,,ii #aaeth ,,congress #ast ,session ,s4 #accd ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #ab1 #bjag,mr4 ,warner 7for himself1 ,mr4 ,isakson1 ,ms4 ,baldwin1 ,ms4 ,collins1 ,ms4 ,klobuchar1 and ,mrs4 ,capito7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to provide for advanced illness care coordination services for ,medicare beneficiaries1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,patient ,choice and ,quality ,care ,act of #bjag4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,findings4 ,sec4 #c4 ,advanced illness care and management model4 ,sec4 #d4 ,quality measurement development and implementation4 ,sec4 #e4 ,enhancing coverage of advance care planning services4 ,sec4 #f4 ,advance care planning support tools4 ,sec4 #g4 ,advance directives4 ,sec4 #h4 ,additional requirements for facilities4 ,sec4 #i4 ,grants for increasing public awareness and training4 ,sec4 #aj4 ,advance ,care ,planning ,advisory ,council4 ,sec4 #aa4 ,annual report on ,medicare decedents4 ,sec4 #ab4 ,rule of construction4 #b4 ,findings ,congress makes the following findings3 7#a7 ,the population of the ,united ,states is estimated to age rapidly1 with the number of people over the age of #fe set to double to more than #ih million1 or #a in #e ,americans1 by #bjdj4 7#b7 ,as ,americans live longer and healthier lives1 they also face increased incidence of multiple serious or chronic progressive conditions and advanced illness as they age4 7#c7 ,americans with serious1 chronic progressive1 or advanced illness face a complicated and fragmented system of care delivery that puts them at risk for repeat hospitalizations1 adverse drug reactions1 and conflicting medical advice that may be overwhelming to individuals and families4 7#d7 ,the progression of serious1 chronic progressive1 or advanced illness leads to the need for increasingly intensive decision support1 health care services1 and support from family caregivers4 7#e7 ,the complexity of care needed by individuals with serious1 chronic progressive1 or advanced illness may result in uncoordinated care1 adverse health outcomes1 frustration1 wasted time1 and undue emotional burdens on individuals and their family caregivers4 7#f7 ,numerous private sector leaders1 including hospitals1 health systems1 home health agencies1 hospice programs1 long-term care providers1 employers1 and other entities1 have put in place innovative solutions to provide more comprehensive and coordinated care for ,americans living with serious1 chronic progressive1 or advanced illness4 7#g7 ,hospice and palliative care programs offer patients and families appropriate and patient-centered care1 delivered by an interdisciplinary care team4 ,these programs should serve as models for serious1 chronic progressive1 or advanced illness care delivery4 7#h7 ,individuals have the well-established right to accept or reject medical treatment that is offered and all individuals should be afforded the opportunity to fully participate in decisions related to their health care4 7#i7 ,too often1 individuals with serious1 chronic progressive1 or advanced illness do not understand the conditions they are facing or their treatment options1 and they do not receive the information or support they need to evaluate treatment options in light of their personal goals and values and to document treatment plans in a manner that allows providers and facilities to follow their plans4 7#aj7 ,providing high-quality advanced care planning services and supports to individuals with serious1 chronic progressive1 or advanced illness will protect and preserve their dignity and ensure care is aligned with an individual's goals1 values1 and stated preferences4 #c4 ,advanced illness care and management model ,section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 is amended-- 7#a7 in subsection 7b77#b77;,a71 by adding at the end the following new sentence3 ,the models selected under this subparagraph shall include the model described in subsection 7h71 which shall be implemented by not later than #a year after the date of the enactment of the ,patient ,choice and ,quality ,care ,act of #bjag42 7#b7 by adding at the end the following new subsection3 7h7 ,advanced illness care and management model 7#a7 ,model 7,a7 ,in general ,the model described in this subparagraph is a model under which payments are made under title ,,xviii to applicable providers that furnish advanced illness care and management services1 including care coordination and palliative care services1 to eligible individuals with serious1 chronic progressive1 or advanced illness in order to test the use of targeted advanced illness management and early use of palliative care under the ,medicare program4 7,b7 ,voluntary ,participation under the model shall be voluntary with respect to both eligible individuals and applicable providers4 7,c7 ,requirements 7i7 ,hospice provider ,at least one applicable provider selected for participation under the model shall be a hospice program 7as defined in section #ahfa7;dd77#b774 7ii7 ,comparison ,the ,secretary shall establish the model in such a manner as will permit the comparison of outcomes for eligible individuals participating under the model and eligible individuals who are not so participating4 7iii7 ,incorporation into existing models ,in addition to operating the model independently1 the ,secretary shall incorporate the model into existing models related to the ,medicare program1 such as models involving accountable care organizations1 bundled payments1 and value based purchasing arrangements1 and other coordinated care models as the ,secretary determines to be appropriate4 7#b7 ,payments ,under the model1 the ,secretary shall establish payment amounts for advanced illness care and management services that is targeted to eligible individuals with a serious1 chronic progressive1 or advanced illness4 ,the payments may include payments under a fee schedule1 capitated payments1 bundled payments1 value-based purchasing agreements1 and other payment mechanisms determined appropriate by the ,secretary4 7#c7 ,advanced illness care and management services defined ,in this subsection1 the term advanced illness care and management services means the following services1 as appropriate for the individual's illness and stage of illness3 7,a7 ,one or more face-to-face encounters between one or more members of the interdisciplinary team and the individual and1 at the individual's discretion1 family caregivers1 or1 for an individual who lacks decisionmaking capacity under ,state law1 the individual's legally authorized representative4 7,b7 ,the provision of information about the typical trajectory of illnesses or conditions that affect the individual1 including foreseeable care decisions that may need to be made at a future time when the individual is likely to be unable to make decisions due to temporary or permanent cognitive or medical incapacity4 7,c7 ,assisting the individual in defining and articulating goals of care1 values1 and preferences4 7,d7 ,providing the individual with and discussing information about the benefits and burdens of relevant ranges of treatment options available to the individual1 including disease modifying or potentially curative treatment1 palliative care1 which may be provided alone or in conjunction with disease modifying treatment1 and1 when the individual may be currently eligible or may become eligible for hospice care due to disease progression4 7,e7 ,assisting the individual in evaluating treatment options and approaches to care to identify those that most closely align with the individual's goals of care1 values1 and preferences4 7,f7 ,preparing1 and sharing with relevant providers1 documentation-- 7i7 that states the individual's goals of care1 preferences1 and values1 preferred decisionmaking strategies1 and a plan of care that is concrete and actionable2 and 7ii7 that is in ,state or locally recognized forms that are used for the purpose of assuring that providers can follow the plan across care settings1 such as advance directives or portable treatment orders4 7,g7 ,referrals to providers1 including medical and social service providers1 who deliver care consistent with the plan4 7,h7 ,providing culturally and educationally appropriate training for the individual and family caregivers to support their ability to carry out the plan4 7,i7 ,a multidimensional assessment of the individual's strengths and limitations4 7,j7 ,an assessment of the individual's paid and unpaid supports1 including family caregivers4 7,k7 ,comprehensive medication review and management 7including1 if appropriate1 counseling and self-management support74 7,l7 ,visits to the patient in all sites of care 7including the home1 a hospital1 and a nursing home7 as needed to respond appropriately to problems and concerns4 7,m7 ,additional services1 consistent with the care plan1 that the interdisciplinary team believes would assist the eligible individual and family caregivers in more effectively managing their health condition4 7,n7 #bd-;,hour access to emergency support in person or via telephone or telemedicine with the individual's medical record and care plan available to the responder4 7,o7 ,care coordination and communication across health care and social service settings and providers1 including involvement of the interdisciplinary team to evaluate quality and address concerns over time4 7,p7 ,such other palliative and other services that the ,secretary determines appropriate4 7#d7 ,applicable provider defined ,in this subsection1 the term applicable provider means a hospice program 7as defined in section #ahfa7;dd77#b77 or other provider of services 7as defined in section #ahfa7u77 or supplier 7as defined in section #ahfa7;d77 that-- 7,a7 furnishes services through an interdisciplinary team2 and 7,b7 meets such other requirements the ,secretary may determine to be appropriate4 7#e7 ,eligible individual defined ,in this subsection1 the term eligible individual means an individual who-- 7,a7 is entitled to1 or enrolled for1 benefits under part ,a of title ,,xviii and enrolled under part ,b of such title1 but not enrolled under part ,c of such title2 7,b7 resides at home or in an institutional setting1 whichever is consistent with their personal goals and preferences2 and 7,c7 meets at least one of the following3 7i7 ,the individual has the need for assistance with two or more activities of daily living 7defined as bathing1 dressing1 eating1 getting out of bed or a chair1 mobility1 and toileting7 that is caused by one or more serious or life threatening conditions or frailty and that is not associated with an acute or post-operative condition4 7ii7 ,the individual is diagnosed with a serious1 chronic progressive or advanced illness that-- 7,i7 has a strong negative impact on the individual's quality of life and functioning in life roles1 independent of its impact on mortality2 or 7,,ii7 is burdensome in symptoms1 treatments or caregiver stress4 7iii7 ,the individual is diagnosed with-- 7,i7 metastatic or locally advanced cancer2 7,,ii7 ,alzheimer's disease or another progressive dementia2 7,,iii7 late-stage neuromuscular disease2 7,,iv7 late-stage diabetes2 7,v7 late-stage kidney1 liver1 heart1 gastrointestinal1 cerebrovascular1 or lung disease2 or 7,,vi7 age-related physical debility4 7iv7 ,the individual meets other criteria determined appropriate by the ,secretary4 7#f7 ,interdisciplinary team 7,a7 ,in general ,subject to subparagraph 7,b71 in this subsection1 the term interdisciplinary team means a group that-- 7i7 includes at least-- 7,i7 one physician who is board certified in geriatrics1 internal medicine1 or family medicine2 7,,ii7 one physician1 advance practice registered nurse1 or physician assistant1 who is a palliative specialist 7defined as having a certification in hospice and palliative care7 or who has at least one year's experience providing hospice or palliative care2 7,,iii7 one nurse2 and 7,,iv7 one social worker2 7ii7 may include a chaplain1 minister1 or pastoral counselor2 7iii7 may include other direct care personnel 7including pharmacists1 dieticians1 physical therapists1 occupational therapists1 and psychotherapists72 and 7iv7 meets requirements that may be established by the ,secretary4 7,b7 ,additional member at the request of the eligible individual ,an applicable provider shall offer to the eligible individual 7or the individual's legally authorized representative when the individual has been found to lack decisional capacity7 the opportunity to select either a chaplain affiliated with the applicable provider1 a minister1 or personal religious or spiritual advisor who can help to represent the individual's goals1 values1 and preferences to serve as a core interdisciplinary team member at the individual's 7or legally authorized representative's7 request4 4 #d4 ,quality measurement development and implementation 7a7 ,facilitation of increased coordination and alignment between the public and private sector with respect to quality measures regarding advanced illness1 palliative1 and end-of-,life care 7#a7 ,in general ,section #ahij7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7b77 is amended by inserting after paragraph 7#c7 the following new paragraph3 7#d7 ,increased coordination and alignment between the public and private sector with respect to quality measures regarding advanced illness1 palliative1 and end-of-life care 7,a7 ,in general ,the entity shall facilitate increased coordination and alignment between the public and private sector with respect to quality measures regarding advanced illness1 palliative1 and end-of-life care across the care settings and programs described in this section and across other services and care settings under this title1 as appropriate4 7,b7 ,environmental scan ,the entity shall conduct an environmental scan of measures1 measure concepts1 and preferred practices for advanced illness1 palliative1 and end-of-life care used in both the private and public sectors and from multiple settings of care4 ,such scan shall include a review of the following3 7i7 ,the process of eliciting and documenting patient 7and1 where relevant and appropriate1 family caregiver or legally authorized representative7 goals1 preferences1 and values regarding care and treatment1 including the articulation of goals for end-of-life care that adequately reflect how the patient wants to live4 7ii7 ,the effectiveness1 patient-centeredness 7and1 where relevant1 family caregiver-centeredness71 and adequacy of care plans1 including documentation of individual goals1 preferences1 and values4 7iii7 ,agreement and consistency among-- 7,i7 the patient's goals1 preferences1 and values2 7,,ii7 any documented care plan2 and 7,,iii7 the care delivered4 7iv7 ,timely and appropriate referral to hospice care4 7,c7 ,identification and prioritization of measures ,the entity shall1 based on the scan conducted under subparagraph 7,b71 identify and prioritize measures1 measure concepts1 and preferred practices1 that are aligned across settings of care1 condition1 and patient population4 7,d7 ,report ,not later than #ah months after the date of enactment of this paragraph1 the entity shall submit to the ,secretary a report containing the findings of the entity with respect to the environmental scan under subparagraph 7,b7 and the identification and prioritization of measures1 measure concepts1 and preferred practices under subparagraph 7,c74 4 7b7 ,study and report on ,,nih development of additional measures related to care planning ,section #ahij;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa-#a7 is amended by adding at the end the following new subsection3 7g7 ,study and report on ,,nih development of additional measures related to care planning 7#a7 ,study ,the ,secretary1 in consultation with the ,palliative ,care ,research ,cooperative ,group1 the ,national ,institute of ,nursing ,research1 and the ,office of ,end-of-,life and ,palliative ,care ,research of the ,national ,institutes of ,health shall conduct a study regarding the development of measures related to-- 7,a7 concordance of care between the wishes of an individual and the treatment received by the individual1 including documentation of such wishes in the medical record2 7,b7 understanding the population with serious1 chronic progressive1 or advanced illness that would benefit from palliative care and advance care planning services2 and 7,c7 appropriate transitions to hospice care4 7#b7 ,report ,not later than ,december #ca1 #bjai1 the ,secretary shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a74 4 7c7 ,medicare physician fee schedule ,section #ahdh7s77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7s77#a77 is amended by adding at the end the following new subparagraph3 7,g7 ,clinical care measures relating to palliative and end-of-life care ,beginning after the completion of the environmental scan under section #ahij7;b77#d77;,b71 within one or more appropriate quality domains1 the ,secretary shall1 in consultation with the entity with a contract under section #ahij7;a71 establish appropriate clinical care measures relating to palliative and end-of-life care1 including at least one measure for each of the areas studied under subparagraphs 7,a71 7,b71 and 7,c7 of section #ahij;,a7g77#a74 4 7d7 ,post-,acute care ,section #ahii;,b of the ,social ,security ,act 7#db ,u4,s4,c4 #acielll7 is amended-- 7#a7 in subsection 7a77#b77;,e77i7-- 7,a7 in subclause 7,,iv71 by striking and at the end2 7,b7 in subclause 7,v71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subclause3 7,,vi7 with respect to the domain described in subsection 7c77#a77;,f7 7relating to end-of-life care7-- 7aa7 for ,,pac providers described in clauses 7ii71 7iii71 and 7iv7 of paragraph 7#b77;,a71 ,october #a1 #bjbj2 and 7bb7 for ,,pac providers described in clauses 7i7 of such paragraph1 ,january #a1 #bjba4 2 and 7#b7 in subsection 7c77#a71 by adding at the end the following new subparagraph3 7,f7 ,the effectiveness1 patient-centeredness 7and1 where relevant1 family caregiver-centeredness71 and adequacy of care plans and communications relating to such plans1 including-- 7i7 documentation of a patient's goals1 preferences1 and values2 7ii7 agreement and consistency with respect to care among-- 7,i7 the patient's goals1 preferences1 and values2 7,,ii7 any documented care plan2 and 7,,iii7 the care delivered2 and 7iii7 timely and appropriate referral to hospice care4 4 7e7 ,medicare advantage ,section #aheb7;e77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;e77#c77 is amended by adding at the end the following new subparagraph3 7,c7 ,palliative and end-of-life care ,the ,secretary1 in consultation with the ,national ,committee for ,quality ,assurance1 shall prioritize the development of standards for palliative and end-of-life care1 including transition to hospice care1 with respect to ,medicare ,advantage organizations under this part for use under the quality improvement program under paragraph 7#a7 that are the equivalent of such standards in quality programs applicable to providers of services and suppliers under the original ,medicare fee-for-service program under parts ,a and ,b4 4 7f7 ,alternative payment models ,section #ahii7;b77#c77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7b77#c77;,c77 is amended-- 7#a7 by striking standards4--,the ,secretary and inserting 8standards4-- 7i7 ,in general ,the ,secretary 2 and 7#b7 by adding at the end the following new clause3 7ii7 ,palliative and end-of-life care ,the ,secretary1 in consultation with the entity with a contract under section #ahij7;a71 shall ensure that quality performance standards established under this subparagraph include measures that apply to palliative and end-of-life care1 including transition to hospice care4 4 #e4 ,enhancing coverage of advance care planning services 7a7 ,definition ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end the following new subsection3 7jjj7 ,advance care planning services 7#a7 ,the term advance care planning services means services identified as of the date of enactment of this subsection as ,current ,procedural ,terminology 7,,cpt7 codes #iidig and #iidih1 and such codes as subsequently modified1 that are furnished by a physician or other eligible practitioner 7as determined by the ,secretary74 7#b7 ,for purposes of paragraph 7#a71 the term eligible practitioner includes1 in addition to a practitioner eligible to bill such ,,cpt codes as of the date of enactment of this subsection1 an individual who-- 7,a7 is a clinical social worker 7as defined in subsection 7hh77#a772 and 7,b7 possesses-- 7i7 a relevant care planning certification2 or 7ii7 experience providing care planning conversations or similar services1 as defined by the ,secretary1 in the course of their work4 4 7b7 ,no application of coinsurance or deductible 7#a7 ,amount ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7,a7 by striking and 7,,bb7 and inserting 7,,bb72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,cc7 with respect to advance care planning services 7as defined in section #ahfa7;jjj77#a771 the amounts paid shall be #ajj percent of the lesser of the actual charge for the services or the amount determined under the fee schedule established under section #ahdh7;b744 7#b7 ,waiver of application of deductible ,the first sentence of section #ahcc7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7b77 is amended-- 7,a7 by striking and before 7#aj72 and 7,b7 by inserting before the period the following3 1 and 7#aa7 such deductible shall not apply with respect to advance care planning services 7as defined in section #ahfa7;jjj77#a774 7c7 ,effective date ,the amendment made by this subsection shall apply to advance care planning services furnished on or after ,january #a1 #bjah4 #f4 ,advance care planning support tools 7a7 ,inclusion of advance care planning materials in the ,medicare ,you handbook 7#a7 ,in general ,section #ahjd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7;a77 is amended-- 7,a7 in paragraph 7#b71 by striking and at the end2 7,b7 in paragraph 7#c71 by striking the period at the end and inserting a semicolon2 and 7,c7 by inserting after paragraph 7#c7 the following new paragraphs3 7#d7 information on-- 7,a7 care planning2 7,b7 how individual goals1 values1 and preferences should be considered in framing a care plan2 and 7,c7 a range of approaches for treating serious1 chronic progressive1 or advanced illness1 including disease modifying options1 palliative care that supports individuals from the onset of serious1 chronic progressive1 or advanced illness and can be provided at the same time as all other care types1 and hospice care2 and 7#e7 information on documentation options for care planning or advance care planning1 including advance directives and portable treatment orders4 4 7#b7 ,effective date ,the amendments made by this section shall apply to notices distributed on or after ,january #a1 #bjah4 7b7 ,advance care planning standards for electronic health records 7#a7 ,in general ,notwithstanding section #cjjd7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ad7;b77#c771 not later than #d years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall adopt1 by rule1 standards for a qualified electronic health record 7as defined in section #cjjj7ac7 of such ,act 7#db ,u4,s4,c4 #cjj;jj7#ac771 with respect to organizing patient communications with health care providers about care goals and to provide one-click access to the following3 7,a7 ,the patient's current advance directive 7as defined in section #ahff7;f77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77#c771 as applicable4 7,b7 ,the patient's current order for life-sustaining treatment 7described in section #i7;d77#c77;,b771 as applicable4 7,c7 ,documentation of advance care planning discussion between the patient and the provider4 7#b7 ,treatment of standards ,a standard adopted under paragraph 7#a7 shall be treated as a standard adopted under section #cjjd of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ad7 for purposes of certifying qualified electronic health records pursuant to section #cjja7;c77#e7 of such ,act 7#db ,u4,s4,c4 #cjj;jj-#aa7;c77#e774 #g4 ,advance directives 7a7 ,portability ,section #ahff7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77 is amended by adding at the end the following new paragraph3 7#e7 7,a7 ,an advance directive validly executed outside the ,state in which such directive is presented may be given effect by a provider of services or organization to the same extent as an advance directive validly executed under the law of the ,state in which it is presented4 7,b7 ,in the absence of knowledge to the contrary1 a physician or other health care provider or organization may presume that a written advance health care directive or similar instrument1 regardless of where executed1 is valid4 7,c7 ,the provisions of this paragraph shall preempt any ,state law on advance directive portability to the extent such law is inconsistent with such provisions4 7,d7 ,nothing in the paragraph shall be construed to-- 7i7 authorize the administration of health care treatment otherwise prohibited by the laws of the ,state in which the directive is presented2 7ii7 require a provider of services or an organization to act in a manner contrary to its religious or moral convictions2 7iii7 apply to a request or directive ordering a sterilization or abortion or ordering withdrawal of treatment from a pregnant woman if continued treatment can reasonably be expected to bring her child to live birth2 7iv7 prohibit the application of a ,state law which allows for an objection on the basis of conscience for any health care provider or any agent of such provider which as a matter of conscience cannot implement an advance directive or portable treatment order2 or 7v7 permit the ,secretary to seek civil penalties1 including exclusion from participation in the program under this title or the program under title ,,xix1 against a provider or organization if the provider or organization-- 7,i7 used reasonable efforts to deliver care that is consistent with an individual's goals1 preferences1 and values when addressing decisionmaking for an individual who lacks decisional capacity2 or 7,,ii7 exercised its right of conscience in accordance with clause 7ii7 or 7iv74 4 7b7 ,clarification with respect to advance directives ,paragraph 7#b7 of section #g of the ,assisted ,suicide ,funding ,restriction ,act of #aiig 7#db ,u4,s4,c4 #addjf7 is amended to read as follows3 7#b7 to require any provider or organization1 or any employee of such a provider or organization1 to follow or be bound by a request from an individual or legally authorized representative1 an advance directive1 or a portable treatment order that directs the purposeful causing of1 or the purposeful assisting in causing1 the death of any individuals1 such as by assisted suicide1 euthanasia1 or mercy killing4 4 7c7 ,,gao study on health care decisionmaking laws and barriers to the use of advance directives 7#a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study that examines the use1 portability1 and electronic storage of advance directives and that identifies barriers towards adopting1 using1 and following advance directives in the clinical setting4 ,such examination shall include issues that remain unresolved after the ,stage #c ,meaningful ,use final rule1 including barriers and solutions to finding and accessing advance care planning documents1 best practices for alerting eligible providers to the presence of an advance care plan1 and best practices for transmitting advance care plans across sites of care4 7#b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on the study conducted under paragraph 7#a7 and shall include in the report such recommendations regarding improving advance health care planning as the ,comptroller ,general deems appropriate4 #h4 ,additional requirements for facilities 7a7 ,requirements 7#a7 ,in general ,section #ahff7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is amended-- 7,a7 in subparagraph 7,y71 by striking the period at the end and inserting 2 and2 and 7,b7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 in the case of hospitals1 skilled nursing facilities1 home health agencies1 and hospice programs1 to assure that documented care plans include any advance directives or portable treatment orders made while the individual received care by the provider and that such plan is sent to the individual's primary care provider upon discharge and any facility to which the individual is transferred4 4 7#b7 ,effective ,date ,the amendments made by this subsection shall apply to agreements entered into or renewed on or after ,january #a1 #bjai4 7b7 ,,hhs study and report 7#a7 ,study ,the ,secretary of ,health and ,human ,services shall conduct a study on the extent to which hospitals1 skilled nursing facilities1 hospice programs1 home health agencies1 and providers of advance care planning services work with individuals to-- 7,a7 engage in a care planning process2 7,b7 thoroughly and completely document the care planning process in the medical record and to update the care plan on a regular basis2 7,c7 complete documents necessary to support the treatment and care plan1 such as portable treatment orders and advance directives2 7,d7 provide services and support that are free from discrimination based on advanced age1 disability status1 or diagnosis1 including serious1 chronic progressive1 or advanced illness2 and 7,e7 provide documentation necessary to carry out the treatment plan to-- 7i7 subsequent providers or facilities2 and 7ii7 the individual1 their legally authorized representatives1 and1 where appropriate and relevant1 their family caregiver4 7#b7 ,report ,not later than ,january #a1 #bjba1 the ,secretary of ,health and ,human ,services shall submit to ,congress a report on the study conducted under paragraph 7#a7 together with recommendations for such legislation and administrative action as the ,secretary determines to be appropriate4 #i4 ,grants for increasing public awareness and training 7a7 ,material and resources development ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in consultation with the ,advance ,care ,planning ,advisory ,council 7established in section #aj71 may award grants to public or private entities 7including1 as appropriate1 ,states1 political subdivisions of ,states1 medical schools1 nursing schools1 health care systems1 faith-based organizations1 and religious educational institutions71 or a consortium of any such entities1 to develop online training modules1 decision support tools1 and instructional materials for individuals1 family caregivers1 and health care providers that include-- 7#a7 with respect to healthy individuals1 the importance of-- 7,a7 identifying an individual who will make treatment decisions in the event of future cognitive incapacity2 7,b7 discussing values and goals relevant to serious injury or illness2 and 7,c7 completing an advance directive that-- 7i7 appoints a surrogate2 and 7ii7 documents goals and values and other information that should be considered in making treatment decisions2 7#b7 with respect to individuals with serious1 chronic progressive1 or advanced illness1 the importance of-- 7,a7 articulating goals of care2 7,b7 understanding prognosis and typical disease trajectory2 7,c7 evaluating treatment options in light of goals of care2 7,d7 developing a treatment plan2 and 7,e7 documenting the treatment plan on advance directives1 portable treatment orders1 and other documentation forms used in the locality where the plan is to be executed2 7#c7 the role and effective use of ,state and other advance directive forms and portable treatment orders2 7#d7 the range of services for individuals facing serious1 chronic progressive1 or advanced illness1 including advance care planning services1 palliative care1 and hospice care2 and 7#e7 with respect to providers of advance care planning1 advance illness care1 hospice care1 and palliative care in hospital1 hospice1 home1 community1 and long-term care settings1 material to assist in-- 7,a7 developing and implementing programs and initiatives to train and educate individuals2 7,b7 providing training and continuing education to individuals who will provide advance care planning services or palliative care in the hospital1 hospice1 home1 community1 and long-term care settings2 and 7,c7 developing curricula or teaching materials related to advance care planning or palliative care in such settings4 7b7 ,establishment and maintenance of web- and telephone-,based resources 7#a7 ,in general ,the ,secretary may award grants to public or private entities 7including ,states1 political subdivisions of ,states1 faith-based organizations1 and religious educational institutions71 or a consortium of any such entities1 to establish and maintain an ,internet website and telephone hotline to disseminate resources developed under subsection 7a7 and materials for faith communities designed by the ,department of ,health and ,human ,services ,center for ,faith-,based and ,neighborhood ,partnerships4 7#b7 ,ability to sustain activities ,in determining whether to award a grant under paragraph 7#a71 the ,secretary shall take into account the ability of an entity to sustain the activities described in paragraph 7#a7 beyond the initial grant period4 7c7 ,national public education campaign ,the ,secretary may award grants to public or private entities 7including ,states1 political subdivisions of ,states1 faith-based organizations1 and religious educational institutions7 to conduct a national public education campaign to raise public awareness of advance care planning and serious1 chronic progressive1 or advanced illness care1 including the availability of the resources created under this section4 7d7 ,orders for life-,sustaining treatment 7#a7 ,in general ,the ,secretary may award grants to eligible entities for the purposes of carrying out the activities under paragraph 7#b74 7#b7 ,authorized activities ,activities funded through a grant under this section for an area may include-- 7,a7 establishing and operating a ,national ,resource ,center on ,,polst ,programs to provide-- 7i7 technical assistance and professional training to programs for orders for life-sustaining treatment2 7ii7 analysis and dissemination of best practices in implementing program for orders for life-sustaining treatment2 7iii7 voluntary standards for the establishment and operation of program for orders for life-sustaining treatment2 and 7iv7 compilations and summaries of recently conducted research and other resources relevant to program for orders for life-sustaining treatment2 7,b7 developing such a program for the area that includes hospitals1 home care1 hospice1 long-term care1 community and assisted living residences1 skilled nursing facilities1 and emergency medical services within a ,state2 and 7,c7 expanding an existing program for orders regarding life-sustaining treatment to serve more patients or enhance the quality of services1 including educational services for patients and patients' families1 training of health care professionals1 or establishing an orders for life-sustaining treatment registry4 7#c7 ,definitions ,in this subsection-- 7,a7 the term eligible entity means-- 7i7 an academic medical center1 a medical school1 a ,state health department1 a ,state medical association1 a multistate task force1 a hospital1 or a health system capable of administering a program for physician orders regarding life-sustaining treatment for a ,state2 or 7ii7 any other health care agency or entity as the ,secretary determines appropriate2 and 7,b7 the term program for orders for life-sustaining treatment means a program that1 regardless of its name-- 7i7 implements a clinical process designed to facilitate shared1 informed medical decisionmaking and communication between health care professionals and patients with serious1 progressive illness or frailty and results in a set of medical orders that-- 7,i7 are consistent with the national standard as reflected by the ,national ,,polst ,paradigm1 representing health care providers1 organizations1 and stakeholders2 7,,ii7 are portable and honored across care settings2 and 7,,iii7 address key medical decisions consistent with the patient's goals of care2 and 7ii7 is guided by a coalition of stakeholders1 such as patient advocacy groups and representatives from across the continuum of health care services1 disability rights advocates1 senior advocates1 emergency medical services1 long-term care1 medical associations1 hospitals1 home health1 hospice1 palliative care1 nursing associations1 the ,state agency responsible for senior and disability services1 faith-based groups1 and the ,state department of health4 7e7 ,authorization of appropriations 7#a7 ,in general ,there are authorized to be appropriated to the ,secretary1 for purposes of awarding grants under this section1 #ej1jjj1jjj for the period of fiscal years #bjah through #bjbb4 7#b7 ,limitation ,none of the funds appropriated under paragraph 7#a7 shall be used to-- 7,a7 develop a model advance directive2 7,b7 develop or employ a dollars-per-quality adjusted life year 7or similar measure that discounts the value of a life because of an individual's disability72 or 7,c7 make a grant to a private entity that advocates1 promotes1 or facilitates any item or procedure for which funding is unavailable under the ,assisted ,suicide ,funding ,restriction ,act of #aiig 7,public ,law #aje-ab74 #aj4 ,advance ,care ,planning ,advisory ,council 7a7 ,establishment ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall establish within the ,office of the ,secretary an advisory committee to be known as the ,advance ,care ,planning ,advisory ,council 7in this section referred to as the ,council74 7b7 ,duties 7#a7 ,mission ,the ,council shall advise the ,secretary regarding the compilation1 development1 and dissemination of resources for developed with grants awarded under section #i4 7#b7 ,responsibilities ,responsibilities of the council include the following3 7,a7 ,ensuring that resources provided contain unbiased information about the range of options available to individuals with serious1 chronic progressive1 advanced1 or terminal illness1 including information about conventional1 curative treatments1 palliative care1 and hospice care4 7,b7 ,developing strategies for increasing public understanding about serious1 chronic progressive1 or advanced illness and the important role advance care planning can play in documenting an individual's wishes for medical care for loved ones in the event that the individual cannot communicate such wishes4 7,c7 ,compiling information for dissemination regarding existing advance care planning models including ,,polst1 advance directives1 and healthcare proxies4 7,d7 ,promoting interagency coordination and minimizing overlap regarding advance care planning1 including opportunities to coordinate efforts between the ,federal agencies and external stakeholders4 7,e7 ,identifying and evaluating cross-cutting issues such as pediatric end-of-life care and advance care planning access issues4 7c7 ,membership 7#a7 ,in general ,the ,council shall be composed of up to #ae members appointed by the ,secretary from among qualified individuals who are not officers or employees of the ,federal ,government4 7#b7 ,groups ,the members of the ,council shall include the following3 7,a7 ,at least #c members with clinical training and an expertise in palliative care1 advanced illness1 or end-of-life care4 7,b7 ,at least #c members from patient and family advocacy groups4 7,c7 ,at least #c members from religious or spiritual organizations4 7,d7 ,other members from interested stakeholder groups with a proven expertise in palliative1 chronic1 advanced1 or end-of-life care4 7d7 ,applicability of ,,faca ,the ,council shall be treated as an advisory committee subject to the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app474 #aa4 ,annual report on ,medicare decedents ,the ,secretary of ,health and ,human ,services shall issue for each fiscal year 7beginning no later than fiscal year #bjah7 an annual report that analyzes the circumstances of ,medicare beneficiaries who died during the fiscal year covered by such report4 ,such analysis shall include at least the following with respect to such decedents3 7#a7 ,information on the care or payor settings 7such as under part ,a or part ,c of ,medicare7 at the time of death4 7#b7 ,information on the demographic characteristics of such decedents4 7#c7 ,information on the geographic distribution of such decedents4 7#d7 ,an evaluation of the ,medicare claims data for such decedents for services furnished in the last year of life1 including an analysis of the setting of care for decedents who had more than one chronic illness at the time of death4 7#e7 ,such other information as the ,secretary deems appropriate4 #ab4 ,rule of construction ,nothing in the provisions of1 or the amendments made by1 this ,act shall be construed to limit the restrictions of1 or to authorize the use of ,federal funds for any service1 material1 or activity pertaining to an item or service or procedure for which funds are unavailable under1 the ,assisted ,suicide ,funding ,restriction ,act of #aiig 7,public ,law #aje-ab74