,,ii #aacth ,,congress #b;d ,session ,s4 #bbdj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,april #aj1 #bjad ,mr4 ,coons 7for ,mr4 ,coburn 7for himself1 ,mr4 ,coons1 and ,mr4 ,blumenthal77 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to encourage ,medicare beneficiaries to voluntarily adopt advance directives guiding the medical care they receive4 #a4 ,short title ,this ,act may be cited as the ,medicare ,choices ,empowerment and ,protection ,act4 #b4 ,medicare advance directive certification program ,part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by adding at the end the following new section3 #ahdi4 ,medicare advance directive certification program 7a7 ,in general 7#a7 ,establishment of ,program ,the ,secretary shall establish and implement an ,advance ,directive ,certification ,program 7in this section referred to as the ,program7 under which the ,secretary shall encourage eligible beneficiaries to adopt and maintain certified advance directives to guide the delivery of health care to such beneficiaries4 ,the ,secretary shall implement the ,program within #c years of the date of enactment of this section4 7#b7 ,definitions ,in this section3 7,a7 ,certified advance directive ,the term certified advance directive means any written or electronically stored statement by an eligible beneficiary that-- 7i7 provides instructions that outline the kind of medical treatments and care that such beneficiary would want or not want under particular conditions1 and may also include the identification of a health care proxy or legal representative to make medical treatment decisions for the beneficiary if the beneficiary becomes unable to make or communicate those decisions2 and 7ii7 is offered by an entity that has received accreditation from the ,secretary under this section4 7,b7 ,eligible ,beneficiary ,the term eligible beneficiary means an individual enrolled under this part4 7#c7 ,voluntary ,participation in the ,program shall be voluntary with respect to the eligible beneficiary and an eligible beneficiary who has registered a certified advance directive under the ,program may terminate such directive at any time4 ,nothing in this section shall require an eligible beneficiary to adopt or maintain a certified advance directive4 7#d7 ,best practices ,in establishing and implementing the ,program1 the ,secretary shall consider best practices within existing advance directive registry technologies1 programs1 and systems1 including web-based or cloud-based advance directive technologies1 which may utilize time and date stamps1 video1 or other innovative measures to protect the authenticity1 improve the quality1 and enhance the security of such directives4 7#e7 ,state ,law ,this section shall in no way supercede1 abrogate1 or otherwise interfere with ,state law governing advance directives4 7b7 ,registration 7#a7 ,in general ,the ,secretary shall establish procedures for an eligible beneficiary to register such beneficiary's adoption of a certified advance directive under the ,program4 ,such procedures shall ensure that registration is available both through an online and manual process4 ,the ,secretary shall also establish procedures to ensure ,program participants can update previously registered information that is no longer accurate and indicate that an advance directive has been terminated4 7#b7 ,required information ,in addition to such other information as the ,secretary may deem appropriate1 an eligible beneficiary seeking to register a certified advance directive under the program shall indicate where the advance directive is maintained4 7#c7 ,registration periods ,the procedures established under paragraph 7#a7 shall provide that registration under the ,program shall occur during-- 7,a7 an eligible beneficiary's initial ,part ,c enrollment as described in paragraph 7#a7 of section #ahea7;e72 and 7,b7 the annual1 coordinated election period under paragraph 7#c7 of such section4 7#d7 ,privacy and security 7,a7 ,in general ,the ,secretary shall ensure that all aspects of the registration system comply with the ,federal regulations 7concerning the privacy of individually identifiable health information7 promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif4 7,b7 ,access ,the ,secretary shall utilize standardized data protections and privacy standards1 including the ,federal regulations described in paragraph 7#a71 to ensure that the registration record of an eligible beneficiary can only be accessed by-- 7i7 the beneficiary1 through the process established under paragraph 7#a72 and 7ii7 providers of services and suppliers participating under this title1 through a process established by the ,secretary4 7c7 ,accreditation 7#a7 ,in general ,under the ,program1 the ,secretary shall-- 7,a7 grant accreditation to advance directive vendors and other entities providing advance directives that meet the accreditation criteria established under paragraph 7#b72 and 7,b7 establish a process whereby advance directive vendors and other entities providing advance directives may obtain accreditation under this subsection4 7#b7 ,accreditation criteria ,the ,secretary shall establish accreditation criteria for advance directive vendors and other entities providing advance directives that seek to offer advance directives to be certified under the ,program4 ,such criteria shall include the following3 7,a7 ,process for adopting advance directive ,the advance directive vendor or other entity providing an advance directive shall allow a beneficiary to create1 adopt1 modify1 and terminate an advance directive-- 7i7 through an online process2 and 7ii7 as an alternative to the online process1 through a manual process that employs paper documents4 7,b7 ,access ,the advance directive vendor or other entity providing an advance directive shall maintain advance directives in such a way that-- 7i7 an eligible beneficiary who has adopted an advance directive with such vendor or entity and any family member1 legal representative1 or health care proxy legally designated by such beneficiary has direct1 near real-time online access to the beneficiary's advance directive for purposes of viewing and sharing such advance directive2 7ii7 in the case of an eligible beneficiary who has adopted an advance directive with such vendor or entity or any family member1 legal representative1 or health care proxy legally designated by such beneficiary who is unable or unwilling to use the online access under subparagraph 7,a71 such individual is able to obtain a hard copy of the beneficiary's advance directive for the purposes of viewing and sharing such advance directive2 and 7iii7 providers of services and suppliers participating under this title have near real-time access to the advance directive of an eligible beneficiary who has adopted an advance directive with such vendor or entity4 7,c7 ,privacy protections 7i7 ,in general ,the advance directive vendor or other entity providing an advance directive shall comply with the ,federal regulations 7concerning the privacy of individually identifiable health information7 promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note74 7ii7 ,access ,such vendor or entity shall utilize standardized data protections and privacy standards1 including the ,federal regulations described in paragraph 7#a71 to ensure that the content of an eligible beneficiary's advance directive is owned and maintained by the beneficiary and can only be accessed by-- 7,i7 the beneficiary or the beneficiary's designee pursuant to clauses 7i7 and 7ii7 of subparagraph 7,a72 and 7,,ii7 a provider of services or a supplier pursuant to subparagraph 7,a77iii74 7,d7 ,security and testing ,the advance directive vendor or other entity providing an advance directive shall certify that-- 7i7 all data management and data transfer elements involved in adopting1 maintaining1 and accessing the advance directive have successfully passed rigorous independent testing regarding standards of timeliness1 accuracy1 and efficiency2 7ii7 the data management and data transfer elements involved in adopting1 maintaining1 and accessing the advance directive meet widely accepted industry security standards2 and 7iii7 the system that provides access to the advance directive has passed real-time tests simulating a realistic volume of beneficiaries and providers accessing advance directives simultaneously4 7,e7 ,certified advance directives ,the advance directive vendor or other entity providing an advance directive shall agree to offer certified advance directives 7as defined in subsection 7a77#b77;,a774 7,f7 ,other ,such other criteria as the ,secretary may require4 7d7 ,incentive 7#a7 ,in general ,the ,secretary shall make a one-time payment of the amount specified in paragraph 7#b7 to each eligible beneficiary that adopts a certified advance directive and registers such directive with the ,program4 7#b7 ,amount 7,a7 ,in general ,for purposes of paragraph 7#a71 the amount specified in this paragraph is-- 7i7 for a beneficiary who registers a certified advance directive with the ,program in #bjae-- 7,i7 in the case of a beneficiary that creates1 adopts1 and registers a certified advance directive using online processes only1 #ge2 or 7,,ii7 in the case of a beneficiary that creates1 adopts1 or registers a certified advance directive using a manual process1 #ej2 and 7ii7 for a beneficiary who registers a certified advance directive with the ,program in a subsequent year1 the amount specified in this paragraph for the preceding year increased by the percentage increase in the ,chained ,consumer ,price ,index for ,all ,urban ,consumers 7as published by the ,bureau of ,labor ,statistics of the ,department of ,labor7 over the preceding year4 7,b7 ,rounding ,if any amount determined under subparagraph 7,a7 is not a multiple of #aj cents1 such amount shall be rounded to the nearest multiple of #aj cents4 7#c7 ,administration ,the ,secretary shall1 through a full notice and comment rulemaking process1 establish procedures for-- 7,a7 making the incentive payment directly to the eligible beneficiary or a personal account maintained by the beneficiary at a financial institution that has been designated by the beneficiary1 and ensuring that no other entity receives the payment on the beneficiary's behalf2 and 7,b7 ensuring that a beneficiary does not receive an incentive payment under this section more than once4 7e7 ,education and outreach ,the ,secretary shall work with stakeholders to conduct appropriate educational and outreach activities under the ,program1 including-- 7#a7 the inclusion of detailed information regarding the personal benefits of adopting a certified advance directive and participating in the ,program in the ,medicare and ,you handbook under section #ahjd2 and 7#b7 the inclusion of detailed information regarding the personal benefits of adopting a certified advance directive and participating in the ,program and an explanation of how the ,program works 7which may include sample certified advance directives1 links to the websites of certified advance directive vendors1 other entities providing advance directives1 and stakeholder organizations1 and such other information as the ,secretary determines useful7 on the ,internet website of the ,centers for ,medicare ,medicaid ,services4 7f7 ,consultation ,in establishing and implementing the ,program1 the ,secretary shall consult with1 and solicit feedback from1 a broad array of stakeholders representing the interests of eligible beneficiaries1 health care providers1 the advance directive industry and advance directive vendors1 and faith-based organizations4 ,such stakeholders shall include physicians1 nurses1 hospital representatives1 palliative and hospice caregivers1 advance directive companies and vendors1 patients' rights groups1 health information privacy experts1 elder law experts1 senior groups1 counselors1 chaplains1 clergy1 ethicists1 various other members of the faith community1 and other individuals and entities that the ,secretary determines appropriate4 4