,,ii  #aad? ,,congress  #b;d ,session   
,s4 #bifa  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #ai1 #bjaf ,mr4   
,blum5?al 7= himself & ,mrs4 ,capito7   
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to improve end-(-life c>e4  
#a4 ,%ort title  7a7 ,%ort title  ,?is  
,act may be cit$ z ! ,compassionate ,c>e
 ,act4  7b7 ,table ( cont5ts ,! table ( 
cont5ts ( ?is ,act is z foll[s3 ,sec4   
#a4 ,%ort title4 ,sec4 #b4 ,def9itions4 
,,title ,i--,advance c>e plann+         
,subtitle ,a--,consum] education ,sec4  
#aja4 ,advance c>e plann+ guidel9es4    
,sec4 #ajb4 ,national public education  
campaign4 ,subtitle ,b--,provid]        
education ,sec4 #aaa4 ,public provid]   
advance c>e plann+ website4 ,sec4 #aab4 
,advance c>e curricula pilot program4   
,sec4 #aac4 ,developm5t ( core          
end-(-life c>e quality measures across  
ea* relevant provid] sett+4 ,sec4 #aad4 
,cont9u+ education = qualifi$ heal? c>e 

provid]s4 ,,title ,,ii--,reports1       
rese>*1 & evaluations ,sec4 #bja4       
,demon/ration projects = use (          
telem$ic9e s]vices 9 advance c>e plann+4
 ,sec4 #bjb4 ,/udy & report by !        
,secret>y reg>d+ ! e/abli%m5t &         
implem5tation ( a national uni=m policy 
on advance directives4 ,sec4 #bjc4 ,gao 
/udy & report on e/abli%m5t ( national  
advance directive regi/ry2 o!r /udies4  
#b4 ,def9itions ,9 ?is ,act3  7#a7      
,advance c>e plann+ ,! t]m advance c>e  
plann+ means ! process ( discussion (   
end-(-life c>e1 cl>ification ( relat$   
values & goals1 & embodim5t ( pref]5ces 
?r\gh writt5 docum5ts & m$ical ord]s4   
7#b7 ,advance directive ,! t]m advance  
directive means a writt5 or o!rwise     
record$ in/ruction1 su* z a liv+ w or   
durable p[] ( attorney = heal? c>e1     
recogniz$ "u ! law ( ! ,/ate 9 :i* x 0  
execut$ 7:e!r /atutory or z recogniz$ by
 ! c\rts ( ! ,/ate7 & relat+ to !       
provision ( su* c>e :5 ! individual is  
incapacitat$4  7#c7 ,,*ip ,! t]m ,,*ip  

means ! ,/ate ,*ildr5's ,heal?          
,insurance ,program "u title ,,xxi ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acig;aa et seq47  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
 prep>ations = an imp5d+ dea?4  7#e7    
,heal? c>e ag5t ,! t]m heal? c>e ag5t   
means ! p]son1 designat$ 9 a heal? c>e  
p[] ( attorney1 :o is select$ to make   
m$ical decisions on behalf ( ! p]son :o 
execut$ su* p[] ( attorney1 9 ! case (  
incapacity ( su* p]son :o execut$ ! p[] 
( attorney4  7#f7 ,heal? c>e p[] (      
attorney ,! t]m heal? c>e p[] ( attorney
 means a legal docum5t t id5tifies !    
heal? c>e ag5t ( ! p]son execut+ su*    
docum5t4  7#g7 ,liv+ w ,! t]m liv+ w    
means a writt5 docum5t or a video       
/atem5t ab\t ! k9ds ( m$ical c>e or o!r 
c>e a p]son does or does n want "u c]ta9
 specific conditions1 9 ! ev5t t su*    
p]son no long] is able to express ^?    
wi%es4  7#h7 ,m$icaid ,! t]m ,m$icaid   

means ! program e/abli%$ "u title ,,xix 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif et seq474  7#i7 ,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#aj7 ,ord]s = life-su/a9+ treatm5t ,!  
t]m ord]s = life-su/a9+ treatm5t means a
 set ( portable m$ical ord]s 7su* z     
physician ord]s = life-su/a9+ treatm5t  
or simil> portable m$ical ord]s7 t      
address key m$ical decisions consi/5t ) 
! pati5t's goals ( c>e & results f a    
cl9ical process design$ to facilitate   
%>$1 in=m$ m$ical decisionmak+ &        
communication betwe5 qualifi$ heal? c>e 
pr(essionals & pati5ts ) s]i\s1         
progressive illness or frailty4  7#aa7  
,qualifi$ heal? c>e provid] ,! t]m      
qualifi$ heal? c>e provid] means a      
m$ical doctor1 doctor ( o/eopa?y1 nurse1
 physician assi/ant1 nurse practition]1 
social work]1 home heal? aide1          
palliative c>e pr(essional1 or          
individual 9 a simil> position1 z       

designat$ by ! ,secret>y4  7#ab7        
,secret>y ,! t]m ,secret>y means !      
,secret>y ( ,heal? & ,human ,s]vices4   
,i ,advance c>e plann+  ,a ,consum]     
education  #aja4 ,advance c>e plann+    
guidel9es ,x is ! s5se ( ! ,s5ate t1 to 
! ext5t practicable1 advance c>e plann+ 
%\ld--  7#a7 occur ) an individual & su*
 individual's heal? c>e ag5t1 prim>y    
cl9ician1 o!r au?oriz$ decisionmak]1 or 
memb]s ( ! entire int]discipl9>y heal?  
c>e team2  7#b7 be record$ & updat$ z   
ne$$2 &  7#c7 all[ = flexible           
decisionmak+ 9 ! context ( ! pati5t's   
m$ical situation1 9 accordance )        
guidel9es provid$ by ! ,secret>y4  #ajb4
 ,national public education campaign    
7a7 ,national public education campaign 
7#a7 ,9 g5]al ,n lat] ?an ,janu>y #a1   
#bjag1 ! ,secret>y1 act+ ?r\gh !        
,director ( ! ,c5t]s = ,disease ,control
 & ,prev5tion & 9 consultation ) public 
& private entities1 z ! ,secret>y       
det]m9es appropriate1 %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 decisions affect+ su*        
individual4  7#b7 ,cont5t ( educational 
campaign ,! national public education   
campaign e/abli%$ "u p>agraph 7#a7 may--
 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 ! ,int]net ,websites ( !   
,dep>tm5t ( ,heal? & ,human ,s]vice's   
,national ,cle>+h\se = ,long-,t]m ,c>e  
,in=mation1 ! ,adm9i/ration = ,*ildr5 & 
,families1 ! ,adm9i/ration = ,community 
,liv+1 & ! ,c5t]s = ,m$ic>e  ,m$icaid   
,s]vices2  7,e7 address ! importance (  
individuals speak+ to family memb]s1    
heal? c>e proxies1 & qualifi$ heal? c>e 
provid]s z "p ( an ongo+ dialogue reg>d+

 heal? c>e *oices2  7,f7 address ! ne$ =
 individuals to communicate _! heal? c>e
 goals & wi%es ?r\gh a v>iety ( means1  
includ+ ! use ( readily available legal 
& m$ical docum5ts t express _! heal? c>e
 decisions 9 ! =m ( advance directives  
7includ+ liv+ wills1 ord]s = life-su/a9+
 treatm5t1 & durable p[]s ( attorney =  
heal? c>e72  7,g7 raise public aw>5ess  
reg>d+ ! availability ( hospice &       
palliative c>e & ! quality ( life       
b5efits ( e>ly use ( su* s]vices2 &     
7,h7 enc\rage individuals to speak )    
qualifi$ heal? c>e pr(essionals ab\t _! 
options & int5tions = end-(-life c>e4   
7#c7 ,evaluation ,n lat] ?an ,july #a   
#bjai1 ! ,secret>y %all report to !     
appropriate committees ( ,congress on ! 
effectiv5ess ( ! public education       
campaign "u ?is section1 & include 9 su*
 report any recomm5dations t ! ,secret>y
 det]m9es appropriate reg>d+ ! ne$ =    
cont9uation ( legislative or            
adm9i/rative *anges to facilitate *ang+ 
public aw>5ess1 attitudes1 & behaviors  

reg>d+ advance c>e plann+4  7b7 ,repeal 
,section #dgea7;d7 ( ! ,omnibus ,budget 
,reconciliation ,act ( #aiij 7#db       
,u4,s4,c4 #acif;a note2 ,public ,law    
#aja-ejh7 is repeal$4  ,b ,provid]      
education  #aaa4 ,public provid] advance
 c>e plann+ website  7a7 ,developm5t ,n 
lat] ?an ,janu>y #a1 #bjah1 ! ,secret>y1
 act+ ?r\gh ! ,adm9i/rator ( ! ,c5t]s = 
,m$ic>e  ,m$icaid ,s]vices & ! ,director
 ( ! ,ag5cy = ,heal?c>e ,rese>* &       
,quality1 %all e/abli% an1 or exp& ^u an
 exi/+1 ,int]net ,website = provid]s "u 
,m$ic>e1 ,m$icaid1 ,,*ip1 ! ,indian     
,heal? ,s]vice 7includ+ contract        
provid]s71 & o!r qualifi$ heal? c>e     
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 & engage 9 advance   
c>e plann+4  7b7 ,ma9t5ance ,! ,int]net 
,website describ$ 9 subsection 7a7 %all 
be ma9ta9$ & publiciz$ by ! ,secret>y on
 an ongo+ basis4  7c7 ,cont5t ,!        
,int]net ,website may include cont5t1   

tools1 & res\rces necess>y to d !       
foll[+3 7#a7 ,in=m qualifi$ heal? c>e   
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 qualifi$ heal? c>e provid]s
 to--  7,a7 integrate advance c>e plann+
 docum5ts into electronic heal? records1
 includ+ oral directives2 &  7,b7       
develop & dissem9ate advance c>e plann+ 
in=mational mat]ials = pati5ts4  7#d7   
,in=m qualifi$ heal? c>e provid]s ab\t  
advance c>e plann+ cont9u+ education    
requirem5ts & opportunities4  7#e7      
,enc\rage qualifi$ heal? c>e provid]s to
 discuss advance c>e plann+ ) pati5ts ( 
all ages4  7#f7 ,assi/ qualifi$ heal?   
c>e provid]s' und]/&+ ( ! cont9uum (    
end-(-life c>e s]vices & supports       
available to pati5ts1 includ+ palliative
 c>e & hospice4  7#g7 ,in=m qualifi$    

heal? c>e provid]s ( be/ practices =    
discuss+ end-(-life c>e ) dy+ pati5ts & 
_! lov$ ones4  #aab4 ,advance c>e       
curricula pilot program  7a7 ,9 g5]al ,!
 ,secret>y1 9 consultation ) appropriate
 pr(essional associations1 %all e/abli% 
a pilot program by :i* ! ,secret>y aw>ds
 grants to eligible entities t require a
 m9imum am\nt ( end-(-life tra9+ z a    
requirem5t = obta9+ a degree f su*      
entity4  7b7 ,eligibility ,to be        
eligible to p>ticipate 9 ! pilot program
 "u ?is section1 an entity %all-- 7#a7  
be a s*ool ( m$ic9e1 s*ool ( o/eopa?ic  
m$ic9e1 a physician assi/ant education  
program 7z def9$ 9 section #gii;,b7#c7 (
 ! ,public ,heal? ,s]vice ,act 7#db     
,u4,s4,c4 #biep7#c7771 a s*ool ( alli$  
heal? 7z def9$ 9 section #gii;,b7#d7 ( !
 ,public ,heal? ,s]vice ,act7#db        
,u4,s4,c4 #biep7#d7771 a s*ool ( nurs+1 
a s*ool ( social "w1 a graduate m$ical  
education program accr$it$ by !         
,accr$itation ,c\ncil = ,graduate       
,m$ical ,education or ! ,am]ican        

,o/eopa?ic ,association1 or o!r s*ool1 z
 ! ,secret>y det]m9es appropriate2  7#b7
 be /aff$ by tea*+ heal? pr(essionals :o
 h exp]i5ce or tra9+ 9 palliative       
m$ic9e2  7#c7 provide tra9+ 9 palliative
 m$ic9e ?r\gh a v>iety ( s]vice         
rotations1 su* z consultation s]vices1  
acute c>e s]vices1 ext5d$ c>e           
facilities1 ambulatory c>e &            
compreh5sive evaluation units1 hospice1 
home heal?1 & community c>e programs2   
7#d7 develop specific p]=mance-bas$     
measures to evaluate ! compet5cy (      
tra9ees2 &  7#e7 ensure t by n lat] ?an 
! end ( ! #b-ye> p]iod beg9n+ on ! date 
( enactm5t ( ?is ,act1 pr(essionals :o  
are applicable faculty at ! entity1 or  
o!rs z det]m9$ appropriate by !         
,secret>y1 %all be (f]$ retra9+ 9       
hospice & palliative m$ic9e4  7c7 ,tra9+
 ,eligible entities p>ticipat+ 9 ! pilot
 program "u ?is section %all require    
m9imum tra9+ = tra9ees t includes--     
7#a7 tra9+ 9 h[ to discuss & help       
pati5ts & _! lov$ ones ) advance c>e    

plann+2  7#b7 ) respect to 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$ical & legal      
issues tra9+ associat$ ) end ( life c>e2
  7#f7 tra9+ 9 cultural compet5cy2 &    
7#g7 9 ! case ( a graduate m$ical       
education program accr$it$ by !         
,accr$itation ,c\ncil = ,graduate       
,m$ical ,education or ! ,am]ican        
,o/eopa?ic ,association1 a longitud9al  
compon5t ( at lea/ #f mon?s4  7d7       
,reports ,ea* recipi5t ( a grant "u ?is 
section %all report to ! ,secret>y on ! 
outcomes ( ! program )9 #ah mon?s (     
receipt ( ! f9al allotm5t ( grant funds4
 ,n lat] ?an #a ye> aft] receipt ( all  
su* reports1 ! ,secret>y %all submit to 
,congress a report compil+ su* results f
 all grant recipi5ts4  #aac4 ,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 )
 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices1 %all require !       
developm5t ( specific end-(-life quality
 measures = ea* relevant qualifi$ heal? 
c>e 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 bas$ on  
an assessm5t ( :at is likely to h !     
greate/ positive impact on quality (    
end-(-life c>e 9 t sett+1 & made 9      
consultation ) affect$ provid]s1        
pati5ts1 & 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/rator1 & %all be

 pati5t-ori5t$4  7#c7 ,! ,adm9i/rator   
%all ensure t report+ requirem5ts relat$
 to su* measures are impos$ consi/5tly )
 o!r applicable laws & regulations1 & 9 
a mann] t takes into acc\nt exi/+       
measures1 ! ne$s ( pati5t populations1 !
 specific s]vices provid$1 & ! pot5tial 
adm9i/rative burd5 to provid]s4  7#d7 ,n
 lat] ?an-- 7,a7 ,april #a1 #bjag1 !    
,secret>y %all dissem9ate ! report+     
requirem5ts to all affect$ provid]s &   
provide = a #fj-;day p]iod = public     
comm5t2 &  7,b7 ,april #a1 #bjah1       
initial report+ by heal? c>e provid]s   
relat+ to ! measures %all beg94  #aad4  
,cont9u+ education = qualifi$ heal? c>e 
provid]s  7a7 ,9 g5]al ,n lat] ?an      
,janu>y #a1 #bjah1 ! ,secret>y1 act+    
?r\gh ! ,director ( ,heal? ,res\rces &  
,s]vices ,adm9i/ration1 %all approve    
exi/+ & develop1 9 consultation )       
qualifi$ heal? c>e provid]s1 o!r        
pr(essionals z ! ,secret>y det]m9es     
appropriate1 & ,/ate bo>ds ( m$ic9e &   
nurs+1 new curricula on advance c>e     

plann+ & end-(-life c>e = cont9u+       
education t ,/ates may adopt = qualifi$ 
heal? c>e provid]s4  7b7 ,cont5t  ,!    
cont9u+ education curriculum develop$ "u
 subsection 7a7 %all1 at a m9imum1      
include--  7#a7 a description ( ! mean+ 
& importance ( advance c>e plann+2  7#b7
 a description ( advance c>e plann+     
docum5ts1 includ+ liv+ wills & durable  
p[]s ( attorney1 & ! use ( su*          
directives2  7#c7 ! appropriate use (   
ord]s = scope ( treatm5t2  7#d7 c\nsel+ 
skills = :5 & h[ to introduce & engage 9
 advance c>e plann+ ) pati5ts & _! lov$ 
ones2  7#e7 palliative c>e pr9ciples &  
approa*es to c>e2  7#f7 ! cont9uum (    
end-(-life s]vices & supports1 includ+  
palliative c>e & hospice2 &  7#g7 !     
importance ( introduc+ palliative c>e & 
hospice e>ly 9 illness 9 ord] to improve
 quality ( life4  ,,ii ,reports1 rese>*1
 & evaluations  #bja4 ,demon/ration     
projects = use ( telem$ic9e s]vices 9   
advance c>e plann+  7a7 ,9 g5]al ,n lat]
 ?an ,july #a1 #bjai1 ! ,secret>y %all  

e/abli% a demon/ration program to       
reimburse eligible entities = co/s      
associat$ ) ! use ( telem$ic9e s]vices  
7includ+ equipm5t & connection co/s7 to 
provide advance c>e plann+ ?r\gh        
telem$ic9e consultations )              
geographically di/ant provid]s & _!     
pati5ts4  7b7 ,duration ,! demon/ration 
project "u ?is section %all be conduct$ 
= at lea/ a #c-ye> p]iod4  7c7 ,report  
,n lat] ?an ,m>* #ae1 #bjag1 ! ,secret>y
 %all1 us+ quantitative & qualitative   
rese>* me?ods1 submit a report to       
,congress on ! /atus ( telem$ic9e       
programs1 includ+ in=mation t           
id5tifies--  7#a7 ! teleheal? s]vices = 
:i* paym5t c be made1 z ( ! date ( !    
enactm5t ( ?is ,act1 "u ! fee-=-s]vice  
program "u p>ts ,a & ,b ( title ,,xviii 
( ! ,social ,security ,act2  7#b7 !     
teleheal? s]vices = :i* paym5t c be     
made1 z ( su* date1 "u private heal?    
insurance plans2  7#c7 ) respect to     
s]vices id5tifi$ "u p>agraph 7#b7 b n "u
 p>agraph 7#a71 ways 9 :i* paym5t = su* 

s]vices might be incorporat$ into su*   
fee-=-s]vice program 7includ+ any       
recomm5dations = ways to accompli% ?is  
incorporation72 &  7#d7 any legal or    
regulatory *all5ges to exp&+ teleheal?  
s]vices1 & any promis+ solutions to su* 
*all5ges4  7d7 ,def9itions ,= purposes (
 ?is section3 7#a7 ,! t]m eligible      
entity means an academic m$ical c5t]1 a 
m$ical s*ool1 a ,/ate heal? dep>tm5t1 a 
,/ate m$ical association1 a multi-,/ate 
task=ce1 a hospital1 a home heal? ag5cy1
 or a heal? sy/em or coalition (        
/akehold]s capable ( adm9i/]+ a program 
= ord]s reg>d+ life-su/a9+ treatm5t = a 
,/ate or locality4  7#b7 ,! t]m         
geographically di/ant has ! mean+ giv5 t
 t]m by ! ,secret>y = purposes (        
conduct+ ! demon/ration program e/abli%$
 "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     
7includ+ ! family c>egiv] ( ! pati5t if 

! pati5t agrees7 or a qualifi$ heal? c>e
 provid] at a sep>ate location ?r\gh    
real-"t videoconf]enc+1 or a simil>     
=mat1 = ! purpose ( provid+ heal? c>e   
diagnosis & treatm5t4  7e7 ,au?orization
 ( appropriations ,!re are au?oriz$ to  
be appropriat$ to ! ,secret>y su* sums z
 may be necess>y to c>ry out ?is        
section4 ,any funds made available "u   
?is section %all be us$ to supplem5t1 n 
supplant1 o!r ,f$]al1 ,/ate1 & local    
fund+ provid$ = telem$ic9e s]vices4     
#bjb4 ,/udy & report by ! ,secret>y     
reg>d+ ! e/abli%m5t & implem5tation ( a 
national uni=m policy on advance        
directives  7a7 ,/udy  7#a7 ,9 g5]al ,! 
,secret>y1 act+ ?r\gh ! ,(fice ( !      
,assi/ant ,secret>y = ,plann+ &         
,evaluation1 %all conduct a /udy to     
evaluate ! b>ri]s to e/abli%+ &         
implem5t+ a national uni=m policy on    
advance directives & :at ne$s to be done
 to ov]come ^? b>ri]s4  7#b7 ,matt]s    
/udi$ ,! matt]s /udi$ by ! ,secret>y "u 
p>agraph 7#a7 may 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 "o heal? c>e sett+ to      
ano!r2  7,c7 ! feasibility ( e/abli%+ an
 optional1 national advance directive =m
 deem$ valid by any heal? c>e entity or 
qualifi$ heal? c>e provid] p>ticipat+ 9 
,m$ic>e1 ,m$icaid1 or ,,*ip1 reg>dless (
 ,/ate law2 &  7,d7 ,/ate v>iations 9   
advance directive laws t are relevant to
 ! e/abli%m5t & implem5tation ( a       
national uni=m policy ( advance         
directives4  7b7 ,report to congress ,n 
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