,,ii  #aad? ,,congress  #a/ ,session    
,s4 #aedi  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #aj1 #bjae,mr4   
,w>n] 7= himself1 ,mr4 ,isakson1 ,ms4   
,baldw91 ,mrs4 ,capito1 ,ms4 ,coll9s1 & 
,ms4 ,klobu*>7 introduc$ ! foll[+ bill2 
:i* 0 read twice & ref]r$ to !          
,committee on ,f9ance  ,a ,,bill  ,to   
am5d title ,,xviii ( ! ,social ,security
 ,act to provide = advanc$ illness c>e  
coord9ation s]vices = ,m$ic>e           
b5efici>ies1 & = o!r purposes4  #a4     
,%ort title2 table ( cont5ts  7a7 ,%ort 
title ,?is ,act may be cit$ z ! ,c>e    
,plann+ ,act ( #bjae4  7b7 ,table (     
cont5ts ,! table ( cont5ts ( ?is ,act is
 z foll[s3 ,sec4 #a4 ,%ort title2 table 
( cont5ts4 ,sec4 #b4 ,f9d+s4 ,sec4 #c4  
,improvem5t ( advanc$ illness plann+ &  
coord9ation4 ,sec4 #d4 ,quality         
measurem5t developm5t4 ,sec4 #e4        
,inclusion ( advance c>e plann+ mat]ials
 9 ! ,m$ic>e  ,y h&book4 ,sec4 #f4      
,improvem5t ( policies relat$ to ! use &
 portability ( advance directives4 ,sec4

 #g4 ,additional requirem5ts =          
facilities4 ,sec4 #h4 ,grants = increas+
 public aw>5ess ( advance c>e plann+ &  
advanc$ illness c>e4 ,sec4 #i4 ,rule (  
con/ruction4  #b4 ,f9d+s ,congress makes
 ! foll[+ f9d+s3  7#a7 ,! population ( !
 ,unit$ ,/ates is e/imat$ to age        
rapidly1 ) ! numb] ( p ov] ! age ( #fe  
set to d\ble to m ?an #gb1jjj1jjj1 or #a
 9 #e ,am]icans1 ov] ! next two decades4
  7#b7 ,am]icans today are liv+ long] & 
heal?i] lives ?an ev] be=e 9 ! hi/ory ( 
! ,unit$ ,/ates yet are also fac+       
increas$ incid5ce ( multiple s]i\s      
conditions z ag+ progresses4  7#c7      
,am]icans ) advanc$ illness face a      
complicat$ & fragm5t$ sy/em ( c>e       
deliv]y t puts !m at risk = repeat      
hospitalizations1 adv]se drug reactions1
 & conflict+ m$ical advice t may be     
ov]:elm+ to individuals & families4     
7#d7 ,! progression ( advanc$ illness   
leads to ! ne$ = increas+ly int5sive    
decision support1 heal? c>e s]vices1 &  
support f family c>egiv]s4  7#e7 ,!     

complexity ( c>e ne$$ by individuals )  
advanc$ illness may result 9 uncoord9at$
 c>e1 adv]se heal? outcomes1 fru/ration1
 wa/$ "t1 & undue emotional burd5s on   
individuals & _! family c>egiv]s4  7#f7 
,num]\s private sector lead]s1 includ+  
hospitals1 heal? sy/ems1 home heal?     
ag5cies1 hospice programs1 long-t]m c>e 
provid]s1 employ]s1 & o!r entities1 h   
put 9 place innovative solutions to     
provide m compreh5sive & coord9at$ c>e =
 ,am]icans liv+ ) advanc$ illness4  7#g7
 ,hospice programs1 z "o ( ! longe/ /&+ 
,m$ic>e c>e coord9ation b5efits t (f] a 
compreh5sive set ( s]vices via an       
int]discipl9>y team work+ to provide    
p]son- & family-c5t]$ c>e to ! fraile/ &
 mo/ vuln]able individuals 9 our        
communities1 c s]ve z a model = advanc$ 
illness c>e deliv]y4  7#h7 ,palliative  
c>e programs t s]ve pati5ts beg9n+ at   
diagnosis ) advanc$ illness & provide   
c>e design$ to r$uce ! symptom burd5 (  
illness c s]ve z a model =              
int]discipl9>y team c>e plann+ bas$ on !

 individual's goals ( c>e4  7#i7 ,!     
,gov]nm5t ( ! ,unit$ ,/ates1 z !        
,nation's l>ge/ pur*as] ( heal? c>e     
s]vices1 mu/ le>n f ^! innovators &     
enc\rage heal? c>e provid]s to furni% m 
supportive & compreh5sive advanc$       
illness c>e to improve ! efficacy &     
quality ( heal? c>e deliv]$ = g5]ations 
( ,am]icans to come4  7#aj7 ,heal? c>e  
provid]s :o s]ve individuals ) advanc$  
illness face complicat$ c>e sy/ems &    
legal conc]ns t may result 9 ov]- or    
"u-treatm5t ( individuals ) advanc$     
illness4  7#aa7 ,individuals h !        
well-e/abli%$ "r to accept or reject    
m$ical treatm5t t is (f]$1 z well z !   
well-e/abli%$ "r to docum5t _! pref]5ces
 = h[ treatm5t decisions %\ld be made   
if1 at "s po9t 9 ! future1 !y lose !    
ability to make heal? c>e decisions4    
7#ab7 ,too (t51 individuals ) advanc$   
illness d n und]/& ! conditions !y are  
fac+ or _! treatm5t options1 & !y d n   
receive ! in=mation or support !y ne$ to
 evaluate treatm5t options 9 light ( _! 

p]sonal goals & values & to docum5t     
treatm5t plans 9 a mann] t all[s        
provid]s & facilities to foll[ _! plans4
  7#ac7 ,provid+ quality s]vices &      
plann+ support to individuals ) advanc$ 
illness w protect & pres]ve _! dignity4 
#c4 ,improvem5t ( advanc$ illness plann+
 & coord9ation  7a7 ,m$ic>e cov]age (   
plann+ s]vices  7#a7 ,cov]age ,section  
#ahfa7s77#b7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciex7s77#b77 is am5d$--
  7,a7 9 subp>agraph 7,,ee71 by /rik+ & 
at ! end2  7,b7 9 subp>agraph 7,,ff71 by
 ins]t+ & at ! end2 &  7,c7 by ins]t+   
aft] subp>agraph 7,,ff7 ! foll[+ new    
p>agraph3  7,,gg7 plann+ s]vices 7z     
def9$ 9 subsection 7iii772  4  7#b7     
,s]vices describ$ ,section #ahfa ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7 is am5d$ by add+ at ! end !     
foll[+ new subsection3  7iii7 ,plann+   
s]vices  7#a7 7,a7 ,! t]m plann+ s]vices
 means a volunt>y decisionmak+ process t
 includes ! elem5ts describ$ 9 p>agraph 
7#b7 & is furni%$ to a plann+ s]vices   

eligible individual by an applicable    
provid] ?r\gh an int]discipl9>y team4   
7,b7 7i7 ,except z provid$ 9 clause     
7ii71 plann+ s]vices may only be furni%$
 to a plann+ s]vices eligible individual
 "u ?is title once 9 ea* #ab-mon? p]iod4
  7ii7 ,! ,secret>y %all e/abli%        
appropriate exceptions to ! frequ5cy    
limitation "u clause 7i71 su* z :5 !re  
is a *ange 9 ! individual's m$ical      
condition4  7#b7 7,a7 ,! elem5ts        
describ$ 9 ?is p>agraph are ! foll[+3   
7i7 ,"o or m face-to-face enc\nt]s      
betwe5 "o or m memb]s ( ! int]discipl9>y
 team & ! individual &1 at !            
individual's discretion1 family         
c>egiv]s1 or1 = an individual :o lacks  
decisionmak+ capacity "u ,/ate law1 !   
individual's legally au?oriz$           
repres5tative4  7ii7 ,! provision (     
in=mation ab\t ! typical trajectory (   
illnesses or conditions t affect !      
individual1 includ+ =eseeable c>e       
decisions t may ne$ to be made at a     
future "t :5 ! individual is likely to  

be unable to make decisions due to      
tempor>y or p]man5t cognitive           
incapacity4  7iii7 ,assi/+ ! individual 
9 def9+ & articulat+ goals ( c>e1       
values1 & pref]5ces4  7iv7 ,provid+ !   
individual ) & discuss+ in=mation ab\t !
 b5efits & burd5s ( relevant ranges (   
treatm5t options available to !         
individual1 includ+ disease modify+ or  
pot5tially curative treatm5t1 palliative
 c>e1 :i* may be provid$ alone or 9     
conjunction ) disease modify+ treatm5t1 
&1 :5 ! individual may be curr5tly      
eligible or may become eligible =       
hospice c>e due to disease progression4 
7v7 ,assi/+ ! individual 9 evaluat+     
treatm5t options & approa*es to c>e to  
id5tify ^? t mo/ closely align ) !      
individual's goals ( c>e1 values1 &     
pref]5ces4  7vi7 ,prep>+1 & %>+ )       
relevant provid]s1 docum5tation--  7,i7 
t /ates ! individual's goals ( c>e1     
pref]5ces1 & values1 pref]r$            
decisionmak+ /rategies1 & a plan ( c>e t
 is concrete & actionable2 &  7,,ii7 t  

is 9 ,/ate or locally recogniz$ =ms t   
are us$ = ! purpose ( assur+ t provid]s 
c foll[ ! plan across c>e sett+s1 su* z 
advance directives or portable treatm5t 
ord]s4  7vii7 ,ref]rals to provid]s1    
includ+ m$ical & social s]vice provid]s1
 :o deliv] c>e consi/5t ) ! plan4       
7viii7 ,provid+ culturally &            
educationally appropriate tra9+ = !     
individual & family c>egiv]s to support 
_! ability to c>ry out ! plan4  7,b7    
,ev5 :5 ! individual's decisional       
capacity is impair$ & ano!r p]son or    
entity1 su* z an appo9t$ ag5t1 proxy1 or
 surrogate1 is ex]cis+ legal au?ority "u
 ,/ate law gov]n+ decisionmak+ on behalf
 ( incapacitat$ individuals1 !          
int]discipl9>y team %all make a         
reasonable attempt to include !         
individual 9 ! plann+ process4  7#c7 ,= 
purposes ( ?is subsection1 ! t]m plann+ 
s]vices eligible individual means an    
individual t meets at lea/ "o ( ! foll[+
 crit]ia3  7,a7 ,! individual is        
diagnos$ ) meta/atic or locally advanc$ 

canc]4  7,b7 ,! individual is diagnos$ )
 ,alzheim]'s disease or ano!r           
progressive dem5tia4  7,c7 ,! individual
 is diagnos$ ) late-/age neuromuscul>   
disease4  7,d7 ,! individual is diagnos$
 ) late-/age diabetes4  7,e7 ,!         
individual is diagnos$ ) late-/age      
kidney1 liv]1 he>t1 ga/ro9te/9al1       
c]ebrovascul>1 or lung disease4  7,f7 ,!
 individual ne$s assi/ance ) two or m   
activities ( daily liv+ 7def9$ z ba?+1  
dress+1 eat+1 gett+ out ( b$ or a *air1 
mobility1 & toilet+7 n associat$ ) an   
acute or po/-op]ative conditions t are  
caus$ by "o or m s]i\s or life ?reat5+  
illnesses or frailty4  7,g7 ,!          
individual meets o!r crit]ia det]m9$    
appropriate by ! ,secret>y1 includ+     
crit]ia t are design$ to id5tify        
individuals ) a ne$ = plann+ s]vices due
 to a s]i\s or life ?reat5+ illness or  
risk ( decl9e 9 cognitive function ov]  
"t4  7#d7 ,= purposes ( ?is subsection1 
! t]m applicable provid] means a hospice
 program 7z def9$ 9 section             

#ahfa7;dd77#b77 or o!r provid] ( s]vices
 7z def9$ 9 section #ahfa7u77 or suppli]
 7z def9$ 9 section #ahfa7;d77 t--  7,a7
 furni%es plann+ s]vices ?r\gh an       
int]discipl9>y team2 &  7,b7 meets su*  
o!r requirem5ts ! ,secret>y may det]m9e 
to be appropriate4  7#e7 7,a7 ,=        
purposes ( ?is subsection1 ! t]m        
int]discipl9>y team means a gr\p t--    
7i7 includes ! p]sonnel describ$ 9      
subsection 7dd77#b77;,b77i72  7ii7 may  
include a *apla91 m9i/]1 or p]sonal     
religi\s or spiritual advisor2  7iii7   
may include o!r direct c>e p]sonnel2 &  
7iv7 meets requirem5ts t may be e/abli%$
 by ! ,secret>y4  7,b7 ,an applicable   
provid] furni%+ plann+ s]vices to a     
plann+ s]vices eligible individual %all 
(f] to ! individual 7or ! individual's  
legally au?oriz$ repres5tative :5 !     
individual has be5 f\nd to lack         
decisional capacity7 ! opportunity to   
select ei!r a *apla9 affiliat$ ) !      
provid]1 a m9i/]1 or p]sonal religi\s or
 spiritual advisor :o c help to repres5t

 ! individual's goals1 values1 &        
pref]5ces to s]ve z a core team memb] at
 ! individual's 7or legally au?oriz$    
repres5tative's7 reque/4  7,c7 ,!       
requirem5ts e/abli%$ by ! ,secret>y "u  
subp>agraph 7,a77ii7 %all include a     
requirem5t t int]discipl9>y team memb]s 
7except = ! *os5 *apla91 m9i/]1 or      
p]sonal religi\s or spiritual advisor7 h
 tra9+ & exp]i5ce 9 deliv]+             
p]son-direct$ plann+ s]vices & 9        
team-bas$ deliv]y ( s]vices =           
individuals ) dem5t+ illness &          
individuals ) a s]i\s or life ?reat5+   
illness4  4  7#c7 ,paym5t "u physician  
fee s*$ule ,section #ahdh7;j77#c7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#d7;j77#c77 is am5d$ by ins]t+   
7#b77;,,gg71 aft] 7#b77;,,ff7 7includ+  
adm9i/ration ( ! heal? risk assessm5t714
  7#d7 ,frequ5cy limitation ,section    
#ahfb7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciey7a77 is am5d$--    
7,a7 9 p>agraph 7#a7--  7i7 9           
subp>agraph 7,o71 by /rik+ & at ! end2  

7ii7 9 subp>agraph 7,p7 by /rik+ !      
semicolon at ! end & ins]t+ 1 &2 &      
7iii7 by add+ at ! end ! foll[+ new     
subp>agraph3  7,q7 9 ! case ( plann+    
s]vices 7z def9$ 9 section              
#ahfa7;iii77#a771 :i* are furni%$ m     
frequ5tly ?an is cov]$ "u subp>agraph   
7,b7 ( su* section2  2 &  7,b7 9        
p>agraph 7#g71 by /rik+ or 7,p7 & ins]t+
 7,p71 or 7,q74  7#e7 ,effective date ,!
 am5dm5ts made by ?is subsection %all   
apply to s]vices furni%$ on or aft]     
,janu>y #a1 #bjag4  7b7 ,advanc$ illness
 c>e coord9ation s]vices project        
,section #aaae;,a7b77#b7 ( title ,,xi ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acae;a7b77#b77 is am5d$--  7#a7 9      
subp>agraph 7,a71 by add+ at ! end !    
foll[+ new s5t5ce3 ,! models select$ "u 
?is subp>agraph %all include ! model    
describ$ 9 subp>agraph 7,d7 & su* model 
%all be implem5t$ by n lat] ?an ,decemb]
 #ca1 #bjag42 &  7#b7 by add+ at ! end !
 foll[+ new subp>agraph3  7,d7 ,advanc$ 
illness c>e coord9ation s]vices model   

7i7 ,model  7,i7 ,9 g5]al ,! model      
describ$ 9 ?is subp>agraph is a model "u
 :i* paym5ts are made to applicable     
provid]s t furni% advanc$ illness c>e   
coord9ation s]vices to eligible         
individuals4  7,,ii7 ,requirem5t ,at    
lea/ "o applicable provid] select$ =    
p>ticipation "u ! model %all be a       
hospice program 7z def9$ 9 section      
#ahfa7;dd77#b774  7ii7 ,applicable      
provid] ,9 ?is subp>agraph1 ! t]m       
applicable provid] has ! mean+ giv5 su* 
t]m 9 section #ahfa7;iii77#d74  7iii7   
,advanc$ illness c>e coord9ation s]vices
 ,9 ?is subp>agraph1 ! t]m advanc$      
illness c>e coord9ation s]vices means ! 
foll[+ s]vices3  7,i7 ,plann+ s]vices 7z
 def9$ 9 section #ahfa7;iii774  7,,ii7  
,a multi-dim5sional assessm5t ( !       
individual's /r5g?s & limitations4      
7,,iii7 ,an assessm5t ( ! individual's  
=mal & in=mal supports1 includ+ family  
c>egiv]s4  7,,iv7 ,compreh5sive         
m$ication review & managem5t 7includ+1  
if appropriate1 c\nsel+ & self-managem5t

 support74  7,v7 ,9-home supportive     
s]vices = ! eligible individual & family
 c>egiv]s consi/5t ) ! c>e plan4  7,,vi7
 #bd-;h\r access to em]g5cy support 9   
p]son or via telephone or telem$ic9e ) !
 individual's m$ical record & c>e plan  
available to ! respond]4  7,,vii7       
,coord9ation across heal? c>e & social  
s]vice sy/ems1 includ+ involvem5t ( !   
int]discipl9>y team to evaluate quality 
& address conc]ns ov] "t4  7,,viii7 ,su*
 o!r s]vices z specifi$ by ! ,secret>y4 
7iv7 ,eligible individual ,9 ?is        
subp>agraph1 ! t]m eligible individual  
means an individual :o--  7,i7 is       
entitl$ to1 or enroll$ =1 b5efits "u "p 
,a ( title ,,xviii & enroll$ "u "p ,b ( 
su* title1 b n enroll$ "u "p ,c ( su*   
title2 &  7,,ii7 has ! ne$ = assi/ance )
 two or m activities ( daily liv+ 7def9$
 z ba?+1 dress+1 eat+1 gett+ out ( b$ or
 a *air1 mobility1 & toilet+7 t is n    
associat$ ) an acute or po/-op]ative    
condition t is caus$ by "o or m s]i\s or
 life ?reat5+ conditions or frailty4  4 

#d4 ,quality measurem5t developm5t  7a7 
,9 g5]al ,section #ica7;c77#b7 ( !      
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bii;b-#ca7;c77#b77 is am5d$--
  7#a7 by r$esignat+ subp>agraphs 7,i7 &
 7,j7 z subp>agraphs 7,l7 & 7,m71       
respectively2 &  7#b7 by ins]t+ aft]    
subp>agraph 7,h7 ! foll[+ new           
subp>agraphs3  7,i7 ! process ( elicit+ 
& docum5t+ pati5t 7&1 :]e relevant &    
appropriate1 family c>egiv]7 goals1     
pref]5ces1 & values f ! pati5t or f a   
legally au?oriz$ repres5tative1 includ+ 
! articulation ( goals t accurately     
reflect h[ ! pati5t wants to live2  7,j7
 ! effectiv5ess1 pati5t-c5t]$ness 7&1   
:]e relevant1 family c>egiv]-c5t]$ness71
 & accuracy ( c>e plans1 includ+        
docum5tation ( individual goals1        
pref]5ces1 & values2  7,k7 agreem5t &   
consi/5cy among--  7i7 ! pati5t's goals1
 values1 & pref]5ces2  7ii7 any docum5t$
 c>e plan2  7iii7 ! treatm5t deliv]$2 & 
7iv7 outcomes ( treatm5t2  4  7b7       
,au?orization ( appropriations ,!re are 

au?oriz$ to be appropriat$ to !         
,secret>y ( ,heal? & ,human ,s]vices to 
c>ry out ! am5dm5ts made by ?is section1
 #e1jjj1jjj = fiscal ye> #bjaf4 ,am\nts 
appropriat$ "u ! prec$+ s5t5ce %all     
rema9 available until exp5d$4  #e4      
,inclusion ( advance c>e plann+ mat]ials
 9 ! ,m$ic>e  ,y h&book  7a7 ,9 g5]al   
,section #ahjd7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;b-#b7;a77 is 
am5d$--  7#a7 9 p>agraph 7#b71 by /rik+ 
& at ! end2  7#b7 9 p>agraph 7#c71 by   
/rik+ ! p]iod at ! end & ins]t+ a       
semicolon2 &  7#c7 by ins]t+ aft]       
p>agraph 7#c7 ! foll[+ new p>agraphs3   
7#d7 in=mation on--  7,a7 c>e plann+2   
7,b7 h[ individual goals1 values1 &     
pref]5ces %\ld be consid]$ 9 fram+ a c>e
 plan2 &  7,c7 a range ( approa*es =    
treat+ advanc$ illness1 includ+ disease 
modify+ options1 palliative c>e t       
supports individuals f ! onset ( advanc$
 illness & c be provid$ at ! same "t z  
all o!r c>e types1 & hospice c>e2 &     
7#e7 in=mation on docum5tation options =

 c>e plann+ or advance c>e plann+1      
includ+ advance directives & portable   
treatm5t ord]s4  4  7b7 ,effective date 
,! am5dm5ts made by ?is section %all    
apply to notices di/ribut$ on or aft]   
,janu>y #a1 #bjag4  #f4 ,improvem5t (   
policies relat$ to ! use & portability (
 advance directives  7a7 ,m$ic>e  7#a7  
,9 g5]al ,section #ahff7;f7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acie;cc7f77 is am5d$--  7,a7 9 p>agraph
 7#a7-- 7i7 9 subp>agraph 7,a77i7--     
7,i7 by ins]t+ relevant aft] rights "u2 
&  7,,ii7 by /rik+ ( ! ,/ate2  7ii7 by  
/rik+ subp>agraph 7,b72  7iii7 by       
r$esignat+ subp>agraphs 7,c71 7,d71 &   
7,e7 z subp>agraphs 7,g71 7,h71 & 7,i71 
respectively2  7iv7 by ins]t+ aft]      
subp>agraph 7,a7 ! foll[+ new           
subp>agraphs3  7,b7 to reque/ & docum5t 
9 a prom95t "p ( ! individual's curr5t  
m$ical record ! cont5t ( 7or a copy (7  
an advance directive or portable        
treatm5t ord]2  7,c7 to provide ea*     
individual ) res\rces to assi/ !m 9     

und]/&+ ! in=mation provid$ to !m       
pursuant to subp>agraph 7,a72  7,d7 9 ! 
case ( an individual ) decisional       
capacity "u ,/ate law1 to foll[ !       
individual's curr5t treatm5t            
in/ructions1 z express$ 9 writ+ or ?r\gh
 v]bal or non-v]bal communications2     
7,e7 9 ! case ( an individual :o lacks  
decisional capacity--  7i7 to foll[     
treatm5t decisions 9 accordance ) curr5t
 advance directives & portable treatm5t 
ord]s t are valid "u ,/ate law :]e ! c>e
 is deliv]$ & ! in/ructions provid$ by  
legally au?oriz$ repres5tatives 9       
accordance ) ,/ate law2 &  7ii7 9 !     
abs5ce ( a curr5t advance directive or  
portable treatm5t ord] t is valid "u    
,/ate law :]e ! c>e is deliv]$ or       
in/ructions provid$ by a legally        
au?oriz$ repres5tative 9 accordance )   
,/ate law1 to deliv] treatm5t bas$ on   
cr$ible evid5ce ( ! individual's        
treatm5t pref]5ces1 goals1 & values1 :i*
 evid5ce may include a curr5t advance   
directive or portable treatm5t ord]     

execut$ 9 ano!r ,/ate2  7,f7 t specify  
conditions or circum/ances "u :i* an    
advance directive1 portable treatm5t    
ord]1 or treatm5t directions f an       
individual or legally au?oriz$          
repres5tative w\ld n be foll[$2  2  7v7 
9 subp>agraph 7,h71 z r$esignat$ by     
subp>agraph 7,c71 by /rik+ ,/ate law &  
all t foll[s ?r\gh respect+ & ins]t+ ?is
 section & relevant ,/ate & ,f$]al law  
respect+2  7vi7 9 subp>agraph 7,i71 z   
r$esignat$ by subp>agraph 7,c71 by      
ins]t+ & portable treatm5t ord]s be=e ! 
p]iod at ! end2  7vii7 9 ! flu% matt] at
 ! end1 by /rik+ 7,c7 & ins]t+ 7,g72 &  
7viii7 by add+ at ! end ! foll[+ new    
s5t5ce3 ,no?+ 9 subp>agraph 7,d7 or 7,e7
 %all be con/ru$ to apply to a reque/ or
 directive ord]+ a /]ilization or       
abortion or ord]+ )drawal ( treatm5t f a
 pregnant woman if cont9u$ treatm5t c   
reasonably be expect$ to br+ h] *ild to 
live bir?42  7,b7 by r$esignat+         
p>agraphs 7#c7 & 7#d7 z p>agraphs 7#d7 &
 7#e71 respectively2  7,c7 by ins]t+    

aft] p>agraph 7#b7 ! foll[+ new         
p>agraph3  7#c7 ,no?+ 9 ?is section %all
 be con/ru$ to prohibit ! application ( 
a ,/ate law :i* all[s = an objection on 
! basis ( consci5ce = any heal? c>e     
provid] or any ag5t ( su* provid] :i* z 
a matt] ( consci5ce _c implem5t an      
advance directive or portable treatm5t  
ord]4  2  7,d7 9 p>agraph 7#d71 z       
r$esignat$ by p>agraph 7#b7--  7i7 by   
/rik+ a writt5 & ins]t+ an2  7ii7 by    
/rik+ ,/ate law & ins]t+ ,/ate or ,f$]al
 law2 &  7iii7 by /rik+ ( ! ,/ate2  7,e7
 by r$esignat+ p>agraph 7#e71 z         
r$esignat$ by p>agraph 7#b71 z p>agraph 
7#f72  7,f7 by ins]t+ aft] p>agraph 7#d7
 ! foll[+ new p>agraph3  7#e7 ,9 ?is    
subsection1 ! t]m portable treatm5t ord]
 means a treatm5t ord] design$ to       
docum5t a cl9ical process t includes    
%>$1 in=m$ m$ical decisionmak+1 t       
reflects ! individual's goals ( c>e &   
values1 & t is design$ to apply across  
c>e sett+s1 includ+ ! home4  2 &  7,g7  
by ins]t+ aft] p>agraph 7#f71 z         

r$esignat$ by p>agraph 7#f71 ! foll[+   
new p>agraph3  7#g7 ,no?+ 9 ?is         
subsection %all p]mit ! ,secret>y to    
seek civil p5alties1 includ+ exclusion f
 p>ticipation 9 ! program "u ?is title  
or ! program "u title ,,xix1 aga9/ a    
provid] or organization if ! provid] or 
organization--  7,a7 us$ reasonable     
ef=ts to deliv] c>e t is consi/5t ) an  
individual's goals1 pref]5ces1 & values 
:5 address+ decisionmak+ = an individual
 :o lacks decisional capacity2 or  7,b7 
ex]cis$ its "r ( consci5ce 9 accordance 
) p>agraph 7#c74  4  7#b7 ,effective    
date ,! am5dm5ts made by p>agraph 7#a7  
%all apply to provid] agreem5ts &       
contracts ent]$ into1 r5ew$1 or ext5d$  
"u title ,,xviii ( ! ,social ,security  
,act on or aft] su* date z ! ,secret>y (
 ,heal? & ,human ,s]vices specifies1 b 9
 no case may su* date be lat] ?an #a ye>
 aft] ! date ( ! enactm5t ( ?is ,act4   
7#c7 ,rule ( con/ruction ,no?+ 9 !      
provisions (1 or ! am5dm5ts made by1 ?is
 subsection %all be con/ru$ to require a

 provid] ( s]vices or an organization to
 act 9 a mann] contr>y to its religi\s  
or moral convictions4  7b7 ,cl>ification
 ) respect to advance directives        
,p>agraph 7#b7 ( section #g ( ! ,assi/$ 
,suicide ,fund+ ,re/riction ,act ( #aiig
 7#db ,u4,s4,c4 #addjf7 is am5d$ to read
 z foll[s3  7#b7 to require any provid] 
or organization1 or any employee ( su* a
 provid] or organization1 to foll[ or be
 b\nd by a reque/ f an individual or    
legally au?oriz$ repres5tative1 an      
advance directive1 or a portable        
treatm5t ord] t directs ! purposeful    
caus+ (1 or ! purposeful assi/+ 9 caus+1
 ! dea? ( any individuals1 su* z by     
assi/$ suicide1 eu?anasia1 or m]cy      
kill+4  4  #g4 ,additional requirem5ts =
 facilities  7a7 ,requirem5ts  7#a7 ,9  
g5]al ,section #ahff7;a77#a7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acie;cc7a77#a77 is am5d$--  7,a7 9     
subp>agraph 7,v71 by /rik+ & at ! end2  
7,b7 9 subp>agraph 7,w71 z add$ by      
section #cjje7a77;,c7 ( ! ,pati5t       

,protection & ,af=dable ,c>e ,act       
7,public ,law #aaa-adh71 by r$esignat+  
su* subp>agraph z subp>agraph 7,x71 mov+
 su* subp>agraph to foll[ subp>agraph   
7,v71 mov+ su* subp>agraph #b ems to !  
left1 & /rik+ ! p]iod at ! end & ins]t+ 
a comma2  7,c7 9 subp>agraph 7,w71 z    
add$ by section #fdjf7;b77#c7 ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act 7,public ,law #aaa-adh71 by        
r$esignat+ su* subp>agraph z subp>agraph
 7,y71 mov+ su* subp>agraph to foll[    
subp>agraph 7,x71 z add$ by subp>agraph 
7,b71 mov+ su* subp>agraph #b ems to !  
left1 & /rik+ ! p]iod at ! end & ins]t+ 
1 &2 &  7,d7 by ins]t+ aft] subp>agraph 
7,y7 ! foll[+ new subp>agraph3  7,z7 9 !
 case ( hospitals1 skill$ nurs+         
facilities1 home heal? ag5cies1 &       
hospice programs1 to assure t docum5t$  
c>e plans include any advance directives
 or portable treatm5t ord]s made :ile ! 
individual receiv$ c>e by ! provid] & t 
su* plan is s5t to ! individual's prim>y
 c>e provid] ^u dis*>ge & any facility  

to :i* ! individual is transf]r$4  4    
7#b7 ,effective ,date ,! am5dm5ts made  
by ?is subsection %all apply to         
agreem5ts ent]$ into or r5ew$ on or aft]
 ,janu>y #a1 #bjag4  7b7 ,,hhs /udy &   
report  7#a7 ,/udy ,! ,secret>y ( ,heal?
 & ,human ,s]vices %all conduct a /udy  
on ! ext5t to :i* hospitals1 skill$     
nurs+ facilities1 hospice programs1 home
 heal? ag5cies1 & applicable provid]s ( 
plann+ s]vices "u section #ahfa7;iii7 ( 
! ,social ,security ,act1 z add$ by     
section #c7;a71 "w ) individuals to--   
7,a7 engage 9 a c>e plann+ process2     
7,b7 ?or\ghly & completely docum5t ! c>e
 plann+ process 9 ! m$ical record2  7,c7
 complete docum5ts necess>y to support !
 treatm5t & c>e plan1 su* z portable    
treatm5t ord]s & advance directives2    
7,d7 provide s]vices & support t is free
 f discrim9ation bas$ on advanc$ age1   
disability /atus1 or advanc$ illness2 & 
7,e7 provide docum5tation necess>y to   
c>ry out ! treatm5t plan to--  7i7      
subsequ5t provid]s or facilities2 &     

7ii7 ! individual1 _! legally au?oriz$  
repres5tatives1 &1 :]e appropriate &    
relevant1 _! family c>egiv]4  7#b7      
,report ,n lat] ?an ,janu>y #a1 #bjbj1 !
 ,secret>y ( ,heal? & ,human ,s]vices   
%all submit to ,congress a report on !  
/udy conduct$ "u p>agraph 7#a7 toge!r ) 
recomm5dations = su* legislation &      
adm9i/rative action z ! ,secret>y       
det]m9es to be appropriate4  #h4 ,grants
 = increas+ public aw>5ess ( advance c>e
 plann+ & advanc$ illness c>e  7a7      
,mat]ial & res\rces developm5t  7#a7 ,9 
g5]al ,! ,secret>y ( ,heal? & ,human    
,s]vices 79 ?is section ref]r$ to z !   
,secret>y7 is au?oriz$ to aw>d grants to
 entities describ$ 9 subsection 7d7 to  
develop onl9e tra9+ modules1 decision   
support tools1 & in/ructional mat]ials =
 individuals1 family c>egiv]s1 & heal?  
c>e provid]s t include--  7,a7 = heal?y 
individuals1 ! importance (--  7i7      
id5tify+ an individual :o w make        
treatm5t decisions 9 ! ev5t ( future    
cognitive incapacity2  7ii7 discuss+    

values & goals relevant to cata/rophic  
injury or illness2 &  7iii7 complet+ an 
advance directive t--  7,i7 appo9ts a   
surrogate2 &  7,,ii7 docum5ts goals &   
values & o!r in=mation t %\ld be        
consid]$ 9 mak+ treatm5t decisions2     
7,b7 = individuals ) advanc$ illness1 ! 
importance (--  7i7 articulat+ goals (  
c>e2  7ii7 und]/&+ prognosis & typical  
disease trajectory2  7iii7 evaluat+     
treatm5t options 9 light ( goals ( c>e2 
7iv7 develop+ a treatm5t plan2 &  7v7   
docum5t+ ! treatm5t plan on advance     
directives1 portable treatm5t ord]s1 &  
o!r docum5tation =ms us$ 9 ! locality   
:]e ! plan is to be execut$2  7,c7 !    
role & effective use ( ,/ate & o!r      
advance directive =ms & portable        
treatm5t ord]s2 &  7,d7 ! range (       
s]vices = individuals fac+ advanc$      
illness1 includ+ plann+ s]vices1        
palliative c>e1 & hospice c>e4  7#b7    
,p]iod ,any grant aw>d$ "u p>agraph 7#a7
 %all be = a p]iod ( #c ye>s4  7b7      
,e/abli%m5t & ma9t5ance ( web- &        

telephone-,bas$ res\rces  7#a7 ,9 g5]al 
,! ,secret>y is au?oriz$ to aw>d grants 
to entities describ$ 9 subsection 7d7 to
 e/abli% & ma9ta9 a website & telephone 
hotl9e to dissem9ate res\rces develop$  
"u subsection 7a7 & mat]ials design$ by 
! ,dep>tm5t ( ,heal? & ,human ,s]vices  
,c5t] = ,fai?-,bas$ & ,neighborhood     
,p>tn]%ips = fai? communities4  7#b7    
,p]iod ,any grant aw>d$ "u p>agraph 7#a7
 %all be = a p]iod ( #e ye>s4  7#c7     
,ability to su/a9 activities ,!         
,secret>y %all take into acc\nt !       
ability ( an entity to su/a9 !          
activities describ$ 9 p>agraph 7#a7     
beyond ! #e-ye> grant p]iod 9 det]m9+   
:e!r to aw>d a grant "u p>agraph 7#a7 to
 ! entity4  7c7 ,national public        
education campaign  7#a7 ,9 g5]al ,!    
,secret>y is au?oriz$ to aw>d grants to 
entities describ$ 9 subsection 7d7 to   
conduct a national public education     
campaign to raise public aw>5ess (      
advance c>e plann+ & advanc$ illness    
c>e1 includ+ ! availability ( ! res\rces

 creat$ "u subsections 7a7 & 7b74  7#b7 
,p]iod ,any grant aw>d$ "u p>agraph 7#a7
 %all be = a p]iod ( #e ye>s4  7d7      
,eligible entities ,entities describ$ 9 
?is subsection are public or private    
entities 7includ+ ,/ates or political   
subdivisions ( a ,/ate1 fai?-bas$       
organizations1 & religi\s educational   
in/itutions71 or a consortium ( any su* 
entities4  7e7 ,au?orization (          
appropriations  7#a7 ,9 g5]al ,!re are  
au?oriz$ to be appropriat$ to !         
,secret>y--  7,a7 = purposes ( mak+     
grants "u subsection 7a71 #e1jjj1jjj =  
fiscal ye> #bjag1 to rema9 available    
until exp5d$2  7,b7 = purposes ( mak+   
grants "u subsection 7b71 #e1jjj1jjj =  
fiscal ye> #bjag1 to rema9 available    
until exp5d$2 &  7,c7 = purposes ( mak+ 
grants "u subsection 7c71 #e1jjj1jjj =  
fiscal ye> #bjag to rema9 available     
until exp5d$4  7#b7 ,limitation ,none ( 
! funds appropriat$ "u p>agraph 7#a7    
%all be us$ to--  7,a7 develop a model  
advance directive2  7,b7 develop or     

employ a doll>s-p]-quality adju/$ life  
ye> 7or simil> measure t disc\nts !     
value ( a life because ( an individual's
 disability72 or  7,c7 make a grant to a
 private entity t advocates1 promotes1  
or facilitates any item or proc$ure =   
:i* fund+ is unavailable "u ! ,assi/$   
,suicide ,fund+ ,re/riction ,act ( #aiig
 7,public ,law #aje-ab74  #i4 ,rule (   
con/ruction ,no?+ 9 ! provisions (1 or !
 am5dm5ts made by1 ?is ,act %all be     
con/ru$ to limit ! re/rictions (1 or to 
au?orize ! use ( ,f$]al funds = any     
s]vice1 mat]ial1 or activity p]ta9+ to  
an item or s]vice or proc$ure = :i*     
funds are unavailable "u1 ! ,assi/$     
,suicide ,fund+ ,re/riction ,act ( #aiig
 7,public ,law #aje-ab74