,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #bgig  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,june #g1 #bjag,mr4   
,blum5au] 7= himself & ,mr4 ,roe (      
,t5nessee7 introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,en]gy &    
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,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 ! ,pati5t 
,*oice & ,quality ,c>e ,act ( #bjag4    
7b7 ,table ( cont5ts ,! table ( cont5ts 
( ?is ,act is z foll[s3  ,sec4 #a4 ,%ort
 title2 table ( cont5ts4 ,sec4 #b4      
,f9d+s4 ,sec4 #c4 ,advanc$ illness c>e &
 managem5t model4 ,sec4 #d4 ,quality    
measurem5t developm5t & implem5tation4  

,sec4 #e4 ,enhanc+ cov]age ( advance c>e
 plann+ s]vices4 ,sec4 #f4 ,advance c>e 
plann+ support tools4 ,sec4 #g4 ,advance
 directives4 ,sec4 #h4 ,additional      
requirem5ts = facilities4 ,sec4 #i4     
,grants = increas+ public aw>5ess &     
tra9+4 ,sec4 #aj4 ,advance ,c>e ,plann+ 
,advisory ,c\ncil4 ,sec4 #aa4 ,annual   
report on ,m$ic>e dec$5ts4 ,sec4 #ab4   
,rule ( con/ruction4  #b4 ,f9d+s        
,congress makes ! foll[+ f9d+s3 7#a7 ,! 
population ( ! ,unit$ ,/ates is e/imat$ 
to age rapidly1 ) ! numb] ( p ov] ! age 
( #fe set to d\ble to m ?an #ih million1
 or #a 9 #e ,am]icans1 by #bjdj4  7#b7  
,z ,am]icans live long] & heal?i] lives1
 !y also face increas$ incid5ce (       
multiple s]i\s or *ronic progressive    
conditions & advanc$ illness z !y age4  
7#c7 ,am]icans ) s]i\s1 *ronic          
progressive1 or 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 ( s]i\s1 *ronic     
progressive1 or 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 ) s]i\s1 *ronic 
progressive1 or 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+ ) s]i\s1 *ronic progressive1 or   
advanc$ illness4  7#g7 ,hospice &       
palliative c>e programs (f] pati5ts &   
families appropriate & pati5t-c5t]$ c>e1
 deliv]$ by an int]discipl9>y c>e team4 
,^! programs %\ld s]ve z models =       
advanc$ illness c>e deliv]y4  7#h7      

,individuals h ! well-e/abli%$ "r to    
accept or reject m$ical treatm5t t is   
(f]$ & all individuals %\ld be af=d$ !  
opportunity to fully p>ticipate 9       
decisions relat$ to _! heal? c>e4  7#i7 
,too (t51 individuals ) s]i\s1 *ronic   
progressive1 or 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#aj7    
,provid+ high-quality advanc$ c>e plann+
 s]vices & supports to individuals )    
s]i\s1 *ronic progressive1 or advanc$   
illness w protect & pres]ve _! dignity &
 ensure c>e is align$ ) an individual's 
goals1 values1 & /at$ pref]5ces4  #c4   
,advanc$ illness c>e & managem5t model  
,section #aaae;,a ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acae;a7 is am5d$-- 
7#a7 9 subsection 7b77#b77;,a71 by add+ 
at ! end ! foll[+ new s5t5ce3 ,! models 

select$ "u ?is subp>agraph %all include 
! model describ$ 9 subsection 7h71 :i*  
%all be implem5t$ by n lat] ?an #a ye>  
aft] ! date ( ! enactm5t ( ! ,pati5t    
,*oice & ,quality ,c>e ,act ( #bjag42 & 
7#b7 by add+ at ! end ! foll[+ new      
subsection3  7h7 ,advanc$ illness c>e & 
managem5t model  7#a7 ,model  7,a7 ,9   
g5]al ,! model describ$ 9 ?is           
subp>agraph is a model "u :i* paym5ts   
are made "u title ,,xviii to applicable 
provid]s t furni% advanc$ illness c>e & 
managem5t s]vices1 includ+ c>e          
coord9ation & palliative c>e s]vices1 to
 eligible individuals ) s]i\s1 *ronic   
progressive1 or advanc$ illness 9 ord]  
to te/ ! use ( t>get$ advanc$ illness   
managem5t & e>ly use ( palliative c>e "u
 ! ,m$ic>e program4  7,b7 ,volunt>y     
,p>ticipation "u ! model %all be        
volunt>y ) respect to bo? eligible      
individuals & applicable provid]s4  7,c7
 ,requirem5ts  7i7 ,hospice provid] ,at 
lea/ "o applicable provid] select$ =    
p>ticipation "u ! model %all be a       

hospice program 7z def9$ 9 section      
#ahfa7;dd77#b774  7ii7 ,comp>ison ,!    
,secret>y %all e/abli% ! model 9 su* a  
mann] z w p]mit ! comp>ison ( outcomes =
 eligible individuals p>ticipat+ "u !   
model & eligible individuals :o are n s 
p>ticipat+4  7iii7 ,incorporation into  
exi/+ models ,9 addition to op]at+ !    
model indep5d5tly1 ! ,secret>y %all     
incorporate ! model into exi/+ models   
relat$ to ! ,m$ic>e program1 su* z      
models involv+ acc\ntable c>e           
organizations1 bundl$ paym5ts1 & value  
bas$ pur*as+ arrangem5ts1 & o!r         
coord9at$ c>e models z ! ,secret>y      
det]m9es to be appropriate4  7#b7       
,paym5ts ,"u ! model1 ! ,secret>y %all  
e/abli% paym5t am\nts = advanc$ illness 
c>e & managem5t s]vices t is t>get$ to  
eligible individuals ) a s]i\s1 *ronic  
progressive1 or advanc$ illness4 ,!     
paym5ts may include paym5ts "u a fee    
s*$ule1 capitat$ paym5ts1 bundl$        
paym5ts1 value-bas$ pur*as+ agreem5ts1 &
 o!r paym5t me*anisms det]m9$           

appropriate by ! ,secret>y4  7#c7       
,advanc$ illness c>e & managem5t s]vices
 def9$ ,9 ?is subsection1 ! t]m advanc$ 
illness c>e & managem5t s]vices means ! 
foll[+ s]vices1 z appropriate = !       
individual's illness & /age ( illness3  
7,a7 ,"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  7,b7 ,! 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 or m$ical 
incapacity4  7,c7 ,assi/+ ! individual 9
 def9+ & articulat+ goals ( c>e1 values1
 & pref]5ces4  7,d7 ,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 
7,e7 ,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  7,f7 ,prep>+1 & %>+ )       
relevant provid]s1 docum5tation-- 7i7 t 
/ates ! individual's goals ( c>e1       
pref]5ces1 & values1 pref]r$            
decisionmak+ /rategies1 & a plan ( c>e t
 is concrete & actionable2 &  7ii7 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  7,g7 ,ref]rals to provid]s1     
includ+ m$ical & social s]vice provid]s1

 :o deliv] c>e consi/5t ) ! plan4  7,h7 
,provid+ culturally & educationally     
appropriate tra9+ = ! individual &      
family c>egiv]s to support _! ability to
 c>ry out ! plan4  7,i7 ,a              
multidim5sional assessm5t ( !           
individual's /r5g?s & limitations4  7,j7
 ,an assessm5t ( ! individual's paid &  
unpaid supports1 includ+ family         
c>egiv]s4  7,k7 ,compreh5sive m$ication 
review & managem5t 7includ+1 if         
appropriate1 c\nsel+ & self-managem5t   
support74  7,l7 ,visits to ! pati5t 9   
all sites ( c>e 7includ+ ! home1 a      
hospital1 & a nurs+ home7 z ne$$ to     
respond appropriately to problems &     
conc]ns4  7,m7 ,additional s]vices1     
consi/5t ) ! c>e plan1 t !              
int]discipl9>y team believes w\ld assi/ 
! eligible individual & family c>egiv]s 
9 m effectively manag+ _! heal?         
condition4  7,n7 #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,o7 ,c>e coord9ation &      
communication across heal? c>e & social 
s]vice sett+s & provid]s1 includ+       
involvem5t ( ! int]discipl9>y team to   
evaluate quality & address conc]ns ov]  
"t4  7,p7 ,su* o!r palliative & o!r     
s]vices t ! ,secret>y det]m9es          
appropriate4  7#d7 ,applicable provid]  
def9$ ,9 ?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 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 ,eligible      
individual def9$ ,9 ?is subsection1 !   
t]m eligible individual means an        
individual :o-- 7,a7 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,b7 
resides at home or 9 an in/itutional    

sett+1 :i*ev] is consi/5t ) _! p]sonal  
goals & pref]5ces2 &  7,c7 meets at lea/
 "o ( ! foll[+3 7i7 ,! individual 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 caus$ by "o or m s]i\s or 
life ?reat5+ conditions or frailty & t  
is n associat$ ) an acute or            
po/-op]ative condition4  7ii7 ,!        
individual is diagnos$ ) a s]i\s1 *ronic
 progressive or advanc$ illness t-- 7,i7
 has a /rong negative impact on !       
individual's quality ( life & function+ 
9 life roles1 indep5d5t ( its impact on 
mortality2 or  7,,ii7 is burd5some 9    
symptoms1 treatm5ts or c>egiv] /ress4   
7iii7 ,! individual is diagnos$ )--     
7,i7 meta/atic or locally advanc$ canc]2
  7,,ii7 ,alzheim]'s disease or ano!r   
progressive dem5tia2  7,,iii7 late-/age 
neuromuscul> disease2  7,,iv7 late-/age 
diabetes2  7,v7 late-/age kidney1 liv]1 
he>t1 ga/ro9te/9al1 c]ebrovascul>1 or   
lung disease2 or  7,,vi7 age-relat$     

physical debility4  7iv7 ,! individual  
meets o!r crit]ia det]m9$ appropriate by
 ! ,secret>y4  7#f7 ,int]discipl9>y team
  7,a7 ,9 g5]al ,subject to subp>agraph 
7,b71 9 ?is subsection1 ! t]m           
int]discipl9>y team means a gr\p t--    
7i7 includes at lea/-- 7,i7 "o physician
 :o is bo>d c]tifi$ 9 g]iatrics1 int]nal
 m$ic9e1 or family m$ic9e2  7,,ii7 "o   
physician1 advance practice regi/]$     
nurse1 or physician assi/ant1 :o is a   
palliative speciali/ 7def9$ z hav+ a    
c]tification 9 hospice & palliative c>e7
 or :o has at lea/ "o ye>'s exp]i5ce    
provid+ hospice or palliative c>e2      
7,,iii7 "o nurse2 &  7,,iv7 "o social   
work]2  7ii7 may include a *apla91      
m9i/]1 or pa/oral c\nselor2  7iii7 may  
include o!r direct c>e p]sonnel 7includ+
 ph>maci/s1 dieticians1 physical        
!rapi/s1 occupational !rapi/s1 &        
psy*o!rapi/s72 &  7iv7 meets requirem5ts
 t may be e/abli%$ by ! ,secret>y4  7,b7
 ,additional memb] at ! reque/ ( !      
eligible individual ,an applicable      

provid] %all (f] to ! eligible          
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$ ) ! applicable        
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              
int]discipl9>y team memb] at !          
individual's 7or legally au?oriz$       
repres5tative's7 reque/4  4  #d4        
,quality measurem5t developm5t &        
implem5tation  7a7 ,facilitation (      
increas$ coord9ation & alignm5t betwe5 !
 public & private sector ) respect to   
quality measures reg>d+ advanc$ illness1
 palliative1 & end-(-,life c>e  7#a7 ,9 
g5]al ,section #ahij7;b7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acie;aaa7b77 is am5d$ by ins]t+ aft]   
p>agraph 7#c7 ! foll[+ new p>agraph3    
7#d7 ,increas$ coord9ation & alignm5t   
betwe5 ! public & private sector )      

respect to quality measures reg>d+      
advanc$ illness1 palliative1 &          
end-(-life c>e  7,a7 ,9 g5]al ,! entity 
%all facilitate increas$ coord9ation &  
alignm5t betwe5 ! public & private      
sector ) respect to quality measures    
reg>d+ advanc$ illness1 palliative1 &   
end-(-life c>e across ! c>e sett+s &    
programs describ$ 9 ?is section & across
 o!r s]vices & c>e sett+s "u ?is title1 
z appropriate4  7,b7 ,environm5tal scan 
,! entity %all conduct an environm5tal  
scan ( measures1 measure concepts1 &    
pref]r$ practices = advanc$ illness1    
palliative1 & end-(-life c>e us$ 9 bo? !
 private & public sectors & f multiple  
sett+s ( c>e4 ,su* scan %all include a  
review ( ! foll[+3  7i7 ,! process (    
elicit+ & docum5t+ pati5t 7&1 :]e       
relevant & appropriate1 family c>egiv]  
or legally au?oriz$ repres5tative7      
goals1 pref]5ces1 & values reg>d+ c>e & 
treatm5t1 includ+ ! articulation ( goals
 = end-(-life c>e t adequately reflect  
h[ ! pati5t wants to live4  7ii7 ,!     

effectiv5ess1 pati5t-c5t]$ness 7&1 :]e  
relevant1 family c>egiv]-c5t]$ness71 &  
adequacy ( c>e plans1 includ+           
docum5tation ( individual goals1        
pref]5ces1 & values4  7iii7 ,agreem5t & 
consi/5cy among-- 7,i7 ! pati5t's goals1
 pref]5ces1 & values2  7,,ii7 any       
docum5t$ c>e plan2 &  7,,iii7 ! c>e     
deliv]$4  7iv7 ,timely & appropriate    
ref]ral to hospice c>e4  7,c7           
,id5tification & prioritization (       
measures ,! entity %all1 bas$ on ! scan 
conduct$ "u subp>agraph 7,b71 id5tify & 
prioritize measures1 measure concepts1 &
 pref]r$ practices1 t are align$ across 
sett+s ( c>e1 condition1 & pati5t       
population4  7,d7 ,report ,n lat] ?an   
#ah mon?s aft] ! date ( enactm5t ( ?is  
p>agraph1 ! entity %all submit to !     
,secret>y a report conta9+ ! f9d+s ( !  
entity ) respect to ! environm5tal scan 
"u subp>agraph 7,b7 & ! id5tification & 
prioritization ( measures1 measure      
concepts1 & pref]r$ practices "u        
subp>agraph 7,c74  4  7b7 ,/udy & report

 on ,,nih developm5t ( additional       
measures relat$ to c>e plann+ ,section  
#ahij;,a ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acie;aaa-#a7 is am5d$ by    
add+ at ! end ! foll[+ new subsection3  
7g7 ,/udy & report on ,,nih developm5t (
 additional measures relat$ to c>e      
plann+  7#a7 ,/udy ,! ,secret>y1 9      
consultation ) ! ,palliative ,c>e       
,rese>* ,coop]ative ,gr\p1 ! ,national  
,in/itute ( ,nurs+ ,rese>*1 & ! ,(fice (
 ,end-(-,life & ,palliative ,c>e ,rese>*
 ( ! ,national ,in/itutes ( ,heal? %all 
conduct a /udy reg>d+ ! developm5t (    
measures relat$ to--  7,a7 concordance (
 c>e betwe5 ! wi%es ( an individual & ! 
treatm5t receiv$ by ! individual1       
includ+ docum5tation ( su* wi%es 9 !    
m$ical record2  7,b7 und]/&+ !          
population ) s]i\s1 *ronic progressive1 
or advanc$ illness t w\ld b5efit f      
palliative c>e & advance c>e plann+     
s]vices2 &  7,c7 appropriate transitions
 to hospice c>e4  7#b7 ,report ,n lat]  
?an ,decemb] #ca1 #bjai1 ! ,secret>y    

%all submit to ,congress a report       
conta9+ ! results ( ! /udy conduct$ "u  
p>agraph 7#a74  4  7c7 ,m$ic>e physician
 fee s*$ule ,section #ahdh7s77#a7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#d7s77#a77 is am5d$ by add+ at ! 
end ! foll[+ new subp>agraph3  7,g7     
,cl9ical c>e measures relat+ to         
palliative & end-(-life c>e ,beg9n+ aft]
 ! completion ( ! environm5tal scan "u  
section #ahij7;b77#d77;,b71 )9 "o or m  
appropriate quality doma9s1 ! ,secret>y 
%all1 9 consultation ) ! entity ) a     
contract "u section #ahij7;a71 e/abli%  
appropriate cl9ical c>e measures relat+ 
to palliative & end-(-life c>e1 includ+ 
at lea/ "o measure = ea* ( ! areas /udi$
 "u subp>agraphs 7,a71 7,b71 & 7,c7 (   
section #ahij;,a7g77#a74  4  7d7        
,po/-,acute c>e ,section #ahii;,b ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acielll7 is am5d$-- 7#a7 9 subsection  
7a77#b77;,e77i7--  7,a7 9 subclause     
7,,iv71 by /rik+ & at ! end2  7,b7 9    
subclause 7,v71 by /rik+ ! p]iod at !   

end & ins]t+ 2 &2 &  7,c7 by add+ at !  
end ! foll[+ new subclause3  7,,vi7 )   
respect to ! doma9 describ$ 9 subsection
 7c77#a77;,f7 7relat+ to end-(-life     
c>e7--  7aa7 = ,,pac provid]s describ$ 9
 clauses 7ii71 7iii71 & 7iv7 ( p>agraph 
7#b77;,a71 ,octob] #a1 #bjbj2 &  7bb7 = 
,,pac provid]s describ$ 9 clauses 7i7 ( 
su* p>agraph1 ,janu>y #a1 #bjba4  2 &   
7#b7 9 subsection 7c77#a71 by add+ at ! 
end ! foll[+ new subp>agraph3  7,f7 ,!  
effectiv5ess1 pati5t-c5t]$ness 7&1 :]e  
relevant1 family c>egiv]-c5t]$ness71 &  
adequacy ( c>e plans & communications   
relat+ to su* plans1 includ+--  7i7     
docum5tation ( a pati5t's goals1        
pref]5ces1 & values2  7ii7 agreem5t &   
consi/5cy ) respect to c>e among--  7,i7
 ! pati5t's goals1 pref]5ces1 & values2 
7,,ii7 any docum5t$ c>e plan2 &  7,,iii7
 ! c>e deliv]$2 &  7iii7 timely &       
appropriate ref]ral to hospice c>e4  4  
7e7 ,m$ic>e advantage ,section          
#aheb7;e77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#bb7;e77#c77 is  

am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,c7 ,palliative &        
end-(-life c>e ,! ,secret>y1 9          
consultation ) ! ,national ,committee = 
,quality ,assurance1 %all prioritize !  
developm5t ( /&>ds = palliative &       
end-(-life c>e1 includ+ transition to   
hospice c>e1 ) respect to ,m$ic>e       
,advantage organizations "u ?is "p = use
 "u ! quality improvem5t program "u     
p>agraph 7#a7 t are ! equival5t ( su*   
/&>ds 9 quality programs applicable to  
provid]s ( s]vices & suppli]s "u !      
orig9al ,m$ic>e fee-=-s]vice program "u 
p>ts ,a & ,b4  4  7f7 ,alt]native paym5t
 models ,section #ahii7;b77#c77;,c7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acie;jjj7b77#c77;,c77 is am5d$-- 7#a7  
by /rik+ /&>ds4--,! ,secret>y & ins]t+  
8/&>ds4--  7i7 ,9 g5]al ,! ,secret>y  2 
&  7#b7 by add+ at ! end ! foll[+ new   
clause3  7ii7 ,palliative & end-(-life  
c>e ,! ,secret>y1 9 consultation ) !    
entity ) a contract "u section          
#ahij7;a71 %all ensure t quality        

p]=mance /&>ds e/abli%$ "u ?is          
subp>agraph include measures t apply to 
palliative & end-(-life c>e1 includ+    
transition to hospice c>e4  4  #e4      
,enhanc+ cov]age ( advance c>e plann+   
s]vices  7a7 ,def9ition ,section #ahfa (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciex7 is am5d$ by add+ at ! end !    
foll[+ new subsection3  7jjj7 ,advance  
c>e plann+ s]vices  7#a7 ,! t]m advance 
c>e plann+ s]vices means s]vices        
id5tifi$ z ( ! date ( enactm5t ( ?is    
subsection z ,curr5t ,proc$ural         
,t]m9ology 7,,cpt7 codes #iidig &       
#iidih1 & su* codes z subsequ5tly       
modifi$1 t are furni%$ by a physician or
 o!r eligible practition] 7z det]m9$ by 
! ,secret>y74  7#b7 ,= purposes (       
p>agraph 7#a71 ! t]m eligible           
practition] includes1 9 addition to a   
practition] eligible to bill su* ,,cpt  
codes z ( ! date ( enactm5t ( ?is       
subsection1 an individual :o--  7,a7 is 
a cl9ical social work] 7z def9$ 9       
subsection 7hh77#a772 &  7,b7           

possesses--  7i7 a relevant c>e plann+  
c]tification2 or  7ii7 exp]i5ce provid+ 
c>e plann+ conv]sations or simil>       
s]vices1 z def9$ by ! ,secret>y1 9 !    
c\rse ( _! "w4  4  7b7 ,no application (
 co9surance or d$uctible  7#a7 ,am\nt   
,section #ahcc7;a77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciel7a77#a77 is am5d$-- 7,a7 by /rik+ 
& 7,,bb7 & ins]t+ 7,,bb72 &  7,b7 by    
ins]t+ be=e ! semicolon at ! end !      
foll[+3 1 & 7,,cc7 ) respect to advance 
c>e plann+ s]vices 7z def9$ 9 section   
#ahfa7;jjj77#a771 ! am\nts paid %all be 
#ajj p]c5t ( ! less] ( ! actual *>ge = !
 s]vices or ! am\nt det]m9$ "u ! fee    
s*$ule e/abli%$ "u section #ahdh7;b744  
7#b7 ,waiv] ( application ( d$uctible ,!
 fir/ s5t5ce ( section #ahcc7;b7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7b77 is am5d$-- 7,a7 by /rik+ &   
be=e 7#aj72 &  7,b7 by ins]t+ be=e !    
p]iod ! foll[+3 1 & 7#aa7 su* d$uctible 
%all n apply ) respect to advance c>e   
plann+ s]vices 7z def9$ 9 section       

#ahfa7;jjj77#a774  7c7 ,effective date  
,! am5dm5t made by ?is subsection %all  
apply to advance c>e plann+ s]vices     
furni%$ on or aft] ,janu>y #a1 #bjah4   
#f4 ,advance c>e plann+ support tools   
7a7 ,inclusion ( advance c>e plann+     
mat]ials 9 ! ,m$ic>e  ,y h&book  7#a7 ,9
 g5]al ,section #ahjd7;a7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acie;b-#b7;a77 is am5d$-- 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+ s]i\s1 *ronic        
progressive1 or advanc$ illness1 includ+
 disease modify+ options1 palliative c>e
 t supports individuals f ! onset (     
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  7#b7 ,effective date
 ,! am5dm5ts made by ?is section %all   
apply to notices di/ribut$ on or aft]   
,janu>y #a1 #bjah4  7b7 ,advance c>e    
plann+ /&>ds = electronic heal? records 
7#a7 ,9 g5]al ,not)/&+ section          
#cjjd7;b77#c7 ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4                    
#cjj;jj-#ad7;b77#c771 n lat] ?an #d ye>s
 aft] ! date ( ! enactm5t ( ?is ,act1 ! 
,secret>y ( ,heal? & ,human ,s]vices    
%all adopt1 by rule1 /&>ds = a qualifi$ 
electronic heal? record 7z def9$ 9      
section #cjjj7ac7 ( su* ,act 7#db       
,u4,s4,c4 #cjj;jj7#ac7771 ) respect to  
organiz+ pati5t communications ) heal?  
c>e provid]s ab\t c>e goals & to provide
 "o-click access to ! foll[+3  7,a7 ,!  
pati5t's curr5t advance directive 7z    
def9$ 9 section #ahff7;f77#c7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc7f77#c7771 z applicable4  7,b7  
,! pati5t's curr5t ord] = life-su/a9+   

treatm5t 7describ$ 9 section            
#i7;d77#c77;,b771 z applicable4  7,c7   
,docum5tation ( advance c>e plann+      
discussion betwe5 ! pati5t & ! provid]4 
7#b7 ,treatm5t ( /&>ds ,a /&>d adopt$ "u
 p>agraph 7#a7 %all be treat$ z a /&>d  
adopt$ "u section #cjjd ( ! ,public     
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;jj-#ad7 = purposes ( c]tify+       
qualifi$ electronic heal? records       
pursuant to section #cjja7;c77#e7 ( su* 
,act 7#db ,u4,s4,c4                     
#cjj;jj-#aa7;c77#e774  #g4 ,advance     
directives  7a7 ,portability ,section   
#ahff7;f7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;cc7f77 is am5d$ by 
add+ at ! end ! foll[+ new p>agraph3    
7#e7  7,a7 ,an advance directive validly
 execut$ outside ! ,/ate 9 :i* su*      
directive is pres5t$ may be giv5 effect 
by a provid] ( s]vices or organization  
to ! same ext5t z an advance directive  
validly execut$ "u ! law ( ! ,/ate 9 :i*
 x is pres5t$4  7,b7 ,9 ! abs5ce ( k to 
! contr>y1 a physician or o!r heal? c>e 

provid] or organization may presume t a 
writt5 advance heal? c>e directive or   
simil> in/rum5t1 reg>dless ( :]e        
execut$1 is valid4  7,c7 ,! provisions (
 ?is p>agraph %all preempt any ,/ate law
 on advance directive portability to !  
ext5t su* law is inconsi/5t ) su*       
provisions4  7,d7 ,no?+ 9 ! p>agraph    
%all be con/ru$ to-- 7i7 au?orize !     
adm9i/ration ( heal? c>e treatm5t       
o!rwise prohibit$ by ! laws ( ! ,/ate 9 
:i* ! directive is pres5t$2  7ii7       
require a provid] ( s]vices or an       
organization to act 9 a mann] contr>y to
 its religi\s or moral convictions2     
7iii7 apply to a reque/ or directive    
ord]+ a /]ilization or abortion or ord]+
 )drawal ( treatm5t f a pregnant woman  
if cont9u$ treatm5t c reasonably be     
expect$ to br+ h] *ild to live bir?2    
7iv7 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]2 or 
7v7 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,i7 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,,ii7 ex]cis$ its "r ( consci5ce 9     
accordance ) clause 7ii7 or 7iv74  4    
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  7c7 ,,gao 
/udy on heal? c>e decisionmak+ laws &   
b>ri]s to ! use ( advance directives    
7#a7 ,/udy ,! ,comptroll] ,g5]al ( !    
,unit$ ,/ates %all conduct a /udy t     
exam9es ! use1 portability1 & electronic
 /orage ( advance directives & t        
id5tifies b>ri]s t[>ds adopt+1 us+1 &   
foll[+ advance directives 9 ! cl9ical   
sett+4 ,su* exam9ation %all include     
issues t rema9 unresolv$ aft] ! ,/age #c
 ,mean+ful ,use f9al rule1 includ+      
b>ri]s & solutions to f9d+ & access+    
advance c>e plann+ docum5ts1 be/        
practices = al]t+ eligible provid]s to !
 pres5ce ( an advance c>e plan1 & be/   
practices = transmitt+ advance c>e plans
 across sites ( c>e4  7#b7 ,report ,n   
lat] ?an #a ye> aft] ! date ( ! enactm5t
 ( ?is ,act1 ! ,comptroll] ,g5]al %all  
submit to ,congress a report on ! /udy  
conduct$ "u p>agraph 7#a7 & %all include
 9 ! report su* recomm5dations reg>d+   

improv+ advance heal? c>e plann+ z !    
,comptroll] ,g5]al deems appropriate4   
#h4 ,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$-- 7,a7 9      
subp>agraph 7,y71 by /rik+ ! p]iod at ! 
end & ins]t+ 2 &2 &  7,b7 by ins]t+ aft]
 subp>agraph 7,y7 ! foll[+ new          
subp>agraph3  7,z7 9 ! case ( hospitals1
 skill$ 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 #bjai4  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 & provid]s ( advance c>e      
plann+ s]vices "w ) individuals to--    
7,a7 engage 9 a c>e plann+ process2     
7,b7 ?or\ghly & completely docum5t ! c>e
 plann+ process 9 ! m$ical record & to  
update ! c>e plan on a regul> basis2    
7,c7 complete docum5ts necess>y to      
support ! treatm5t & c>e plan1 su* z    
portable treatm5t ord]s & advance       
directives2  7,d7 provide s]vices &     
support t are free f discrim9ation bas$ 
on advanc$ age1 disability /atus1 or    
diagnosis1 includ+ s]i\s1 *ronic        
progressive1 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 #bjba1 !
 ,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  #i4 ,grants
 = increas+ public aw>5ess & tra9+  7a7 
,mat]ial & res\rces developm5t ,!       
,secret>y ( ,heal? & ,human ,s]vices    
7ref]r$ to 9 ?is section z ! ,secret>y71
 9 consultation ) ! ,advance ,c>e       
,plann+ ,advisory ,c\ncil 7e/abli%$ 9   
section #aj71 may aw>d grants to public 
or private entities 7includ+1 z         
appropriate1 ,/ates1 political          
subdivisions ( ,/ates1 m$ical s*ools1   
nurs+ s*ools1 heal? c>e sy/ems1         
fai?-bas$ organizations1 & religi\s     
educational in/itutions71 or a          
consortium ( any su* entities1 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 ) respect
 to heal?y individuals1 ! importance (--
 7,a7 id5tify+ an individual :o w make  

treatm5t decisions 9 ! ev5t ( future    
cognitive incapacity2  7,b7 discuss+    
values & goals relevant to s]i\s injury 
or illness2 &  7,c7 complet+ an advance 
directive t--  7i7 appo9ts a surrogate2 
&  7ii7 docum5ts goals & values & o!r   
in=mation t %\ld be consid]$ 9 mak+     
treatm5t decisions2  7#b7 ) respect to  
individuals ) s]i\s1 *ronic progressive1
 or advanc$ illness1 ! importance (--   
7,a7 articulat+ goals ( c>e2  7,b7      
und]/&+ prognosis & typical disease     
trajectory2  7,c7 evaluat+ treatm5t     
options 9 light ( goals ( c>e2  7,d7    
develop+ a treatm5t plan2 &  7,e7       
docum5t+ ! treatm5t plan on advance     
directives1 portable treatm5t ord]s1 &  
o!r docum5tation =ms us$ 9 ! locality   
:]e ! plan is to be execut$2  7#c7 !    
role & effective use ( ,/ate & o!r      
advance directive =ms & portable        
treatm5t ord]s2  7#d7 ! range ( s]vices 
= individuals fac+ s]i\s1 *ronic        
progressive1 or advanc$ illness1 includ+
 advance c>e plann+ s]vices1 palliative 

c>e1 & hospice c>e2 &  7#e7 ) respect to
 provid]s ( advance c>e plann+1 advance 
illness c>e1 hospice c>e1 & palliative  
c>e 9 hospital1 hospice1 home1          
community1 & long-t]m c>e sett+s1       
mat]ial to assi/ 9--  7,a7 develop+ &   
implem5t+ programs & initiatives to tra9
 & educate individuals2  7,b7 provid+   
tra9+ & cont9u+ education to individuals
 :o w provide advance c>e plann+ s]vices
 or palliative c>e 9 ! hospital1        
hospice1 home1 community1 & long-t]m c>e
 sett+s2 &  7,c7 develop+ curricula or  
tea*+ mat]ials relat$ to advance c>e    
plann+ or palliative c>e 9 su* sett+s4  
7b7 ,e/abli%m5t & ma9t5ance ( web- &    
telephone-,bas$ res\rces  7#a7 ,9 g5]al 
,! ,secret>y may aw>d grants to public  
or private entities 7includ+ ,/ates1    
political subdivisions ( ,/ates1        
fai?-bas$ organizations1 & religi\s     
educational in/itutions71 or a          
consortium ( any su* entities1 to       
e/abli% & ma9ta9 an ,int]net website &  
telephone hotl9e to dissem9ate res\rces 

develop$ "u subsection 7a7 & mat]ials = 
fai? communities design$ by ! ,dep>tm5t 
( ,heal? & ,human ,s]vices ,c5t] =      
,fai?-,bas$ & ,neighborhood ,p>tn]%ips4 
7#b7 ,ability to su/a9 activities ,9    
det]m9+ :e!r to aw>d a grant "u p>agraph
 7#a71 ! ,secret>y %all take into acc\nt
 ! ability ( an entity to su/a9 !       
activities describ$ 9 p>agraph 7#a7     
beyond ! initial grant p]iod4  7c7      
,national public education campaign ,!  
,secret>y may aw>d grants to public or  
private entities 7includ+ ,/ates1       
political subdivisions ( ,/ates1        
fai?-bas$ organizations1 & religi\s     
educational in/itutions7 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 ?is 
section4  7d7 ,ord]s = life-,su/a9+     
treatm5t  7#a7 ,9 g5]al ,! ,secret>y may
 aw>d grants to eligible entities = !   
purposes ( c>ry+ out ! activities "u    
p>agraph 7#b74  7#b7 ,au?oriz$          

activities ,activities fund$ ?r\gh a    
grant "u ?is section = an area may      
include-- 7,a7 e/abli%+ & op]at+ a      
,national ,res\rce ,c5t] on ,,pol/      
,programs to provide--  7i7 te*nical    
assi/ance & pr(essional tra9+ to        
programs = ord]s = life-su/a9+ treatm5t2
  7ii7 analysis & dissem9ation ( be/    
practices 9 implem5t+ program = ord]s = 
life-su/a9+ treatm5t2  7iii7 volunt>y   
/&>ds = ! e/abli%m5t & op]ation (       
program = ord]s = life-su/a9+ treatm5t2 
&  7iv7 compilations & summ>ies (       
rec5tly conduct$ rese>* & o!r res\rces  
relevant to program = ord]s =           
life-su/a9+ treatm5t2  7,b7 develop+ su*
 a program = ! area t includes          
hospitals1 home c>e1 hospice1 long-t]m  
c>e1 community & assi/$ liv+ resid5ces1 
skill$ nurs+ facilities1 & em]g5cy      
m$ical s]vices )9 a ,/ate2 &  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'

 families1 tra9+ ( heal? c>e            
pr(essionals1 or e/abli%+ an ord]s =    
life-su/a9+ treatm5t regi/ry4  7#c7     
,def9itions ,9 ?is subsection-- 7,a7 !  
t]m eligible entity means--  7i7 an     
academic m$ical c5t]1 a m$ical s*ool1 a 
,/ate heal? dep>tm5t1 a ,/ate m$ical    
association1 a multi/ate task =ce1 a    
hospital1 or a heal? sy/em capable (    
adm9i/]+ a program = physician ord]s    
reg>d+ life-su/a9+ treatm5t = a ,/ate2  
or  7ii7 any o!r heal? c>e ag5cy or     
entity z ! ,secret>y det]m9es           
appropriate2 &  7,b7 ! t]m program =    
ord]s = life-su/a9+ treatm5t means a    
program t1 reg>dless ( its "n--  7i7    
implem5ts a cl9ical process design$ to  
facilitate %>$1 in=m$ m$ical            
decisionmak+ & communication betwe5     
heal? c>e pr(essionals & pati5ts )      
s]i\s1 progressive illness or frailty & 
results 9 a set ( m$ical ord]s t--  7,i7
 are consi/5t ) ! national /&>d z       
reflect$ by ! ,national ,,pol/ ,p>adigm1
 repres5t+ heal? c>e provid]s1          

organizations1 & /akehold]s2  7,,ii7 are
 portable & honor$ across c>e sett+s2 & 
7,,iii7 address key m$ical decisions    
consi/5t ) ! pati5t's goals ( c>e2 &    
7ii7 is guid$ by a coalition (          
/akehold]s1 su* z pati5t advocacy gr\ps 
& repres5tatives f across ! cont9uum (  
heal? c>e s]vices1 disability rights    
advocates1 s5ior advocates1 em]g5cy     
m$ical s]vices1 long-t]m c>e1 m$ical    
associations1 hospitals1 home heal?1    
hospice1 palliative c>e1 nurs+          
associations1 ! ,/ate ag5cy responsible 
= s5ior & disability s]vices1 fai?-bas$ 
gr\ps1 & ! ,/ate dep>tm5t ( heal?4  7e7 
,au?orization ( appropriations  7#a7 ,9 
g5]al ,!re are au?oriz$ to be           
appropriat$ to ! ,secret>y1 = purposes (
 aw>d+ grants "u ?is section1           
#ej1jjj1jjj = ! p]iod ( fiscal ye>s     
#bjah ?r\gh #bjbb4  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    
#aj4 ,advance ,c>e ,plann+ ,advisory    
,c\ncil  7a7 ,e/abli%m5t ,n lat] ?an    
#ahj days aft] ! date ( ! enactm5t ( ?is
 ,act1 ! ,secret>y ( ,heal? & ,human    
,s]vices 79 ?is section ref]r$ to z !   
,secret>y7 %all e/abli% )9 ! ,(fice ( ! 
,secret>y an advisory committee to be   
kn[n z ! ,advance ,c>e ,plann+ ,advisory
 ,c\ncil 79 ?is section ref]r$ to z !   
,c\ncil74  7b7 ,duties  7#a7 ,mission ,!
 ,c\ncil %all advise ! ,secret>y reg>d+ 
! compilation1 developm5t1 &            
dissem9ation ( res\rces = develop$ )    
grants aw>d$ "u section #i4  7#b7       
,responsibilities ,responsibilities ( ! 
c\ncil include ! foll[+3 7,a7 ,ensur+ t 
res\rces provid$ conta9 unbias$         

in=mation ab\t ! range ( options        
available to individuals ) s]i\s1 *ronic
 progressive1 advanc$1 or t]m9al        
illness1 includ+ in=mation ab\t         
conv5tional1 curative treatm5ts1        
palliative c>e1 & hospice c>e4  7,b7    
,develop+ /rategies = increas+ public   
und]/&+ ab\t s]i\s1 *ronic progressive1 
& advanc$ illness & ! important role    
advance c>e plann+ c play 9 docum5t+ an 
individual's wi%es = m$ical c>e = lov$  
ones 9 ! ev5t t ! individual _c         
communicate su* wi%es4  7,c7 ,compil+   
in=mation = dissem9ation reg>d+ exi/+   
advance c>e plann+ models includ+       
,,pol/1 advance directives1 & heal?c>e  
proxies4  7,d7 ,promot+ int]ag5cy       
coord9ation & m9imiz+ ov]lap reg>d+     
advance c>e plann+1 includ+             
opportunities to coord9ate ef=ts betwe5 
! ,f$]al ag5cies & ext]nal /akehold]s4  
7,e7 ,id5tify+ & evaluat+ cross-cutt+   
issues su* z p$iatric end-(-life c>e &  
advance c>e plann+ access issues4  7c7  
,memb]%ip  7#a7 ,9 g5]al ,! ,c\ncil %all

 be compos$ ( up to #ae memb]s appo9t$  
by ! ,secret>y f among qualifi$         
individuals :o are n (fic]s or employees
 ( ! ,f$]al ,gov]nm5t4  7#b7 ,gr\ps ,!  
memb]s ( ! ,c\ncil %all include !       
foll[+3 7,a7 ,at lea/ #c memb]s )       
cl9ical tra9+ & an exp]tise 9 palliative
 c>e1 advanc$ illness1 or end-(-life    
c>e4  7,b7 ,at lea/ #c memb]s f pati5t &
 family advocacy gr\ps4  7,c7 ,at lea/  
#c memb]s f religi\s or spiritual       
organizations4  7,d7 ,o!r memb]s f      
int]e/$ /akehold] gr\ps ) a prov5       
exp]tise 9 palliative1 *ronic1 advanc$1 
or end-(-life c>e4  7d7 ,applicability (
 ,,faca ,! ,c\ncil %all be treat$ z an  
advisory committee subject to ! ,f$]al  
,advisory ,committee ,act 7#e ,u4,s4,c4 
,app474  #aa4 ,annual report on ,m$ic>e 
dec$5ts ,! ,secret>y ( ,heal? & ,human  
,s]vices %all issue = ea* fiscal ye>    
7beg9n+ no lat] ?an fiscal ye> #bjah7 an
 annual report t analyzes ! circum/ances
 ( ,m$ic>e b5efici>ies :o di$ dur+ !    
fiscal ye> cov]$ by su* report4 ,su*    

analysis %all include at lea/ ! foll[+ )
 respect to su* dec$5ts3  7#a7          
,in=mation on ! c>e or payor sett+s 7su*
 z "u "p ,a or "p ,c ( ,m$ic>e7 at ! "t 
( dea?4  7#b7 ,in=mation on !           
demographic *>act]i/ics ( su* dec$5ts4  
7#c7 ,in=mation on ! geographic         
di/ribution ( su* dec$5ts4  7#d7 ,an    
evaluation ( ! ,m$ic>e claims data = su*
 dec$5ts = s]vices furni%$ 9 ! la/ ye> (
 life1 includ+ an analysis ( ! sett+ (  
c>e = dec$5ts :o _h m ?an "o *ronic     
illness at ! "t ( dea?4  7#e7 ,su* o!r  
in=mation z ! ,secret>y deems           
appropriate4  #ab4 ,rule ( con/ruction  
,no?+ 9 ! provisions (1 or ! am5dm5ts   
made by1 ?is ,act %all be con/ru$ 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