,,ii #aac? ,,congress #b;d ,session ,s4 #cjji ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,decemb] #ab1 #bjad,mr4 ,blum5?al 7= himself & ,mr4 ,rockefell]7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to improve end-(-life c>e4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,advance ,plann+ & ,compassionate ,c>e ,act ( #bjad4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4,sec4 #b4 ,def9itions4,,title ,i--,advance ,c>e ,planning,subtitle ,a--,consum] & ,provid] ,education,part ,i--,consum] ,education,s,u,b,p,a,r,t ,a--,national initiatives,sec4 #aja4 ,advance c>e plann+ telephone hotl9e4,sec4 #ajb4 ,advance c>e plann+ in=mation cle>+h\ses4,sec4 #ajc4 ,advance c>e plann+ toolkit4,sec4 #ajd4 ,national public education campaign4,sec4 #aje4 ,update ( ,m$ic>e & ,social ,security h&books4,sec4 #ajf4 ,au?orization ( appropriations4,,subp>t ,b--,/ate & local initiatives,sec4 #aaa4 ,f9ancial assi/ance = advance c>e plann+4,sec4 #aab4 ,grants = programs = ord]s reg>d+ life su/a9+ treatm5t4,"p ,,ii--,provid] ,education,sec4 #aba4 ,public provid] advance c>e plann+ website4,sec4 #abb4 ,cont9u+ education = physicians & nurses4,subtitle ,b--,portability ( ,advance ,directives2 ,heal? ,in=mation ,technology,sec4 #aca4 ,portability ( advance directives4,sec4 #acb4 ,/ate advance directive regi/ries2 driv]'s lic5se advance directive notation4,sec4 #acc4 ,,gao /udy & report on e/abli%m5t ( national advance directive regi/ry4,subtitle ,c--,national ,uni=m ,policy on ,advance ,c>e ,planning,sec4 #ada4 ,/udy & report by ! ,secret>y reg>d+ ! e/abli%m5t & implem5tation ( a national uni=m policy on advance directives4,,title ,,ii--,compassionate ,care,subtitle ,a--,work=ce development,part ,i--,education & training,sec4 #bja4 ,national ,g]iatric & ,palliative ,c>e ,s]vices ,corps4,sec4 #bjb4 ,exemption ( palliative m$ic9e fell[%ip tra9+ f ,m$ic>e graduate m$ical education caps4,sec4 #bjc4 ,m$ical s*ool curricula4,subtitle ,b--,cov]age "u ,m$ic>e1 ,m$icaid1 & ,,*ip ,"p ,i--,cov]age ( advance c>e planning,sec4 #baa4 ,m$ic>e1 ,m$icaid1 & ,,*ip cov]age4,"p ,,ii--,hospice,sec4 #bba4 ,adoption ( ,med,p,a,c hospice paym5t me?odology recomm5dations4,sec4 #bbb4 ,remov+ hospice inpati5t days 9 sett+ p] diem rates = critical access hospitals4,sec4 #bbc4 ,hospice paym5ts = dual eligible individuals resid+ 9 long-t]m c>e facilities4,sec4 #bbd4 ,del9eation ( respective c>e responsibilities ( hospice programs & long-t]m c>e facilities4,sec4 #bbe4 ,adoption ( ,med,p,a,c hospice program eligibility c]tification & rec]tification recomm5dations4,sec4 #bbf4 ,concurr5t c>e = *ildr54,sec4 #bbg4 ,mak+ hospice a requir$ b5efit "u ,m$icaid & ,,*ip4,sec4 #bbh4 ,m$ic>e ,hospice paym5t model demon/ration projects4,sec4 #bbi4 ,med,p,a,c /udies & reports4,sec4 #bcj4 ,,hhs ,evaluations4,subtitle ,c--,quality ,improvement,sec4 #bda4 ,pati5t satisfaction surveys4,sec4 #bdb4 ,developm5t ( core end-(-life c>e quality measures across ea* relevant provid] sett+4,sec4 #bdc4 ,accr$itation ( hospital-bas$ palliative c>e programs4,sec4 #bdd4 ,survey & data requirem5ts = all ,m$ic>e p>ticipat+ hospice programs4,subtitle ,d--,additional reports1 rese>*1 & evaluations,sec4 #bea4 ,national ,c5t] ,on ,palliative & ,end-(-,life ,c>e4,sec4 #beb4 ,national ,mortality ,foll[back ,survey4,sec4 #bec4 ,demon/ration projects = use ( telem$ic9e s]vices 9 advance c>e plann+4,sec4 #bed4 ,inspector ,g5]al inve/igation ( fraud & abuse4,sec4 #bee4 ,,gao /udy & report on provid] adh]5ce to advance directives4 #b4 ,def9itions ,9 ?is ,act3 7#a7 ,advance c>e plann+ ,! t]m advance c>e plann+ means ! process (-- 7,a7 det]m9+ an individual's priorities1 values & goals = c>e 9 ! future :5 ! individual is no long] able to express 8 or h] wi%es2 7,b7 engag+ family memb]s1 heal? c>e proxies1 & heal? c>e provid]s 9 an ongo+ dialogue ab\t-- 7i7 ! individual's wi%es = c>e2 7ii7 :at ! future may hold = p ) s]i\s illnesses or injuries2 7iii7 h[ individuals1 _! heal? c>e proxies1 & family memb]s want _! beliefs & pref]5ces to guide c>e decisions2 & 7iv7 ! /eps t individuals & family memb]s c take reg>d+1 & ! res\rces available to help )1 f9ances1 family matt]s1 spiritual que/ions1 & o!r issues t impact s]i\sly ill or dy+ pati5ts & _! families2 & 7,c7 execut+ & updat+ advance directives & appo9t+ a heal? c>e proxy4 7#b7 ,advance directive ,! t]m advance directive means a liv+ w1 m$ical directive1 heal? c>e p[] ( attorney1 durable p[] ( attorney1 or o!r writt5 /atem5t by a compet5t individual t is recogniz$ "u ,/ate law & indicates ! individual's wi%es reg>d+ m$ical treatm5t 9 ! ev5t ( future incompet5ce4 ,su* t]m includes an advance heal? c>e directive & a heal? c>e directive recogniz$ "u ,/ate law4 7#c7 ,,*ip ,! t]m ,,*ip means ! program e/abli%$ "u title ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq474 7#d7 ,end-(-life-c>e ,! t]m end-(-life c>e means all aspects ( c>e ( a pati5t ) a pot5tially fatal condition1 & includes c>e t is focus$ on specific prep>ations = an imp5d+ dea?4 7#e7 ,heal? c>e p[] ( attorney ,! t]m heal? c>e p[] ( attorney means a legal docum5t t id5tifies a heal? c>e proxy or decisionmak] = a pati5t :o has ! au?ority to act on ! pati5t's behalf :5 ! pati5t is unable to communicate 8 or h] wi%es = m$ical c>e on matt]s t ! pati5t specifies :5 he or %e is compet5t4 ,su* t]m includes a durable p[] ( attorney t relates to m$ical c>e4 7#f7 ,liv+ w ,! t]m liv+ w means a legal docum5t-- 7,a7 us$ to specify ! type ( m$ical c>e 7includ+ any type ( m$ical treatm5t1 includ+ life-su/a9+ proc$ures if t p]son becomes p]man5tly unconsci\s or is o!rwise dy+7 t an individual wants provid$ or )held 9 ! ev5t ! individual _c speak = himself or h]self & _c express 8 or h] wi%es2 & 7,b7 t requires a physician to honor ! provisions ( ^u receipt or to transf] ! c>e ( ! individual cov]$ by ! docum5t to ano!r physician t w honor su* provisions4 7#g7 ,m$icaid ,! t]m ,m$icaid means ! program e/abli%$ "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#h7 ,m$ic>e ,! t]m ,m$ic>e means ! program e/abli%$ "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7#i7 ,ord]s = life-su/a9+ treatm5t ,! t]m ord]s = life-su/a9+ treatm5t means a process = focus+ a pati5ts' values1 goals1 & pref]5ces on curr5t m$ical circum/ances & to translate su* into visible & portable m$ical ord]s applicable across c>e sett+s1 includ+ home1 long-t]m c>e1 em]g5cy m$ical s]vices1 & hospitals4 7#aj7 ,palliative c>e ,! t]m palliative c>e means int]discipl9>y c>e = individuals ) a life-?reat5+ illness or injury relat+ to pa9 & symptom managem5t & psy*ological1 social1 & spiritual ne$s & t seeks to improve ! quality ( life = ! individual & ! individual's family4 7#aa7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 ,i ,advance ,c>e ,plann+ ,a ,consum] & ,provid] ,education ,i ,consum] ,education ,a ,national initiatives #aja4 ,advance c>e plann+ telephone hotl9e 7a7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjaf1 ! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all e/abli% & op]ate directly1 or by grant1 contract1 or int]ag5cy agreem5t1 a #bd-;h\r toll-free telephone hotl9e to provide consum] in=mation reg>d+ advance c>e plann+1 includ+-- 7#a7 an explanation ( advanc$ c>e plann+ & its importance2 7#b7 issues to be consid]$ :5 develop+ an individual's advance c>e plan2 7#c7 h[ to e/abli% an advance directive2 7#d7 proc$ures to help ensure t an individual's directives = end-(-life c>e are foll[$2 7#e7 ,f$]al & ,/ate-specific res\rces = assi/ance ) advance c>e plann+2 & 7#f7 hospice & palliative c>e 7includ+ _! respective purposes & s]vices74 7b7 ,e/abli%m5t ,9 c>ry+ out ! requirem5ts "u subsection 7a71 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion may designate an exi/+ #bd-;h\r toll-free telephone hotl9e or1 if no su* s]vice is available or appropriate1 e/abli% a new #bd-;h\r toll-free telephone hotl9e4 #ajb4 ,advance c>e plann+ in=mation cle>+h\ses 7a7 ,expansion ( ,national ,cle>+h\se = ,long-,t]m ,c>e ,in=mation 7#a7 ,developm5t ,n lat] ?an ,janu>y #a1 #bjae1 ! ,secret>y %all develop an onl9e cle>+h\se to provide compreh5sive in=mation reg>d+ advance c>e plann+4 7#b7 ,ma9t5ance ,! advance c>e plann+ cle>+h\se1 :i* %all be cle>ly id5tifiable & available on ! homepage ( ! ,dep>tm5t ( ,heal? & ,human ,s]vice's ,national ,cle>+h\se = ,long-,t]m ,c>e ,in=mation website1 %all be ma9ta9$ & publiciz$ by ! ,secret>y on an ongo+ basis4 7#c7 ,cont5t ,! advance c>e plann+ cle>+h\se %all include-- 7,a7 any relevant cont5t conta9$ 9 ! national public education campaign requir$ "u section #ajd2 7,b7 cont5t address+-- 7i7 an explanation ( advanc$ c>e plann+ & its importance2 7ii7 issues to be consid]$ :5 develop+ an individual's advance c>e plan2 7iii7 h[ to e/abli% an advance directive2 7iv7 proc$ures to help ensure t an individual's directives = end-(-life c>e are foll[$2 & 7v7 hospice & palliative c>e 7includ+ _! respective purposes & s]vices72 7,c7 available ,f$]al & ,/ate-specific res\rces = assi/ance ) advance c>e plann+1 includ+-- 7i7 contact in=mation = any ,/ate public heal? dep>tm5ts t are responsible = issues reg>d+ end-(-life c>e2 7ii7 contact in=mation = relevant legal s]vice organizations1 includ+ ^? fund$ "u ! ,old] ,am]icans ,act ( #aife 7#db ,u4,s4,c4 #cjja et seq472 & 7iii7 advance directive =ms = ea* ,/ate2 & 7,d7 any additional in=mation1 z det]m9$ by ! ,secret>y4 7b7 ,e/abli%m5t ( p$iatric advance c>e plann+ cle>+h\se 7#a7 ,developm5t ,n lat] ?an ,janu>y #a1 #bjaf1 ! ,secret>y1 9 consultation ) ! ,assi/ant ,secret>y = ,*ildr5 & ,families ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 %all develop an onl9e cle>+h\se to provide compreh5sive in=mation reg>d+ p$iatric advance c>e plann+4 7#b7 ,ma9t5ance ,! p$iatric advance c>e plann+ cle>+h\se1 :i* %all be cle>ly id5tifiable on ! homepage ( ! ,adm9i/ration = ,*ildr5 & ,families website1 %all be ma9ta9$ & publiciz$ by ! ,secret>y on an ongo+ basis4 7#c7 ,cont5t ,! p$iatric advance c>e plann+ cle>+h\se %all provide advance c>e plann+ in=mation specific to *ildr5 ) life-?reat5+ illnesses or injuries & _! families4 #ajc4 ,advance c>e plann+ toolkit 7a7 ,developm5t ,n lat] ?an ,july #a1 #bjae1 ! ,secret>y1 9 consultation ) ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all develop an onl9e advance c>e plann+ toolkit4 7b7 ,ma9t5ance ,! advance c>e plann+ toolkit1 :i* %all be available 9 ,engli%1 ,spani%1 & any o!r languages t ! ,secret>y deems appropriate1 %all be ma9ta9$ & publiciz$ by ! ,secret>y on an ongo+ basis & made available on ! websites ( ! foll[+ ag5cies3 7#a7 ,! ,c5t]s = ,disease ,control & ,prev5tion4 7#b7 ,! ,dep>tm5t ( ,heal? & ,human ,s]vice's ,national ,cle>+h\se = ,long-,t]m ,c>e ,in=mation4 7#c7 ,! ,adm9i/ration = ,*ildr5 & ,families4 7c7 ,cont5t ,! advance c>e plann+ toolkit %all include cont5t address+-- 7#a7 common issues & que/ions reg>d+ advance c>e plann+1 includ+ individuals & res\rces to contact = fur!r inquiries2 7#b7 advance directives & _! uses1 includ+ liv+ wills & durable p[]s ( attorney2 7#c7 ! roles & responsibilities ( a heal? c>e proxy2 7#d7 ,f$]al & ,/ate-specific res\rces to assi/ individuals & _! families ) advance c>e plann+1 includ+-- 7,a7 ! advance c>e plann+ toll-free telephone hotl9e e/abli%$ "u section #aja2 7,b7 ! advance c>e plann+ cle>+h\ses e/abli%$ "u section #ajb2 7,c7 ! advance c>e plann+ toolkit e/abli%$ "u ?is section2 7,d7 available ,/ate legal s]vice organizations to assi/ individuals ) advance c>e plann+1 includ+ ^? organizations t receive fund+ pursuant to ! ,old] ,am]icans ,act ( #aife 7#db ,u4,s4,c4 #cjja et seq472 & 7,e7 website l9ks or addresses = ,/ate-specific advance directive =ms2 & 7#e7 any additional in=mation1 z det]m9$ by ! ,secret>y4 #ajd4 ,national public education campaign 7a7 ,national public education campaign 7#a7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjaf1 ! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all1 directly or ?r\gh grants1 contracts1 or int]ag5cy agreem5ts1 develop & implem5t a national campaign to in=m ! public ( ! importance ( advance c>e plann+ & ( an individual's "r to direct & p>ticipate 9 _! heal? c>e decisions4 7#b7 ,cont5t ( ,educational ,campaign ,! national public education campaign e/abli%$ "u p>agraph 7#a7 %all-- 7,a7 employ ! use ( v>i\s m$ia1 includ+ regul>ly televis$ public s]vice ann\ncem5ts2 7,b7 provide culturally & l+ui/ically appropriate in=mation2 7,c7 be conduct$ cont9u\sly ov] a p]iod ( n less ?an #e ye>s2 7,d7 id5tify & promote ! advance c>e plann+ in=mation available on ! ,dep>tm5t ( ,heal? & ,human ,s]vice's ,national ,cle>+h\se = ,long-,t]m ,c>e ,in=mation website & ,adm9i/ration = ,*ildr5 & ,families website1 z well z any o!r relevant ,f$]al or ,/ate-specific advance c>e plann+ res\rces2 7,e7 raise public aw>5ess ( ! consequ5ces t may result if an individual is no long] able to express or communicate _! heal? c>e decisions2 7,f7 address ! importance ( individuals speak+ to family memb]s1 heal? c>e proxies1 & heal? c>e provid]s z "p ( an ongo+ dialogue reg>d+ _! heal? c>e *oices2 7,g7 address ! ne$ = individuals to obta9 readily available legal docum5ts t express _! heal? c>e decisions ?r\gh advance directives 7includ+ liv+ wills1 com=t c>e ord]s1 & durable p[]s ( attorney = heal? c>e72 7,h7 raise public aw>5ess reg>d+ ! availability ( hospice & palliative c>e2 & 7,i7 enc\rage individuals to speak ) _! physicians ab\t _! options & int5tions = end-(-life c>e4 7#c7 ,evaluation 7,a7 ,9 ,g5]al ,n lat] ?an ,july #a1 #bjah1 ! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all conduct a nationwide survey to evaluate :e!r ! national campaign conduct$ "u ?is subsection has a*iev$ its goal ( *ang+ public aw>5ess1 attitudes1 & behaviors reg>d+ advance c>e plann+4 7,b7 ,basel9e ,survey ,9 ord] to evaluate ! effectiv5ess ( ! national campaign1 ! ,secret>y %all conduct a basel9e survey prior to implem5tation ( ! campaign4 7,c7 ,report+ ,requirem5t ,n lat] ?an ,decemb] #ca1 #bjah1 ! ,secret>y %all report ! f9d+s ( su* survey1 z well z any recomm5dations t ! ,secret>y det]m9es appropriate reg>d+ ! ne$ = cont9uation or legislative or adm9i/rative *anges to facilitate *ang+ public aw>5ess1 attitudes1 & behaviors reg>d+ advance c>e plann+1 to ! appropriate committees ( ! ,congress4 7b7 ,repeal ,section #dgea7;d7 ( ! ,omnibus ,budget ,reconciliation ,act ( #aiij 7#db ,u4,s4,c4 #acif;a note2 ,public ,law #aja-ejh7 is repeal$4 #aje4 ,update ( ,m$ic>e & ,social ,security h&books 7a7 ,m$ic>e ,y h&book 7#a7 ,9 g5]al ,n lat] ?an #fj days aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all update ! onl9e v]sion ( ! ,plan ,ahead = ,long-,t]m ,c>e section ( ! ,m$ic>e ,y ,h&book to include-- 7,a7 an explanation ( advance c>e plann+ & advance directives1 includ+-- 7i7 liv+ wills2 7ii7 heal? c>e proxies2 & 7iii7 aft]-dea? directives2 7,b7 ,f$]al & ,/ate-specific res\rces to assi/ individuals & _! families ) advance c>e plann+1 includ+-- 7i7 ! advance c>e plann+ toll-free telephone hotl9e e/abli%$ "u section #aja2 7ii7 ! advance c>e plann+ cle>+h\ses e/abli%$ "u section #ajb2 7iii7 ! advance c>e plann+ toolkit e/abli%$ "u section #ajc2 7iv7 available ,/ate legal s]vice organizations to assi/ individuals ) advance c>e plann+1 includ+ ^? organizations t receive fund+ pursuant to ! ,old] ,am]icans ,act ( #aife 7#db ,u4,s4,c4 #cjja et seq472 & 7v7 website l9ks or addresses = ,/ate-specific advance directive =ms2 & 7,c7 any additional in=mation1 z det]m9$ by ! ,secret>y4 7#b7 ,update ( pap] & subsequ5t v]sions ,! ,secret>y %all include ! in=mation describ$ 9 p>agraph 7#a7 9 all pap] & electronic v]sions ( ! ,m$ic>e ,y ,h&book t are publi%$ on or aft] ! date t is #fj days aft] ! date ( enactm5t ( ?is ,act4 7b7 ,social ,security h&book ,! ,commission] ( ,social ,security %all-- 7#a7 n lat] ?an #fj days aft] ! date ( enactm5t ( ?is ,act1 update ! onl9e v]sion ( ! ,social ,security ,h&book = b5efici>ies to include ! in=mation describ$ 9 subsection 7a77#a72 & 7#b7 include su* in=mation 9 all pap] & onl9e v]sions ( su* h&book t are publi%$ on or aft] ! date t is #fj days aft] ! date ( enactm5t ( ?is ,act4 #ajf4 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ = ! p]iod ( fiscal ye>s #bjae ?r\gh #bjai-- 7#a7 #aie1jjj1jjj to ! ,secret>y to c>ry out sections #aja1 #ajb1 #ajc1 #ajd & #aje7;a72 & 7#b7 #e1jjj1jjj to ! ,commission] ( ,social ,security to c>ry out section #aje7;b74 ,b ,/ate & local initiatives #aaa4 ,f9ancial assi/ance = advance c>e plann+ 7a7 ,legal assi/ance = advance c>e plann+ 7#a7 ,def9ition ( recipi5t ,section #ajjb7f7 ( ! ,legal ,s]vices ,corporation ,act 7#db ,u4,s4,c4 #biif;a7#f77 is am5d$ by /rik+ clause 7,a7 ( & ins]t+ subp>agraph 7,a7 or 7,b7 (4 7#b7 ,advance c>e plann+ ,section #ajjf ( ! ,legal ,s]vices ,corporation ,act 7#db ,u4,s4,c4 #biif;e7 is am5d$-- 7,a7 9 subsection 7a77#a7-- 7i7 by /rik+ title1 & 7,b7 to make & ins]t+ ! foll[+3 8title2 7,c7 to make 2 & 7ii7 by ins]t+ aft] subp>agraph 7,a7 ! foll[+3 7,b7 to provide f9ancial assi/ance1 & make grants & contracts1 z describ$ 9 subp>agraph 7,a71 on a competitive basis = ! purpose ( provid+ legal assi/ance 9 ! =m ( advance c>e plann+ 7z def9$ 9 section #c ( ! ,advance ,plann+ & ,compassionate ,c>e ,act ( #bjad1 & includ+ provid+ in=mation ab\t ,/ate-specific advance directives1 z def9$ 9 t section7 = eligible cli5ts "u ?is title1 includ+ provid+ su* plann+ to ! family memb]s ( eligible cli5ts & p]sons ) p[] ( attorney to make heal? c>e decisions = ! cli5ts2 & 2 & 7,b7 9 subsection 7b71 by add+ at ! end ! foll[+3 7#b7 ,advance c>e plann+ provid$ 9 accordance ) subsection 7a77#a77;,b7 %all n be con/ru$ to violate ! ,assi/$ ,suicide ,fund+ ,re/riction ,act ( #aiig 7#db ,u4,s4,c4 #addja et seq474 4 7#c7 ,reports ,section #ajjh7;a7 ( ! ,legal ,s]vices ,corporation ,act 7#db ,u4,s4,c4 #biif;g7a77 is am5d$ by add+ at ! end ! foll[+3 ,! ,corporation %all require su* a report1 on an annual basis1 f ea* grantee1 contractor1 or o!r recipi5t ( f9ancial assi/ance "u section #ajjf7;a77#a77;,b744 7#d7 ,au?orization ( appropriations ,section #ajaj ( ! ,legal ,s]vices ,corporation ,act 7#db ,u4,s4,c4 #biif;i7 is am5d$-- 7,a7 9 subsection 7a7-- 7i7 by /rik+ 7a7 & ins]t+ 7a77#a72 7ii7 9 ! la/ s5t5ce1 by /rik+ ,appropriations = t purpose & ins]t+ ! foll[+3 7#c7 ,appropriations = a purpose describ$ 9 p>agraph 7#a7 or 7#b7 2 & 7iii7 by ins]t+ be=e p>agraph 7#c7 7z designat$ by clause 7ii77 ! foll[+3 7#b7 ,!re are au?oriz$ to be appropriat$ to c>ry out section #ajjf7;a77#a77;,b71 #aj1jjj1jjj = ea* ( fiscal ye>s #bjae1 #bjaf1 #bjag1 #bjah1 & #bjai4 2 & 7,b7 9 subsection 7d71 by /rik+ subsection 7a7 & ins]t+ subsection 7a77#a74 7#e7 ,effective date ,?is subsection & ! am5dm5ts made by ?is subsection take effect ,july #a1 #bjae4 7b7 ,/ate heal? insurance assi/ance programs 7#a7 ,9 g5]al ,! ,secret>y %all use am\nts made available "u p>agraph 7#c7 to aw>d grants to ,/ates = ,/ate heal? insurance assi/ance programs receiv+ assi/ance "u section #dcfj ( ! ,omnibus ,budget ,reconciliation ,act ( #aiij to provide advance c>e plann+ s]vices to ,m$ic>e b5efici>ies1 p]sonal repres5tatives ( su* b5efici>ies1 & ! families ( su* b5efici>ies4 ,su* s]vices %all include in=mation reg>d+ ,/ate-specific advance directives & ways to discuss individual c>e wi%es ) heal? c>e provid]s4 7#b7 ,requirem5ts 7,a7 ,aw>d ( grants ,9 mak+ grants "u ?is subsection = a fiscal ye>1 ! ,secret>y %all satisfy ! foll[+ requirem5ts3 7i7 ,two-?irds ( ! total am\nt ( funds available "u p>agraph 7#c7 = a fiscal ye> %all be allocat$ among ^? ,/ates approv$ = a grant "u ?is section t h adopt$ ! ,uni=m ,heal?-,c>e ,decisions ,act draft$ by ! ,national ,conf]5ce ( ,commission]s on ,uni=m ,/ate ,laws & approv$ & recomm5d$ = enactm5t by all ,/ates at ! annual conf]5ce ( su* commission]s 9 #aiic4 7ii7 ,"o-?ird ( ! total am\nt ( funds available "u p>agraph 7#c7 = a fiscal ye> %all be allocat$ among ^? ,/ates approv$ = a grant "u ?is section t h adopt$ a uni=m =m = ord]s reg>d+ life su/a9+ treatm5t z def9$ 9 section #ahfa7;hhh77#e7 ( ! ,social ,security ,act 7z am5d$ by section #baa ( ?is ,act7 or a comp>able approa* to advance c>e plann+4 7,b7 ,"w plan2 report ,z a condition ( be+ aw>d$ a grant "u ?is subsection1 a ,/ate %all submit ! foll[+ to ! ,secret>y3 7i7 ,an approv$ plan = exp5d+ grant funds4 7ii7 ,= ea* fiscal ye> = :i* ! ,/ate is paid grant funds "u ?is subsection1 an annual report reg>d+ ! use ( ! funds1 includ+ ! numb] ( ,m$ic>e b5efici>ies s]v$ & _! satisfaction ) ! s]vices provid$4 7,c7 ,limitation ,no ,/ate %all be paid funds f a grant made "u ?is subsection prior to ,july #a1 #bjae4 7#c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to ! ,secret>y to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt1 #ab1jjj1jjj = ea* ( fiscal ye>s #bjae ?r\gh #bjai = purposes ( aw>d+ grants to ,/ates "u p>agraph 7#a74 7c7 ,m$icaid trans=mation grants = advance c>e plann+ ,section #aijc7z7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7z77 is am5d$-- 7#a7 9 p>agraph 7#b71 by add+ at ! end ! foll[+ new subp>agraph3 7,g7 ,me?ods = improv+ ! effectiv5ess & effici5cy ( m$ical assi/ance provid$ "u ?is title by mak+ available to individuals enroll$ 9 ! ,/ate plan or "u a waiv] ( su* plan in=mation reg>d+ advance c>e plann+ 7z def9$ 9 section #c ( ! ,advance ,plann+ & ,compassionate ,c>e ,act ( #bjad71 includ+ at "t ( enrollm5t or r5ewal ( enrollm5t 9 ! plan or waiv]1 ?r\gh provid]s1 & ?r\gh su* o!r innovative means z ! ,/ate det]m9es appropriate4 2 7#b7 9 p>agraph 7#c71 by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ,"w plan requir$ = aw>d ( advance c>e plann+ grants ,paym5t to a ,/ate "u ?is subsection to adopt ! innovative me?ods describ$ 9 p>agraph 7#b77;,g7 is condition$ on ! ,/ate submitt+ to ! ,secret>y an approv$ plan = exp5d+ ! funds aw>d$ to ! ,/ate "u ?is subsection4 2 & 7#c7 9 p>agraph 7#d7-- 7,a7 9 subp>agraph 7,a7-- 7i7 9 clause 7i71 by /rik+ & at ! end2 7ii7 9 clause 7ii71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7iii7 by ins]t+ aft] clause 7ii71 ! foll[+ new clause3 7iii7 #bj1jjj1jjj = ea* ( fiscal ye>s #bjae ?r\gh #bjai4 2 & 7,b7 by /rik+ subp>agraph 7,b71 & ins]t+ ! foll[+3 7,b7 ,allocation ( funds ,! ,secret>y %all specify a me?od = allocat+ ! funds made available "u ?is subsection among ,/ates aw>d$ a grant = fiscal ye> #bjae1 #bjaf1 #bjag1 #bjah1 or #bjai4 ,su* me?od %all provide t-- 7i7 #ajj p]c5t ( su* funds = ea* ( fiscal ye>s #bjae ?r\gh #bjai %all be aw>d$ to ,/ates t design programs to adopt ! innovative me?ods describ$ 9 p>agraph 7#b77;,g72 & 7ii7 9 no ev5t %all a paym5t to a ,/ate aw>d$ a grant "u ?is subsection = fiscal ye> #bjae be made prior to ,july #a1 #bjae4 4 7d7 ,advance c>e plann+ community tra9+ grants 7#a7 ,9 g5]al ,! ,secret>y %all use am\nts made available "u p>agraph 7#c7 to aw>d grants to area ag5cies on ag+ 7z def9$ 9 section #ajb ( ! ,old] ,am]icans ,act ( #aife 7#db ,u4,s4,c4 #cjjb774 7#b7 ,requirem5ts 7,a7 ,use ( funds ,funds aw>d$ to an area ag5cy on ag+ "u ?is subsection %all be us$ to provide advance c>e plann+ education & tra9+ opportunities = local ag+ s]vice provid]s & organizations4 7,b7 ,"w plan2 report ,z a condition ( be+ aw>d$ a grant "u ?is subsection1 an area ag5cy on ag+ %all submit ! foll[+ to ! ,secret>y3 7i7 ,an approv$ plan = exp5d+ grant funds4 7ii7 ,= ea* fiscal ye> = :i* ! ag5cy is paid grant funds "u ?is subsection1 an annual report reg>d+ ! use ( ! funds1 includ+ ! numb] ( ,m$ic>e b5efici>ies s]v$ & _! satisfaction ) ! s]vices provid$4 7,c7 ,limitation ,no area ag5cy on ag+ %all be paid funds f a grant made "u ?is subsection prior to ,july #a1 #bjae4 7#c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to ! ,secret>y to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt1 #ab1jjj1jjj = ea* ( fiscal ye>s #bjae ?r\gh #bjai = purposes ( aw>d+ grants to area ag5cies on ag+ "u p>agraph 7#a74 7e7 ,nonduplication ( activities ,! ,secret>y %all e/abli% proc$ures to ensure t funds made available "u grants aw>d$ "u ?is section or pursuant to am5dm5ts made by ?is section supplem5t1 n supplant1 exi/+ ,f$]al fund+1 & t su* funds are n us$ to duplicate activities c>ri$ out "u su* grants or "u o!r ,f$]ally fund$ programs4 #aab4 ,grants = programs = ord]s reg>d+ life su/a9+ treatm5t 7a7 ,9 g5]al ,! ,secret>y %all make grants to eligible entities = ! purpose (-- 7#a7 e/abli%+ new programs = ord]s reg>d+ life su/a9+ treatm5t 9 ,/ates or localities2 7#b7 exp&+ or enhanc+ an exi/+ program = ord]s reg>d+ life su/a9+ treatm5t 9 ,/ates or localities2 or 7#c7 provid+ a cle>+h\se ( in=mation on programs = ord]s = life su/a9+ treatm5t & consultative s]vices = ! developm5t or enhancem5t ( su* programs4 7b7 ,au?oriz$ activities ,activities fund$ ?r\gh a grant "u ?is section = an area may include-- 7#a7 develop+ su* a program = ! area t includes home c>e1 hospice1 long-t]m c>e1 community & assi/$ liv+ resid5ces1 skill$ nurs+ facilities1 inpati5t rehabilitation facilities1 hospitals1 & em]g5cy m$ical s]vices )9 ! area2 7#b7 secur+ consultative s]vices & advice f in/itutions ) exp]i5ce 9 develop+ & manag+ su* programs2 & 7#c7 exp&+ an exi/+ program = ord]s reg>d+ life su/a9+ treatm5t to s]ve m pati5ts or enhance ! quality ( s]vices1 includ+ educational s]vices = pati5ts & pati5ts' families or tra9+ ( heal? c>e pr(essionals4 7c7 ,di/ribution ( funds ,9 fund+ grants "u ?is section1 ! ,secret>y %all ensure t1 ( ! funds appropriat$ to c>ry out ?is section = ea* fiscal ye>-- 7#a7 at lea/ two-?irds are us$ = e/abli%+ or develop+ new programs = ord]s reg>d+ life su/a9+ treatm5t2 & 7#b7 "o-?ird is us$ = exp&+ or enhanc+ exi/+ programs = ord]s reg>d+ life su/a9+ treatm5t4 7d7 ,def9itions ,9 ?is section3 7#a7 ,! t]m eligible entity includes-- 7,a7 an academic m$ical c5t]1 a m$ical s*ool1 a ,/ate heal? dep>tm5t1 a ,/ate m$ical association1 a multi-,/ate task=ce1 a hospital1 or a heal? sy/em capable ( adm9i/]+ a program = ord]s reg>d+ life su/a9+ treatm5t = a ,/ate or locality2 or 7,b7 any o!r heal? c>e ag5cy or entity z ! ,secret>y det]m9es appropriate4 7#b7 ,! t]m ord] reg>d+ life su/a9+ treatm5t has ! mean+ giv5 su* t]m 9 section #ahfa7;hhh77#e7 ( ! ,social ,security ,act1 z add$ by section #baa4 7#c7 ,! t]m program = ord]s reg>d+ life su/a9+ treatm5t means1 ) respect to an area1 a program t supports ! active use ( ord]s reg>d+ life su/a9+ treatm5t 9 ! area4 7e7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = ea* ( ! fiscal ye>s #bjad ?r\gh #bjai4 ,,ii ,provid] ,education #aba4 ,public provid] advance c>e plann+ website 7a7 ,developm5t ,n lat] ?an ,janu>y #a1 #bjae1 ! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices & ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 %all e/abli% a website = provid]s "u ,m$ic>e1 ,m$icaid1 ! ,*ildr5's ,heal? ,insurance ,program1 ! ,indian ,heal? ,s]vice 7include contract provid]s7 & o!r public heal? provid]s on ea* individual's "r to make decisions conc]n+ m$ical c>e1 includ+ ! "r to accept or refuse m$ical or surgical treatm5t1 & ! exi/5ce ( advance directives4 7b7 ,ma9t5ance ,! website1 %all be ma9ta9$ & publiciz$ by ! ,secret>y on an ongo+ basis4 7c7 ,cont5t ,! website %all include cont5t1 tools1 & res\rces necess>y to d ! foll[+3 7#a7 ,in=m provid]s ab\t ! advance directive requirem5ts "u ! heal? c>e programs describ$ 9 subsection 7a7 & o!r ,/ate & ,f$]al laws & regulations relat$ to advance c>e plann+4 7#b7 ,educate provid]s ab\t advance c>e plann+ quality improvem5t activities4 7#c7 ,provide assi/ance to provid]s to-- 7,a7 integrate advance directives into electronic heal? records1 includ+ oral directives2 & 7,b7 develop & dissem9ate advance c>e plann+ in=mational mat]ials = _! pati5ts4 7#d7 ,in=m provid]s ab\t advance c>e plann+ cont9u+ education requirem5ts & opportunities4 7#e7 ,enc\rage provid]s to discuss advance c>e plann+ ) _! pati5ts ( all ages4 7#f7 ,assi/ provid]s' und]/&+ ( ! cont9uum ( end-(-life c>e s]vices & supports available to pati5ts1 includ+ palliative c>e & hospice4 7#g7 ,in=m provid]s ( be/ practices = discuss+ end-(-life c>e ) dy+ pati5ts & _! lov$ ones4 #abb4 ,cont9u+ education = physicians & nurses 7a7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjag1 ! ,secret>y1 act+ ?r\gh ! ,director ( ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all develop1 9 consultation ) heal? c>e provid]s & ,/ate bo>ds ( m$ic9e & nurs+1 a curriculum = cont9u+ education t ,/ates may adopt = physicians & nurses on advance c>e plann+ & end-(-life c>e4 7b7 ,cont5t 7#a7 ,9 g5]al ,! cont9u+ education curriculum develop$ "u subsection 7a7 = physicians & nurses %all1 at a m9imum1 include-- 7,a7 a description ( ! mean+ & importance ( advance c>e plann+2 7,b7 a description ( advance directives1 includ+ liv+ wills & durable p[]s ( attorney1 & ! use ( su* directives2 7,c7 palliative c>e pr9ciples & approa*es to c>e2 & 7,d7 ! cont9uum ( end-(-life s]vices & supports1 includ+ palliative c>e & hospice4 7#b7 ,additional cont5t = physicians ,! cont9u+ education curriculum = physicians develop$ "u subsection 7a7 %all include in/ruction on h[ to conduct advance c>e plann+ ) pati5ts & _! lov$ ones4 ,b ,portability ( ,advance ,directives2 ,heal? ,in=mation ,te*nology #aca4 ,portability ( advance directives 7a7 ,m$ic>e ,section #ahff7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 9 subp>agraph 7,b71 by ins]t+ & if pres5t$ by ! individual1 to include ! cont5t ( su* advance directive 9 a prom95t "p ( su* record be=e ! semicolon at ! end2 7,b7 9 subp>agraph 7,d71 by /rik+ & aft] ! semicolon at ! end2 7,c7 9 subp>agraph 7,e71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,d7 by ins]t+ aft] subp>agraph 7,e7 ! foll[+ new subp>agraph3 7,f7 to provide ea* individual ) ! opportunity to discuss issues relat+ to ! in=mation provid$ to t individual pursuant to subp>agraph 7,a7 ) an appropriately tra9$ pr(essional4 2 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#e7 7,a7 ,an advance directive validly execut$ outside ( ! ,/ate 9 :i* su* advance directive is pres5t$ by an adult individual to a provid] ( s]vices1 a ,m$ic>e ,advantage organization1 or a prepaid or eligible organization %all be giv5 ! same effect by t provid] or organization z an advance directive validly execut$ "u ! law ( ! ,/ate 9 :i* x is pres5t$ w\ld be giv5 effect4 7,b7 7i7 ,! def9ition ( an advanc$ directive %all also include actual k ( in/ructions made :ile an individual 0 able to express ! wi%es ( su* individual ) reg>d to heal? c>e4 7ii7 ,= purposes ( clause 7i71 ! t]m actual k means ! possession ( in=mation ( an individual's wi%es communicat$ to ! heal? c>e provid] orally or 9 writ+ by ! individual1 ! individual's m$ical p[] ( attorney repres5tative1 ! individual's heal? c>e surrogate1 or o!r individuals result+ 9 ! heal? c>e provid]'s p]sonal cognizance ( ^! wi%es4 ,o!r =ms ( imput$ k are n actual k4 7,c7 ,! provisions ( ?is p>agraph %all preempt any ,/ate law to ! ext5t su* law is inconsi/5t ) su* provisions4 ,! provisions ( ?is p>agraph %all n preempt any ,/ate law t provides = great] portability1 m def]5ce to a pati5t's wi%es1 or m latitude 9 det]m9+ a pati5t's wi%es4 4 7b7 ,m$icaid ,section #aijb7w7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7w77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 9 subp>agraph 7,b7-- 7i7 by /rik+ 9 ! individual's m$ical record & ins]t+ 9 a prom95t "p ( ! individual's curr5t m$ical record2 & 7ii7 by ins]t+ & if pres5t$ by ! individual1 to include ! cont5t ( su* advance directive 9 a prom95t "p ( su* record be=e ! semicolon at ! end2 7,b7 9 subp>agraph 7,d71 by /rik+ & aft] ! semicolon at ! end2 7,c7 9 subp>agraph 7,e71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,d7 by ins]t+ aft] subp>agraph 7,e7 ! foll[+ new subp>agraph3 7,f7 to provide ea* individual ) ! opportunity to discuss issues relat+ to ! in=mation provid$ to t individual pursuant to subp>agraph 7,a7 ) an appropriately tra9$ pr(essional4 2 & 7#b7 by add+ at ! end ! foll[+ p>agraph3 7#f7 7,a7 ,an advance directive validly execut$ outside ( ! ,/ate 9 :i* su* advance directive is pres5t$ by an adult individual to a provid] or organization %all be giv5 ! same effect by t provid] or organization z an advance directive validly execut$ "u ! law ( ! ,/ate 9 :i* x is pres5t$ w\ld be giv5 effect4 7,b7 7i7 ,! def9ition ( an advance directive %all also include actual k ( in/ructions made :ile an individual 0 able to express ! wi%es ( su* individual ) reg>d to heal? c>e4 7ii7 ,= purposes ( clause 7i71 ! t]m actual k means ! possession ( in=mation ( an individual's wi%es communicat$ to ! heal? c>e provid] orally or 9 writ+ by ! individual1 ! individual's m$ical p[] ( attorney repres5tative1 ! individual's heal? c>e surrogate1 or o!r individuals result+ 9 ! heal? c>e provid]'s p]sonal cognizance ( ^! wi%es4 ,o!r =ms ( imput$ k are n actual k4 7,c7 ,! provisions ( ?is p>agraph %all preempt any ,/ate law to ! ext5t su* law is inconsi/5t ) su* provisions4 ,! provisions ( ?is p>agraph %all n preempt any ,/ate law t provides = great] portability1 m def]5ce to a pati5t's wi%es1 or m latitude 9 det]m9+ a pati5t's wi%es4 4 7c7 ,,*ip ,section #bajg7;e77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is am5d$-- 7#a7 by r$esignat+ subp>agraphs 7,g7 ?r\gh 7,o7 z subp>agraphs 7,h7 ?r\gh 7,p71 respectively2 & 7#b7 by ins]t+ aft] subp>agraph 7,f7 ! foll[+3 7,g7 ,section #aijb7w7 7relat+ to advance directives74 4 7d7 ,/udy & report reg>d+ implem5tation 7#a7 ,/udy ,! ,secret>y %all conduct a /udy reg>d+ ! implem5tation ( ! am5dm5ts made by subsections 7a7 & 7b74 7#b7 ,report ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report on ! /udy conduct$ "u p>agraph 7#a71 toge!r ) recomm5dations = su* legislation & adm9i/rative actions z ! ,secret>y consid]s appropriate4 7e7 ,effective dates 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 ! am5dm5ts made by subsections 7a71 7b71 & 7c7 %all apply to provid] agreem5ts & contracts ent]$ into1 r5ew$1 or ext5d$ "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 & to ,/ate plans "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq47 & ,/ate *ild heal? plans "u title ,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa et seq471 on or aft] su* date z ! ,secret>y specifies1 b 9 no case may su* date be lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act4 7#b7 ,ext5sion ( effective date = /ate law am5dm5t ,9 ! case ( a ,/ate plan "u title ,,xix ( ! ,social ,security ,act or a ,/ate *ild heal? plan "u title ,,xxi ( su* ,act :i* ! ,secret>y det]m9es requires ,/ate legislation 9 ord] = ! plan to meet ! additional requirem5ts impos$ by ! am5dm5ts made by subsections 7b7 & 7c71 ! ,/ate plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet ^! additional requirem5ts be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session is consid]$ to be a sep>ate regul> session ( ! ,/ate legislature4 #acb4 ,/ate advance directive regi/ries2 ,driv]'s lic5se advance directive notation ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g7 is am5d$ by ins]t+ aft] section #cii,s ! foll[+ new sections3 #cii,s-#a4 ,/ate advance directive regi/ries 7a7 ,/ate advance directive regi/ry ,9 ?is section1 ! t]m ,/ate advance directive regi/ry means a secure1 electronic database t-- 7#a7 is available free ( *>ge to resid5ts ( a ,/ate2 & 7#b7 /ores advance directive docum5ts & makes su* docum5ts accessible to m$ical s]vice provid]s 9 accordance ) ,f$]al & ,/ate privacy laws4 7b7 ,grant program ,beg9n+ on ,july #a1 #bjae1 ! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all aw>d grants on a competitive basis to eligible entities to e/abli% & op]ate1 directly or indirectly 7by competitive grant or competitive contract71 ,/ate advance directive regi/ries4 7c7 ,eligible entities 7#a7 ,9 g5]al ,to be eligible to receive a grant "u ?is section1 an entity %all-- 7,a7 be a ,/ate dep>tm5t ( heal?2 & 7,b7 submit to ! ,director an application at su* "t1 9 su* mann]1 & conta9+-- 7i7 a plan = ! e/abli%m5t & op]ation ( a ,/ate advance directive regi/ry2 & 7ii7 su* o!r in=mation z ! ,director may require4 7#b7 ,no requirem5t ( notation me*anism ,! ,secret>y %all n require t an entity e/abli% & op]ate a driv]'s lic5se advance directive notation me*anism = ,/ate resid5ts "u section #cii,v to be eligible to receive a grant "u ?is section4 7d7 ,annual report ,= ea* ye> = :i* an entity receives an aw>d "u ?is section1 su* entity %all submit an annual report to ! ,director on ! use ( ! funds receiv$ pursuant to su* aw>d1 includ+ ! numb] ( ,/ate resid5ts s]v$ ?r\gh ! regi/ry4 7e7 ,au?orization ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #bj1jjj1jjj = fiscal ye> #bjae & ea* fiscal ye> !reaft]4 #cii,s-#b4 ,driv]'s lic5se advance directive notation 7a7 ,9 g5]al ,beg9n+ ,july #a1 #bjae1 ! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all aw>d grants on a competitive basis to ,/ates to e/abli% & op]ate a me*anism = a ,/ate resid5t ) a driv]'s lic5se to include a notice ( ! exi/5ce ( an advance directive = su* resid5t on su* lic5se4 7b7 ,eligibility ,to be eligible to receive a grant "u ?is section1 a ,/ate %all-- 7#a7 e/abli% & op]ate a ,/ate advance directive regi/ry "u section #cii,s-#a2 & 7#b7 submit to ! ,director an application at su* "t1 9 su* mann]1 & conta9+-- 7,a7 a plan t includes a description ( h[ ! ,/ate w-- 7i7 dissem9ate in=mation ab\t advance directives at ! "t ( driv]'s lic5se application or r5ewal2 7ii7 enable ea* ,/ate resid5t ) a driv]'s lic5se to include a notice ( ! exi/5ce ( an advance directive = su* resid5t on su* lic5se 9 a mann] consi/5t ) ! notice on su* a lic5se indicat+ a driv]'s int5t to be an organ donor2 & 7iii7 coord9ate ) ! ,/ate dep>tm5t ( heal? to ensure t1 if a ,/ate resid5t has an advance directive notice on 8 or h] driv]'s lic5se1 ! exi/5ce ( su* advance directive is includ$ 9 ! ,/ate regi/ry e/abli%$ "u section #cii,s-#a2 & 7,b7 any o!r in=mation z ! ,director may require4 7c7 ,annual report ,= ea* ye> = :i* a ,/ate receives an aw>d "u ?is section1 su* ,/ate %all submit an annual report to ! ,director on ! use ( ! funds receiv$ pursuant to su* aw>d1 includ+ ! numb] ( ,/ate resid5ts s]v$ ?r\gh ! me*anism4 7d7 ,au?orization ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #ej1jjj1jjj = fiscal ye> #bjae & ea* fiscal ye> !reaft]4 4 #acc4 ,,gao ,/udy & ,report on ,e/abli%m5t ( ,national ,advance ,directive ,regi/ry 7a7 ,/udy ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy on ! feasibility ( a national regi/ry = advance directives1 tak+ into consid]ation ! con/ra9ts creat$ by ! privacy provisions enact$ z a result ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif 7,public ,law #ajd-aia74 7b7 ,report ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on ! /udy conduct$ "u subsection 7a7 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates det]m9es to be appropriate4 ,c ,national ,uni=m ,policy on ,advance ,c>e ,plann+ #ada4 ,/udy & report by ! ,secret>y reg>d+ ! e/abli%m5t & implem5tation ( a national uni=m policy on advance directives 7a7 ,/udy 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,(fice ( ! ,assi/ant ,secret>y = ,plann+ & ,evaluation1 %all conduct a ?or\gh /udy ( all matt]s relat+ to ! e/abli%m5t & implem5tation ( a national uni=m policy on advance directives = individuals receiv+ items & s]vices "u titles ,,xviii1 ,,xix1 or ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq41 #acif et seq41 or #acig;aa et seq474 7#b7 ,matt]s /udi$ ,! matt]s /udi$ by ! ,secret>y "u p>agraph 7#a7 %all include issues conc]n+-- 7,a7 family satisfaction t a pati5t's wi%es1 z /at$ 9 ! pati5t's advance directive1 7 c>ri$ out2 7,b7 ! portability ( advance directives1 includ+ cases involv+ ! transf] ( an individual f #a heal? c>e sett+ to ano!r2 7,c7 immunity f civil liability & crim9al responsibility = heal? c>e provid]s t foll[ ! in/ructions 9 an individual's advance directive t 0 validly execut$ 91 & consi/5t ) ! laws (1 ! ,/ate 9 :i* x 0 execut$2 7,d7 conditions "u :i* an advance directive is op]ative2 7,e7 revocation ( an advance directive by an individual2 7,f7 ! crit]ia us$ by ,/ates = det]m9+ t an individual has a t]m9al condition2 7,g7 surrogate decisionmak+ reg>d+ end-(-life c>e2 7,h7 ! provision ( adequate palliative c>e 7z def9$ 9 p>agraph 7#c771 includ+ pa9 managem5t2 7,i7 adequate & timely ref]rals to hospice c>e programs2 & 7,j7 ! end-(-life c>e ne$s ( *ildr5 & _! families4 7#c7 ,palliative c>e ,= purposes ( p>agraph 7#b77;,h71 ! t]m palliative c>e means int]discipl9>y c>e = individuals ) a life-?reat5+ illness or injury relat+ to pa9 & symptom managem5t & psy*ological1 social1 & spiritual ne$s & t seeks to improve ! quality ( life = ! individual & ! individual's family4 7b7 ,report to congress ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report on ! /udy conduct$ "u subsection 7a71 toge!r ) recomm5dations = su* legislation & adm9i/rative actions z ! ,secret>y consid]s appropriate4 7c7 ,consultation ,9 conduct+ ! /udy & develop+ ! report "u ?is section1 ! ,secret>y %all consult ) ! ,uni=m ,law ,commission]s1 & o!r int]e/$ p>ties4 ,,ii ,compassionate ,c>e ,a ,work=ce developm5t ,i ,education & tra9+ #bja4 ,national ,g]iatric & ,palliative ,c>e ,s]vices ,corps ,section #cca ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;d7 is am5d$-- 7#a7 by r$esignat+ subsection 7j7 z subsection 7k72 & 7#b7 by ins]t+ aft] subsection 7i71 ! foll[+3 7j7 ,national ,g]iatric & ,palliative ,c>e ,s]vices ,corps 7#a7 ,e/abli%m5t ,n lat] ?an ,janu>y #a1 #bjag1 ! ,secret>y %all e/abli% )9 ! ,national ,heal? ,s]vice ,corps a ,national ,g]iatric & ,palliative ,c>e ,s]vices ,corps 7ref]r$ to 9 ?is subsection z ! ,corps7 :i* %all consi/ (-- 7,a7 su* (fic]s ( ! ,regul> & ,res]ve ,corps ( ! ,s]vice z ! ,secret>y may designate2 7,b7 su* civilian employees ( ! ,unit$ ,/ates z ! ,secret>y may appo9t2 & 7,c7 su* o!r individuals :o are n employees ( ! ,unit$ ,/ates4 7#b7 ,duties ,! ,corps %all be utiliz$ by ! ,secret>y to provide g]iatric & palliative c>e s]vices )9 heal? pr(essional %ortage areas4 7#c7 ,application ( provisions ,! loan-=giv5ess1 s*ol>%ip1 & direct f9ancial inc5tives programs provid$ = "u ?is section %all apply to physicians1 nurses1 & o!r heal? pr(essionals 7z id5tifi$ by ! ,secret>y7 ) respect to ! tra9+ necess>y to enable su* individuals to become g]iatric or palliative c>e speciali/s & provide g]iatric & palliative c>e s]vices 9 heal? pr(essional %ortage areas4 7#d7 ,report ,n lat] ?an #f mon?s prior to ! date on :i* ! ,secret>y e/abli%es ! ,corps "u p>agraph 7#a71 ! ,secret>y %all submit to ,congress a report conc]n+ ! organization ( ! ,corps1 ! application process = memb]%ip 9 ! ,corps1 & ! fund+ necess>y = ! ,corps 7t>get$ by pr(ession & by specialization74 4 #bjb4 ,exemption ( palliative m$ic9e fell[%ip tra9+ f ,m$ic>e graduate m$ical education caps 7a7 ,direct graduate m$ical education ,section #ahhf7;h77#d77;,f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#d77;,f77 is am5d$-- 7#a7 9 clause 7i71 by ins]t+ clause 7iii7 & aft] subject to2 & 7#b7 by add+ at ! end ! foll[+ new clause3 7iii7 ,increase all[$ = palliative m$ic9e fell[%ip tra9+ ,= co/ report+ p]iods beg9n+ on or aft] ,janu>y #a1 #bjaf1 9 apply+ clause 7i71 !re %all n be tak5 into acc\nt full-"t equival5t resid5ts 9 ! field ( allopa?ic or o/eopa?ic m$ic9e :o are 9 palliative m$ic9e fell[%ip tra9+ t is approv$ by ! ,accr$itation ,c\ncil = ,graduate ,m$ical ,education4 4 7b7 ,indirect ,m$ical ,education ,section #ahhf7;d77#e77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is am5d$-- 7#a7 by r$esignat+ ! second clause 7x71 z add$ by section #eeje7;b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh71 z clause 7xi7 & mov+ su* clause #d ems to ! left1 & realign+ ! left m>g9s ( subclauses 7,,ii7 & 7,,iii7 ( su* clause & items 7aa71 7bb71 7cc71 & 7dd7 ( subclause 7,,ii7 ( su* clause appropriately2 & 7#b7 by add+ at ! end ! foll[+ new clause3 7xii7 ,clause 7iii7 ( subsection 7h77#d77;,f7 %all apply to clause 7v7 9 ! same mann] & = ! same p]iod z su* clause 7iii7 applies to clause 7i7 ( su* subsection4 4 #bjc4 ,m$ical s*ool curricula 7a7 ,9 g5]al ,! ,secret>y1 9 consultation ) ! ,association ( ,am]ican ,m$ical ,colleges1 %all e/abli% guidel9es = ! imposition by m$ical s*ools ( a m9imum am\nt ( end-(-life tra9+ z a requirem5t = obta9+ a ,doctor ( ,m$ic9e degree 9 ! field ( allopa?ic or o/eopa?ic m$ic9e4 7b7 ,tra9+ ,"u ! guidel9es e/abli%$ "u subsection 7a71 m9imum tra9+ %all include-- 7#a7 tra9+ 9 h[ to discuss & help pati5ts & _! lov$ ones ) advance c>e plann+2 7#b7 ) respect to /ud5ts & tra9ees :o w "w ) *ildr51 specializ$ p$iatric tra9+2 7#c7 tra9+ 9 ! cont9uum ( end-(-life s]vices & supports1 includ+ palliative c>e & hospice2 7#d7 tra9+ 9 h[ to discuss end-(-life c>e ) dy+ pati5ts & _! lov$ ones2 & 7#e7 m$ical & legal issues tra9+4 7c7 ,di/ribution ,n lat] ?an ,janu>y #a1 #bjaf1 ! ,secret>y %all dissem9ate ! guidel9es e/abli%$ "u subsection 7a7 to m$ical s*ools4 7d7 ,compliance ,effective beg9n+ n lat] ?an ,july #a1 #bjag1 a m$ical s*ool t is receiv+ ,f$]al assi/ance %all be requir$ to implem5t ! guidel9es e/abli%$ "u subsection 7a74 ,a m$ical s*ool t ! ,secret>y det]m9es is n implem5t+ su* guidel9es %all n be eligible = ,f$]al assi/ance4 ,b ,cov]age "u ,m$ic>e1 ,m$icaid1 & ,,*ip ,i ,cov]age ( advance c>e plann+ #baa4 ,m$ic>e1 ,m$icaid1 & ,,*ip cov]age 7a7 ,m$ic>e 7#a7 ,9 g5]al ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is am5d$-- 7,a7 9 subsection 7s77#b7-- 7i7 by /rik+ & at ! end ( subp>agraph 7,,ee72 7ii7 by add+ & at ! end ( subp>agraph 7,,ff72 & 7iii7 by add+ at ! end ! foll[+ new subp>agraph3 7,,gg7 advance c>e plann+ consultation 7z def9$ 9 subsection 7iii77#a772 2 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7iii7 ,advance c>e plann+ consultation 7#a7 ,subject to p>agraphs 7#c7 & 7#d71 ! t]m advance c>e plann+ consultation means a consultation betwe5 ! individual & a practition] describ$ 9 p>agraph 7#b7 reg>d+ advance c>e plann+1 if1 subject to subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#c71 ! individual involv$ has n _h su* a consultation )9 ! la/ #e ye>s4 ,su* consultation %all include ! foll[+3 7,a7 ,an explanation by ! practition] ( advance c>e plann+1 includ+ key que/ions & consid]ations1 important /eps1 & sugge/$ p to talk to4 7,b7 ,an explanation by ! practition] ( advance directives1 includ+ liv+ wills & durable p[]s ( attorney1 & _! uses4 7,c7 ,an explanation by ! practition] ( ! role & responsibilities ( a heal? c>e proxy4 7,d7 ,! provision by ! practition] ( a li/ ( national & ,/ate-specific res\rces to assi/ consum]s & _! families ) advance c>e plann+1 includ+ ! national toll-free hotl9e1 ! advance c>e plann+ cle>+h\ses1 & ,/ate legal s]vice organizations 7includ+ ^? fund$ ?r\gh ! ,old] ,am]icans ,act74 7,e7 ,an explanation by ! practition] ( ! cont9uum ( end-(-life s]vices & supports available1 includ+ palliative c>e & hospice1 & b5efits = su* s]vices & supports t are available "u ?is title4 7,f7 7i7 ,subject to clause 7ii71 an explanation ( ord]s reg>d+ life su/a9+ treatm5t or simil> ord]s1 :i* %all include-- 7,i7 ! reasons :y ! developm5t ( su* an ord] is b5eficial to ! individual & ! individual's family & ! reasons :y su* an ord] %\ld be updat$ p]iodically z ! heal? ( ! individual *anges2 7,,ii7 ! in=mation ne$$ = an individual or legal surrogate to make in=m$ decisions reg>d+ ! completion ( su* an ord]2 & 7,,iii7 ! id5tification ( res\rces t an individual may use to det]m9e ! requirem5ts ( ! ,/ate 9 :i* su* individual resides s t ! treatm5t wi%es ( t individual w be c>ri$ out if ! individual is unable to communicate ^? wi%es1 includ+ requirem5ts reg>d+ ! designation ( a surrogate decisionmak] 7also kn[n z a heal? c>e proxy74 7ii7 ,! ,secret>y may limit ! requirem5t = explanations "u clause 7i7 to consultations furni%$ 9 ,/ates1 localities1 or o!r geographic areas 9 :i* ord]s describ$ 9 su* clause h be5 widely adopt$4 7#b7 ,a practition] describ$ 9 ?is p>agraph is-- 7,a7 a physician 7z def9$ 9 subsection 7r77#a772 & 7,b7 a nurse practition] or physician's assi/ant :o has ! au?ority "u ,/ate law to sign ord]s = life su/a9+ treatm5ts4 7#c7 7,a7 ,an initial prev5tive physical exam9ation "u subsection 7ww71 includ+ any relat$ discussion dur+ su* exam9ation1 %all n be consid]$ an advance c>e plann+ consultation = purposes ( apply+ ! #e-ye> limitation "u p>agraph 7#a74 7,b7 ,an advance c>e plann+ consultation ) respect to an individual %all be conduct$ m frequ5tly ?an provid$ "u p>agraph 7#a7 if !re is a significant *ange 9 ! heal? condition ( ! individual1 includ+ diagnosis ( a *ronic1 progressive1 life-limit+ disease1 a life-?reat5+ or t]m9al diagnosis or life-?reat5+ injury1 or ^u admission to a skill$ nurs+ facility1 a long-t]m c>e facility 7z def9$ by ! ,secret>y71 or a hospice program4 7#d7 ,a consultation "u ?is subsection may include ! =mulation ( an ord] reg>d+ life su/a9+ treatm5t or a simil> ord]4 7#e7 7,a7 ,= purposes ( ?is section1 ! t]m ord] reg>d+ life su/a9+ treatm5t means1 ) respect to an individual1 an actionable m$ical ord] relat+ to ! treatm5t ( t individual t-- 7i7 is sign$ & dat$ by a physician 7z def9$ 9 subsection 7r77#a77 or ano!r heal? c>e pr(essional 7z specifi$ by ! ,secret>y & :o is act+ )9 ! scope ( ! pr(essional's au?ority "u ,/ate law 9 sign+ su* an ord]7 & is 9 a =m t p]mits x to /ay ) ! pati5t & be foll[$ by heal? c>e pr(essionals & provid]s across ! cont9uum ( c>e1 includ+ home c>e1 hospice1 long-t]m c>e1 community & assi/$ liv+ resid5ces1 skill$ nurs+ facilities1 inpati5t rehabilitation facilities1 hospitals1 & em]g5cy m$ical s]vices2 7ii7 effectively communicates ! individual's pref]5ces reg>d+ life su/a9+ treatm5t1 includ+ an indication ( ! treatm5t & c>e desir$ by ! individual2 7iii7 is uniquely id5tifiable & /&>diz$ )9 a giv5 locality1 region1 or ,/ate 7z id5tifi$ by ! ,secret>y72 7iv7 is portable across c>e sett+s2 & 7v7 may incorporate any advance directive 7z def9$ 9 section #ahff7;f77#c77 if execut$ by ! individual4 7,b7 ,! level ( treatm5t indicat$ "u subp>agraph 7,a77ii7 may range f an indication = full treatm5t to an indication to limit "s or all or specifi$ int]v5tions4 ,su* indicat$ levels ( treatm5t may include indications respect+1 among o!r items-- 7i7 ! int5sity ( m$ical int]v5tion if ! pati5t is pulseless1 apneic1 or has s]i\s c>diac or pulmon>y problems2 7ii7 ! individual's desire reg>d+ transf] to a hospital or rema9+ at ! curr5t c>e sett+2 7iii7 ! use ( antibiotics2 & 7iv7 ! use ( artificially adm9i/]$ nutrition & hydration4 4 7#b7 ,paym5t ,section #ahdh7;j77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is am5d$ by ins]t+ 7#b77;,,gg71 aft] 7includ+ adm9i/ration ( ! heal? risk assessm5t714 7#c7 ,frequ5cy ,limitation ,section #ahfb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77 is am5d$-- 7,a7 9 p>agraph 7#a7-- 7i7 9 subp>agraph 7,o71 by /rik+ & at ! end2 7ii7 9 subp>agraph 7,p71 by /rik+ ! semicolon at ! end & ins]t+ 1 &2 & 7iii7 by add+ at ! end ! foll[+ new subp>agraph3 7,q7 9 ! case ( advance c>e plann+ consultations 7z def9$ 9 section #ahfa7;iii77#a771 :i* are p]=m$ m frequ5tly ?an is cov]$ "u su* section2 2 & 7,b7 9 p>agraph 7#g71 by /rik+ or 7,p7 & ins]t+ 7,p71 or 7,q74 7#d7 ,effective ,date ,! am5dm5ts made by ?is subsection %all apply to consultations furni%$ on or aft] ,janu>y #a1 #bjaf4 7b7 ,m$icaid 7#a7 ,m&atory b5efit ,section #aijb7;a77#aj77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is am5d$ 9 ! matt] prec$+ clause 7i7 by /rik+ & 7#bh7 & ins]t+ 7#bh71 & 7#bi74 7#b7 ,m$ical assi/ance ,section #aije ( su* ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7,a7 9 subsection 7a7-- 7i7 9 p>agraph 7#bh71 by /rik+ & at ! end2 7ii7 by r$esignat+ p>agraph 7#bi7 z p>agraph 7#cj72 & 7iii7 by ins]t+ aft] p>agraph 7#bh7 ! foll[+ new p>agraph3 7#bi7 advance c>e plann+ consultations 7z def9$ 9 subsection 7ee772 2 & 7,b7 by add+ at ! end ! foll[+3 7ee7 7#a7 ,= purposes ( subsection 7a77#bi71 ! t]m advance c>e plann+ consultation means a consultation betwe5 ! individual & a practition] describ$ 9 p>agraph 7#b7 reg>d+ advance c>e plann+1 if1 subject to p>agraph 7#c71 ! individual involv$ has n _h su* a consultation )9 ! la/ #e ye>s4 ,su* consultation %all include ! foll[+3 7,a7 ,an explanation by ! practition] ( advance c>e plann+1 includ+ key que/ions & consid]ations1 important /eps1 & sugge/$ p to talk to4 7,b7 ,an explanation by ! practition] ( advance directives1 includ+ liv+ wills & durable p[]s ( attorney1 & _! uses4 7,c7 ,an explanation by ! practition] ( ! role & responsibilities ( a heal? c>e proxy4 7,d7 ,! provision by ! practition] ( a li/ ( national & ,/ate-specific res\rces to assi/ consum]s & _! families ) advance c>e plann+1 includ+ ! national toll-free hotl9e1 ! advance c>e plann+ cle>+h\ses1 & ,/ate legal s]vice organizations 7includ+ ^? fund$ ?r\gh ! ,old] ,am]icans ,act74 7,e7 ,an explanation by ! practition] ( ! cont9uum ( end-(-life s]vices & supports available1 includ+ palliative c>e & hospice1 & b5efits = su* s]vices & supports t are available "u ?is title4 7,f7 7i7 ,subject to clause 7ii71 an explanation ( ord]s = life su/a9+ treatm5ts or simil> ord]s1 :i* %all include-- 7,i7 ! reasons :y ! developm5t ( su* an ord] is b5eficial to ! individual & ! individual's family & ! reasons :y su* an ord] %\ld be updat$ p]iodically z ! heal? ( ! individual *anges2 7,,ii7 ! in=mation ne$$ = an individual or legal surrogate to make in=m$ decisions reg>d+ ! completion ( su* an ord]2 & 7,,iii7 ! id5tification ( res\rces t an individual may use to det]m9e ! requirem5ts ( ! ,/ate 9 :i* su* individual resides s t ! treatm5t wi%es ( t individual w be c>ri$ out if ! individual is unable to communicate ^? wi%es1 includ+ requirem5ts reg>d+ ! designation ( a surrogate decisionmak] 7also kn[n z a heal? c>e proxy74 7ii7 ,! ,secret>y may limit ! requirem5t = explanations "u clause 7i7 to consultations furni%$ 9 ,/ates1 localities1 or o!r geographic areas 9 :i* ord]s describ$ 9 su* clause h be5 widely adopt$4 7#b7 ,a practition] describ$ 9 ?is p>agraph is-- 7,a7 a physician 7z def9$ 9 section #ahfa7r77#a772 & 7,b7 a nurse practition] or physician's assi/ant :o has ! au?ority "u ,/ate law to sign ord]s = life su/a9+ treatm5ts4 7#c7 ,an advance c>e plann+ consultation ) respect to an individual %all be conduct$ m frequ5tly ?an provid$ "u p>agraph 7#a7 if !re is a significant *ange 9 ! heal? condition ( ! individual includ+ diagnosis ( a *ronic1 progressive1 life-limit+ disease1 a life-?reat5+ or t]m9al diagnosis or life-?reat5+ injury1 or ^u admission to a nurs+ facility1 a long-t]m c>e facility 7z def9$ by ! ,secret>y71 or a hospice program4 7#d7 ,a consultation "u ?is subsection may include ! =mulation ( an ord] reg>d+ life su/a9+ treatm5t or a simil> ord]4 7#e7 ,= purposes ( ?is subsection1 ! t]m ord]s reg>d+ life su/a9+ treatm5t has ! mean+ giv5 t t]m 9 section #ahfa7;iii77#e74 4 7c7 ,,*ip 7#a7 ,*ild heal? assi/ance ,section #baaj7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7 is am5d$-- 7,a7 by r$esignat+ p>agraph 7#bh7 z p>agraph 7#bi72 & 7,b7 by ins]t+ aft] p>agraph 7#bg71 ! foll[+3 7#bh7 ,advance c>e plann+ consultations 7z def9$ 9 section #aije7;ee774 4 7#b7 ,m&atory cov]age 7,a7 ,9 g5]al ,section #bajc ( su* ,act 7#db ,u4,s4,c4 #acig;cc71 is am5d$-- 7i7 9 subsection 7a71 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ & 7#g7 & ins]t+ 7#g71 & 7#i72 & 7ii7 9 subsection 7c71 by add+ at ! end ! foll[+3 7#i7 ,end-(-life c>e ,! *ild heal? assi/ance provid$ to a t>get$ l[-income *ild %all include cov]age ( advance c>e plann+ consultations 7z def9$ 9 section #aije7;ee7 & at ! same paym5t rate z ! rate t w\ld apply to su* a consultation "u ! ,/ate plan "u title ,,xix74 4 7,b7 ,con=m+ am5dm5t ,section #bajb7;a77#g77;,b7 ( su* ,act 7#db ,u4,s4,c4 #acig;bb7a77#g77;,b77 is am5d$ by /rik+ section #bajc7;c77#e7 & ins]t+ p>agraphs 7#e7 & 7#i7 ( section #bajc7;c74 7d7 ,def9ition ( advance directive "u ,m$ic>e1 ,m$icaid1 & ,,*ip 7#a7 ,m$ic>e ,section #ahff7;f77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77#c77 is am5d$ by /rik+ means & all t foll[s ?r\gh ! p]iod & ins]t+ means a liv+ w1 m$ical directive1 heal? c>e p[] ( attorney1 durable p[] ( attorney1 or o!r writt5 /atem5t by a compet5t individual t is recogniz$ "u ,/ate law & indicates ! individual's wi%es reg>d+ m$ical treatm5t 9 ! ev5t ( future incompet5ce4 ,su* t]m includes an advance heal? c>e directive & a heal? c>e directive recogniz$ "u ,/ate law44 7#b7 ,m$icaid & *ip ,section #aijb7w77#d7 ( su* ,act 7#db ,u4,s4,c4 #acif;a7w77#d77 is am5d$ by /rik+ means & all t foll[s ?r\gh ! p]iod & ins]t+ means a liv+ w1 m$ical directive1 heal? c>e p[] ( attorney1 durable p[] ( attorney1 or o!r writt5 /atem5t by a compet5t individual t is recogniz$ "u ,/ate law & indicates ! individual's wi%es reg>d+ m$ical treatm5t 9 ! ev5t ( future incompet5ce4 ,su* t]m includes an advance heal? c>e directive & a heal? c>e directive recogniz$ "u ,/ate law44 7e7 ,effective date ,! am5dm5ts made by ?is section take effect ,janu>y #a1 #bjae4 ,,ii ,hospice #bba4 ,adoption ( ,med,p,a,c hospice paym5t me?odology recomm5dations ,section #ahad7;i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7i77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#h7 7,a7 ,! ,secret>y %all conduct an evaluation ( ! recomm5dations ( ! ,m$ic>e ,paym5t ,commission = re=m+ ! hospice c>e b5efit "u ?is title t are conta9$ 9 *apt] #f ( ! ,commission's report entitl$ ,report to ,congress3 ,m$ic>e ,paym5t ,policy 7,m>* #bjji71 includ+ ! impact t su* recomm5dations if implem5t$ w\ld h on access to c>e & ! quality ( c>e4 ,9 conduct+ su* evaluation1 ! ,secret>y %all take into acc\nt data collect$ 9 accordance ) section #bfc7;b7 ( ! ,advance ,plann+ & ,compassionate ,c>e ,act ( #bjad4 7,b7 ,bas$ on ! results ( ! exam9ation conduct$ "u subp>agraph 7,a71 ! ,secret>y %all make appropriate ref9em5ts to ! recomm5dations describ$ 9 subp>agraph 7,a74 ,su* ref9em5ts %all take into acc\nt-- 7i7 ! impact on pati5t populations ) long] t av]age l5g?s ( /ay2 7ii7 ! impact on populations ) %ort] t av]age l5g?s ( /ay2 & 7iii7 ! utilization patt]ns ( hospice provid]s 9 und]s]v$ areas1 includ+ rural hospices4 7,c7 ,n lat] ?an ,janu>y #a1 #bjah1 ! ,secret>y %all submit to ,congress a report t conta9s a detail$ description (-- 7i7 ! ref9em5ts det]m9$ appropriate by ! ,secret>y "u subp>agraph 7,b72 7ii7 ! revisions t ! ,secret>y w implem5t ?r\gh regulation "u ?is title pursuant to subp>agraph 7,d72 & 7iii7 ! revisions t ! ,secret>y det]m9es require additional legislative action by ,congress4 7,d7 7i7 ,! ,secret>y %all implem5t ! recomm5dations describ$ 9 subp>agraph 7,a71 z ref9$ "u subp>agraph 7,b74 7ii7 ,subject to clause 7iii71 ! implem5tation ( su* recomm5dations %all apply to hospice c>e furni%$ on or aft] ,janu>y #a1 #bjai4 7iii7 ,! ,secret>y %all e/abli% an appropriate transition to ! implem5tation ( su* recomm5dations4 7,e7 ,= purposes ( c>ry+ out ! provisions ( ?is p>agraph1 ! ,secret>y %all provide = ! transf]1 f ! ,f$]al ,hospital ,insurance ,tru/ ,fund "u section #ahag1 ( su* sums z may be necess>y to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt4 4 #bbb4 ,remov+ hospice inpati5t days 9 sett+ p] diem rates = critical access hospitals ,section #ahad7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7l771 z am5d$ by section #dajb7;b77#b7 ( ! ,,hite* ,act 7,public ,law #aaa-e71 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#f7 ,= co/ report+ p]iods beg9n+ on or aft] ,janu>y #a1 #bjaf1 ! ,secret>y %all remove ,m$ic>e-c]tifi$ hospice inpati5t days f ! calculation ( p] diem rates = inpati5t critical access hospital s]vices4 4 #bbc4 ,hospice paym5ts = dual eligible individuals resid+ 9 long-t]m c>e facilities 7a7 ,9 g5]al ,section #ahhh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7i7 ,paym5ts = ,dual ,eligible ,individuals ,resid+ 9 ,long-,t]m ,c>e ,facilities ,= co/ report+ p]iods beg9n+ on or aft] ,janu>y #a1 #bjaf1 ! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all e/abli% proc$ures "u :i* paym5ts = room & bo>d "u ! ,/ate ,m$icaid plan ) respect to an applicable individual are made directly to ! long-t]m c>e facility 7z def9$ by ! ,secret>y = purposes ( title ,,xix7 ! individual is a resid5t (4 ,= purposes ( ! prec$+ s5t5ce1 ! t]m applicable individual means an individual :o is entitl$ to or enroll$ = b5efits "u "p ,a or enroll$ = b5efits "u "p ,b & is eligible = m$ical assi/ance = hospice c>e "u a ,/ate plan "u title ,,xix4 4 7b7 ,/ate plan requirem5t 7#a7 ,9 g5]al ,section #aijb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is am5d$-- 7,a7 9 p>agraph 7#gd71 by /rik+ & at ! end2 7,b7 9 p>agraph 7#hj71 by /rik+ & at ! end2 7,c7 9 p>agraph 7#ha71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,d7 by ins]t+ aft] p>agraph 7#ha7 ! foll[+ new p>agraph3 7#hb7 provide t ! ,/ate w make paym5ts = room & bo>d ) respect to applicable individuals 9 accordance ) section #ahhh7;i74 4 7#b7 ,effective date 7,a7 ,9 g5]al ,except z provid$ 9 subp>agraph 7,b71 ! am5dm5ts made by p>agraph 7#a7 take effect on ,janu>y #a1 #bjaf4 7,b7 ,ext5sion ( effective date = /ate law am5dm5t ,9 ! case ( a ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 :i* ! ,secret>y det]m9es requires ,/ate legislation 9 ord] = ! plan to meet ! additional requirem5ts impos$ by ! am5dm5ts made by p>agraph 7#a71 ! ,/ate plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet ^! additional requirem5ts be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session is consid]$ to be a sep>ate regul> session ( ! ,/ate legislature4 #bbd4 ,del9eation ( respective c>e responsibilities ( hospice programs & long-t]m c>e facilities ,section #ahhh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieyy71 z am5d$ by section #bbc7;a71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7j7 ,del9eation ( respective c>e responsibilities ( hospice programs & long-t]m c>e facilities ,n lat] ?an ,july #a1 #bjaf1 ! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all del9eate & en=ce ! respective c>e responsibilities ( hospice programs & long-t]m c>e facilities 7z def9$ by ! ,secret>y = purposes ( title ,,xix7 ) respect to individuals resid+ 9 su* facilities :o are furni%$ hospice c>e4 4 #bbe4 ,adoption ( ,med,p,a,c hospice program eligibility c]tification & rec]tification recomm5dations ,9 accordance ) ! recomm5dations ( ! ,m$ic>e ,paym5t ,advisory ,commission conta9$ 9 ! ,m>* #bjji report entitl$ ,report to ,congress3 ,m$ic>e ,paym5t ,policy1 section #ahad7;a77#g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7a77#g77 is am5d$-- 7#a7 9 subp>agraph 7,c71 by /rik+ & at ! end2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,e7 on or aft] ,janu>y #a1 #bjaf-- 7i7 a hospice physician or advance practice nurse visits ! individual to det]m9e cont9u$ eligibility ( ! individual = hospice c>e prior to ! #ahj?-day rec]tification & ea* subsequ5t rec]tification "u subp>agraph 7,a77ii7 & atte/s t su* visit took place 79 accordance ) proc$ures e/abli%$ by ! ,secret>y1 9 consultation ) ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices72 & 7ii7 any c]tification or rec]tification "u subp>agraph 7,a7 includes a brief n>rative describ+ ! cl9ical basis = ! individual's prognosis 79 accordance ) proc$ures e/abli%$ by ! ,secret>y1 9 consultation ) ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices72 & 4 #bbf4 ,concurr5t c>e = *ildr5 7a7 ,p]mitt+ ,m$ic>e hospice b5efici>ies #ah ye>s ( age or y\ng] ,to receive curative c>e 7#a7 ,9 g5]al ,section #ahab ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;d7 is am5d$-- 7,a7 9 subsection 7a77#d71 by ins]t+ 7subject to ! second s5t5ce ( subsection 7d77#b77;,a77 aft] 9 lieu ( c]ta9 o!r b5efits2 & 7,b7 9 subsection 7d7-- 7i7 9 p>agraph 7#a71 by ins]t+ 1 subject to ! second s5t5ce ( p>agraph 7#b77;,a71 aft] in/ead2 & 7ii7 9 p>agraph 7#b77;,a71 by add+ at ! end ! foll[+ new s5t5ce3 ,clause 7ii77,i7 %all n apply to an individual :o is #ah ye>s ( age or y\ng]4 7#b7 ,con=m+ am5dm5t ,section #ahfb7;a77#a77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#a77;,c77 is am5d$ ins]t+ subject to ! second s5t5ce ( section #ahab7;d77#b77;,a71 aft] hospice c>e14 7b7 ,application to ,m$icaid & ,,*ip 7#a7 ,m$icaid ,section #aije7o77#a77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;d7o77#a77;,a77 is am5d$ by ins]t+ 7subject1 9 ! case ( an individual :o is a *ild1 to ! second s5t5ce ( su* section7 aft] section #ahab7;d77#b77;,a74 7#b7 ,,*ip ,section #baaj7;a77#bc7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7a77#bc77 is am5d$ by /rik+ 7concurr5t & all t foll[s ?r\gh ! p]iod & ins]t+ 7concurr5t1 9 ! case ( an individual :o is a *ild1 ) c>e relat$ to ! treatm5t ( ! individual's condition ) respect to :i* a diagnosis ( t]m9al illness has be5 made744 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjaf4 #bbg4 ,mak+ hospice a requir$ b5efit "u ,m$icaid & ,,*ip 7a7 ,m&atory b5efit 7#a7 ,m$icaid 7,a7 ,9 g5]al ,section #aijb7;a77#aj77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a771 z am5d$ by section #baa7;b77#a71 is am5d$ 9 ! matt] prec$+ clause 7i7 by ins]t+ 7#ah71 aft] 7#ag714 7,b7 ,con=m+ am5dm5t ,section #aijb7;a77#aj77;,c7 ( su* ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,c77 is am5d$-- 7i7 9 clause 7iii7-- 7,i7 9 subclause 7,i71 by ins]t+ & hospice c>e aft] ambulatory s]vices2 & 7,,ii7 9 subclause 7,,ii71 by ins]t+ & hospice c>e aft] deliv]y s]vices2 & 7ii7 9 clause 7iv71 by ins]t+ & 7#ah7 aft] 7#ag74 7#b7 ,,*ip ,section #bajc7;c77#i7 ( su* ,act 7#db ,u4,s4,c4 #acig;cc7c77#i771 z add$ by section #baa7;c77#b77;,a71 is am5d$ by ins]t+ & hospice c>e be=e ! p]iod4 7b7 ,effective date ,! am5dm5ts made subsection 7a7 take effect on ,janu>y #a1 #bjaf4 #bbh4 ,m$ic>e ,hospice paym5t model demon/ration projects 7a7 ,e/abli%m5t ,n lat] ?an ,july #a1 #bjag1 ! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices & ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 %all conduct demon/ration projects to exam9e ways to improve h[ ! ,m$ic>e hospice c>e b5efit pr$icts disease trajectory4 ,projects %all include ! foll[+ models3 7#a7 ,models t bett] & m appropriately c>e =1 & transition z ne$$1 pati5ts 9 _! la/ ye>s ( life :o ne$ palliative c>e1 b d n qualify = hospice c>e "u ! ,m$ic>e hospice eligibility crit]ia4 7#b7 ,models t bett] & m appropriately c>e = long-t]m pati5ts :o are n rec]tifi$ 9 hospice b /ill ne$ palliative c>e4 7#c7 ,any o!r models det]m9$ appropriate by ! ,secret>y4 7b7 ,waiv] au?ority ,! ,secret>y may waive compliance ( su* requirem5ts ( titles ,,xi & ,,xviii ( ! ,social ,security ,act z ! ,secret>y det]m9es necess>y to conduct ! demon/ration projects "u ?is section4 7c7 ,reports ,! ,secret>y %all submit to ,congress p]iodic reports on ! demon/ration projects conduct$ "u ?is section4 #bbi4 ,med,p,a,c /udies & reports 7a7 ,/udy & report reg>d+ an alt]native paym5t me?odology = hospice c>e "u ! ,m$ic>e program 7#a7 ,/udy ,! ,m$ic>e ,paym5t ,advisory ,commission 79 ?is section ref]r$ to z ! ,commission7 %all conduct a /udy on ! e/abli%m5t ( a reimbursem5t sy/em = hospice c>e furni%$ "u ! ,m$ic>e program t is bas$ on diagnoses4 ,9 conduct+ su* /udy1 ! ,commission %all use data collect$ "u new provid] data requirem5ts4 ,su* /udy %all include an analysis ( ! foll[+3 7,a7 ,:e!r su* a reimbursem5t sy/em bett] meets pati5t ne$s & bett] corresponds ) provid] res\rce exp5ditures ?an ! curr5t sy/em4 7,b7 ,:e!r su* a reimbursem5t sy/em improves quality1 includ+ facilitat+ /&>dization ( c>e t[>d be/ practices & diagnoses-specific cl9ical pa?ways 9 hospice4 7,c7 ,:e!r su* a reimbursem5t sy/em c\ld address conc]ns ab\t ! blanket #f-mon? t]m9al prognosis requirem5t 9 hospice4 7,d7 ,:e!r su* a reimbursem5t sy/em is m co/ effective ?an ! curr5t sy/em4 7,e7 ,any o!r areas det]m9$ appropriate by ! ,commission4 7#b7 ,report ,n lat] ?an ,june #ae1 #bjah1 ! ,commission %all submit to ,congress a report on ! /udy conduct$ "u subsection 7a7 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,commission det]m9es appropriate4 7b7 ,/udy & report reg>d+ rural hospice transportation co/s "u ! ,m$ic>e program 7#a7 ,/udy ,! ,commission %all conduct a /udy on rural ,m$ic>e hospice transportation mileage to det]m9e pot5tial ,m$ic>e reimbursem5t *anges to acc\nt = pot5tial high] co/s4 7#b7 ,report ,n lat] ?an ,june #ae1 #bjah1 ! ,commission %all submit to ,congress a report on ! /udy conduct$ "u subsection 7a7 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,commission det]m9es appropriate4 7c7 ,evaluation ( reimbursem5t dis9c5tives ,to elect m$ic>e hospice )9 ! m$ic>e skill$ nurs+ facility b5efit 7#a7 ,/udy ,! ,commission %all conduct a /udy to det]m9e pot5tial ,m$ic>e reimbursem5t *anges to remove ,m$ic>e reimbursem5t dis9c5tives = pati5ts 9 a skill$ nurs+ facility :o want to elect hospice4 7#b7 ,report ,n lat] ?an ,june #ae1 #bjah1 ! ,commission %all submit to ,congress a report on ! /udy conduct$ "u subsection 7a7 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,commission det]m9es appropriate4 #bcj4 ,,hhs ,evaluations 7a7 ,evaluation ( ,access to ,hospice & ,hospital-,bas$ ,palliative ,c>e 7#a7 ,evaluation ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all conduct an evaluation ( geographic areas & populations und]s]v$ by hospice & hospital-bas$ palliative c>e to id5tify pot5tial b>ri]s to access4 7#b7 ,report ,n lat] ?an ,decemb] #ca1 #bjag1 ! ,secret>y %all report to ,congress1 on ! evaluation conduct$ "u subsection 7a7 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,secret>y det]m9es appropriate to address b>ri]s to access to hospice & hospital-bas$ palliative c>e4 7b7 ,evaluation ( aw>5ess & use ( hospice respite c>e "u ,m$ic>e1 ,m$icaid1 & ,,*ip 7#a7 ,evaluation ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,m$ic>e & ,m$icaid ,s]vices1 %all evaluate ! aw>5ess & use ( hospice respite c>e by in=mal c>egiv]s ( b5efici>ies "u ,m$ic>e1 ,m$icaid1 & ,,*ip4 7#b7 ,report ,n lat] ?an ,decemb] #ca1 #bjae1 ! ,secret>y %all report to ,congress1 on ! evaluation conduct$ "u subsection 7a7 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,secret>y det]m9es appropriate to increase aw>5ess or use ( hospice respite c>e "u ,m$ic>e1 ,m$icaid1 & ,,*ip4 ,c ,quality ,improvem5t #bda4 ,pati5t satisfaction surveys ,n lat] ?an ,janu>y #a1 #bjag1 ! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all e/abli% a me*anism =-- 7#a7 collect+ in=mation f pati5ts 7or _! heal? c>e proxies or families memb]s 9 ! ev5t pati5ts are unable to speak = !mselves7 9 relevant provid] sett+s reg>d+ _! c>e at ! end ( life2 & 7#b7 incorporat+ su* in=mation 9 a timely mann] into me*anisms us$ by ! ,adm9i/rator to provide quality ( c>e in=mation to consum]s1 includ+ ! ,hospital ,comp>e & ,nurs+ ,home ,comp>e websites ma9ta9$ by ! ,adm9i/rator4 #bdb4 ,developm5t ( core end-(-life c>e quality measures across ea* relevant provid] sett+ 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality 79 ?is section ref]r$ to z ! ,adm9i/rator7 & 9 consultation ) ! ,director ( ! ,national ,in/itutes ( ,heal?1 %all require specific end-(-life quality measures = ea* relevant provid] sett+1 z id5tifi$ by ! ,adm9i/rator1 9 accordance ) ! requirem5ts ( subsection 7b74 7b7 ,requirem5ts ,= purposes ( subsection 7a71 ! requirem5ts specifi$ 9 ?is subsection are ! foll[+3 7#a7 ,selection ( ! specific measure or measures = an id5tifi$ provid] sett+ %all be-- 7,a7 bas$ on an assessm5t ( :at is likely to h ! greate/ positive impact on quality ( end-(-life c>e 9 t sett+2 & 7,b7 made 9 consultation ) affect$ provid]s & public & private organizations1 t h develop$ su* measures4 7#b7 ,! measures may be /ructure-ori5t$1 process-ori5t$1 or outcome-ori5t$1 z det]m9$ appropriate by ! ,adm9i/rator4 7#c7 ,! ,adm9i/rator %all ensure t report+ requirem5ts relat$ to su* measures are impos$ consi/5t ) o!r applicable laws & regulations1 & 9 a mann] t takes into acc\nt exi/+ measures1 ! ne$s ( pati5t populations1 & ! specific s]vices provid$4 7#d7 ,n lat] ?an-- 7,a7 ,april #a1 #bjaf1 ! ,secret>y %all dissem9ate ! report+ requirem5ts to all affect$ provid]s2 & 7,b7 ,april #a1 #bjag1 initial report+ relat+ to ! measures %all beg94 #bdc4 ,accr$itation ( ,hospital-,bas$ ,palliative ,c>e ,programs 7a7 ,9 ,g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 %all designate a public or private ag5cy1 entity1 or organization to develop requirem5ts1 /&>ds1 & proc$ures = accr$itation ( hospital-bas$ palliative c>e programs4 7b7 ,report+ ,n lat] ?an ,janu>y #a1 #bjag1 ! ,secret>y %all prep>e & submit a report to ,congress on ! propos$ accr$itation process = hospital-bas$ palliative c>e programs4 7c7 ,accr$itation ,n lat] ?an ,july #a1 #bjag1 ! ,secret>y %all-- 7#a7 e/abli% & promulgate /&>ds & proc$ures = accr$itation ( hospital-bas$ palliative c>e programs2 & 7#b7 designate an ag5cy1 entity1 or organization t %all be responsible = c]tify+ su* programs 9 accordance ) ! /&>ds e/abli%$ "u p>agraph 7#a74 7d7 ,def9itions ,= ! purposes ( ?is section3 7#a7 ,! t]m hospital-bas$ palliative c>e program means a hospital-bas$ program t is compris$ ( an int]discipl9>y team t specializes 9 provid+ palliative c>e s]vices & consultations 9 a v>iety ( heal? c>e sett+s1 includ+ hospitals1 nurs+ homes1 & home & community-bas$ s]vices4 7#b7 ,! t]m int]discipl9>y team means a gr\p ( heal? c>e pr(essionals 7consi/+ (1 at a m9imum1 a doctor1 a nurse1 & a social work]7 t h receiv$ specializ$ tra9+ 9 palliative c>e4 #bdd4 ,survey & data requirem5ts = all ,m$ic>e p>ticipat+ hospice programs 7a7 ,hospice surveys ,section #ahfa7;dd7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#f7 ,9 accordance ) ! recomm5dations ( ! ,m$ic>e ,paym5t ,advisory ,commission conta9$ 9 ! ,m>* #bjji report entitl$ ,report to ,congress3 ,m$ic>e ,paym5t ,policy1 ! ,secret>y %all e/abli%1 effective ,july #a1 #bjae1 ! foll[+ survey requirem5ts = hospice programs3 7,a7 ,any hospice program seek+ initial c]tification "u ?is title on or aft] t date %all be subject to an initial survey by an appropriate ,/ate or local ag5cy1 or an approv$ accr$itation ag5cy1 n lat] ?an #f mon?s aft] ! program fir/ seeks su* c]tification4 7,b7 ,all hospice programs c]tifi$ = p>ticipation "u ?is title %all be subject to a /&>d survey by an appropriate ,/ate or local ag5cy1 or an approv$ accr$itation ag5cy1 at lea/ e #c ye>s aft] initially be+ s c]tifi$4 4 7b7 ,requir$ hospice res\rce inputs data ,section #ahfa7;dd7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd771 z am5d$ by subsection 7a71 is am5d$-- 7#a7 9 p>agraph 7#b7-- 7,a7 9 subp>agraph 7,f71 by /rik+ & at ! end2 7,b7 by r$esignat+ subp>agraph 7,g7 z subp>agraph 7,h72 & 7,c7 by ins]t+ aft] subp>agraph 7,f7 ! foll[+ new subp>agraph3 7,g7 complies ) ! report+ requirem5ts "u p>agraph 7#g72 & 2 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#g7 7,a7 ,9 accordance ) ! recomm5dations ( ! ,m$ic>e ,paym5t ,advisory ,commission = additional data 7z conta9$ 9 ! ,m>* #bjji report entitl$ ,report to ,congress3 ,m$ic>e ,paym5t ,policy71 beg9n+ ,janu>y #a1 #bjaf1 a hospice program %all report to ! ,secret>y1 9 su* =m & mann]1 & at su* int]vals1 z ! ,secret>y %all require1 ! foll[+ data ) respect to ea* pati5t visit3 7i7 ,visit type 7su* z admission1 r\t9e1 em]g5cy1 education = family1 o!r74 7ii7 ,visit l5g?4 7iii7 ,pr(essional or p>apr(essional discipl9es involv$ 9 ! visit1 includ+ nurse1 social work]1 home heal? aide1 physician1 nurse practition]1 *apla9 or spiritual c\nselor1 c\nselor1 dietician1 physical !rapi/1 occupational !rapi/1 spee* language pa?ologi/1 music or art !rapi/1 & includ+ b]eavem5t & support s]vices provid$ to a family aft] a pati5t's dea?4 7iv7 ,drugs & o!r !rapeutic int]v5tions provid$4 7v7 ,home m$ical equipm5t & o!r m$ical supplies provid$4 7,b7 ,9 collect+ ! data requir$ "u subp>agraph 7,a71 ! ,secret>y %all ensure t ! data are report$ 9 a mann] t all[s = summ>iz$ cross-tabulations ( ! data by pati5ts' t]m9al diagnoses1 l5g?s ( /ay1 age1 sex1 & race4 4 ,d ,additional reports1 rese>*1 & evaluations #bea4 ,national ,c5t] ,on ,palliative & ,end-(-,life ,c>e ,"p ,e ( title ,,iv ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhg et seq47 is am5d$ by add+ at ! end ! foll[+3 #g ,national ,c5t] on ,palliative & ,end-(-,life ,c>e #dhe;,j4 ,national ,c5t] ,on ,palliative & ,end-(-,life ,c>e 7a7 ,e/abli%m5t ,n lat] ?an ,july #a1 #bjaf1 !re %all be e/abli%$ )9 ! ,national ,in/itutes ( ,heal?1 a ,national ,c5t] on ,palliative & ,end-(-,life ,c>e 7ref]r$ to 9 ?is section z ! ,c5t]74 7b7 ,purpose ,! g5]al purpose ( ! ,c5t] is to conduct & support rese>* relat+ to palliative & end-(-life c>e int]v5tions & approa*es4 7c7 ,activities ,! ,c5t] %all-- 7#a7 develop & cont9u\sly update a rese>* ag5da ) ! goal (-- 7,a7 provid+ a bett] biom$ical und]/&+ ( ! end ( life2 & 7,b7 improv+ ! quality ( c>e & life at ! end ( life2 & 7#b7 provide fund+ = pe]-review-select$ extra- & intra-mural rese>* t includes ! evaluation ( exi/+1 & ! developm5t ( new1 palliative & end-(-life c>e int]v5tions & approa*es4 4 #beb4 ,national ,mortality ,foll[back ,survey 7a7 ,9 g5]al ,n lat] ?an ,decemb] #ca1 #bjae1 & annually !reaft]1 ! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all r5ew & conduct ! ,national ,mortality ,foll[back ,survey 7ref]r$ to 9 ?is section z ! ,survey7 to collect data on end-(-life c>e4 7b7 ,purpose ,! purpose ( ! ,survey %all be to ga9 a bett] und]/&+ ( curr5t end-(-life c>e 9 ! ,unit$ ,/ates4 7c7 ,que/ions 7#a7 ,9 g5]al ,9 conduct+ ! ,survey1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all1 at a m9imum1 include ! foll[+ que/ions ) respect to ! lov$ "o ( a respond5t3 7,a7 ,did he or %e h an advance directive1 & if s1 :5 x 0 complet$4 7,b7 ,did he or %e h an ord] = life-su/a9+ treatm5t1 & if s1 :5 0 x complet$4 7,c7 ,did he or %e h a durable p[] ( attorney1 & if s1 :5 x 0 complet$4 7,d7 ,_h he or %e discuss$ 8 or h] wi%es ) lov$ ones1 & if s1 :54 7,e7 ,_h he or %e discuss$ 8 or h] wi%es ) 8 or h] physician1 & if s1 :54 7,f7 ,9 ! op9ion ( ! respond5t1 0 he or %e satisfi$ ) ! c>e he or %e receiv$ 9 ! la/ ye> ( life & 9 ! la/ week ( life4 7,g7 ,0 he or %e c>$ = by hospice1 & if s1 :54 7,h7 ,0 he or %e c>$ = by palliative c>e speciali/s1 & if s1 :54 7,i7 ,did he or %e receive effective pa9 managem5t 7if ne$$74 7,j7 ,:at 0 ! exp]i5ce ( ! ma9 c>egiv] 7includ+ if su* c>egiv] 0 ! respond5t71 & :e!r he or %e receiv$ suffici5t support 9 ?is role4 7#b7 ,additional que/ions ,additional que/ions to be ask$ dur+ ! ,survey %all be det]m9$ by ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion on an ongo+ basis ) input f relevant rese>* entities4 #bec4 ,demon/ration ,projects = ,use ( ,telem$ic9e ,s]vices 9 ,advance ,c>e ,plann+ 7a7 ,9 ,g5]al ,n lat] ?an ,july #a1 #bjah1 ! ,secret>y %all e/abli% a demon/ration program to reimburse eligible entities = co/s associat$ ) ! use ( telem$ic9e s]vices 7includ+ equipm5t & connection co/s7 to provide advance c>e plann+ consultations ) geographically di/ant physicians & _! pati5ts4 7b7 ,duration ,! demon/ration project "u ?is section %all be conduct$ = at lea/ a #c-ye> p]iod4 7c7 ,def9itions ,= purposes ( ?is section3 7#a7 ,! t]m eligible entity means a physician or an advance practice nurse :o provides s]vices pursuant to a hospital-bas$ palliative c>e program 7z def9$ 9 section #bfb7;d77#a774 7#b7 ,! t]m geographically di/ant has ! mean+ giv5 t t]m by ! ,secret>y = purposes ( conduct+ ! demon/ration program e/abli%$ "u ?is section4 7#c7 ,! t]m telem$ic9e s]vices means a s]vice or consultation provid$ via telecommunication equipm5t t all[s an eligible entity to ex*ange or discuss m$ical in=mation ) a pati5t or a heal? c>e pr(essional at a sep>ate location ?r\gh real-"t videoconf]5c+1 or a simil> =mat1 = ! purpose ( provid+ heal? c>e diagnosis & treatm5t4 7d7 ,fund+ ,!re are au?oriz$ to be appropriat$ to ! ,secret>y su* sums z may be necess>y to c>ry out ?is section4 #bed4 ,inspector ,g5]al inve/igation ( fraud & abuse ,9 accordance ) ! recomm5dations ( ! ,m$ic>e ,paym5t ,advisory ,commission = additional data 7z conta9$ 9 ! ,m>* #bjji report entitl$ ,report to ,congress3 ,m$ic>e ,paym5t ,policy71 ! ,secret>y %all direct ! ,(fice ( ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices to inve/igate1 n lat] ?an ,janu>y #a1 #bjag1 ! foll[+ ) respect to hospice b5efit "u ,m$ic>e1 ,m$icaid1 & ,,*ip3 7#a7 ,! preval5ce ( f9ancial relation%ips betwe5 hospices & long-t]m c>e facilities1 su* z nurs+ facilities & assi/$ liv+ facilities1 t may repres5t a conflict ( int]e/ & influ5ce admissions to hospice4 7#b7 ,diff]5ces 9 patt]ns ( nurs+ home ref]rals to hospice4 7#c7 ,! appropriat5ess ( enrollm5t practices = hospices ) unusual utilization patt]ns 7su* z high frequ5cy ( v long /ays1 v %ort /ays1 or enrollm5t ( pati5ts dis*>g$ f o!r hospices74 7#d7 ,! appropriat5ess ( hospice m>ket+ mat]ials & o!r admissions practices & pot5tial correlations betwe5 l5g? ( /ay & defici5cies 9 m>ket+ or admissions practices4 #bee4 ,,gao /udy & report on provid] adh]5ce to advance directives ,n lat] ?an ,janu>y #a1 #bjag1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy ( ! ext5t to :i* provid]s comply ) advance directives "u ! ,m$ic>e & ,m$icaid programs & %all submit a report to ,congress on ! results ( su* /udy1 toge!r ) su* recomm5dations = adm9i/rative or legislative *anges z ! ,comptroll] ,g5]al det]m9es appropriate4