9 ! case ( plann+
 s]vices 7z def9$ 9 section             
#ahfa7;iii77#a771 :i* are furni%$ m     
frequ5tly ?an is cov]$ "u subp>agraph   
7,b7 ( su* section2  2 &  7,b7 9        
p>agraph 7#g71 by /rik+ or 7,p7 & ins]t+
 7,p71 or 7,q74  7#e7 ,effective date ,!
 am5dm5ts made by ?is subsection %all   
apply to s]vices furni%$ on or aft]     

,janu>y #a1 #bjae4  7b7 ,m$icaid cov]age
 ( plann+ s]vices  7#a7 ,9 g5]al        
,section #aije7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif;d7a77 is     
am5d$--  7,a7 by r$esignat+ p>agraph    
7#bi7 z p>agraph 7#cj72  7,b7 9 p>agraph
 7#bh71 by /rik+ at ! end &2 &  7,c7 by 
ins]t+ aft] p>agraph 7#bh7 ! foll[+ new 
p>agraph3  7#bi7 plann+ s]vices 7z def9$
 9 section #ahfa7;iii772 &  4  7#b7     
,con=m+ am5dm5t ,section                
#aijb7;a77#aj77;,a7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#aj77;,a77 is am5d$ by /rik+ 
& 7#bh7 & ins]t+ 1 7#bh71 & 7#bi74  7#c7
 ,effective date  7,a7 ,9 g5]al ,except 
z provid$ 9 subp>agraph 7,b71 ! am5dm5ts
 made by p>agraphs 7#a7 & 7#b7 take     
effect on ,janu>y #a1 #bjae4  7,b7      
,ext5sion ( effective date = ,/ate law  
am5dm5t ,9 ! case ( a ,/ate plan "u     
title ,,xix ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acif et seq47 :i* !     
,secret>y det]m9es requires ,/ate       
legislation 9 ord] = ! plan to meet !   

additional requirem5ts impos$ by !      
am5dm5ts made by p>agraphs 7#a7 & 7#b71 
! ,/ate plan %all n be reg>d$ z fail+ to
 comply ) ! requirem5ts ( su* title     
solely on ! basis ( its failure to meet 
^! additional requirem5ts be=e ! fir/   
day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! 
close ( ! fir/ regul> session ( ! ,/ate 
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 ! session is consid]$ to be a sep>ate  
regul> session ( ! ,/ate legislature4   
7c7 ,advanc$ illness c>e coord9ation    
s]vices project ,section #aaae;,a7b77#b7
 ( title ,,xi ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acae;a7b77#b77 is      
am5d$--  7#a7 9 subp>agraph 7,a71 by    
add+ at ! end ! foll[+ new s5t5ce3 ,!   
models select$ "u ?is subp>agraph %all  
include ! model describ$ 9 subp>agraph  
7,d7 & su* model %all be implem5t$ by n 
lat] ?an ,decemb] #ca1 #bjae42 &  7#b7  
by add+ at ! end ! foll[+ new           

subp>agraph3  7,d7 ,advanc$ illness c>e 
coord9ation s]vices model  7i7 ,model   
7,i7 ,9 g5]al ,! model describ$ 9 ?is   
subp>agraph is a model "u :i* paym5ts   
are made to applicable provid]s t furni%
 advanc$ illness c>e coord9ation s]vices
 to eligible individuals4  7,,ii7       
,requirem5t ,at lea/ "o applicable      
provid] select$ = p>ticipation "u !     
model %all be a hospice program 7z def9$
 9 section #ahfa7;dd77#b774  7ii7       
,applicable provid] ,9 ?is subp>agraph1 
! t]m applicable provid] means a hospice
 program 7z def9$ 9 section             
#ahfa7;dd77#b77 or o!r provid] ( s]vices
 7z def9$ 9 section #ahfa7u77 or suppli]
 7z def9$ 9 section #ahfa7;d77 t--  7,i7
 furni%es advanc$ illness c>e           
coord9ation s]vices ?r\gh an            
int]discipl9>y team 7z def9$ 9 section  
#ahfa7;iii77#e772 &  7,,ii7 meets su*   
o!r requirem5ts ! ,secret>y may det]m9e 
to be appropriate4  7iii7 ,advanc$      
illness c>e coord9ation s]vices ,9 ?is  
subp>agraph1 ! t]m advanc$ illness c>e  

coord9ation s]vices means ! foll[+      
s]vices3  7,i7 ,plann+ s]vices 7z def9$ 
9 section #ahfa7;iii774  7,,ii7 ,a      
multi-dim5sional assessm5t ( !          
individual's /r5g?s & limitations4      
7,,iii7 ,an assessm5t ( ! individual's  
=mal & in=mal supports1 includ+ family  
c>egiv]s4  7,,iv7 ,compreh5sive         
m$ication review & managem5t 7includ+1  
if appropriate1 c\nsel+ & self-managem5t
 support74  7,v7 ,9-home supportive     
s]vices = ! eligible individual & family
 c>egiv]s consi/5t ) ! c>e plan4  7,,vi7
 #bd-;h\r access to em]g5cy support 9   
p]son or via telephone or telem$ic9e ) !
 individual's m$ical record & c>e plan  
available to ! respond]4  7,,vii7       
,coord9ation across heal? c>e & social  
s]vice sy/ems1 includ+ involvem5t ( !   
int]discipl9>y team to evaluate quality 
& address conc]ns4  7,,viii7 ,su* o!r   
s]vices z specifi$ by ! ,secret>y4  7iv7
 ,eligible individual ,9 ?is            
subp>agraph1 ! t]m eligible individual  
means an individual :o--  7,i7 is       

entitl$ to1 or enroll$ =1 b5efits "u "p 
,a ( title ,,xviii & enroll$ "u "p ,b ( 
su* title1 b n enroll$ "u "p ,c ( su*   
title2 &  7,,ii7 has ! ne$ = assi/ance )
 two or m activities ( daily liv+ 7def9$
 z ba?+1 dress+1 eat+1 gett+ out ( b$ or
 a *air1 mobility1 & toilet+7 t are     
caus$ by "o or m progressive conditions4
  4  #d4 ,quality measurem5t developm5t 
7a7 ,9 g5]al ,section #ica7;c77#b7 ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bii;b-#ca7;c77#b77 is am5d$--
  7#a7 by r$esignat+ subp>agraphs 7,i7 &
 7,j7 z subp>agraphs 7,l7 & 7,m71       
respectively2 &  7#b7 by ins]t+ aft]    
subp>agraph 7,h7 ! foll[+ new           
subp>agraphs3  7,i7 ! process ( elicit+ 
& docum5t+ pati5t 7&1 :]e relevant &    
appropriate1 family c>egiv]7 goals1     
pref]5ces1 & values f ! pati5t or f a   
legally au?oriz$ repres5tative1 includ+ 
! articulation ( goals t accurately     
reflect h[ ! pati5t wants to live2  7,j7
 ! effectiv5ess1 pati5t-c5t]$ness 7&1   
:]e relevant1 family c>egiv]-c5t]$ness71

 & accuracy ( c>e plans1 includ+        
docum5tation ( individual goals1        
pref]5ces1 & values2  7,k7 agreem5t &   
consi/5cy among--  7i7 ! pati5t's goals1
 values1 & pref]5ces2  7ii7 any docum5t$
 c>e plan2  7iii7 ! treatm5t deliv]$2 & 
7iv7 outcomes ( treatm5t2  4  7b7       
,au?orization ( appropriations ,!re are 
au?oriz$ to be appropriat$ to !         
,secret>y ( ,heal? & ,human ,s]vices to 
c>ry out ! am5dm5ts made by ?is section1
 #e1jjj1jjj = fiscal ye> #bjad4 ,am\nts 
appropriat$ "u ! prec$+ s5t5ce %all     
rema9 available until exp5d$4  #e4      
,inclusion ( advance c>e plann+ mat]ials
 9 ! ,m$ic>e  ,y h&book  7a7 ,9 g5]al   
,section #ahjd7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;b-#b7;a77 is 
am5d$--  7#a7 9 p>agraph 7#b71 by /rik+ 
& at ! end2  7#b7 9 p>agraph 7#c71 by   
/rik+ ! p]iod at ! end & ins]t+ a       
semicolon2 &  7#c7 by ins]t+ aft]       
p>agraph 7#c7 ! foll[+ new p>agraphs3   
7#d7 in=mation on--  7,a7 c>e plann+2   
7,b7 h[ individual goals1 values1 &     

pref]5ces %\ld be consid]$ 9 fram+ a c>e
 plan2 &  7,c7 a range ( approa*es =    
treat+ advanc$ illness1 includ+ disease 
modify+ options1 palliative c>e t       
supports individuals f ! onset ( advanc$
 illness & c be provid$ at ! same "t z  
all o!r c>e types1 & hospice c>e2 &     
7#e7 in=mation on docum5tation options =
 c>e plann+ or advance c>e plann+1      
includ+ advance directives & portable   
treatm5t ord]s4  4  7b7 ,effective date 
,! am5dm5ts made by ?is section %all    
apply to notices di/ribut$ on or aft]   
,janu>y #a1 #bjae4  #f4 ,c>e ,plann+    
,advisory ,bo>d  7a7 ,e/abli%m5t ,!     
,secret>y ( ,heal? & ,human ,s]vices    
%all e/abli% ! ,c>e ,plann+ ,advisory   
,bo>d 79 ?is section ref]r$ to z !      
,advisory ,bo>d74  7b7 ,memb]%ip  7#a7  
,9 g5]al ,! ,advisory ,bo>d %all be     
compos$ ( #ae memb]s1 to be appo9t$ n   
lat] ?an #cj days aft] ! date ( !       
enactm5t ( ?is ,act1 z foll[s3  7,a7 ,! 
,presid5t ( ! ,unit$ ,/ates %all appo9t 
#c memb]s4  7,b7 ,! majority lead] ( !  

,s5ate %all appo9t #c memb]s4  7,c7 ,!  
m9ority lead] ( ! ,s5ate %all appo9t #c 
memb]s4  7,d7 ,! ,speak] ( ! ,h\se (    
,repres5tatives %all appo9t #c memb]s4  
7,e7 ,! m9ority lead] ( ! ,h\se (       
,repres5tatives %all appo9t #c memb]s4  
7#b7 ,repres5tation ,! memb]%ip ( !     
,advisory ,bo>d %all include individuals
 :o 7) a pref]5ce = individuals :o also 
are memb]s ( ! gr\p !y are appo9t$ to   
repres5t7--  7,a7 repres5t ! int]e/s (--
  7i7 pati5t advocacy gr\ps2  7ii7 old] 
adults2  7iii7 individuals ) cognitive  
or functional limitations2  7iv7 family 
c>egiv]s = individuals describ$ 9 clause
 7ii7 or 7iii72  7v7 palliative c>e &   
hospice provid]s2  7vi7 rese>*]s2  7vii7
 e?ici/s2  7viii7 fai? communities2     
7ix7 heal? c>e provid]s2 &  7x7 heal?   
c>e facilities2  7,b7 h demon/rat$      
exp]i5ce 9 deal+ ) issues relat$ to     
heal? c>e decisionmak+ & heal? c>e      
policy2 &  7,c7 repres5t ! heal? c>e    
int]e/s & ne$s ( a v>iety ( geographic  
areas & demographic gr\ps4  7c7 ,duties 

,! ,advisory ,bo>d %all advise !        
,secret>y on issues relat$ to c>e       
plann+1 advanc$ illness coord9ation     
s]vices1 advance c>e plann+1 &          
docum5tation options1 includ+ h[ to--   
7#a7 assure t individuals ) advanc$     
illness receive p]son- & family-c5t]$   
c>e2  7#b7 assi/ individuals ) advanc$  
illness to develop a treatm5t plan t is 
=m$ ar\nd _! goals1 values1 & pref]5ces1
 t is in=m$ by rese>* on disease        
trajectory1 & t includes a docum5t$ plan
 t is reali/ic1 actionable1 & concrete1 
& t may include ! use ( advance         
directives1 portable treatm5t ord]s 7:]e
 appropriate71 or o!r =ms us$ 9 ! ,/ate 
or locality2  7#c7 develop & monitor a  
demon/ration program t includes an      
optimal s]vice array to support         
individuals ) advanc$ illness ) s]vices 
design$ to manage symptoms z illness    
progresses2  7#d7 provide heal? c>e t is
 consi/5t ) individuals' curr5t treatm5t
 pref]5ces or1 = ^? ^: capacity to make 
decisions is impair$1 ) ! individuals'  

values & goals1 & specific directions   
docum5t$ 9 advance directives & portable
 treatm5t ord]s2  7#e7 enc\rage provid] 
p>ticipation 9 educational & tra9+      
activities address+ c>e plann+1 advanc$ 
illness c>e1 & advance c>e plann+2  7#f7
 develop quality measures1 includ+      
process1 outcome1 & exp]i5ce measures1 t
 applicable provid]s %\ld report =      
plann+ s]vices 7z def9$ 9 section       
#ahfa7;iii7 ( ! ,social ,security ,act1 
z add$ by section #c72  7#g7 det]m9e !  
appropriate role = dis*>ge plann]s 9    
educat+ individuals & _! families ab\t  
c>e plann+ s]vices1 advance c>e plann+1 
palliative c>e1 hospice1 advance        
directives1 portable treatm5t ord]s1 &  
o!r relevant s]vices1 supports1 plann+  
tools1 & docum5tation options2  7#h7    
develop & promote be/ practices 9       
communications ab\t advanc$ illness     
betwe5 provid]s1 individuals1 & family  
c>egiv]s 9 diff]5t sett+s1 includ+ acute
 c>e hospitals2  7#i7 evaluate !        
feasibility ( replac+ life expectancy 9 

mon?s ) cl9ical crit]ia to det]m9e      
eligibility = hospice c>e2 &  7#aj7     
promote effective advance c>e plann+ &  
effective & appropriate use ( portable  
treatm5t ord]s4  7d7 ,application (     
,,faca ,! ,f$]al ,advisory ,committee   
,act 7#e ,u4,s4,c4 ,app47 %all apply to 
! ,advisory ,bo>d4  7e7 ,pay &          
reimbursem5t  7#a7 ,no comp5sation =    
memb]s ( ,advisory ,bo>d ,except z      
provid$ 9 p>agraph 7#b71 a memb] ( !    
,advisory ,bo>d may n receive pay1      
all[ances1 or b5efits by reason ( _!    
s]vice on ! ,bo>d4  7#b7 ,travel exp5ses
 ,ea* memb] %all receive travel exp5ses1
 includ+ p] diem 9 lieu ( subsi/5ce "u  
sub*apt] ,i ( *apt] #eg ( title #e1     
,unit$ ,/ates ,code4  7f7 ,report ,n    
lat] ?an #c ye>s aft] ! e/abli%m5t ( !  
,advisory ,bo>d1 ! ,advisory ,bo>d %all 
submit to ,congress a f9al report       
conta9+ ! f9d+s & conclusions ( !       
,advisory ,bo>d1 toge!r ) recomm5dations
 = su* legislation & adm9i/rative       
actions z ! ,advisory ,bo>d consid]s    

appropriate4  7g7 ,t]m9ation ,!         
,advisory ,bo>d %all t]m9ate #cj days   
aft] submitt+ ! report "u subsection    
7f74  7h7 ,au?orization ( appropriations
 ,!re are au?oriz$ to be appropriat$ su*
 sums z may be necess>y to c>ry out ?is 
section4  #g4 ,improvem5t ( policies    
relat$ to ! use & portability ( advance 
directives  7a7 ,m$ic>e ,section        
#ahff7;f7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;cc7f77 is am5d$--  
7#a7 9 p>agraph 7#a7--  7,a7 9          
subp>agraph 7,a77i71 by /rik+ ,/ate law 
& all t foll[s ?r\gh m$ical c>e & ins]t+
 relevant ,/ate & ,f$]al law 7:e!r      
/atutory or z recogniz$ by ! c\rts7 to  
make decisions conc]n+ m$ical c>e2  7,b7
 by /rik+ subp>agraph 7,b72  7,c7 by    
r$esignat+ subp>agraphs 7,c71 7,d71 &   
7,e7 z subp>agraphs 7,g71 7,h71 & 7,i71 
respectively2  7,d7 by ins]t+ aft]      
subp>agraph 7,a7 ! foll[+ new           
subp>agraphs3  7,b7 to docum5t 9 a      
prom95t "p ( ! individual's curr5t      
m$ical record :e!r or n ! individual has

 an advance directive or portable       
treatm5t ord]1 to reque/ a copy ( !     
advance directive or portable treatm5t  
ord]1 z applicable1 & if receiv$1 to    
include ! copy 7or ! cont5t ( ! docum5t 
or docum5ts7 9 a prom95t "p ( su*       
record2  7,c7 to provide ea* individual 
) ! opportunity to discuss ! in=mation  
provid$ pursuant to subp>agraph 7,a7 )  
an appropriately tra9$ employee or      
volunte] ( ! provid] or organization2   
7,d7 = an individual ) decisional       
capacity "u ,/ate law1 to foll[ !       
individual's curr5t treatm5t            
in/ructions1 z express$ 9 writ+ or ?r\gh
 v]bal or nonv]bal communications2  7,e7
 = an individual :o lacks decisional    
capacity--  7i7 to ensure t treatm5t    
decisions are made 9 accordance ) curr5t
 pref]5ces1 values1 & goals ( !         
individual1 :5 possible to asc]ta9 &    
foll[1 & 9 accordance ) curr5t advance  
directives & portable treatm5t ord]s t  
are valid "u ,/ate law :]e ! c>e is     
deliv]$1 & in/ructions provid$ by       

legally au?oriz$ repres5tatives 9       
accordance ) ,/ate & ,f$]al law2  7ii7 9
 ! abs5ce ( a curr5t advance directive  
or portable treatm5t ord] t is valid "u 
,/ate law :]e ! c>e is deliv]$1 to      
deliv] treatm5t bas$ on cr$ible evid5ce 
( ! individual's treatm5t pref]5ces1    
goals1 & values1 su* z a curr5t advance 
directive or portable treatm5t ord]     
execut$ 9 ano!r ,/ate or pa/ /atem5ts   
ab\t treatm5t pref]5ces2 &  7iii7 to    
reconcile actual or suspect$            
discrepancies among advance directives1 
portable treatm5t ord]s1 & o!r evid5ce 9
 accordance ) ,/ate law1 &1 :]e ,/ate   
law is sil5t1 to reconcile discrepancies
 9 ! mann] mo/ likely to deliv] treatm5t
 t is consi/5t ) ! individual's treatm5t
 pref]5ces1 goals1 & values2  7,f7 t    
specify n>r[1 b pot5tially recurr+1     
conditions or circum/ances "u :i* an    
advance directive1 portable treatm5t    
ord]1 or treatm5t directions f an       
individual or legally au?oriz$          
repres5tative w\ld n be foll[$1 su* z-- 

7i7 :]e ! validity or au!nticity ( a    
docum5t is 9 "q2  7ii7 :]e !re is       
evid5ce t an individual's pref]5ces     
*ang$ aft] ! individual docum5t$        
pref]5ces 9 an advance directive or     
portable treatm5t ord]2  7iii7 :]e !    
treatm5t s\ght by ! individual is n     
m$ically indicat$2 &  7iv7 because (    
consci5ce objections 9 accordance )     
p>agraph 7#c72  2  7,e7 9 subp>agraph   
7,h71 z r$esignat$ by subp>agraph 7,c71 
by /rik+ ,/ate law & all t foll[s ?r\gh 
respect+ & ins]t+ ?is section & relevant
 ,/ate & ,f$]al law 7:e!r /atutory or z 
recogniz$ by ! c\rts7 respect+2  7,f7 9 
subp>agraph 7,i71 z r$esignat$ by       
subp>agraph 7,c71 by ins]t+ & portable  
treatm5t ord]s be=e ! p]iod at ! end2   
7,g7 9 ! flu% matt] at ! end1 by /rik+  
7,c7 & ins]t+ 7,g72 &  7,h7 by add+ at !
 end ! foll[+ new s5t5ce3 ,no?+ 9       
subp>agraph 7,d7 or 7,e7 %all be con/ru$
 to apply to /]ilization or abortion42  
7#b7 by r$esignat+ p>agraphs 7#c7 & 7#d7
 z p>agraphs 7#d7 & 7#e71 respectively2 

7#c7 by ins]t+ aft] p>agraph 7#b7 !     
foll[+ new p>agraph3  7#c7 ,no?+ 9 ?is  
section %all be con/ru$ to prohibit !   
application ( a ,/ate law :i* all[s = an
 objection on ! basis ( consci5ce = any 
heal? c>e provid] or any ag5t ( su*     
provid] :i* z a matt] ( consci5ce _c    
implem5t an advance directive4  2  7#d7 
9 p>agraph 7#d71 z r$esignat$ by        
p>agraph 7#b7--  7,a7 by /rik+ writt52  
7,b7 by /rik+ ,/ate law & ins]t+ ,/ate  
or ,f$]al law2 &  7,c7 by /rik+ ( !     
,/ate2  7#e7 by r$esignat+ p>agraph     
7#e71 z r$esignat$ by p>agraph 7#b71 z  
p>agraph 7#f72  7#f7 by ins]t+ aft]     
p>agraph 7#d7 ! foll[+ new p>agraph3    
7#e7 ,9 ?is subsection1 ! t]m portable  
treatm5t ord] means a treatm5t ord]     
design$ to docum5t a cl9ical process t  
includes %>$1 in=m$ m$ical decisionmak+1
 t reflects ! individual's goals ( c>e &
 values1 & t is design$ to apply across 
c>e sett+s1 includ+ ! home4  2 &  7#g7  
by ins]t+ aft] p>agraph 7#f71 z         
r$esignat$ by p>agraph 7#f71 ! foll[+   

new p>agraph3  7#g7 ,no?+ 9 ?is         
subsection %all p]mit ! ,secret>y to    
seek civil p5alties1 includ+ exclusion f
 p>ticipation 9 ! program "u ?is title  
or ! program "u title ,,xix1 aga9/ an   
individual or entity if ! individual or 
entity--  7,a7 us$ reasonable ef=ts to  
deliv] c>e t is consi/5t ) an           
individual's goals1 pref]5ces1 & values 
:5 address+ decisionmak+ = an individual
 :o lacks decisional capacity2 or  7,b7 
decl9$ to furni% c>e 9 accordance )     
p>agraph 7#c74  4  7b7 ,m$icaid ,section
 #aijb7w7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;a7w77 is am5d$--   
7#a7 9 p>agraph 7#a7--  7,a7 9          
subp>agraph 7,a77i71 by /rik+ ,/ate law 
& all t foll[s ?r\gh m$ical c>e & ins]t+
 relevant ,/ate & ,f$]al law 7:e!r      
/atutory or z recogniz$ by ! c\rts7 to  
make decisions conc]n+ m$ical c>e2  7,b7
 by /rik+ subp>agraph 7,b72  7,c7 by    
r$esignat+ subp>agraphs 7,c71 7,d71 &   
7,e7 z subp>agraphs 7,f71 7,g71 & 7,h71 
respectively2  7,d7 by ins]t+ aft]      

subp>agraph 7,a7 ! foll[+ new           
subp>agraphs3  7,b7 to docum5t 9 a      
prom95t "p ( ! individual's curr5t      
m$ical record :e!r or n ! individual has
 an advance directive or portable       
treatm5t ord]1 to reque/ a copy ( !     
advance directive & or portable treatm5t
 ord]1 & if receiv$1 to include ! copy  
7or ! cont5t ( ! docum5t or docum5ts7 9 
a prom95t "p ( su* record2  7,c7 to     
provide ea* individual ) ! opportunity  
to discuss ! in=mation provid$ pursuant 
to subp>agraph 7,a7 ) an appropriately  
tra9$ p]sonnel ( ! provid] or           
organization2  7,d7 = an individual )   
decisional capacity "u ,/ate law1 to    
foll[ ! individual's curr5t treatm5t    
in/ructions1 z express$ 9 writ+ or ?r\gh
 v]bal or non-v]bal communications2     
7,e7 = an individual :o lacks decisional
 capacity--  7i7 to ensure t treatm5t   
decisions are made 9 accordance ) ,/ate 
law address+ legally au?oriz$           
repres5tatives & advance directives2    
7ii7 9 ! abs5ce ( a curr5t advance      

directive or portable treatm5t ord]1 to 
deliv] treatm5t bas$ on cr$ible evid5ce 
( ! individual's treatm5t pref]5ces1    
goals1 & values1 su* z an advance       
directive or portable treatm5t ord]     
execut$ 9 ano!r ,/ate or pa/ /atem5ts   
ab\t treatm5t pref]5ces2 &  7iii7 to    
reconcile actual or suspect$            
discrepancies among advance directives1 
portable treatm5t ord]s1 & o!r evid5ce 9
 accordance ) ,/ate law1 &1 :]e ,/ate   
law is sil5t1 to reconcile discrepancies
 9 ! mann] mo/ likely to deliv] treatm5t
 t is consi/5t ) ! individual's treatm5t
 pref]5ces1 goals1 & values2  7,f7 t    
specify n>r[1 b pot5tially recurr+1     
conditions or circum/ances "u :i* an    
advance directive1 portable treatm5t    
ord]1 or treatm5t directions f an       
individual or legally au?oriz$          
repres5tative w\ld n be foll[$1 su* z-- 
7i7 :]e ! validity or au!nticity ( a    
docum5t is 9 "q2  7ii7 :]e !re is       
evid5ce t an individual's pref]5ces     
*ang$ aft] ! individual docum5t$        

pref]5ces 9 an advance directive or     
portable treatm5t ord]2  7iii7 :]e !    
treatm5t s\ght by ! individual is n     
m$ically indicat$2 &  7iv7 because (    
consci5ce objections 9 accordance )     
p>agraph 7#c72  2  7,e7 9 subp>agraph   
7,h71 z r$esignat$ by subp>agraph 7,c71 
by /rik+ ,/ate law & all t foll[s ?r\gh 
respect+ & ins]t+ ?is section & relevant
 ,/ate & ,f$]al law 7:e!r /atutory or z 
recogniz$ by ! c\rts7 respect+2  7,f7 9 
subp>agraph 7,i71 z r$esignat$ by       
subp>agraph 7,c71 by ins]t+ & portable  
treatm5t ord]s be=e ! p]iod at ! end2   
7,g7 9 ! flu% matt] at ! end1 by /rik+  
7,c7 & ins]t+ 7,g72 &  7,h7 by add+ at !
 end ! foll[+ new s5t5ce3 ,no?+ 9       
subp>agraph 7,d7 or 7,e7 %all be con/ru$
 to apply to /]ilization or abortion42 &
  7#b7 9 p>agraph 7#d7--  7,a7 by /rik+ 
writt52  7,b7 by /rik+ ,/ate law &      
ins]t+ ,/ate or ,f$]al law2 &  7,c7 by  
/rik+ ( ! ,/ate2  7#c7 by r$esignat+    
p>agraph 7#e7 z p>agraph 7#f72  7#d7 by 
ins]t+ aft] p>agraph 7#d7 ! foll[+ new  

p>agraph3  7#e7 ,9 ?is subsection1 ! t]m
 portable treatm5t ord] means a treatm5t
 ord] design$ to docum5t a cl9ical      
process t includes %>$1 in=m$ m$ical    
decisionmak+1 t reflects ! individual's 
goals ( c>e & values1 & t is design$ to 
apply across c>e sett+s1 includ+ ! home4
  2 &  7#e7 by ins]t+ aft] p>agraph     
7#f71 z r$esignat$ by p>agraph 7#c71 !  
foll[+ new p>agraph3  7#g7 ,no?+ 9 ?is  
subsection %all p]mit ! ,secret>y to    
seek civil p5alties1 includ+ exclusion f
 p>ticipation 9 ! program "u ?is title  
or ! program "u title ,,xviii1 aga9/ an 
individual or entity if ! individual or 
entity--  7,a7 us$ reasonable ef=ts to  
deliv] c>e t is consi/5t ) an           
individual's goals1 pref]5ces1 & values 
:5 address+ decisionmak+ = an individual
 :o lacks decisional capacity2 or  7,b7 
decl9$ to furni% c>e 9 accordance )     
p>agraph 7#c74  4  7c7 ,cl>ification )  
respect to advance directives ,section  
#g ( ! ,assi/$ ,suicide ,fund+          
,re/riction ,act ( #aiig 7#db ,u4,s4,c4 

#addjf7 is am5d$--  7#a7 9 p>agraph     
7#a71 by /rik+ or at ! end2 &  7#b7 by  
/rik+ p>agraph 7#b7 & ins]t+ ! foll[+3  
7#b7 to require any provid] or          
organization1 or any employee ( su* a   
provid] or organization1 to foll[ or be 
b\nd by a reque/ f an individual or     
legally au?oriz$ repres5tative1 an      
advance directive1 or a portable        
treatm5t ord] t directs ! purposeful    
caus+ (1 or ! purposeful assi/+ 9 caus+1
 ! dea? ( any individual1 su* z by      
assi/$ suicide1 eu?anasia1 or m]cy      
kill+2 or  7#c7 to all[ discrim9ation   
aga9/ or imposition ( p5alties on any   
provid] or organization1 or any employee
 ( su* a provid] or organization1 t     
refuses1 = any reason1 includ+ an       
objection bas$ on a religi\s1 consci5ce1
 or moral objection1 to in=m1 c\nsel1 or
 9 any way p>ticipate 9 ! purposeful    
caus+ (1 or ! purposeful assi/+ 9 caus+1
 ! dea? ( any individual1 su* z by      
assi/$ suicide1 eu?anasia1 or m]cy      
kill+4  4  7d7 ,effective ,dates  7#a7  

,9 g5]al ,subject to p>agraph 7#b71 !   
am5dm5ts made by subsections 7a7 & 7b7  
%all apply to provid] agreem5ts &       
contracts ent]$ into1 r5ew$1 or ext5d$  
"u title ,,xviii ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #acie et seq471 & to
 ,/ate plans "u title ,,xix ( su* ,act  
7#db ,u4,s4,c4 #acif et seq471 on or    
aft] su* date z ! ,secret>y ( ,heal? &  
,human ,s]vices specifies1 b 9 no case  
may su* date be lat] ?an #a ye> aft] !  
date ( ! enactm5t ( ?is ,act4  7#b7     
,ext5sion ( effective date = ,/ate law  
am5dm5t ,9 ! case ( a ,/ate plan "u     
title ,,xix ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acif et seq47 :i* !     
,secret>y ( ,heal? & ,human ,s]vices    
det]m9es requires ,/ate legislation 9   
ord] = ! plan to meet ! additional      
requirem5ts impos$ by ! am5dm5ts made by
 subsection 7b71 ! ,/ate plan %all n be 
reg>d$ z fail+ to comply ) ! requirem5ts
 ( su* title solely on ! basis ( its    
failure to meet ^! additional           
requirem5ts be=e ! fir/ day ( ! fir/    

cal5d> qu>t] beg9n+ aft] ! close ( !    
fir/ regul> session ( ! ,/ate           
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 ! session is consid]$ to be a sep>ate  
regul> session ( ! ,/ate legislature4   
#h4 ,additional requirem5ts = facilities
  7a7 ,requirem5ts  7#a7 ,9 g5]al       
,section #ahff7;a77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;cc7a77#a77 is am5d$--  7,a7 9     
subp>agraph 7,v71 by /rik+ & at ! end2  
7,b7 9 subp>agraph 7,w71 z add$ by      
section #cjje7a77;,c7 ( ! ,pati5t       
,protection & ,af=dable ,c>e ,act       
7,public ,law #aaa-adh71 by r$esignat+  
su* subp>agraph z subp>agraph 7,x71 mov+
 su* subp>agraph to foll[ subp>agraph   
7,v71 mov+ su* subp>agraph #b ems to !  
left1 & /rik+ ! p]iod at ! end & ins]t+ 
a comma2  7,c7 9 subp>agraph 7,w71 z    
add$ by section #fdjf7;b77#c7 ( !       
,pati5t ,protection & ,af=dable ,c>e    

,act 7,public ,law #aaa-adh71 by        
r$esignat+ su* subp>agraph z subp>agraph
 7,y71 mov+ su* subp>agraph to foll[    
subp>agraph 7,x71 z add$ by subp>agraph 
7,b71 mov+ su* subp>agraph #b ems to !  
left1 & /rik+ ! p]iod at ! end & ins]t+ 
1 &2 &  7,d7 by ins]t+ aft] subp>agraph 
7,y7 ! foll[+ new subp>agraph3  7,z7 9 !
 case ( hospitals1 skill$ nurs+         
facilities1 home heal? ag5cies1 &       
hospice programs1 to assure t           
appropriate docum5tation ( c>e plans    
made :ile ! individual receiv$ c>e by or
 ?r\gh ! provid] 7:i* may include       
advance directives1 portable ord]s1 or  
o!r locally appropriate docum5ts7 be    
complet$ prior to dis*>ge to all[ ! plan
 to be c>ri$ out aft] dis*>ge4  4  7#b7 
,effective ,date ,! am5dm5ts made by ?is
 subsection %all apply to agreem5ts     
ent]$ into or r5ew$ on or aft] ,janu>y  
#a1 #bjae4  7b7 ,,hhs /udy & report     
7#a7 ,/udy ,! ,secret>y ( ,heal? &      
,human ,s]vices %all conduct a /udy on !
 ext5t to :i* hospitals1 skill$ nurs+   

facilities1 hospice programs1 home heal?
 ag5cies1 & applicable provid]s ( plann+
 s]vices "u section #ahfa7;iii7 ( !     
,social ,security ,act1 z add$ by       
section #c7;a71 "w ) individuals to--   
7,a7 engage 9 a c>e plann+ process2     
7,b7 ?or\ghly & completely docum5t ! c>e
 plann+ process 9 ! m$ical record2  7,c7
 complete docum5ts necess>y to support !
 treatm5t & c>e plan1 su* z portable    
treatm5t ord]s & advance directives2    
7,d7 provide s]vices & support t is free
 f discrim9ation bas$ on advanc$ age1   
disability /atus1 or advanc$ illness2 & 
7,e7 provide docum5tation necess>y to   
c>ry out ! treatm5t plan to--  7i7      
subsequ5t provid]s or facilities2 &     
7ii7 ! individual1 _! legally au?oriz$  
repres5tatives1 &1 :]e appropriate &    
relevant1 _! family c>egiv]4  7#b7      
,report ,n lat] ?an ,janu>y #a1 #bjah1 !
 ,secret>y ( ,heal? & ,human ,s]vices   
%all submit to ,congress a report on !  
/udy conduct$ "u p>agraph 7#a7 toge!r ) 
recomm5dations = su* legislation &      

adm9i/rative action z ! ,secret>y       
det]m9es to be appropriate4  #i4 ,grants
 = increas+ public aw>5ess ( advance c>e
 plann+ & advanc$ illness c>e  7a7      
,mat]ial & res\rces developm5t  7#a7 ,9 
g5]al ,! ,secret>y ( ,heal? & ,human    
,s]vices 79 ?is section ref]r$ to z !   
,secret>y7 is au?oriz$ to aw>d grants to
 entities describ$ 9 subsection 7d7 to  
develop onl9e tra9+ modules1 decision   
support tools1 & in/ructional mat]ials =
 individuals1 family c>egiv]s1 & heal?  
c>e provid]s t include--  7,a7 = heal?y 
individuals1 ! importance (--  7i7      
id5tify+ an individual :o w make        
treatm5t decisions 9 ! ev5t ( future    
cognitive incapacity2  7ii7 discuss+    
values & goals relevant to cata/rophic  
injury or illness2 &  7iii7 complet+ an 
advance directive t--  7,i7 appo9ts a   
surrogate2 &  7,,ii7 docum5ts goals &   
values & o!r in=mation t %\ld be        
consid]$ 9 mak+ treatm5t decisions2     
7,b7 = individuals ) advanc$ illness1 ! 
importance (--  7i7 articulat+ goals (  

c>e2  7ii7 und]/&+ prognosis & typical  
disease trajectory2  7iii7 evaluat+     
treatm5t options 9 light ( goals ( c>e2 
7iv7 develop+ a treatm5t plan2 &  7v7   
docum5t+ ! treatm5t plan on advance     
directives1 portable treatm5t ord]s1 &  
o!r docum5tation =ms us$ 9 ! locality   
:]e ! plan is to be execut$2  7,c7 !    
role & effective use ( ,/ate & o!r      
advance directive =ms & portable        
treatm5t ord]s2 &  7,d7 ! range (       
s]vices = individuals fac+ advanc$      
illness1 includ+ plann+ s]vices1        
palliative c>e1 & hospice c>e4  7#b7    
,p]iod ,any grant aw>d$ "u p>agraph 7#a7
 %all be = a p]iod ( #c ye>s4  7b7      
,e/abli%m5t & ma9t5ance ( web- &        
telephone-,bas$ res\rces  7#a7 ,9 g5]al 
,! ,secret>y is au?oriz$ to aw>d grants 
to entities describ$ 9 subsection 7d7 to
 e/abli% & ma9ta9 a website & telephone 
hotl9e to dissem9ate res\rces develop$  
"u subsection 7a7 & mat]ials design$ by 
! ,dep>tm5t ( ,heal? & ,human ,s]vices  
,c5t] = ,fai?-,bas$ & ,neighborhood     

,p>tn]%ips = fai? communities4  7#b7    
,p]iod ,any grant aw>d$ "u p>agraph 7#a7
 %all be = a p]iod ( #e ye>s4  7#c7     
,ability to su/a9 activities ,!         
,secret>y %all take into acc\nt !       
ability ( an entity to su/a9 !          
activities describ$ 9 p>agraph 7#a7     
beyond ! #e-ye> grant p]iod 9 det]m9+   
:e!r to aw>d a grant "u p>agraph 7#a7 to
 ! entity4  7c7 ,national public        
education campaign  7#a7 ,9 g5]al ,!    
,secret>y is au?oriz$ to aw>d grants to 
entities describ$ 9 subsection 7d7 to   
conduct a national public education     
campaign to raise public aw>5ess (      
advance c>e plann+ & advanc$ illness    
c>e1 includ+ ! availability ( ! res\rces
 creat$ "u subsections 7a7 & 7b74  7#b7 
,p]iod ,any grant aw>d$ "u p>agraph 7#a7
 %all be = a p]iod ( #e ye>s4  7d7      
,eligible entities ,entities describ$ 9 
?is subsection are public or private    
entities 7includ+ ,/ates or political   
subdivisions ( a ,/ate1 fai?-bas$       
organizations1 & religi\s educational   

in/itutions71 or a consortium ( any su* 
entities4  7e7 ,au?orization (          
appropriations  7#a7 ,9 g5]al ,!re are  
au?oriz$ to be appropriat$ to !         
,secret>y--  7,a7 = purposes ( mak+     
grants "u subsection 7a71 #e1jjj1jjj =  
fiscal ye> #bjae1 to rema9 available    
until exp5d$2  7,b7 = purposes ( mak+   
grants "u subsection 7b71 #e1jjj1jjj =  
fiscal ye> #bjae1 to rema9 available    
until exp5d$2 &  7,c7 = purposes ( mak+ 
grants "u subsection 7c71 #e1jjj1jjj =  
fiscal ye> #bjae to rema9 available     
until exp5d$4  7#b7 ,limitation ,none ( 
! funds appropriat$ "u p>agraph 7#a7    
%all be us$ to--  7,a7 develop a model  
advance directive2  7,b7 develop or     
employ a doll>s-p]-quality adju/$ life  
ye> 7or simil> measure t disc\nts !     
value ( a life because ( an individual's
 disability72 or  7,c7 make a grant to a
 private entity t advocates1 promotes1  
or facilitates any item or proc$ure =   
:i* fund+ is unavailable "u ! ,assi/$   
,suicide ,fund+ ,re/riction ,act ( #aiig

 7,public ,law #aje-ab74  #aj4 ,,hhs    
/udy & report on ! /orage ( advance     
directives  7a7 ,/udy ,! ,secret>y (    
,heal? & ,human ,s]vices %all conduct a 
/udy on ,/ate & regional activities )   
respect to /or+ complet$ advance        
directives & portable treatm5t ord]s4   
,su* /udy %all include an analysis ( !  
practicality & feasibility ( e/abli%+ a 
national regi/ry = complet$ advance     
directives & portable treatm5t ord]s1   
tak+ into consid]ation ! con/ra9ts      
creat$ by ! privacy provisions enact$ z 
a result ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    
#aiif 7,public ,law #ajd-aia74  7b7     
,report ,n lat] ?an ,janu>y #a1 #bjag1 !
 ,secret>y ( ,heal? & ,human ,s]vices   
%all submit to ,congress a report on !  
/udy conduct$ "u subsection 7a7 toge!r )
 recomm5dations = su* legislation &     
adm9i/rative action z ! ,secret>y       
det]m9es to be appropriate4  #aa4 ,,gao 
/udy & report on ! provisions (1 &      
am5dm5ts made by1 ?is ,act  7a7 ,/udy ,!

 ,comptroll] ,g5]al ( ! ,unit$ ,/ates 79
 ?is section ref]r$ to z ! ,comptroll]  
,g5]al7 %all conduct a /udy on !        
provisions (1 & am5dm5ts made by1 ?is   
,act1 includ+ ! quality 7su* z          
individual & family exp]i5ce1 individual
 und]/&+ ( treatm5t *oices1 & alignm5t  
among individual goals1 values1 &       
pref]5ces1 ! docum5t$ c>e plan1 treatm5t
 deliv]$1 & treatm5t outcomes7 associat$
 ) su* provisions & su* am5dm5ts4  7b7  
,report ,n lat] ?an ,janu>y #a1 #bjah1 !
 ,comptroll] ,g5]al %all submit to      
,congress a report conta9+ ! results ( !
 /udy conduct$ "u subsection 7a71 toge!r
 ) recomm5dations = su* legislation &   
adm9i/rative action z ! ,comptroll]     
,g5]al det]m9es appropriate4  #ab4      
,consultation ) ! ,c>e ,plann+ ,advisory
 ,bo>d ,! ,secret>y ( ,heal? & ,human   
,s]vices %all consult ) ! ,c>e ,plann+  
,advisory ,bo>d e/abli%$ "u section #f 9
 ord] to ensure t e activity c>ri$ out  
"u ! provisions (1 & am5dm5ts made by1  
?is ,act w help individuals to--  7#a7  

receive education & c>e t is free f     
discrim9ation bas$ on advanc$ age1      
disability /atus1 or pres5ce ( advanc$  
illness2  7#b7 develop plans & receive  
c>e t is consi/5t ) ea* individual's    
goals1 values & pref]5ces2 &  7#c7      
receive an explanation ( a range (      
p]spectives on approa*es = treat+       
advanc$ illness1 includ+ disease modify+
 options1 palliative c>e t supports     
individuals f ! onset ( advanc$ illness 
& c be provid$ at ! same "t z all o!r   
c>e types1 & hospice c>e4  #ac4 ,rule ( 
con/ruction ,no?+ 9 ! provisions (1 or !
 am5dm5ts made by1 ?is ,act %all be     
con/ru$ to limit ! re/rictions (1 or to 
au?orize ! use ( ,f$]al funds = any     
s]vice1 mat]ial1 or activity p]ta9+ to  
an item or s]vice or proc$ure = :i*     
funds are unavailable "u1 ! ,assi/$     
,suicide ,fund+ ,re/riction ,act ( #aiig
 7,public ,law #aje-ab74