,,ii  #aad? ,,congress  #b;d ,session   
,s4 #cjif  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bc1 #bjaf ,mr4  
,:iteh\se 7= himself & ,ms4 ,w>r57      
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to e/abli% a pilot 
program promot+ an alt]native paym5t    
model = p]son-c5t]$ c>e = ,m$ic>e       
b5efici>ies ) advanc$ illnesses4  #a4   
,%ort title  ,?is ,act may be cit$ z !  
,remov+ ,b>ri]s to ,p]son-,c5t]$ ,c>e   
,act ( #bjaf4  #b4 ,id5tification &     
developm5t ( advance c>e quality        
measures  7a7 ,9 g5]al ,! ,secret>y (   
,heal? & ,human ,s]vices 7ref]r$ to 9   
?is ,act z ! ,secret>y71 9 consultation 
) ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e   
,m$icaid ,s]vices1 ! ,director ( !      
,ag5cy = ,heal?c>e ,rese>* & ,quality   
,s]vices1 & ! entity ) a contract "u    
section #ahij7;a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acie;aaa7a771 %all 
id5tify & develop a recomm5d$ set ( n m 
?an #bj advance c>e quality measures =  

,m$ic>e b5efici>ies t may be te/$ 91 &  
all[ = ! assessm5t (1 ! pilot program   
e/abli%$ "u subp>agraph 7,d7 ( section  
#aaae;,a7b77#b7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acae;a7b77#b771 z  
add$ by section #c4 ,su* set ( quality  
measures %all include outcome1          
/ructural1 & process measures 9 ! foll[+
 categories3  7#a7 ,pati5t & family     
exp]i5ce ( c>e4  7#b7 ,access to ne$$   
s]vices 7m$ical & supportive71 su* z    
timely ref]ral to hospice4  7#c7        
,completion ( c>e plann+ docum5tation1  
su* z heal? c>e proxies1 advance        
directives1 & portable treatm5t ord]s4  
7#d7 ,consi/5cy ( c>e ) docum5t$ c>e    
pref]5ces4  7#e7 ,scre5+ = physical     
symptoms1 su* z dyspnea1 nausea1 &      
con/ipation4  7#f7 ,utilization ( heal? 
c>e & support s]vices4  7b7 ,process =  
id5tify+ & develop+ quality measures ,9 
id5tify+ & develop+ ! quality measures  
describ$ 9 subsection 7a71 ! ,secret>y  
%all take ! foll[+ actions3  7#a7       
,id5tify exi/+ measures ,id5tify exi/+  

quality measures t are 9 use "u public &
 privately sponsor$ heal? c>e           
arrangem5ts4  7#b7 ,developm5t (        
measures ,ent] into grants1 contracts1  
or int]gov]nm5tal agreem5ts ) eligible  
entities = ! purposes ( develop+ quality
 measures 7:i* may include improv+ exi/+
 quality measures7 t1 to ! ext5t        
practicable1 all[ = ! use ( heal?       
in=mation te*nologies 9 collect+ data   
relat+ to su* quality measures4  7c7    
,publication & report ,n lat] ?an       
,janu>y #a1 #bjah1 ! ,secret>y %all--   
7#a7 publi% an initial core set (       
quality measures2 &  7#b7 submit a      
report to ,congress t-- 7,a7 evaluates !
 set ( quality measures publi%$ "u      
p>agraph 7#a72 &  7,b7 includes a       
/rategy = designat+ a core set ( quality
 measures on advance illness c>e t may  
be us$ across public & private pay]s &  
elim9at+ r$undant measures t are n "p ( 
! core set4  7d7 ,fund+ ,!re are        
au?oriz$ to be appropriat$ su* sums z   
may be necess>y = fiscal ye> #bjag to   

c>ry out ?is section4  #c4 ,pilot       
program = ,m$ic>e b5efici>ies ) advanc$ 
illnesses  7a7 ,9 g5]al ,section        
#aaae;,a ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acae;a7 is am5d$-- 7#a7 9 ! 
la/ s5t5ce ( subp>agraph 7,a7 (         
subsection 7b77#b71 by ins]t+ 1 & %all  
include ! model describ$ 9 subsection   
7h7 be=e ! p]iod at ! end2 &  7#b7 by   
add+ at ! end ! foll[+ new subsection3  
7h7 ,pilot program ,to promote          
p]son-,c5t]$ c>e = m$ic>e b5efici>ies ) 
advanc$ illnesses  7#a7 ,9 g5]al ,!     
model describ$ 9 ?is subsection is a    
pilot program "u :i* ! ,secret>y %all   
ent] into demon/ration project agreem5ts
 ) advance c>e collaboratives to provide
 s]vices & supplies "u p>ts ,a & ,b (   
title ,,xviii 9 a mann] t promotes      
acc\ntability = t>get ,m$ic>e           
b5efici>ies1 coord9ates ! provision (   
items & s]vices "u p>ts ,a & ,b ( su*   
title1 & enc\rages inve/m5t 9           
infra/ructure & r$esign$ c>e processes =
 coord9at$1 p]son- & family-c5t]$1 &    

high-quality s]vice deliv]y4  7#b7      
,eligibility ,an advance c>e            
collaborative %all be eligible to ent]  
into a demon/ration project agreem5t "u 
?is subsection if ! collaborative--     
7,a7 submits a timely application "u    
p>agraph 7#c72 &  7,b7 meets su* o!r    
requirem5ts & satisfies su* conditions z
 ! ,secret>y %all det]m9e4  7#c7        
,application  7,a7 ,9 g5]al ,n lat] ?an 
,octob] #a1 #bjah1 ea* advance c>e      
collaborative t wi%es to ent] into a    
demon/ration project agreem5t ) !       
,secret>y %all submit to ! ,secret>y an 
application t includes--  7i7 in=mation 
ab\t ea* provid] ( s]vices1 physician1 &
 practition] 9 ! collaborative2  7ii7 a 
description (1 & an implem5tation plan  
=1 ! demon/ration project t !           
collaborative int5ds to c>ry out "u     
p>agraph 7#f71 includ+ int5d$ uses (    
grant am\nts "u p>agraph 7#e71 & a      
/rategy = ! cont9u$ p>ticipation (      
community-bas$ social s]vices           
organizations1 includ+ fai?-bas$        

organizations1 9 ! c>e ( ! t>get ,m$ic>e
 b5efici>y population2  7iii7 a         
description ( h[ ! collaborative int5ds 
to use ! waiv]s & exp&$ s]vices describ$
 9 p>agraphs 7#g7 & 7#h7 to conduct !   
demon/ration project2  7iv7 ) respect to
 ! collection & report+ ( data relat+ to
 ! results ( ! demon/ration project--   
7,i7 subject to ! availability ( su*    
measures1 a description ( h[ !          
collaborative w collect & report on data
 p]ta9+ to ! recomm5d$ set ( quality    
measures e/abli%$ by ! ,secret>y "u     
section #b ( ! ,remov+ ,b>ri]s to       
,p]son-,c5t]$ ,c>e ,act ( #bjaf2 &      
7,,ii7 a description ( additional       
quality measures ! collaborative        
proposes to use to measure any          
*>act]i/ics ( its demon/ration project t
 are n captur$ 9 ! quality measures     
describ$ 9 subclause 7,i71 & h[ !       
collaborative w collect & report on data
 p]ta9+ to su* measures2 &  7v7 a       
description ( h[ ! collaborative w      
id5tify its t>get ,m$ic>e b5efici>y     

population = ! demon/ration project4    
7,b7 ,priority ,9 select+ advance c>e   
collaboratives to p>ticipate 9 ! pilot  
program1 ! ,secret>y may give priority  
to collaboratives t are locat$ 9 ,/ates 
t use1 or are 9 ! process ( develop+1 a 
uni=m1 portable m$ical ord] =           
life-su/a9+ treatm5t4  7,c7 ,geographic 
div]sity ,9 select+ advance c>e         
collaboratives to p>ticipate 9 ! pilot  
program1 ! ,secret>y %all make ef=ts to 
select collaboratives f geographically  
div]se areas4  7#d7 ,demon/ration       
project agreem5t  7,a7 ,9 g5]al ,n lat] 
?an ,janu>y #a1 #bjai1 ! ,secret>y %all 
ent] into agreem5ts ) up to #bj advance 
c>e collaboratives to p>ticipate 9 !    
pilot program4  7,b7 ,requir$ t]ms ,z "p
 ( any agreem5t betwe5 ! ,secret>y & an 
advance c>e collaborative "u ?is        
p>agraph3  7i7 ,pre-implem5tation grant 
,! advance c>e collaborative %all       
receive a grant describ$ 9 p>agraph     
7#e74  7ii7 ,demon/ration project ,!    
advance c>e collaborative %all conduct a

 demon/ration project describ$ 9        
p>agraph 7#f74  7,c7 ,t]m9ation ,!      
,secret>y may t]m9ate an agreem5t ) an  
advance c>e collaborative if !          
collaborative's exp5ditures "u !        
demon/ration project = s]vices &        
supplies "u p>ts ,a & ,b ( title ,,xviii
 sub/antially exce$ ! b5*m>k e/abli%$ = 
! collaborative by ! ,secret>y "u       
p>agraph 7#f77;,b77ii74  7#e7 ,grants = 
pre-implem5tation activities  7,a7 ,9   
g5]al ,beg9n+ 9 fiscal ye> #bjai1 f !   
am\nt made available "u subsection      
7f77#b77;,b71 ! ,secret>y %all aw>d     
grants to advance c>e collaboratives t h
 ent]$ into demon/ration project        
agreem5ts ) ! ,secret>y to facilitate ! 
implem5tation ( demon/ration projects4  
7,b7 ,use ( grant am\nts ,a grant aw>d$ 
"u ?is p>agraph may be us$ by an advance
 c>e collaborative = ! foll[+ purposes3 
7i7 ,to conduct a ne$s assessm5t 9      
collaboration ) community-bas$ social   
s]vice organizations1 su* z fai?-bas$   
organizations1 b5efici>y gr\ps1 &       

provid]s ( long-t]m s]vices & supports  
to id5tify gaps 9 s]vices & supports = !
 t>get ,m$ic>e b5efici>y population     
id5tifi$ by ! collaborative4  7ii7 ,to  
modify1 upgrade1 or pur*ase heal?       
in=mation te*nology to facilitate !     
ex*ange ( in=mation betwe5 memb]s ( !   
collaborative1 includ+ te*nologies t    
support data aggregation & analytics1   
increase int]op]ability across m$ical & 
supportive s]vices1 or improve          
accessibility ( b5efici>y c>e plans4    
7iii7 ,to conduct education & tra9+ =   
heal? c>e pr(essionals1 b5efici>ies &   
family c>egiv]s1 or community-bas$      
social s]vice organizations1 includ+    
fai?-bas$ organizations1 9 me?ods =     
le>n+1 docum5t+1 & communicat+ treatm5t 
pref]5ces & goals1 on be/ practices =   
pa9 & symptom managem5t1 & to improve   
und]/&+ ( palliative c>e & hospice      
s]vices1 among o!r topics4  7iv7 ,to    
hire /aff to conduct c>e managem5t &    
coord9ation activities4  7v7 ,to conduct
 o!r activities det]m9$ appropriate by !

 ,secret>y4  7#f7 ,demon/ration project 
7,a7 ,9 g5]al ,n lat] ?an ,janu>y #a1   
#bjbj1 ea* advance c>e collaborative t  
has a demon/ration project agreem5t ) ! 
,secret>y %all beg9 to conduct a        
demon/ration project to provide         
coord9at$1 p]son- & family-c5t]$1 &     
high-quality s]vice deliv]y to t>get    
,m$ic>e b5efici>ies by utiliz+ ! waiv]s 
& exp&$ s]vices describ$ 9 p>agraphs    
7#g7 & 7#h74  7,b7 ,%>$ sav+s paym5ts   
7i7 ,9 g5]al ,beg9n+ 9 fiscal ye> #bjba1
 9 addition to reimbursem5t t w\ld      
o!rwise be due "u title ,,xviii =       
s]vices provid$ by ! advance c>e        
collaborative 9 conduct+ ! demon/ration 
project1 a collaborative %all be        
eligible = %>$ sav+s paym5ts if !       
,secret>y det]m9es t exp5ditures "u !   
demon/ration project = s]vices &        
supplies "u p>ts ,a & ,b ( title ,,xviii
 are bel[ ! exp5ditures b5*m>k e/abli%$ 
by ! ,secret>y = ! collaborative "u     
clause 7ii74  7ii7 ,b5*m>k ,! ,secret>y 
%all e/abli% an appropriate exp5ditures 

b5*m>k = ea* advance c>e collaborative  
conduct+ a demon/ration project "u ?is  
subsection4  7,c7 ,duration ,subject to 
p>agraph 7#d77;,c71 any demon/ration    
project "u ?is p>agraph %all be conduct$
 = n less ?an #c ye>s4  7#g7 ,waiv] (   
c]ta9 requirem5ts ,z "p ( a demon/ration
 project "u ! pilot program1 ! ,secret>y
 %all waive ! foll[+ requirem5ts )      
respect to cov]age (1 & paym5t =1       
s]vices "u title ,,xviii provid$ to a   
t>get ,m$ic>e b5efici>y by an advance   
c>e collaborative "u su* demon/ration   
project3  7,a7 ,cov]age ( curative c>e  
dur+ election p]iod ,! requirem5t       
describ$ 9 section #ahab7;d77#b77;,a7 t 
an individual elect+ to receive hospice 
c>e %all be deem$ to h waiv$ all rights 
to h paym5t made "u title ,,xviii )     
respect to s]vices describ$ 9 clause    
7ii77,i7 ( su* section4  7,b7           
,alt]native c]tification = home c>e ,)  
respect to home heal? s]vices furni%$ to
 an individual by a ,m$ic>e-c]tifi$ home
 heal? ag5cy1 ! requirem5ts describ$ 9  

section #ahad7;a77#b7 & subp>agraph 7,c7
 ( su* section t--  7i7 a physician make
 ! c]tification 7& rec]tification1 :]e  
su* s]vices are provid$ ov] a p]iod (   
"t7 describ$ 9 su* subp>agraph 7,c72    
7ii7 a plan = furni%+ su* s]vices to su*
 individual is p]iodically review$ by a 
physician2 &  7iii7 ! physician 7or     
ano!r practition] :o is collaborat+ ) or
 sup]vis$ by ! physician7 has a         
face-to-face enc\nt] ) ! individual1    
provid$ t su* c]tification &            
rec]tification1 & review ( su* plan1 is 
conduct$ by a nurse practition] 7z def9$
 9 section #ahfa7;aa77#e77 :o is        
au?oriz$ to conduct su* c]tification1   
rec]tification1 & review "u ,/ate law4  
7,c7 ,alt]native c]tification = hospice 
c>e ,! requirem5ts describ$ 9           
subp>agraphs 7,a7 & 7,b7 ( section      
#ahad7;a77#g7 t an individual's att5d+  
physician & ! m$ical director 7or       
physician memb] ( ! int]discipl9>y gr\p 
describ$ 9 section #ahfa7;gg77 ( !      
,m$ic>e-c]tifi$ hospice program provid+ 

7or arrang+ =7 ! individual's hospice   
c>e c]tify t ! individual is t]m9ally   
ill & p]iodically review ! writt5 plan =
 hospice c>e1 provid$ t su* c]tification
 & review is conduct$ by a nurse        
practition] 7z def9$ 9 section          
#ahfa7;aa77#e77 :o is au?oriz$ to       
conduct su* c]tification & review "u    
,/ate law4  7,d7 ,cov]age ( skill$ nurs+
 s]vices )\t inpati5t /ay ,) respect to 
ext5d$ c>e s]vices furni%$ to an        
individual by a ,m$ic>e-c]tifi$ skill$  
nurs+ facility1 ! requirem5t describ$ 9 
section #ahfa7;i7 t an individual mu/ h 
be5 an inpati5t 9 a hospital = n less   
?an #c consecutive days be=e 8 dis*>ge &
 transf] to ! skill$ nurs+ facility be=e
 su* ext5d$ c>e s]vices may be deem$    
po/-hospital ext5d$ c>e s]vices4  7,e7  
,cov]age ( home heal? c>e )\t homeb\nd  
/atus requirem5t ,) respect to home     
heal? s]vices furni%$ to an individual  
by a ,m$ic>e-c]tifi$ home heal? ag5cy 7z
 def9$ 9 section #ahfa7o771 ! requirem5t
 describ$ 9 section #ahad7;a77#b77;,c7 t

 ! individual is or 0 conf9$ to 8 or h] 
home4  7#h7 ,availability ( exp&$       
s]vices ,z "p ( a demon/ration project  
"u ! pilot program1 an advance c>e      
collaborative may receive paym5t = !    
furni%+ ! foll[+ s]vices to t>get       
,m$ic>e b5efici>ies 9 ! same mann]1 &   
subject to ! same limitations1 t a      
hospice program is paid = hospice c>e "u
 section #ahad7;i73  7,a7 ,inpati5t     
alt]native to r\t9e hospice c>e  7i7 ,9 
g5]al ,not)/&+ regulations 9 effect     
prior to ! enactm5t ( ?is subp>agraph1  
if an assessm5t meet+ su* requirem5ts z 
! ,secret>y det]m9es appropriate has be5
 made t ! home ( an individual :o is    
c]tifi$ = hospice c>e & has elect$ to   
receive hospice c>e is unsafe or o!rwise
 unsuitable = ! provision ( su* c>e1 su*
 individual may receive su* c>e 9 an    
inpati5t sett+1 includ+ a               
,m$ic>e-c]tifi$ hospice t meets !       
conditions ( p>ticipation specifi$ 9    
section #dah4aaj ( title #db1 ,code (   
,f$]al ,regulations 7z 9 effect on !    

date ( enactm5t ( ?is subp>agraph71 or a
 skill$ nurs+ facility t meets ! /&>ds  
specifi$ 9 subsections 7b7 & 7e7 ( su*  
section1 = ! duration ( ! election      
p]iod4 ,! assessm5t describ$ 9 ! prec$+ 
s5t5ce may be conduct$ by ! individual's
 att5d+ physician1 a nurse practition]1 
or ! m$ical director 7or physician memb]
 ( ! int]discipl9>y gr\p describ$ 9     
section #ahfa7;gg77 ( ! hospice program 
provid+ 7or arrang+ =7 ! individual's   
hospice c>e4  7ii7 ,application (       
limitation on inpati5t c>e days ,=      
purposes ( any limitation on ! numb] (  
total inpati5t c>e days = :i* a hospice 
may receive paym5t1 hospice c>e t is    
provid$ 9 an inpati5t sett+ "u ?is      
subclause 7b w\ld o!rwise be provid$ 9  
an outpati5t sett+7 %all n c\nt t[>ds   
su* limitation4  7,b7 ,home-bas$        
alt]native to inpati5t respite c>e  7i7 
,9 g5]al ,not)/&+ section               
#ahfa7;dd77#a77;,g71 an individual :o is
 c]tifi$ = hospice c>e & has elect$ to  
receive hospice c>e may receive         

%ort-t]m1 home-bas$ respite c>e z an    
alt]native to inpati5t respite c>e4     
7ii7 ,limitations ,! home-bas$ respite  
c>e describ$ 9 clause 7i7 is subject to 
! same limitations t apply to inpati5t  
respite c>e "u section                  
#ahfa7;dd77#a77;,g71 includ+ !          
limitation t respite c>e may be provid$ 
only on an int]mitt5t1 non-r\t9e1 &     
occasional basis & may n be provid$     
consecutively ov] long] ?an #e days4    
7#i7 ,p>ticipation by b5efici>ies1      
provid]s1 & suppli]s volunt>y           
,p>ticipation 9 a demon/ration project  
conduct$ "u ! pilot program ) respect to
 t>get ,m$ic>e b5efici>ies1 provid]s (  
s]vices1 physicians1 & practition]s %all
 be volunt>y4  7#aj7 ,def9itions ,9 ?is 
subp>agraph3 7,a7 ,advance c>e          
collaborative ,! t]m advance c>e        
collaborative means an affiliat$ gr\p ( 
provid]s ( s]vices1 physicians1 or      
practition]s t--  7i7 has a me*anism =  
%>$ gov]nance betwe5 p>ticipat+ provid]s
 ( s]vices1 physicians1 & practition]s2 

&  7ii7 has a =mal legal /ructure t w\ld
 all[ = ! receipt & di/ribution ( %>$   
sav+s paym5ts "u p>agraph 7#f77;,b7 to !
 provid]s ( s]vices1 physicians1 &      
practition]s t belong to ! gr\p4  7,b7  
,demon/ration project agreem5t ,! t]m   
demon/ration project agreem5t means an  
agreem5t betwe5 ! ,secret>y & an advance
 c>e collaborative "u p>agraph 7#d74    
7,c7 ,pilot program ,! t]m pilot program
 means ! pilot program describ$ 9 ?is   
subsection4  7,d7 ,physician ,! t]m     
physician has ! mean+ giv5 su* t]m 9    
section #ahfa7r77#a74  7,e7 ,practition]
 ,! t]m practition] has ! mean+ giv5 su*
 t]m 9 section #ahdb7;b77#ah77;,c74     
7,f7 ,provid] ( s]vices ,! t]m provid] (
 s]vices has ! mean+ giv5 su* t]m 9     
section #ahfa7u74  7,g7 ,suppli] ,! t]m 
suppli] has ! mean+ giv5 su* t]m 9      
#ahfa7;d74  7,h7 ,t>get ,m$ic>e         
b5efici>y ,! t]m t>get ,m$ic>e b5efici>y
 means an individual :o-- 7i7 is enroll$
 = b5efits "u p>ts ,a & ,b ( title      
,,xviii1 b :o is n enroll$ 9 a ,m$ic>e  

,advantage plan "u "p ,c ( su* title1 an
 eligible organization "u section #ahgf1
 or a ,,pace program "u section #ahid2 &
  7ii7 demon/rates two or m ( ! foll[+  
*>act]i/ics3 7,i7 ,has "o or m advanc$  
*ronic conditions1 su* z late-/age      
canc]1 conge/ive he>t failure1 *ronic   
kidney disease1 *ronic ob/ructive       
pulmon>y disease1 g]iatric frailty1     
,alzheim]'s disease1 or ano!r =m (      
progressive dem5tia4  7,,ii7 ,has       
evid5ce ( rec5t & progressive cognitive 
impairm5t or functional limitations 7su*
 z an inability to p]=m "o or m         
activities ( daily liv+74  7,,iii7 ,has1
 dur+ ! previ\s #ab mon?s1 exp]i5c$ an  
increase 9 heal? c>e utilization1 su* z 
two or m nonelective hospital           
admissions4  7,,iv7 ,o!r *>act]i/ics    
id5tifi$ by ! ,secret>y4  4  7b7        
,availability ( funds =                 
pre-,implem5tation grants ,section      
#aaae;,a7f77#b7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acae;a7f77#b77 is  
am5d$--  7#a7 by /rik+ ,out ( am\nts    

appropriat$ & ins]t+ 7,a7 ,out ( am\nts 
appropriat$2 &  7#b7 by add+ at ! end ! 
foll[+ new subp>agraph3  7,b7 ,out ( !  
am\nt appropriat$ "u subp>agraph 7,b7 ( 
p>agraph 7#a71 #aj1jjj1jjj %all be made 
available = fiscal ye> #bjai = ! purpose
 ( aw>d+ grants "u subsection 7h77#f71 &
 %all rema9 available = su* purpose     
until exp5d$4  4