,,ii  #aac? ,,congress  #b;d ,session   
,s4 #bbdj  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,april #aj1 #bjad ,mr4 
,coons 7= ,mr4 ,coburn 7= himself1 ,mr4 
,coons1 & ,mr4 ,blum5?al77 introduc$ !  
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d title ,,xviii ( ! ,social      
,security ,act to enc\rage ,m$ic>e      
b5efici>ies to volunt>ily adopt advance 
directives guid+ ! m$ical c>e !y        
receive4  #a4 ,%ort title  ,?is ,act may
 be cit$ z ! ,m$ic>e ,*oices ,emp[]m5t &
 ,protection ,act4  #b4 ,m$ic>e advance 
directive c]tification program ,"p ,b ( 
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie et seq47 is am5d$ 
by add+ at ! end ! foll[+ new section3  
#ahdi4 ,m$ic>e advance directive        
c]tification program  7a7 ,9 g5]al  7#a7
 ,e/abli%m5t ( ,program ,! ,secret>y    
%all e/abli% & implem5t an ,advance     
,directive ,c]tification ,program 79 ?is
 section ref]r$ to z ! ,program7 "u :i* 
! ,secret>y %all enc\rage eligible      

b5efici>ies to adopt & ma9ta9 c]tifi$   
advance directives to guide ! deliv]y ( 
heal? c>e to su* b5efici>ies4 ,!        
,secret>y %all implem5t ! ,program )9 #c
 ye>s ( ! date ( enactm5t ( ?is section4
  7#b7 ,def9itions ,9 ?is section3 7,a7 
,c]tifi$ advance directive ,! t]m       
c]tifi$ advance directive means any     
writt5 or electronically /or$ /atem5t by
 an eligible b5efici>y t-- 7i7 provides 
in/ructions t outl9e ! k9d ( m$ical     
treatm5ts & c>e t su* b5efici>y w\ld    
want or n want "u p>ticul> conditions1 &
 may also include ! id5tification ( a   
heal? c>e proxy or legal repres5tative  
to make m$ical treatm5t decisions = !   
b5efici>y if ! b5efici>y becomes unable 
to make or communicate ^? decisions2 &  
7ii7 is (f]$ by an entity t has receiv$ 
accr$itation f ! ,secret>y "u ?is       
section4  7,b7 ,eligible ,b5efici>y ,!  
t]m eligible b5efici>y means an         
individual enroll$ "u ?is "p4  7#c7     
,volunt>y ,p>ticipation 9 ! ,program    
%all be volunt>y ) respect to ! eligible

 b5efici>y & an eligible b5efici>y :o   
has regi/]$ a c]tifi$ advance directive 
"u ! ,program may t]m9ate su* directive 
at any "t4 ,no?+ 9 ?is section %all     
require an eligible b5efici>y to adopt  
or ma9ta9 a c]tifi$ advance directive4  
7#d7 ,be/ practices ,9 e/abli%+ &       
implem5t+ ! ,program1 ! ,secret>y %all  
consid] be/ practices )9 exi/+ advance  
directive regi/ry te*nologies1 programs1
 & sy/ems1 includ+ web-bas$ or cl\d-bas$
 advance directive te*nologies1 :i* may 
utilize "t & date /amps1 video1 or o!r  
innovative measures to protect !        
au!nticity1 improve ! quality1 & enhance
 ! security ( su* directives4  7#e7     
,/ate ,law ,?is section %all 9 no way   
sup]c$e1 abrogate1 or o!rwise int]f]e ) 
,/ate law gov]n+ advance directives4    
7b7 ,regi/ration  7#a7 ,9 g5]al ,!      
,secret>y %all e/abli% proc$ures = an   
eligible b5efici>y to regi/] su*        
b5efici>y's adoption ( a c]tifi$ advance
 directive "u ! ,program4 ,su* proc$ures
 %all ensure t regi/ration is available 

bo? ?r\gh an onl9e & manual process4 ,! 
,secret>y %all also e/abli% proc$ures to
 ensure ,program p>ticipants c update   
previ\sly regi/]$ in=mation t is no     
long] accurate & indicate t an advance  
directive has be5 t]m9at$4  7#b7        
,requir$ in=mation ,9 addition to su*   
o!r in=mation z ! ,secret>y may deem    
appropriate1 an eligible b5efici>y seek+
 to regi/] a c]tifi$ advance directive  
"u ! program %all indicate :]e ! advance
 directive is ma9ta9$4  7#c7            
,regi/ration p]iods ,! proc$ures        
e/abli%$ "u p>agraph 7#a7 %all provide t
 regi/ration "u ! ,program %all occur   
dur+-- 7,a7 an eligible b5efici>y's     
initial ,"p ,c enrollm5t z describ$ 9   
p>agraph 7#a7 ( section #ahea7;e72 &    
7,b7 ! annual1 coord9at$ election p]iod 
"u p>agraph 7#c7 ( su* section4  7#d7   
,privacy & security  7,a7 ,9 g5]al ,!   
,secret>y %all ensure t all aspects ( ! 
regi/ration sy/em comply ) ! ,f$]al     
regulations 7conc]n+ ! privacy (        
individually id5tifiable heal?          

in=mation7 promulgat$ "u section        
#bfd7;c7 ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    
#aiif4  7,b7 ,access ,! ,secret>y %all  
utilize /&>diz$ data protections &      
privacy /&>ds1 includ+ ! ,f$]al         
regulations describ$ 9 p>agraph 7#a71 to
 ensure t ! regi/ration record ( an     
eligible b5efici>y c only be access$    
by-- 7i7 ! b5efici>y1 ?r\gh ! process   
e/abli%$ "u p>agraph 7#a72 &  7ii7      
provid]s ( s]vices & suppli]s p>ticipat+
 "u ?is title1 ?r\gh a process e/abli%$ 
by ! ,secret>y4  7c7 ,accr$itation  7#a7
 ,9 g5]al ,"u ! ,program1 ! ,secret>y   
%all-- 7,a7 grant accr$itation to       
advance directive v5dors & o!r entities 
provid+ advance directives t meet !     
accr$itation crit]ia e/abli%$ "u        
p>agraph 7#b72 &  7,b7 e/abli% a process
 :]eby advance directive v5dors & o!r   
entities provid+ advance directives may 
obta9 accr$itation "u ?is subsection4   
7#b7 ,accr$itation crit]ia ,! ,secret>y 
%all e/abli% accr$itation crit]ia =     

advance directive v5dors & o!r entities 
provid+ advance directives t seek to (f]
 advance directives to be c]tifi$ "u !  
,program4 ,su* crit]ia %all include !   
foll[+3 7,a7 ,process = adopt+ advance  
directive ,! advance directive v5dor or 
o!r entity provid+ an advance directive 
%all all[ a b5efici>y to create1 adopt1 
modify1 & t]m9ate an advance directive--
 7i7 ?r\gh an onl9e process2 &  7ii7 z  
an alt]native to ! onl9e process1 ?r\gh 
a manual process t employs pap]         
docum5ts4  7,b7 ,access ,! advance      
directive v5dor or o!r entity provid+ an
 advance directive %all ma9ta9 advance  
directives 9 su* a way t-- 7i7 an       
eligible b5efici>y :o has adopt$ an     
advance directive ) su* v5dor or entity 
& any family memb]1 legal repres5tative1
 or heal? c>e proxy legally designat$ by
 su* b5efici>y has direct1 ne> real-"t  
onl9e access to ! b5efici>y's advance   
directive = purposes ( view+ & %>+ su*  
advance directive2  7ii7 9 ! case ( an  
eligible b5efici>y :o has adopt$ an     

advance directive ) su* v5dor or entity 
or any family memb]1 legal              
repres5tative1 or heal? c>e proxy       
legally designat$ by su* b5efici>y :o is
 unable or unwill+ to use ! onl9e access
 "u subp>agraph 7,a71 su* individual is 
able to obta9 a h>d copy ( ! b5efici>y's
 advance directive = ! purposes ( view+ 
& %>+ su* advance directive2 &  7iii7   
provid]s ( s]vices & suppli]s p>ticipat+
 "u ?is title h ne> real-"t access to ! 
advance directive ( an eligible         
b5efici>y :o has adopt$ an advance      
directive ) su* v5dor or entity4  7,c7  
,privacy protections  7i7 ,9 g5]al ,!   
advance directive v5dor or o!r entity   
provid+ an advance directive %all comply
 ) ! ,f$]al regulations 7conc]n+ !      
privacy ( individually id5tifiable heal?
 in=mation7 promulgat$ "u section       
#bfd7;c7 ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    
#aiif 7#db ,u4,s4,c4 #acbj;d-#b note74  
7ii7 ,access ,su* v5dor or entity %all  
utilize /&>diz$ data protections &      

privacy /&>ds1 includ+ ! ,f$]al         
regulations describ$ 9 p>agraph 7#a71 to
 ensure t ! cont5t ( an eligible        
b5efici>y's advance directive is own$ & 
ma9ta9$ by ! b5efici>y & c only be      
access$ by-- 7,i7 ! b5efici>y or !      
b5efici>y's designee pursuant to clauses
 7i7 & 7ii7 ( subp>agraph 7,a72 &       
7,,ii7 a provid] ( s]vices or a suppli] 
pursuant to subp>agraph 7,a77iii74  7,d7
 ,security & te/+ ,! advance directive  
v5dor or o!r entity provid+ an advance  
directive %all c]tify t-- 7i7 all data  
managem5t & data transf] elem5ts involv$
 9 adopt+1 ma9ta9+1 & access+ ! advance 
directive h successfully pass$ rigor\s  
indep5d5t te/+ reg>d+ /&>ds ( timel9ess1
 accuracy1 & effici5cy2  7ii7 ! data    
managem5t & data transf] elem5ts involv$
 9 adopt+1 ma9ta9+1 & access+ ! advance 
directive meet widely accept$ indu/ry   
security /&>ds2 &  7iii7 ! sy/em t      
provides access to ! advance directive  
has pass$ real-"t te/s simulat+ a       
reali/ic volume ( b5efici>ies & provid]s

 access+ advance directives             
simultane\sly4  7,e7 ,c]tifi$ advance   
directives ,! advance directive v5dor or
 o!r entity provid+ an advance directive
 %all agree to (f] c]tifi$ advance      
directives 7z def9$ 9 subsection        
7a77#b77;,a774  7,f7 ,o!r ,su* o!r      
crit]ia z ! ,secret>y may require4  7d7 
,inc5tive  7#a7 ,9 g5]al ,! ,secret>y   
%all make a "o-"t paym5t ( ! am\nt      
specifi$ 9 p>agraph 7#b7 to ea* eligible
 b5efici>y t adopts a c]tifi$ advance   
directive & regi/]s su* directive ) !   
,program4  7#b7 ,am\nt  7,a7 ,9 g5]al ,=
 purposes ( p>agraph 7#a71 ! am\nt      
specifi$ 9 ?is p>agraph is-- 7i7 = a    
b5efici>y :o regi/]s a c]tifi$ advance  
directive ) ! ,program 9 #bjae-- 7,i7 9 
! case ( a b5efici>y t creates1 adopts1 
& regi/]s a c]tifi$ advance directive   
us+ onl9e processes only1 #ge2 or       
7,,ii7 9 ! case ( a b5efici>y t creates1
 adopts1 or regi/]s a c]tifi$ advance   
directive us+ a manual process1 #ej2 &  
7ii7 = a b5efici>y :o regi/]s a c]tifi$ 

advance directive ) ! ,program 9 a      
subsequ5t ye>1 ! am\nt specifi$ 9 ?is   
p>agraph = ! prec$+ ye> increas$ by !   
p]c5tage increase 9 ! ,*a9$ ,consum]    
,price ,index = ,all ,urban ,consum]s 7z
 publi%$ by ! ,bureau ( ,labor ,/ati/ics
 ( ! ,dep>tm5t ( ,labor7 ov] ! prec$+   
ye>4  7,b7 ,r\nd+ ,if any am\nt det]m9$ 
"u subp>agraph 7,a7 is n a multiple (   
#aj c5ts1 su* am\nt %all be r\nd$ to !  
ne>e/ multiple ( #aj c5ts4  7#c7        
,adm9i/ration ,! ,secret>y %all1 ?r\gh a
 full notice & comm5t rulemak+ process1 
e/abli% proc$ures =-- 7,a7 mak+ !       
inc5tive paym5t directly to ! eligible  
b5efici>y or a p]sonal acc\nt ma9ta9$ by
 ! b5efici>y at a f9ancial in/itution t 
has be5 designat$ by ! b5efici>y1 &     
ensur+ t no o!r entity receives ! paym5t
 on ! b5efici>y's behalf2 &  7,b7 ensur+
 t a b5efici>y does n receive an        
inc5tive paym5t "u ?is section m ?an    
once4  7e7 ,education & outrea* ,!      
,secret>y %all "w ) /akehold]s to       
conduct appropriate educational &       

outrea* activities "u ! ,program1       
includ+-- 7#a7 ! inclusion ( detail$    
in=mation reg>d+ ! p]sonal b5efits (    
adopt+ a c]tifi$ advance directive &    
p>ticipat+ 9 ! ,program 9 ! ,m$ic>e & ,y
 h&book "u section #ahjd2 &  7#b7 !     
inclusion ( detail$ in=mation reg>d+ !  
p]sonal b5efits ( adopt+ a c]tifi$      
advance directive & p>ticipat+ 9 !      
,program & an explanation ( h[ !        
,program works 7:i* may include sample  
c]tifi$ advance directives1 l9ks to !   
websites ( c]tifi$ advance directive    
v5dors1 o!r entities provid+ advance    
directives1 & /akehold] organizations1 &
 su* o!r in=mation z ! ,secret>y        
det]m9es useful7 on ! ,int]net website (
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices4 
7f7 ,consultation ,9 e/abli%+ &         
implem5t+ ! ,program1 ! ,secret>y %all  
consult )1 & solicit fe$back f1 a broad 
array ( /akehold]s repres5t+ ! int]e/s (
 eligible b5efici>ies1 heal? c>e        
provid]s1 ! advance directive indu/ry & 
advance directive v5dors1 & fai?-bas$   

organizations4 ,su* /akehold]s %all     
include physicians1 nurses1 hospital    
repres5tatives1 palliative & hospice    
c>egiv]s1 advance directive companies & 
v5dors1 pati5ts' rights gr\ps1 heal?    
in=mation privacy exp]ts1 eld] law      
exp]ts1 s5ior gr\ps1 c\nselors1 *apla9s1
 cl]gy1 e?ici/s1 v>i\s o!r memb]s ( !   
fai? community1 & o!r individuals &     
entities t ! ,secret>y det]m9es         
appropriate4  4