,,ii #aacth ,,congress #b;d ,session ,s4 #cjji ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #ab1 #bjad,mr4 ,blumenthal 7for himself and ,mr4 ,rockefeller7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to improve end-of-life care4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,advance ,planning and ,compassionate ,care ,act of #bjad4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,sec4 #b4 ,definitions4,,title ,i--,advance ,care ,planning,subtitle ,a--,consumer and ,provider ,education,part ,i--,consumer ,education,s,u,b,p,a,r,t ,a--,national initiatives,sec4 #aja4 ,advance care planning telephone hotline4,sec4 #ajb4 ,advance care planning information clearinghouses4,sec4 #ajc4 ,advance care planning toolkit4,sec4 #ajd4 ,national public education campaign4,sec4 #aje4 ,update of ,medicare and ,social ,security handbooks4,sec4 #ajf4 ,authorization of appropriations4,,subpart ,b--,state and local initiatives,sec4 #aaa4 ,financial assistance for advance care planning4,sec4 #aab4 ,grants for programs for orders regarding life sustaining treatment4,part ,,ii--,provider ,education,sec4 #aba4 ,public provider advance care planning website4,sec4 #abb4 ,continuing education for physicians and nurses4,subtitle ,b--,portability of ,advance ,directives2 ,health ,information ,technology,sec4 #aca4 ,portability of advance directives4,sec4 #acb4 ,state advance directive registries2 driver's license advance directive notation4,sec4 #acc4 ,,gao study and report on establishment of national advance directive registry4,subtitle ,c--,national ,uniform ,policy on ,advance ,care ,planning,sec4 #ada4 ,study and report by the ,secretary regarding the establishment and implementation of a national uniform policy on advance directives4,,title ,,ii--,compassionate ,care,subtitle ,a--,workforce development,part ,i--,education and training,sec4 #bja4 ,national ,geriatric and ,palliative ,care ,services ,corps4,sec4 #bjb4 ,exemption of palliative medicine fellowship training from ,medicare graduate medical education caps4,sec4 #bjc4 ,medical school curricula4,subtitle ,b--,coverage under ,medicare1 ,medicaid1 and ,,chip ,part ,i--,coverage of advance care planning,sec4 #baa4 ,medicare1 ,medicaid1 and ,,chip coverage4,part ,,ii--,hospice,sec4 #bba4 ,adoption of ,med,p,a,c hospice payment methodology recommendations4,sec4 #bbb4 ,removing hospice inpatient days in setting per diem rates for critical access hospitals4,sec4 #bbc4 ,hospice payments for dual eligible individuals residing in long-term care facilities4,sec4 #bbd4 ,delineation of respective care responsibilities of hospice programs and long-term care facilities4,sec4 #bbe4 ,adoption of ,med,p,a,c hospice program eligibility certification and recertification recommendations4,sec4 #bbf4 ,concurrent care for children4,sec4 #bbg4 ,making hospice a required benefit under ,medicaid and ,,chip4,sec4 #bbh4 ,medicare ,hospice payment model demonstration projects4,sec4 #bbi4 ,med,p,a,c studies and reports4,sec4 #bcj4 ,,hhs ,evaluations4,subtitle ,c--,quality ,improvement,sec4 #bda4 ,patient satisfaction surveys4,sec4 #bdb4 ,development of core end-of-life care quality measures across each relevant provider setting4,sec4 #bdc4 ,accreditation of hospital-based palliative care programs4,sec4 #bdd4 ,survey and data requirements for all ,medicare participating hospice programs4,subtitle ,d--,additional reports1 research1 and evaluations,sec4 #bea4 ,national ,center ,on ,palliative and ,end-of-,life ,care4,sec4 #beb4 ,national ,mortality ,followback ,survey4,sec4 #bec4 ,demonstration projects for use of telemedicine services in advance care planning4,sec4 #bed4 ,inspector ,general investigation of fraud and abuse4,sec4 #bee4 ,,gao study and report on provider adherence to advance directives4 #b4 ,definitions ,in this ,act3 7#a7 ,advance care planning ,the term advance care planning means the process of-- 7,a7 determining an individual's priorities1 values and goals for care in the future when the individual is no longer able to express his or her wishes2 7,b7 engaging family members1 health care proxies1 and health care providers in an ongoing dialogue about-- 7i7 the individual's wishes for care2 7ii7 what the future may hold for people with serious illnesses or injuries2 7iii7 how individuals1 their health care proxies1 and family members want their beliefs and preferences to guide care decisions2 and 7iv7 the steps that individuals and family members can take regarding1 and the resources available to help with1 finances1 family matters1 spiritual questions1 and other issues that impact seriously ill or dying patients and their families2 and 7,c7 executing and updating advance directives and appointing a health care proxy4 7#b7 ,advance directive ,the term advance directive means a living will1 medical directive1 health care power of attorney1 durable power of attorney1 or other written statement by a competent individual that is recognized under ,state law and indicates the individual's wishes regarding medical treatment in the event of future incompetence4 ,such term includes an advance health care directive and a health care directive recognized under ,state law4 7#c7 ,,chip ,the term ,,chip means the program established under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq474 7#d7 ,end-of-life-care ,the term end-of-life care means all aspects of care of a patient with a potentially fatal condition1 and includes care that is focused on specific preparations for an impending death4 7#e7 ,health care power of attorney ,the term health care power of attorney means a legal document that identifies a health care proxy or decisionmaker for a patient who has the authority to act on the patient's behalf when the patient is unable to communicate his or her wishes for medical care on matters that the patient specifies when he or she is competent4 ,such term includes a durable power of attorney that relates to medical care4 7#f7 ,living will ,the term living will means a legal document-- 7,a7 used to specify the type of medical care 7including any type of medical treatment1 including life-sustaining procedures if that person becomes permanently unconscious or is otherwise dying7 that an individual wants provided or withheld in the event the individual cannot speak for himself or herself and cannot express his or her wishes2 and 7,b7 that requires a physician to honor the provisions of upon receipt or to transfer the care of the individual covered by the document to another physician that will honor such provisions4 7#g7 ,medicaid ,the term ,medicaid means the program established under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#h7 ,medicare ,the term ,medicare means the program established under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7#i7 ,orders for life-sustaining treatment ,the term orders for life-sustaining treatment means a process for focusing a patients' values1 goals1 and preferences on current medical circumstances and to translate such into visible and portable medical orders applicable across care settings1 including home1 long-term care1 emergency medical services1 and hospitals4 7#aj7 ,palliative care ,the term palliative care means interdisciplinary care for individuals with a life-threatening illness or injury relating to pain and symptom management and psychological1 social1 and spiritual needs and that seeks to improve the quality of life for the individual and the individual's family4 7#aa7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 ,i ,advance ,care ,planning ,a ,consumer and ,provider ,education ,i ,consumer ,education ,a ,national initiatives #aja4 ,advance care planning telephone hotline 7a7 ,in general ,not later than ,january #a1 #bjaf1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall establish and operate directly1 or by grant1 contract1 or interagency agreement1 a #bd-;hour toll-free telephone hotline to provide consumer information regarding advance care planning1 including-- 7#a7 an explanation of advanced care planning and its importance2 7#b7 issues to be considered when developing an individual's advance care plan2 7#c7 how to establish an advance directive2 7#d7 procedures to help ensure that an individual's directives for end-of-life care are followed2 7#e7 ,federal and ,state-specific resources for assistance with advance care planning2 and 7#f7 hospice and palliative care 7including their respective purposes and services74 7b7 ,establishment ,in carrying out the requirements under subsection 7a71 the ,director of the ,centers for ,disease ,control and ,prevention may designate an existing #bd-;hour toll-free telephone hotline or1 if no such service is available or appropriate1 establish a new #bd-;hour toll-free telephone hotline4 #ajb4 ,advance care planning information clearinghouses 7a7 ,expansion of ,national ,clearinghouse for ,long-,term ,care ,information 7#a7 ,development ,not later than ,january #a1 #bjae1 the ,secretary shall develop an online clearinghouse to provide comprehensive information regarding advance care planning4 7#b7 ,maintenance ,the advance care planning clearinghouse1 which shall be clearly identifiable and available on the homepage of the ,department of ,health and ,human ,service's ,national ,clearinghouse for ,long-,term ,care ,information website1 shall be maintained and publicized by the ,secretary on an ongoing basis4 7#c7 ,content ,the advance care planning clearinghouse shall include-- 7,a7 any relevant content contained in the national public education campaign required under section #ajd2 7,b7 content addressing-- 7i7 an explanation of advanced care planning and its importance2 7ii7 issues to be considered when developing an individual's advance care plan2 7iii7 how to establish an advance directive2 7iv7 procedures to help ensure that an individual's directives for end-of-life care are followed2 and 7v7 hospice and palliative care 7including their respective purposes and services72 7,c7 available ,federal and ,state-specific resources for assistance with advance care planning1 including-- 7i7 contact information for any ,state public health departments that are responsible for issues regarding end-of-life care2 7ii7 contact information for relevant legal service organizations1 including those funded under the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjja et seq472 and 7iii7 advance directive forms for each ,state2 and 7,d7 any additional information1 as determined by the ,secretary4 7b7 ,establishment of pediatric advance care planning clearinghouse 7#a7 ,development ,not later than ,january #a1 #bjaf1 the ,secretary1 in consultation with the ,assistant ,secretary for ,children and ,families of the ,department of ,health and ,human ,services1 shall develop an online clearinghouse to provide comprehensive information regarding pediatric advance care planning4 7#b7 ,maintenance ,the pediatric advance care planning clearinghouse1 which shall be clearly identifiable on the homepage of the ,administration for ,children and ,families website1 shall be maintained and publicized by the ,secretary on an ongoing basis4 7#c7 ,content ,the pediatric advance care planning clearinghouse shall provide advance care planning information specific to children with life-threatening illnesses or injuries and their families4 #ajc4 ,advance care planning toolkit 7a7 ,development ,not later than ,july #a1 #bjae1 the ,secretary1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop an online advance care planning toolkit4 7b7 ,maintenance ,the advance care planning toolkit1 which shall be available in ,english1 ,spanish1 and any other languages that the ,secretary deems appropriate1 shall be maintained and publicized by the ,secretary on an ongoing basis and made available on the websites of the following agencies3 7#a7 ,the ,centers for ,disease ,control and ,prevention4 7#b7 ,the ,department of ,health and ,human ,service's ,national ,clearinghouse for ,long-,term ,care ,information4 7#c7 ,the ,administration for ,children and ,families4 7c7 ,content ,the advance care planning toolkit shall include content addressing-- 7#a7 common issues and questions regarding advance care planning1 including individuals and resources to contact for further inquiries2 7#b7 advance directives and their uses1 including living wills and durable powers of attorney2 7#c7 the roles and responsibilities of a health care proxy2 7#d7 ,federal and ,state-specific resources to assist individuals and their families with advance care planning1 including-- 7,a7 the advance care planning toll-free telephone hotline established under section #aja2 7,b7 the advance care planning clearinghouses established under section #ajb2 7,c7 the advance care planning toolkit established under this section2 7,d7 available ,state legal service organizations to assist individuals with advance care planning1 including those organizations that receive funding pursuant to the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjja et seq472 and 7,e7 website links or addresses for ,state-specific advance directive forms2 and 7#e7 any additional information1 as determined by the ,secretary4 #ajd4 ,national public education campaign 7a7 ,national public education campaign 7#a7 ,in general ,not later than ,january #a1 #bjaf1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall1 directly or through grants1 contracts1 or interagency agreements1 develop and implement a national campaign to inform the public of the importance of advance care planning and of an individual's right to direct and participate in their health care decisions4 7#b7 ,content of ,educational ,campaign ,the national public education campaign established under paragraph 7#a7 shall-- 7,a7 employ the use of various media1 including regularly televised public service announcements2 7,b7 provide culturally and linguistically appropriate information2 7,c7 be conducted continuously over a period of not less than #e years2 7,d7 identify and promote the advance care planning information available on the ,department of ,health and ,human ,service's ,national ,clearinghouse for ,long-,term ,care ,information website and ,administration for ,children and ,families website1 as well as any other relevant ,federal or ,state-specific advance care planning resources2 7,e7 raise public awareness of the consequences that may result if an individual is no longer able to express or communicate their health care decisions2 7,f7 address the importance of individuals speaking to family members1 health care proxies1 and health care providers as part of an ongoing dialogue regarding their health care choices2 7,g7 address the need for individuals to obtain readily available legal documents that express their health care decisions through advance directives 7including living wills1 comfort care orders1 and durable powers of attorney for health care72 7,h7 raise public awareness regarding the availability of hospice and palliative care2 and 7,i7 encourage individuals to speak with their physicians about their options and intentions for end-of-life care4 7#c7 ,evaluation 7,a7 ,in ,general ,not later than ,july #a1 #bjah1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall conduct a nationwide survey to evaluate whether the national campaign conducted under this subsection has achieved its goal of changing public awareness1 attitudes1 and behaviors regarding advance care planning4 7,b7 ,baseline ,survey ,in order to evaluate the effectiveness of the national campaign1 the ,secretary shall conduct a baseline survey prior to implementation of the campaign4 7,c7 ,reporting ,requirement ,not later than ,december #ca1 #bjah1 the ,secretary shall report the findings of such survey1 as well as any recommendations that the ,secretary determines appropriate regarding the need for continuation or legislative or administrative changes to facilitate changing public awareness1 attitudes1 and behaviors regarding advance care planning1 to the appropriate committees of the ,congress4 7b7 ,repeal ,section #dgea7;d7 of the ,omnibus ,budget ,reconciliation ,act of #aiij 7#db ,u4,s4,c4 #acif;a note2 ,public ,law #aja-ejh7 is repealed4 #aje4 ,update of ,medicare and ,social ,security handbooks 7a7 ,medicare ,you handbook 7#a7 ,in general ,not later than #fj days after the date of enactment of this ,act1 the ,secretary shall update the online version of the ,plan ,ahead for ,long-,term ,care section of the ,medicare ,you ,handbook to include-- 7,a7 an explanation of advance care planning and advance directives1 including-- 7i7 living wills2 7ii7 health care proxies2 and 7iii7 after-death directives2 7,b7 ,federal and ,state-specific resources to assist individuals and their families with advance care planning1 including-- 7i7 the advance care planning toll-free telephone hotline established under section #aja2 7ii7 the advance care planning clearinghouses established under section #ajb2 7iii7 the advance care planning toolkit established under section #ajc2 7iv7 available ,state legal service organizations to assist individuals with advance care planning1 including those organizations that receive funding pursuant to the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjja et seq472 and 7v7 website links or addresses for ,state-specific advance directive forms2 and 7,c7 any additional information1 as determined by the ,secretary4 7#b7 ,update of paper and subsequent versions ,the ,secretary shall include the information described in paragraph 7#a7 in all paper and electronic versions of the ,medicare ,you ,handbook that are published on or after the date that is #fj days after the date of enactment of this ,act4 7b7 ,social ,security handbook ,the ,commissioner of ,social ,security shall-- 7#a7 not later than #fj days after the date of enactment of this ,act1 update the online version of the ,social ,security ,handbook for beneficiaries to include the information described in subsection 7a77#a72 and 7#b7 include such information in all paper and online versions of such handbook that are published on or after the date that is #fj days after the date of enactment of this ,act4 #ajf4 ,authorization of appropriations ,there is authorized to be appropriated for the period of fiscal years #bjae through #bjai-- 7#a7 #aie1jjj1jjj to the ,secretary to carry out sections #aja1 #ajb1 #ajc1 #ajd and #aje7;a72 and 7#b7 #e1jjj1jjj to the ,commissioner of ,social ,security to carry out section #aje7;b74 ,b ,state and local initiatives #aaa4 ,financial assistance for advance care planning 7a7 ,legal assistance for advance care planning 7#a7 ,definition of recipient ,section #ajjb7f7 of the ,legal ,services ,corporation ,act 7#db ,u4,s4,c4 #biif;a7#f77 is amended by striking clause 7,a7 of and inserting subparagraph 7,a7 or 7,b7 of4 7#b7 ,advance care planning ,section #ajjf of the ,legal ,services ,corporation ,act 7#db ,u4,s4,c4 #biif;e7 is amended-- 7,a7 in subsection 7a77#a7-- 7i7 by striking title1 and 7,b7 to make and inserting the following3 8title2 7,c7 to make 2 and 7ii7 by inserting after subparagraph 7,a7 the following3 7,b7 to provide financial assistance1 and make grants and contracts1 as described in subparagraph 7,a71 on a competitive basis for the purpose of providing legal assistance in the form of advance care planning 7as defined in section #c of the ,advance ,planning and ,compassionate ,care ,act of #bjad1 and including providing information about ,state-specific advance directives1 as defined in that section7 for eligible clients under this title1 including providing such planning to the family members of eligible clients and persons with power of attorney to make health care decisions for the clients2 and 2 and 7,b7 in subsection 7b71 by adding at the end the following3 7#b7 ,advance care planning provided in accordance with subsection 7a77#a77;,b7 shall not be construed to violate the ,assisted ,suicide ,funding ,restriction ,act of #aiig 7#db ,u4,s4,c4 #addja et seq474 4 7#c7 ,reports ,section #ajjh7;a7 of the ,legal ,services ,corporation ,act 7#db ,u4,s4,c4 #biif;g7a77 is amended by adding at the end the following3 ,the ,corporation shall require such a report1 on an annual basis1 from each grantee1 contractor1 or other recipient of financial assistance under section #ajjf7;a77#a77;,b744 7#d7 ,authorization of appropriations ,section #ajaj of the ,legal ,services ,corporation ,act 7#db ,u4,s4,c4 #biif;i7 is amended-- 7,a7 in subsection 7a7-- 7i7 by striking 7a7 and inserting 7a77#a72 7ii7 in the last sentence1 by striking ,appropriations for that purpose and inserting the following3 7#c7 ,appropriations for a purpose described in paragraph 7#a7 or 7#b7 2 and 7iii7 by inserting before paragraph 7#c7 7as designated by clause 7ii77 the following3 7#b7 ,there are authorized to be appropriated to carry out section #ajjf7;a77#a77;,b71 #aj1jjj1jjj for each of fiscal years #bjae1 #bjaf1 #bjag1 #bjah1 and #bjai4 2 and 7,b7 in subsection 7d71 by striking subsection 7a7 and inserting subsection 7a77#a74 7#e7 ,effective date ,this subsection and the amendments made by this subsection take effect ,july #a1 #bjae4 7b7 ,state health insurance assistance programs 7#a7 ,in general ,the ,secretary shall use amounts made available under paragraph 7#c7 to award grants to ,states for ,state health insurance assistance programs receiving assistance under section #dcfj of the ,omnibus ,budget ,reconciliation ,act of #aiij to provide advance care planning services to ,medicare beneficiaries1 personal representatives of such beneficiaries1 and the families of such beneficiaries4 ,such services shall include information regarding ,state-specific advance directives and ways to discuss individual care wishes with health care providers4 7#b7 ,requirements 7,a7 ,award of grants ,in making grants under this subsection for a fiscal year1 the ,secretary shall satisfy the following requirements3 7i7 ,two-thirds of the total amount of funds available under paragraph 7#c7 for a fiscal year shall be allocated among those ,states approved for a grant under this section that have adopted the ,uniform ,health-,care ,decisions ,act drafted by the ,national ,conference of ,commissioners on ,uniform ,state ,laws and approved and recommended for enactment by all ,states at the annual conference of such commissioners in #aiic4 7ii7 ,one-third of the total amount of funds available under paragraph 7#c7 for a fiscal year shall be allocated among those ,states approved for a grant under this section that have adopted a uniform form for orders regarding life sustaining treatment as defined in section #ahfa7;hhh77#e7 of the ,social ,security ,act 7as amended by section #baa of this ,act7 or a comparable approach to advance care planning4 7,b7 ,work plan2 report ,as a condition of being awarded a grant under this subsection1 a ,state shall submit the following to the ,secretary3 7i7 ,an approved plan for expending grant funds4 7ii7 ,for each fiscal year for which the ,state is paid grant funds under this subsection1 an annual report regarding the use of the funds1 including the number of ,medicare beneficiaries served and their satisfaction with the services provided4 7,c7 ,limitation ,no ,state shall be paid funds from a grant made under this subsection prior to ,july #a1 #bjae4 7#c7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account1 #ab1jjj1jjj for each of fiscal years #bjae through #bjai for purposes of awarding grants to ,states under paragraph 7#a74 7c7 ,medicaid transformation grants for advance care planning ,section #aijc7z7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7z77 is amended-- 7#a7 in paragraph 7#b71 by adding at the end the following new subparagraph3 7,g7 ,methods for improving the effectiveness and efficiency of medical assistance provided under this title by making available to individuals enrolled in the ,state plan or under a waiver of such plan information regarding advance care planning 7as defined in section #c of the ,advance ,planning and ,compassionate ,care ,act of #bjad71 including at time of enrollment or renewal of enrollment in the plan or waiver1 through providers1 and through such other innovative means as the ,state determines appropriate4 2 7#b7 in paragraph 7#c71 by adding at the end the following new subparagraph3 7,d7 ,work plan required for award of advance care planning grants ,payment to a ,state under this subsection to adopt the innovative methods described in paragraph 7#b77;,g7 is conditioned on the ,state submitting to the ,secretary an approved plan for expending the funds awarded to the ,state under this subsection4 2 and 7#c7 in paragraph 7#d7-- 7,a7 in subparagraph 7,a7-- 7i7 in clause 7i71 by striking and at the end2 7ii7 in clause 7ii71 by striking the period at the end and inserting 2 and2 and 7iii7 by inserting after clause 7ii71 the following new clause3 7iii7 #bj1jjj1jjj for each of fiscal years #bjae through #bjai4 2 and 7,b7 by striking subparagraph 7,b71 and inserting the following3 7,b7 ,allocation of funds ,the ,secretary shall specify a method for allocating the funds made available under this subsection among ,states awarded a grant for fiscal year #bjae1 #bjaf1 #bjag1 #bjah1 or #bjai4 ,such method shall provide that-- 7i7 #ajj percent of such funds for each of fiscal years #bjae through #bjai shall be awarded to ,states that design programs to adopt the innovative methods described in paragraph 7#b77;,g72 and 7ii7 in no event shall a payment to a ,state awarded a grant under this subsection for fiscal year #bjae be made prior to ,july #a1 #bjae4 4 7d7 ,advance care planning community training grants 7#a7 ,in general ,the ,secretary shall use amounts made available under paragraph 7#c7 to award grants to area agencies on aging 7as defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb774 7#b7 ,requirements 7,a7 ,use of funds ,funds awarded to an area agency on aging under this subsection shall be used to provide advance care planning education and training opportunities for local aging service providers and organizations4 7,b7 ,work plan2 report ,as a condition of being awarded a grant under this subsection1 an area agency on aging shall submit the following to the ,secretary3 7i7 ,an approved plan for expending grant funds4 7ii7 ,for each fiscal year for which the agency is paid grant funds under this subsection1 an annual report regarding the use of the funds1 including the number of ,medicare beneficiaries served and their satisfaction with the services provided4 7,c7 ,limitation ,no area agency on aging shall be paid funds from a grant made under this subsection prior to ,july #a1 #bjae4 7#c7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account1 #ab1jjj1jjj for each of fiscal years #bjae through #bjai for purposes of awarding grants to area agencies on aging under paragraph 7#a74 7e7 ,nonduplication of activities ,the ,secretary shall establish procedures to ensure that funds made available under grants awarded under this section or pursuant to amendments made by this section supplement1 not supplant1 existing ,federal funding1 and that such funds are not used to duplicate activities carried out under such grants or under other ,federally funded programs4 #aab4 ,grants for programs for orders regarding life sustaining treatment 7a7 ,in general ,the ,secretary shall make grants to eligible entities for the purpose of-- 7#a7 establishing new programs for orders regarding life sustaining treatment in ,states or localities2 7#b7 expanding or enhancing an existing program for orders regarding life sustaining treatment in ,states or localities2 or 7#c7 providing a clearinghouse of information on programs for orders for life sustaining treatment and consultative services for the development or enhancement of such programs4 7b7 ,authorized activities ,activities funded through a grant under this section for an area may include-- 7#a7 developing such a program for the area that includes home care1 hospice1 long-term care1 community and assisted living residences1 skilled nursing facilities1 inpatient rehabilitation facilities1 hospitals1 and emergency medical services within the area2 7#b7 securing consultative services and advice from institutions with experience in developing and managing such programs2 and 7#c7 expanding an existing program for orders regarding life sustaining treatment to serve more patients or enhance the quality of services1 including educational services for patients and patients' families or training of health care professionals4 7c7 ,distribution of funds ,in funding grants under this section1 the ,secretary shall ensure that1 of the funds appropriated to carry out this section for each fiscal year-- 7#a7 at least two-thirds are used for establishing or developing new programs for orders regarding life sustaining treatment2 and 7#b7 one-third is used for expanding or enhancing existing programs for orders regarding life sustaining treatment4 7d7 ,definitions ,in this section3 7#a7 ,the term eligible entity includes-- 7,a7 an academic medical center1 a medical school1 a ,state health department1 a ,state medical association1 a multi-,state taskforce1 a hospital1 or a health system capable of administering a program for orders regarding life sustaining treatment for a ,state or locality2 or 7,b7 any other health care agency or entity as the ,secretary determines appropriate4 7#b7 ,the term order regarding life sustaining treatment has the meaning given such term in section #ahfa7;hhh77#e7 of the ,social ,security ,act1 as added by section #baa4 7#c7 ,the term program for orders regarding life sustaining treatment means1 with respect to an area1 a program that supports the active use of orders regarding life sustaining treatment in the area4 7e7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of the fiscal years #bjad through #bjai4 ,,ii ,provider ,education #aba4 ,public provider advance care planning website 7a7 ,development ,not later than ,january #a1 #bjae1 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services and the ,director of the ,agency for ,healthcare ,research and ,quality1 shall establish a website for providers under ,medicare1 ,medicaid1 the ,children's ,health ,insurance ,program1 the ,indian ,health ,service 7include contract providers7 and other public health providers on each individual's right to make decisions concerning medical care1 including the right to accept or refuse medical or surgical treatment1 and the existence of advance directives4 7b7 ,maintenance ,the website1 shall be maintained and publicized by the ,secretary on an ongoing basis4 7c7 ,content ,the website shall include content1 tools1 and resources necessary to do the following3 7#a7 ,inform providers about the advance directive requirements under the health care programs described in subsection 7a7 and other ,state and ,federal laws and regulations related to advance care planning4 7#b7 ,educate providers about advance care planning quality improvement activities4 7#c7 ,provide assistance to providers to-- 7,a7 integrate advance directives into electronic health records1 including oral directives2 and 7,b7 develop and disseminate advance care planning informational materials for their patients4 7#d7 ,inform providers about advance care planning continuing education requirements and opportunities4 7#e7 ,encourage providers to discuss advance care planning with their patients of all ages4 7#f7 ,assist providers' understanding of the continuum of end-of-life care services and supports available to patients1 including palliative care and hospice4 7#g7 ,inform providers of best practices for discussing end-of-life care with dying patients and their loved ones4 #abb4 ,continuing education for physicians and nurses 7a7 ,in general ,not later than ,january #a1 #bjag1 the ,secretary1 acting through the ,director of ,health ,resources and ,services ,administration1 shall develop1 in consultation with health care providers and ,state boards of medicine and nursing1 a curriculum for continuing education that ,states may adopt for physicians and nurses on advance care planning and end-of-life care4 7b7 ,content 7#a7 ,in general ,the continuing education curriculum developed under subsection 7a7 for physicians and nurses shall1 at a minimum1 include-- 7,a7 a description of the meaning and importance of advance care planning2 7,b7 a description of advance directives1 including living wills and durable powers of attorney1 and the use of such directives2 7,c7 palliative care principles and approaches to care2 and 7,d7 the continuum of end-of-life services and supports1 including palliative care and hospice4 7#b7 ,additional content for physicians ,the continuing education curriculum for physicians developed under subsection 7a7 shall include instruction on how to conduct advance care planning with patients and their loved ones4 ,b ,portability of ,advance ,directives2 ,health ,information ,technology #aca4 ,portability of advance directives 7a7 ,medicare ,section #ahff7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,b71 by inserting and if presented by the individual1 to include the content of such advance directive in a prominent part of such record before the semicolon at the end2 7,b7 in subparagraph 7,d71 by striking and after the semicolon at the end2 7,c7 in subparagraph 7,e71 by striking the period at the end and inserting 2 and2 and 7,d7 by inserting after subparagraph 7,e7 the following new subparagraph3 7,f7 to provide each individual with the opportunity to discuss issues relating to the information provided to that individual pursuant to subparagraph 7,a7 with an appropriately trained professional4 2 and 7#b7 by adding at the end the following new paragraph3 7#e7 7,a7 ,an advance directive validly executed outside of the ,state in which such advance directive is presented by an adult individual to a provider of services1 a ,medicare ,advantage organization1 or a prepaid or eligible organization shall be given the same effect by that provider or organization as an advance directive validly executed under the law of the ,state in which it is presented would be given effect4 7,b7 7i7 ,the definition of an advanced directive shall also include actual knowledge of instructions made while an individual was able to express the wishes of such individual with regard to health care4 7ii7 ,for purposes of clause 7i71 the term actual knowledge means the possession of information of an individual's wishes communicated to the health care provider orally or in writing by the individual1 the individual's medical power of attorney representative1 the individual's health care surrogate1 or other individuals resulting in the health care provider's personal cognizance of these wishes4 ,other forms of imputed knowledge are not actual knowledge4 7,c7 ,the provisions of this paragraph shall preempt any ,state law to the extent such law is inconsistent with such provisions4 ,the provisions of this paragraph shall not preempt any ,state law that provides for greater portability1 more deference to a patient's wishes1 or more latitude in determining a patient's wishes4 4 7b7 ,medicaid ,section #aijb7w7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7w77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,b7-- 7i7 by striking in the individual's medical record and inserting in a prominent part of the individual's current medical record2 and 7ii7 by inserting and if presented by the individual1 to include the content of such advance directive in a prominent part of such record before the semicolon at the end2 7,b7 in subparagraph 7,d71 by striking and after the semicolon at the end2 7,c7 in subparagraph 7,e71 by striking the period at the end and inserting 2 and2 and 7,d7 by inserting after subparagraph 7,e7 the following new subparagraph3 7,f7 to provide each individual with the opportunity to discuss issues relating to the information provided to that individual pursuant to subparagraph 7,a7 with an appropriately trained professional4 2 and 7#b7 by adding at the end the following paragraph3 7#f7 7,a7 ,an advance directive validly executed outside of the ,state in which such advance directive is presented by an adult individual to a provider or organization shall be given the same effect by that provider or organization as an advance directive validly executed under the law of the ,state in which it is presented would be given effect4 7,b7 7i7 ,the definition of an advance directive shall also include actual knowledge of instructions made while an individual was able to express the wishes of such individual with regard to health care4 7ii7 ,for purposes of clause 7i71 the term actual knowledge means the possession of information of an individual's wishes communicated to the health care provider orally or in writing by the individual1 the individual's medical power of attorney representative1 the individual's health care surrogate1 or other individuals resulting in the health care provider's personal cognizance of these wishes4 ,other forms of imputed knowledge are not actual knowledge4 7,c7 ,the provisions of this paragraph shall preempt any ,state law to the extent such law is inconsistent with such provisions4 ,the provisions of this paragraph shall not preempt any ,state law that provides for greater portability1 more deference to a patient's wishes1 or more latitude in determining a patient's wishes4 4 7c7 ,,chip ,section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended-- 7#a7 by redesignating subparagraphs 7,g7 through 7,o7 as subparagraphs 7,h7 through 7,p71 respectively2 and 7#b7 by inserting after subparagraph 7,f7 the following3 7,g7 ,section #aijb7w7 7relating to advance directives74 4 7d7 ,study and report regarding implementation 7#a7 ,study ,the ,secretary shall conduct a study regarding the implementation of the amendments made by subsections 7a7 and 7b74 7#b7 ,report ,not later than #ah months after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative actions as the ,secretary considers appropriate4 7e7 ,effective dates 7#a7 ,in general ,subject to paragraph 7#b71 the amendments made by subsections 7a71 7b71 and 7c7 shall apply to provider agreements and contracts entered into1 renewed1 or extended under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 and to ,state plans under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 and ,state child health plans under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq471 on or after such date as the ,secretary specifies1 but in no case may such date be later than #a year after the date of enactment of this ,act4 7#b7 ,extension of effective date for state law amendment ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act or a ,state child health plan under title ,,xxi of such ,act which the ,secretary determines requires ,state legislation in order for the plan to meet the additional requirements imposed by the amendments made by subsections 7b7 and 7c71 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 ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session is considered to be a separate regular session of the ,state legislature4 #acb4 ,state advance directive registries2 ,driver's license advance directive notation ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g7 is amended by inserting after section #cii,s the following new sections3 #cii,s-#a4 ,state advance directive registries 7a7 ,state advance directive registry ,in this section1 the term ,state advance directive registry means a secure1 electronic database that-- 7#a7 is available free of charge to residents of a ,state2 and 7#b7 stores advance directive documents and makes such documents accessible to medical service providers in accordance with ,federal and ,state privacy laws4 7b7 ,grant program ,beginning on ,july #a1 #bjae1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall award grants on a competitive basis to eligible entities to establish and operate1 directly or indirectly 7by competitive grant or competitive contract71 ,state advance directive registries4 7c7 ,eligible entities 7#a7 ,in general ,to be eligible to receive a grant under this section1 an entity shall-- 7,a7 be a ,state department of health2 and 7,b7 submit to the ,director an application at such time1 in such manner1 and containing-- 7i7 a plan for the establishment and operation of a ,state advance directive registry2 and 7ii7 such other information as the ,director may require4 7#b7 ,no requirement of notation mechanism ,the ,secretary shall not require that an entity establish and operate a driver's license advance directive notation mechanism for ,state residents under section #cii,v to be eligible to receive a grant under this section4 7d7 ,annual report ,for each year for which an entity receives an award under this section1 such entity shall submit an annual report to the ,director on the use of the funds received pursuant to such award1 including the number of ,state residents served through the registry4 7e7 ,authorization ,there is authorized to be appropriated to carry out this section #bj1jjj1jjj for fiscal year #bjae and each fiscal year thereafter4 #cii,s-#b4 ,driver's license advance directive notation 7a7 ,in general ,beginning ,july #a1 #bjae1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall award grants on a competitive basis to ,states to establish and operate a mechanism for a ,state resident with a driver's license to include a notice of the existence of an advance directive for such resident on such license4 7b7 ,eligibility ,to be eligible to receive a grant under this section1 a ,state shall-- 7#a7 establish and operate a ,state advance directive registry under section #cii,s-#a2 and 7#b7 submit to the ,director an application at such time1 in such manner1 and containing-- 7,a7 a plan that includes a description of how the ,state will-- 7i7 disseminate information about advance directives at the time of driver's license application or renewal2 7ii7 enable each ,state resident with a driver's license to include a notice of the existence of an advance directive for such resident on such license in a manner consistent with the notice on such a license indicating a driver's intent to be an organ donor2 and 7iii7 coordinate with the ,state department of health to ensure that1 if a ,state resident has an advance directive notice on his or her driver's license1 the existence of such advance directive is included in the ,state registry established under section #cii,s-#a2 and 7,b7 any other information as the ,director may require4 7c7 ,annual report ,for each year for which a ,state receives an award under this section1 such ,state shall submit an annual report to the ,director on the use of the funds received pursuant to such award1 including the number of ,state residents served through the mechanism4 7d7 ,authorization ,there is authorized to be appropriated to carry out this section #ej1jjj1jjj for fiscal year #bjae and each fiscal year thereafter4 4 #acc4 ,,gao ,study and ,report on ,establishment of ,national ,advance ,directive ,registry 7a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on the feasibility of a national registry for advance directives1 taking into consideration the constraints created by the privacy provisions enacted as a result of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7,public ,law #ajd-aia74 7b7 ,report ,not later than #ah months after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on the study conducted under subsection 7a7 together with recommendations for such legislation and administrative action as the ,comptroller ,general of the ,united ,states determines to be appropriate4 ,c ,national ,uniform ,policy on ,advance ,care ,planning #ada4 ,study and report by the ,secretary regarding the establishment and implementation of a national uniform policy on advance directives 7a7 ,study 7#a7 ,in general ,the ,secretary1 acting through the ,office of the ,assistant ,secretary for ,planning and ,evaluation1 shall conduct a thorough study of all matters relating to the establishment and implementation of a national uniform policy on advance directives for individuals receiving items and services under titles ,,xviii1 ,,xix1 or ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq41 #acif et seq41 or #acig;aa et seq474 7#b7 ,matters studied ,the matters studied by the ,secretary under paragraph 7#a7 shall include issues concerning-- 7,a7 family satisfaction that a patient's wishes1 as stated in the patient's advance directive1 were carried out2 7,b7 the portability of advance directives1 including cases involving the transfer of an individual from #a health care setting to another2 7,c7 immunity from civil liability and criminal responsibility for health care providers that follow the instructions in an individual's advance directive that was validly executed in1 and consistent with the laws of1 the ,state in which it was executed2 7,d7 conditions under which an advance directive is operative2 7,e7 revocation of an advance directive by an individual2 7,f7 the criteria used by ,states for determining that an individual has a terminal condition2 7,g7 surrogate decisionmaking regarding end-of-life care2 7,h7 the provision of adequate palliative care 7as defined in paragraph 7#c771 including pain management2 7,i7 adequate and timely referrals to hospice care programs2 and 7,j7 the end-of-life care needs of children and their families4 7#c7 ,palliative care ,for purposes of paragraph 7#b77;,h71 the term palliative care means interdisciplinary care for individuals with a life-threatening illness or injury relating to pain and symptom management and psychological1 social1 and spiritual needs and that seeks to improve the quality of life for the individual and the individual's family4 7b7 ,report to congress ,not later than #ah months after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative actions as the ,secretary considers appropriate4 7c7 ,consultation ,in conducting the study and developing the report under this section1 the ,secretary shall consult with the ,uniform ,law ,commissioners1 and other interested parties4 ,,ii ,compassionate ,care ,a ,workforce development ,i ,education and training #bja4 ,national ,geriatric and ,palliative ,care ,services ,corps ,section #cca of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;d7 is amended-- 7#a7 by redesignating subsection 7j7 as subsection 7k72 and 7#b7 by inserting after subsection 7i71 the following3 7j7 ,national ,geriatric and ,palliative ,care ,services ,corps 7#a7 ,establishment ,not later than ,january #a1 #bjag1 the ,secretary shall establish within the ,national ,health ,service ,corps a ,national ,geriatric and ,palliative ,care ,services ,corps 7referred to in this subsection as the ,corps7 which shall consist of-- 7,a7 such officers of the ,regular and ,reserve ,corps of the ,service as the ,secretary may designate2 7,b7 such civilian employees of the ,united ,states as the ,secretary may appoint2 and 7,c7 such other individuals who are not employees of the ,united ,states4 7#b7 ,duties ,the ,corps shall be utilized by the ,secretary to provide geriatric and palliative care services within health professional shortage areas4 7#c7 ,application of provisions ,the loan-forgiveness1 scholarship1 and direct financial incentives programs provided for under this section shall apply to physicians1 nurses1 and other health professionals 7as identified by the ,secretary7 with respect to the training necessary to enable such individuals to become geriatric or palliative care specialists and provide geriatric and palliative care services in health professional shortage areas4 7#d7 ,report ,not later than #f months prior to the date on which the ,secretary establishes the ,corps under paragraph 7#a71 the ,secretary shall submit to ,congress a report concerning the organization of the ,corps1 the application process for membership in the ,corps1 and the funding necessary for the ,corps 7targeted by profession and by specialization74 4 #bjb4 ,exemption of palliative medicine fellowship training from ,medicare graduate medical education caps 7a7 ,direct graduate medical education ,section #ahhf7;h77#d77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#d77;,f77 is amended-- 7#a7 in clause 7i71 by inserting clause 7iii7 and after subject to2 and 7#b7 by adding at the end the following new clause3 7iii7 ,increase allowed for palliative medicine fellowship training ,for cost reporting periods beginning on or after ,january #a1 #bjaf1 in applying clause 7i71 there shall not be taken into account full-time equivalent residents in the field of allopathic or osteopathic medicine who are in palliative medicine fellowship training that is approved by the ,accreditation ,council for ,graduate ,medical ,education4 4 7b7 ,indirect ,medical ,education ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended-- 7#a7 by redesignating the second clause 7x71 as added by section #eeje7;b7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 as clause 7xi7 and moving such clause #d ems to the left1 and realigning the left margins of subclauses 7,,ii7 and 7,,iii7 of such clause and items 7aa71 7bb71 7cc71 and 7dd7 of subclause 7,,ii7 of such clause appropriately2 and 7#b7 by adding at the end the following new clause3 7xii7 ,clause 7iii7 of subsection 7h77#d77;,f7 shall apply to clause 7v7 in the same manner and for the same period as such clause 7iii7 applies to clause 7i7 of such subsection4 4 #bjc4 ,medical school curricula 7a7 ,in general ,the ,secretary1 in consultation with the ,association of ,american ,medical ,colleges1 shall establish guidelines for the imposition by medical schools of a minimum amount of end-of-life training as a requirement for obtaining a ,doctor of ,medicine degree in the field of allopathic or osteopathic medicine4 7b7 ,training ,under the guidelines established under subsection 7a71 minimum training shall include-- 7#a7 training in how to discuss and help patients and their loved ones with advance care planning2 7#b7 with respect to students and trainees who will work with children1 specialized pediatric training2 7#c7 training in the continuum of end-of-life services and supports1 including palliative care and hospice2 7#d7 training in how to discuss end-of-life care with dying patients and their loved ones2 and 7#e7 medical and legal issues training4 7c7 ,distribution ,not later than ,january #a1 #bjaf1 the ,secretary shall disseminate the guidelines established under subsection 7a7 to medical schools4 7d7 ,compliance ,effective beginning not later than ,july #a1 #bjag1 a medical school that is receiving ,federal assistance shall be required to implement the guidelines established under subsection 7a74 ,a medical school that the ,secretary determines is not implementing such guidelines shall not be eligible for ,federal assistance4 ,b ,coverage under ,medicare1 ,medicaid1 and ,,chip ,i ,coverage of advance care planning #baa4 ,medicare1 ,medicaid1 and ,,chip coverage 7a7 ,medicare 7#a7 ,in general ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7,a7 in subsection 7s77#b7-- 7i7 by striking and at the end of subparagraph 7,,ee72 7ii7 by adding and at the end of subparagraph 7,,ff72 and 7iii7 by adding at the end the following new subparagraph3 7,,gg7 advance care planning consultation 7as defined in subsection 7iii77#a772 2 and 7,b7 by adding at the end the following new subsection3 7iii7 ,advance care planning consultation 7#a7 ,subject to paragraphs 7#c7 and 7#d71 the term advance care planning consultation means a consultation between the individual and a practitioner described in paragraph 7#b7 regarding advance care planning1 if1 subject to subparagraphs 7,a7 and 7,b7 of paragraph 7#c71 the individual involved has not had such a consultation within the last #e years4 ,such consultation shall include the following3 7,a7 ,an explanation by the practitioner of advance care planning1 including key questions and considerations1 important steps1 and suggested people to talk to4 7,b7 ,an explanation by the practitioner of advance directives1 including living wills and durable powers of attorney1 and their uses4 7,c7 ,an explanation by the practitioner of the role and responsibilities of a health care proxy4 7,d7 ,the provision by the practitioner of a list of national and ,state-specific resources to assist consumers and their families with advance care planning1 including the national toll-free hotline1 the advance care planning clearinghouses1 and ,state legal service organizations 7including those funded through the ,older ,americans ,act74 7,e7 ,an explanation by the practitioner of the continuum of end-of-life services and supports available1 including palliative care and hospice1 and benefits for such services and supports that are available under this title4 7,f7 7i7 ,subject to clause 7ii71 an explanation of orders regarding life sustaining treatment or similar orders1 which shall include-- 7,i7 the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual changes2 7,,ii7 the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order2 and 7,,iii7 the identification of resources that an individual may use to determine the requirements of the ,state in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes1 including requirements regarding the designation of a surrogate decisionmaker 7also known as a health care proxy74 7ii7 ,the ,secretary may limit the requirement for explanations under clause 7i7 to consultations furnished in ,states1 localities1 or other geographic areas in which orders described in such clause have been widely adopted4 7#b7 ,a practitioner described in this paragraph is-- 7,a7 a physician 7as defined in subsection 7r77#a772 and 7,b7 a nurse practitioner or physician's assistant who has the authority under ,state law to sign orders for life sustaining treatments4 7#c7 7,a7 ,an initial preventive physical examination under subsection 7ww71 including any related discussion during such examination1 shall not be considered an advance care planning consultation for purposes of applying the #e-year limitation under paragraph 7#a74 7,b7 ,an advance care planning consultation with respect to an individual shall be conducted more frequently than provided under paragraph 7#a7 if there is a significant change in the health condition of the individual1 including diagnosis of a chronic1 progressive1 life-limiting disease1 a life-threatening or terminal diagnosis or life-threatening injury1 or upon admission to a skilled nursing facility1 a long-term care facility 7as defined by the ,secretary71 or a hospice program4 7#d7 ,a consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order4 7#e7 7,a7 ,for purposes of this section1 the term order regarding life sustaining treatment means1 with respect to an individual1 an actionable medical order relating to the treatment of that individual that-- 7i7 is signed and dated by a physician 7as defined in subsection 7r77#a77 or another health care professional 7as specified by the ,secretary and who is acting within the scope of the professional's authority under ,state law in signing such an order7 and is in a form that permits it to stay with the patient and be followed by health care professionals and providers across the continuum of care1 including home care1 hospice1 long-term care1 community and assisted living residences1 skilled nursing facilities1 inpatient rehabilitation facilities1 hospitals1 and emergency medical services2 7ii7 effectively communicates the individual's preferences regarding life sustaining treatment1 including an indication of the treatment and care desired by the individual2 7iii7 is uniquely identifiable and standardized within a given locality1 region1 or ,state 7as identified by the ,secretary72 7iv7 is portable across care settings2 and 7v7 may incorporate any advance directive 7as defined in section #ahff7;f77#c77 if executed by the individual4 7,b7 ,the level of treatment indicated under subparagraph 7,a77ii7 may range from an indication for full treatment to an indication to limit some or all or specified interventions4 ,such indicated levels of treatment may include indications respecting1 among other items-- 7i7 the intensity of medical intervention if the patient is pulseless1 apneic1 or has serious cardiac or pulmonary problems2 7ii7 the individual's desire regarding transfer to a hospital or remaining at the current care setting2 7iii7 the use of antibiotics2 and 7iv7 the use of artificially administered nutrition and hydration4 4 7#b7 ,payment ,section #ahdh7;j77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is amended by inserting 7#b77;,,gg71 after 7including administration of the health risk assessment714 7#c7 ,frequency ,limitation ,section #ahfb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77 is amended-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,o71 by striking and at the end2 7ii7 in subparagraph 7,p71 by striking the semicolon at the end and inserting 1 and2 and 7iii7 by adding at the end the following new subparagraph3 7,q7 in the case of advance care planning consultations 7as defined in section #ahfa7;iii77#a771 which are performed more frequently than is covered under such section2 2 and 7,b7 in paragraph 7#g71 by striking or 7,p7 and inserting 7,p71 or 7,q74 7#d7 ,effective ,date ,the amendments made by this subsection shall apply to consultations furnished on or after ,january #a1 #bjaf4 7b7 ,medicaid 7#a7 ,mandatory benefit ,section #aijb7;a77#aj77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is amended in the matter preceding clause 7i7 by striking and 7#bh7 and inserting 7#bh71 and 7#bi74 7#b7 ,medical assistance ,section #aije of such ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7,a7 in subsection 7a7-- 7i7 in paragraph 7#bh71 by striking and at the end2 7ii7 by redesignating paragraph 7#bi7 as paragraph 7#cj72 and 7iii7 by inserting after paragraph 7#bh7 the following new paragraph3 7#bi7 advance care planning consultations 7as defined in subsection 7ee772 2 and 7,b7 by adding at the end the following3 7ee7 7#a7 ,for purposes of subsection 7a77#bi71 the term advance care planning consultation means a consultation between the individual and a practitioner described in paragraph 7#b7 regarding advance care planning1 if1 subject to paragraph 7#c71 the individual involved has not had such a consultation within the last #e years4 ,such consultation shall include the following3 7,a7 ,an explanation by the practitioner of advance care planning1 including key questions and considerations1 important steps1 and suggested people to talk to4 7,b7 ,an explanation by the practitioner of advance directives1 including living wills and durable powers of attorney1 and their uses4 7,c7 ,an explanation by the practitioner of the role and responsibilities of a health care proxy4 7,d7 ,the provision by the practitioner of a list of national and ,state-specific resources to assist consumers and their families with advance care planning1 including the national toll-free hotline1 the advance care planning clearinghouses1 and ,state legal service organizations 7including those funded through the ,older ,americans ,act74 7,e7 ,an explanation by the practitioner of the continuum of end-of-life services and supports available1 including palliative care and hospice1 and benefits for such services and supports that are available under this title4 7,f7 7i7 ,subject to clause 7ii71 an explanation of orders for life sustaining treatments or similar orders1 which shall include-- 7,i7 the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual changes2 7,,ii7 the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order2 and 7,,iii7 the identification of resources that an individual may use to determine the requirements of the ,state in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes1 including requirements regarding the designation of a surrogate decisionmaker 7also known as a health care proxy74 7ii7 ,the ,secretary may limit the requirement for explanations under clause 7i7 to consultations furnished in ,states1 localities1 or other geographic areas in which orders described in such clause have been widely adopted4 7#b7 ,a practitioner described in this paragraph is-- 7,a7 a physician 7as defined in section #ahfa7r77#a772 and 7,b7 a nurse practitioner or physician's assistant who has the authority under ,state law to sign orders for life sustaining treatments4 7#c7 ,an advance care planning consultation with respect to an individual shall be conducted more frequently than provided under paragraph 7#a7 if there is a significant change in the health condition of the individual including diagnosis of a chronic1 progressive1 life-limiting disease1 a life-threatening or terminal diagnosis or life-threatening injury1 or upon admission to a nursing facility1 a long-term care facility 7as defined by the ,secretary71 or a hospice program4 7#d7 ,a consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order4 7#e7 ,for purposes of this subsection1 the term orders regarding life sustaining treatment has the meaning given that term in section #ahfa7;iii77#e74 4 7c7 ,,chip 7#a7 ,child health assistance ,section #baaj7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7 is amended-- 7,a7 by redesignating paragraph 7#bh7 as paragraph 7#bi72 and 7,b7 by inserting after paragraph 7#bg71 the following3 7#bh7 ,advance care planning consultations 7as defined in section #aije7;ee774 4 7#b7 ,mandatory coverage 7,a7 ,in general ,section #bajc of such ,act 7#db ,u4,s4,c4 #acig;cc71 is amended-- 7i7 in subsection 7a71 in the matter preceding paragraph 7#a71 by striking and 7#g7 and inserting 7#g71 and 7#i72 and 7ii7 in subsection 7c71 by adding at the end the following3 7#i7 ,end-of-life care ,the child health assistance provided to a targeted low-income child shall include coverage of advance care planning consultations 7as defined in section #aije7;ee7 and at the same payment rate as the rate that would apply to such a consultation under the ,state plan under title ,,xix74 4 7,b7 ,conforming amendment ,section #bajb7;a77#g77;,b7 of such ,act 7#db ,u4,s4,c4 #acig;bb7a77#g77;,b77 is amended by striking section #bajc7;c77#e7 and inserting paragraphs 7#e7 and 7#i7 of section #bajc7;c74 7d7 ,definition of advance directive under ,medicare1 ,medicaid1 and ,,chip 7#a7 ,medicare ,section #ahff7;f77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77#c77 is amended by striking means and all that follows through the period and inserting means a living will1 medical directive1 health care power of attorney1 durable power of attorney1 or other written statement by a competent individual that is recognized under ,state law and indicates the individual's wishes regarding medical treatment in the event of future incompetence4 ,such term includes an advance health care directive and a health care directive recognized under ,state law44 7#b7 ,medicaid and chip ,section #aijb7w77#d7 of such ,act 7#db ,u4,s4,c4 #acif;a7w77#d77 is amended by striking means and all that follows through the period and inserting means a living will1 medical directive1 health care power of attorney1 durable power of attorney1 or other written statement by a competent individual that is recognized under ,state law and indicates the individual's wishes regarding medical treatment in the event of future incompetence4 ,such term includes an advance health care directive and a health care directive recognized under ,state law44 7e7 ,effective date ,the amendments made by this section take effect ,january #a1 #bjae4 ,,ii ,hospice #bba4 ,adoption of ,med,p,a,c hospice payment methodology recommendations ,section #ahad7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7i77 is amended by adding at the end the following new paragraph3 7#h7 7,a7 ,the ,secretary shall conduct an evaluation of the recommendations of the ,medicare ,payment ,commission for reforming the hospice care benefit under this title that are contained in chapter #f of the ,commission's report entitled ,report to ,congress3 ,medicare ,payment ,policy 7,march #bjji71 including the impact that such recommendations if implemented would have on access to care and the quality of care4 ,in conducting such evaluation1 the ,secretary shall take into account data collected in accordance with section #bfc7;b7 of the ,advance ,planning and ,compassionate ,care ,act of #bjad4 7,b7 ,based on the results of the examination conducted under subparagraph 7,a71 the ,secretary shall make appropriate refinements to the recommendations described in subparagraph 7,a74 ,such refinements shall take into account-- 7i7 the impact on patient populations with longer that average lengths of stay2 7ii7 the impact on populations with shorter that average lengths of stay2 and 7iii7 the utilization patterns of hospice providers in underserved areas1 including rural hospices4 7,c7 ,not later than ,january #a1 #bjah1 the ,secretary shall submit to ,congress a report that contains a detailed description of-- 7i7 the refinements determined appropriate by the ,secretary under subparagraph 7,b72 7ii7 the revisions that the ,secretary will implement through regulation under this title pursuant to subparagraph 7,d72 and 7iii7 the revisions that the ,secretary determines require additional legislative action by ,congress4 7,d7 7i7 ,the ,secretary shall implement the recommendations described in subparagraph 7,a71 as refined under subparagraph 7,b74 7ii7 ,subject to clause 7iii71 the implementation of such recommendations shall apply to hospice care furnished on or after ,january #a1 #bjai4 7iii7 ,the ,secretary shall establish an appropriate transition to the implementation of such recommendations4 7,e7 ,for purposes of carrying out the provisions of this paragraph1 the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag1 of such sums as may be necessary to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account4 4 #bbb4 ,removing hospice inpatient days in setting per diem rates for critical access hospitals ,section #ahad7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7l771 as amended by section #dajb7;b77#b7 of the ,,hitech ,act 7,public ,law #aaa-e71 is amended by adding at the end the following new paragraph3 7#f7 ,for cost reporting periods beginning on or after ,january #a1 #bjaf1 the ,secretary shall remove ,medicare-certified hospice inpatient days from the calculation of per diem rates for inpatient critical access hospital services4 4 #bbc4 ,hospice payments for dual eligible individuals residing in long-term care facilities 7a7 ,in general ,section #ahhh of the ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7 is amended by adding at the end the following new subsection3 7i7 ,payments for ,dual ,eligible ,individuals ,residing in ,long-,term ,care ,facilities ,for cost reporting periods beginning on or after ,january #a1 #bjaf1 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall establish procedures under which payments for room and board under the ,state ,medicaid plan with respect to an applicable individual are made directly to the long-term care facility 7as defined by the ,secretary for purposes of title ,,xix7 the individual is a resident of4 ,for purposes of the preceding sentence1 the term applicable individual means an individual who is entitled to or enrolled for benefits under part ,a or enrolled for benefits under part ,b and is eligible for medical assistance for hospice care under a ,state plan under title ,,xix4 4 7b7 ,state plan requirement 7#a7 ,in general ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended-- 7,a7 in paragraph 7#gd71 by striking and at the end2 7,b7 in paragraph 7#hj71 by striking and at the end2 7,c7 in paragraph 7#ha71 by striking the period at the end and inserting 2 and2 and 7,d7 by inserting after paragraph 7#ha7 the following new paragraph3 7#hb7 provide that the ,state will make payments for room and board with respect to applicable individuals in accordance with section #ahhh7;i74 4 7#b7 ,effective date 7,a7 ,in general ,except as provided in subparagraph 7,b71 the amendments made by paragraph 7#a7 take effect on ,january #a1 #bjaf4 7,b7 ,extension of effective date for state law amendment ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 which the ,secretary determines requires ,state legislation in order for the plan to meet the additional requirements imposed by the amendments made by paragraph 7#a71 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 ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session is considered to be a separate regular session of the ,state legislature4 #bbd4 ,delineation of respective care responsibilities of hospice programs and long-term care facilities ,section #ahhh of the ,social ,security ,act 7#db ,u4,s4,c4 #acieyy71 as amended by section #bbc7;a71 is amended by adding at the end the following new subsection3 7j7 ,delineation of respective care responsibilities of hospice programs and long-term care facilities ,not later than ,july #a1 #bjaf1 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall delineate and enforce the respective care responsibilities of hospice programs and long-term care facilities 7as defined by the ,secretary for purposes of title ,,xix7 with respect to individuals residing in such facilities who are furnished hospice care4 4 #bbe4 ,adoption of ,med,p,a,c hospice program eligibility certification and recertification recommendations ,in accordance with the recommendations of the ,medicare ,payment ,advisory ,commission contained in the ,march #bjji report entitled ,report to ,congress3 ,medicare ,payment ,policy1 section #ahad7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7a77#g77 is amended-- 7#a7 in subparagraph 7,c71 by striking and at the end2 and 7#b7 by adding at the end the following new subparagraph3 7,e7 on or after ,january #a1 #bjaf-- 7i7 a hospice physician or advance practice nurse visits the individual to determine continued eligibility of the individual for hospice care prior to the #ahjth-day recertification and each subsequent recertification under subparagraph 7,a77ii7 and attests that such visit took place 7in accordance with procedures established by the ,secretary1 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services72 and 7ii7 any certification or recertification under subparagraph 7,a7 includes a brief narrative describing the clinical basis for the individual's prognosis 7in accordance with procedures established by the ,secretary1 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services72 and 4 #bbf4 ,concurrent care for children 7a7 ,permitting ,medicare hospice beneficiaries #ah years of age or younger ,to receive curative care 7#a7 ,in general ,section #ahab of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;d7 is amended-- 7,a7 in subsection 7a77#d71 by inserting 7subject to the second sentence of subsection 7d77#b77;,a77 after in lieu of certain other benefits2 and 7,b7 in subsection 7d7-- 7i7 in paragraph 7#a71 by inserting 1 subject to the second sentence of paragraph 7#b77;,a71 after instead2 and 7ii7 in paragraph 7#b77;,a71 by adding at the end the following new sentence3 ,clause 7ii77,i7 shall not apply to an individual who is #ah years of age or younger4 7#b7 ,conforming amendment ,section #ahfb7;a77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#a77;,c77 is amended inserting subject to the second sentence of section #ahab7;d77#b77;,a71 after hospice care14 7b7 ,application to ,medicaid and ,,chip 7#a7 ,medicaid ,section #aije7o77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;d7o77#a77;,a77 is amended by inserting 7subject1 in the case of an individual who is a child1 to the second sentence of such section7 after section #ahab7;d77#b77;,a74 7#b7 ,,chip ,section #baaj7;a77#bc7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7a77#bc77 is amended by striking 7concurrent and all that follows through the period and inserting 7concurrent1 in the case of an individual who is a child1 with care related to the treatment of the individual's condition with respect to which a diagnosis of terminal illness has been made744 7c7 ,effective date ,the amendments made by this section shall apply to items and services furnished on or after ,january #a1 #bjaf4 #bbg4 ,making hospice a required benefit under ,medicaid and ,,chip 7a7 ,mandatory benefit 7#a7 ,medicaid 7,a7 ,in general ,section #aijb7;a77#aj77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a771 as amended by section #baa7;b77#a71 is amended in the matter preceding clause 7i7 by inserting 7#ah71 after 7#ag714 7,b7 ,conforming amendment ,section #aijb7;a77#aj77;,c7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,c77 is amended-- 7i7 in clause 7iii7-- 7,i7 in subclause 7,i71 by inserting and hospice care after ambulatory services2 and 7,,ii7 in subclause 7,,ii71 by inserting and hospice care after delivery services2 and 7ii7 in clause 7iv71 by inserting and 7#ah7 after 7#ag74 7#b7 ,,chip ,section #bajc7;c77#i7 of such ,act 7#db ,u4,s4,c4 #acig;cc7c77#i771 as added by section #baa7;c77#b77;,a71 is amended by inserting and hospice care before the period4 7b7 ,effective date ,the amendments made subsection 7a7 take effect on ,january #a1 #bjaf4 #bbh4 ,medicare ,hospice payment model demonstration projects 7a7 ,establishment ,not later than ,july #a1 #bjag1 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services and the ,director of the ,agency for ,healthcare ,research and ,quality1 shall conduct demonstration projects to examine ways to improve how the ,medicare hospice care benefit predicts disease trajectory4 ,projects shall include the following models3 7#a7 ,models that better and more appropriately care for1 and transition as needed1 patients in their last years of life who need palliative care1 but do not qualify for hospice care under the ,medicare hospice eligibility criteria4 7#b7 ,models that better and more appropriately care for long-term patients who are not recertified in hospice but still need palliative care4 7#c7 ,any other models determined appropriate by the ,secretary4 7b7 ,waiver authority ,the ,secretary may waive compliance of such requirements of titles ,,xi and ,,xviii of the ,social ,security ,act as the ,secretary determines necessary to conduct the demonstration projects under this section4 7c7 ,reports ,the ,secretary shall submit to ,congress periodic reports on the demonstration projects conducted under this section4 #bbi4 ,med,p,a,c studies and reports 7a7 ,study and report regarding an alternative payment methodology for hospice care under the ,medicare program 7#a7 ,study ,the ,medicare ,payment ,advisory ,commission 7in this section referred to as the ,commission7 shall conduct a study on the establishment of a reimbursement system for hospice care furnished under the ,medicare program that is based on diagnoses4 ,in conducting such study1 the ,commission shall use data collected under new provider data requirements4 ,such study shall include an analysis of the following3 7,a7 ,whether such a reimbursement system better meets patient needs and better corresponds with provider resource expenditures than the current system4 7,b7 ,whether such a reimbursement system improves quality1 including facilitating standardization of care toward best practices and diagnoses-specific clinical pathways in hospice4 7,c7 ,whether such a reimbursement system could address concerns about the blanket #f-month terminal prognosis requirement in hospice4 7,d7 ,whether such a reimbursement system is more cost effective than the current system4 7,e7 ,any other areas determined appropriate by the ,commission4 7#b7 ,report ,not later than ,june #ae1 #bjah1 the ,commission shall submit to ,congress a report on the study conducted under subsection 7a7 together with recommendations for such legislation and administrative action as the ,commission determines appropriate4 7b7 ,study and report regarding rural hospice transportation costs under the ,medicare program 7#a7 ,study ,the ,commission shall conduct a study on rural ,medicare hospice transportation mileage to determine potential ,medicare reimbursement changes to account for potential higher costs4 7#b7 ,report ,not later than ,june #ae1 #bjah1 the ,commission shall submit to ,congress a report on the study conducted under subsection 7a7 together with recommendations for such legislation and administrative action as the ,commission determines appropriate4 7c7 ,evaluation of reimbursement disincentives ,to elect medicare hospice within the medicare skilled nursing facility benefit 7#a7 ,study ,the ,commission shall conduct a study to determine potential ,medicare reimbursement changes to remove ,medicare reimbursement disincentives for patients in a skilled nursing facility who want to elect hospice4 7#b7 ,report ,not later than ,june #ae1 #bjah1 the ,commission shall submit to ,congress a report on the study conducted under subsection 7a7 together with recommendations for such legislation and administrative action as the ,commission determines appropriate4 #bcj4 ,,hhs ,evaluations 7a7 ,evaluation of ,access to ,hospice and ,hospital-,based ,palliative ,care 7#a7 ,evaluation ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall conduct an evaluation of geographic areas and populations underserved by hospice and hospital-based palliative care to identify potential barriers to access4 7#b7 ,report ,not later than ,december #ca1 #bjag1 the ,secretary shall report to ,congress1 on the evaluation conducted under subsection 7a7 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate to address barriers to access to hospice and hospital-based palliative care4 7b7 ,evaluation of awareness and use of hospice respite care under ,medicare1 ,medicaid1 and ,,chip 7#a7 ,evaluation ,the ,secretary1 acting through the ,director of the ,centers for ,medicare and ,medicaid ,services1 shall evaluate the awareness and use of hospice respite care by informal caregivers of beneficiaries under ,medicare1 ,medicaid1 and ,,chip4 7#b7 ,report ,not later than ,december #ca1 #bjae1 the ,secretary shall report to ,congress1 on the evaluation conducted under subsection 7a7 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate to increase awareness or use of hospice respite care under ,medicare1 ,medicaid1 and ,,chip4 ,c ,quality ,improvement #bda4 ,patient satisfaction surveys ,not later than ,january #a1 #bjag1 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall establish a mechanism for-- 7#a7 collecting information from patients 7or their health care proxies or families members in the event patients are unable to speak for themselves7 in relevant provider settings regarding their care at the end of life2 and 7#b7 incorporating such information in a timely manner into mechanisms used by the ,administrator to provide quality of care information to consumers1 including the ,hospital ,compare and ,nursing ,home ,compare websites maintained by the ,administrator4 #bdb4 ,development of core end-of-life care quality measures across each relevant provider setting 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,agency for ,healthcare ,research and ,quality 7in this section referred to as the ,administrator7 and in consultation with the ,director of the ,national ,institutes of ,health1 shall require specific end-of-life quality measures for each relevant provider setting1 as identified by the ,administrator1 in accordance with the requirements of subsection 7b74 7b7 ,requirements ,for purposes of subsection 7a71 the requirements specified in this subsection are the following3 7#a7 ,selection of the specific measure or measures for an identified provider setting shall be-- 7,a7 based on an assessment of what is likely to have the greatest positive impact on quality of end-of-life care in that setting2 and 7,b7 made in consultation with affected providers and public and private organizations1 that have developed such measures4 7#b7 ,the measures may be structure-oriented1 process-oriented1 or outcome-oriented1 as determined appropriate by the ,administrator4 7#c7 ,the ,administrator shall ensure that reporting requirements related to such measures are imposed consistent with other applicable laws and regulations1 and in a manner that takes into account existing measures1 the needs of patient populations1 and the specific services provided4 7#d7 ,not later than-- 7,a7 ,april #a1 #bjaf1 the ,secretary shall disseminate the reporting requirements to all affected providers2 and 7,b7 ,april #a1 #bjag1 initial reporting relating to the measures shall begin4 #bdc4 ,accreditation of ,hospital-,based ,palliative ,care ,programs 7a7 ,in ,general ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 shall designate a public or private agency1 entity1 or organization to develop requirements1 standards1 and procedures for accreditation of hospital-based palliative care programs4 7b7 ,reporting ,not later than ,january #a1 #bjag1 the ,secretary shall prepare and submit a report to ,congress on the proposed accreditation process for hospital-based palliative care programs4 7c7 ,accreditation ,not later than ,july #a1 #bjag1 the ,secretary shall-- 7#a7 establish and promulgate standards and procedures for accreditation of hospital-based palliative care programs2 and 7#b7 designate an agency1 entity1 or organization that shall be responsible for certifying such programs in accordance with the standards established under paragraph 7#a74 7d7 ,definitions ,for the purposes of this section3 7#a7 ,the term hospital-based palliative care program means a hospital-based program that is comprised of an interdisciplinary team that specializes in providing palliative care services and consultations in a variety of health care settings1 including hospitals1 nursing homes1 and home and community-based services4 7#b7 ,the term interdisciplinary team means a group of health care professionals 7consisting of1 at a minimum1 a doctor1 a nurse1 and a social worker7 that have received specialized training in palliative care4 #bdd4 ,survey and data requirements for all ,medicare participating hospice programs 7a7 ,hospice surveys ,section #ahfa7;dd7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd77 is amended by adding at the end the following new paragraph3 7#f7 ,in accordance with the recommendations of the ,medicare ,payment ,advisory ,commission contained in the ,march #bjji report entitled ,report to ,congress3 ,medicare ,payment ,policy1 the ,secretary shall establish1 effective ,july #a1 #bjae1 the following survey requirements for hospice programs3 7,a7 ,any hospice program seeking initial certification under this title on or after that date shall be subject to an initial survey by an appropriate ,state or local agency1 or an approved accreditation agency1 not later than #f months after the program first seeks such certification4 7,b7 ,all hospice programs certified for participation under this title shall be subject to a standard survey by an appropriate ,state or local agency1 or an approved accreditation agency1 at least every #c years after initially being so certified4 4 7b7 ,required hospice resource inputs data ,section #ahfa7;dd7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd771 as amended by subsection 7a71 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 in subparagraph 7,f71 by striking and at the end2 7,b7 by redesignating subparagraph 7,g7 as subparagraph 7,h72 and 7,c7 by inserting after subparagraph 7,f7 the following new subparagraph3 7,g7 complies with the reporting requirements under paragraph 7#g72 and 2 and 7#b7 by adding at the end the following new paragraph3 7#g7 7,a7 ,in accordance with the recommendations of the ,medicare ,payment ,advisory ,commission for additional data 7as contained in the ,march #bjji report entitled ,report to ,congress3 ,medicare ,payment ,policy71 beginning ,january #a1 #bjaf1 a hospice program shall report to the ,secretary1 in such form and manner1 and at such intervals1 as the ,secretary shall require1 the following data with respect to each patient visit3 7i7 ,visit type 7such as admission1 routine1 emergency1 education for family1 other74 7ii7 ,visit length4 7iii7 ,professional or paraprofessional disciplines involved in the visit1 including nurse1 social worker1 home health aide1 physician1 nurse practitioner1 chaplain or spiritual counselor1 counselor1 dietician1 physical therapist1 occupational therapist1 speech language pathologist1 music or art therapist1 and including bereavement and support services provided to a family after a patient's death4 7iv7 ,drugs and other therapeutic interventions provided4 7v7 ,home medical equipment and other medical supplies provided4 7,b7 ,in collecting the data required under subparagraph 7,a71 the ,secretary shall ensure that the data are reported in a manner that allows for summarized cross-tabulations of the data by patients' terminal diagnoses1 lengths of stay1 age1 sex1 and race4 4 ,d ,additional reports1 research1 and evaluations #bea4 ,national ,center ,on ,palliative and ,end-of-,life ,care ,part ,e of title ,,iv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhg et seq47 is amended by adding at the end the following3 #g ,national ,center on ,palliative and ,end-of-,life ,care #dhe;,j4 ,national ,center ,on ,palliative and ,end-of-,life ,care 7a7 ,establishment ,not later than ,july #a1 #bjaf1 there shall be established within the ,national ,institutes of ,health1 a ,national ,center on ,palliative and ,end-of-,life ,care 7referred to in this section as the ,center74 7b7 ,purpose ,the general purpose of the ,center is to conduct and support research relating to palliative and end-of-life care interventions and approaches4 7c7 ,activities ,the ,center shall-- 7#a7 develop and continuously update a research agenda with the goal of-- 7,a7 providing a better biomedical understanding of the end of life2 and 7,b7 improving the quality of care and life at the end of life2 and 7#b7 provide funding for peer-review-selected extra- and intra-mural research that includes the evaluation of existing1 and the development of new1 palliative and end-of-life care interventions and approaches4 4 #beb4 ,national ,mortality ,followback ,survey 7a7 ,in general ,not later than ,december #ca1 #bjae1 and annually thereafter1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall renew and conduct the ,national ,mortality ,followback ,survey 7referred to in this section as the ,survey7 to collect data on end-of-life care4 7b7 ,purpose ,the purpose of the ,survey shall be to gain a better understanding of current end-of-life care in the ,united ,states4 7c7 ,questions 7#a7 ,in general ,in conducting the ,survey1 the ,director of the ,centers for ,disease ,control and ,prevention shall1 at a minimum1 include the following questions with respect to the loved one of a respondent3 7,a7 ,did he or she have an advance directive1 and if so1 when it was completed4 7,b7 ,did he or she have an order for life-sustaining treatment1 and if so1 when was it completed4 7,c7 ,did he or she have a durable power of attorney1 and if so1 when it was completed4 7,d7 ,had he or she discussed his or her wishes with loved ones1 and if so1 when4 7,e7 ,had he or she discussed his or her wishes with his or her physician1 and if so1 when4 7,f7 ,in the opinion of the respondent1 was he or she satisfied with the care he or she received in the last year of life and in the last week of life4 7,g7 ,was he or she cared for by hospice1 and if so1 when4 7,h7 ,was he or she cared for by palliative care specialists1 and if so1 when4 7,i7 ,did he or she receive effective pain management 7if needed74 7,j7 ,what was the experience of the main caregiver 7including if such caregiver was the respondent71 and whether he or she received sufficient support in this role4 7#b7 ,additional questions ,additional questions to be asked during the ,survey shall be determined by the ,director of the ,centers for ,disease ,control and ,prevention on an ongoing basis with input from relevant research entities4 #bec4 ,demonstration ,projects for ,use of ,telemedicine ,services in ,advance ,care ,planning 7a7 ,in ,general ,not later than ,july #a1 #bjah1 the ,secretary shall establish a demonstration program to reimburse eligible entities for costs associated with the use of telemedicine services 7including equipment and connection costs7 to provide advance care planning consultations with geographically distant physicians and their patients4 7b7 ,duration ,the demonstration project under this section shall be conducted for at least a #c-year period4 7c7 ,definitions ,for purposes of this section3 7#a7 ,the term eligible entity means a physician or an advance practice nurse who provides services pursuant to a hospital-based palliative care program 7as defined in section #bfb7;d77#a774 7#b7 ,the term geographically distant has the meaning given that term by the ,secretary for purposes of conducting the demonstration program established under this section4 7#c7 ,the term telemedicine services means a service or consultation provided via telecommunication equipment that allows an eligible entity to exchange or discuss medical information with a patient or a health care professional at a separate location through real-time videoconferencing1 or a similar format1 for the purpose of providing health care diagnosis and treatment4 7d7 ,funding ,there are authorized to be appropriated to the ,secretary such sums as may be necessary to carry out this section4 #bed4 ,inspector ,general investigation of fraud and abuse ,in accordance with the recommendations of the ,medicare ,payment ,advisory ,commission for additional data 7as contained in the ,march #bjji report entitled ,report to ,congress3 ,medicare ,payment ,policy71 the ,secretary shall direct the ,office of the ,inspector ,general of the ,department of ,health and ,human ,services to investigate1 not later than ,january #a1 #bjag1 the following with respect to hospice benefit under ,medicare1 ,medicaid1 and ,,chip3 7#a7 ,the prevalence of financial relationships between hospices and long-term care facilities1 such as nursing facilities and assisted living facilities1 that may represent a conflict of interest and influence admissions to hospice4 7#b7 ,differences in patterns of nursing home referrals to hospice4 7#c7 ,the appropriateness of enrollment practices for hospices with unusual utilization patterns 7such as high frequency of very long stays1 very short stays1 or enrollment of patients discharged from other hospices74 7#d7 ,the appropriateness of hospice marketing materials and other admissions practices and potential correlations between length of stay and deficiencies in marketing or admissions practices4 #bee4 ,,gao study and report on provider adherence to advance directives ,not later than ,january #a1 #bjag1 the ,comptroller ,general of the ,united ,states shall conduct a study of the extent to which providers comply with advance directives under the ,medicare and ,medicaid programs and shall submit a report to ,congress on the results of such study1 together with such recommendations for administrative or legislative changes as the ,comptroller ,general determines appropriate4