,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #dide  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #b1 #bjbj ,mr4
 ,blum5?al introduc$ ! foll[+ bill2 :i* 
0 read twice & ref]r$ to ! ,committee on
 ,heal?1 ,education1 ,labor1 & ,p5sions 
,a ,,bill  ,to improve end-(-life c>e4  
#a4 ,%ort title  7a7 ,%ort title ,?is   
,act may be cit$ z ! ,compassionate ,c>e
 ,act4  7b7 ,table ( cont5ts ,! table ( 
cont5ts ( ?is ,act is z foll[s3  ,sec4  
#a4 ,%ort title4 ,sec4 #b4 ,def9itions4 
,,title ,i--,advance c>e plann+         
,subtitle ,a--,consum] education ,sec4  
#aja4 ,advance c>e plann+ guidel9es4    
,sec4 #ajb4 ,national public education  
campaign4 ,subtitle ,b--,provid]        
education ,sec4 #aaa4 ,public provid]   
advance c>e plann+ website4 ,sec4 #aab4 
,advance c>e curricula pilot program4   
,sec4 #aac4 ,developm5t ( core          
end-(-life c>e quality measures across  
ea* relevant provid] sett+4 ,sec4 #aad4 
,cont9u+ education = qualifi$ heal? c>e 
provid]s4 ,subtitle ,c--,m$ic>e am5dm5ts

 ,sec4 #aba4 ,p]man5t ext5sion (        
au?orization = use ( teleheal? to       
conduct face-to-face enc\nt] prior to   
rec]tification ( eligibility = hospice  
c>e4 ,sec4 #abb4 ,improvem5ts to advance
 c>e plann+ ?r\gh teleheal?4 ,,title    
,,ii--,reports1 rese>*1 & evaluations   
,sec4 #bja4 ,/udy & report by !         
,secret>y reg>d+ ! e/abli%m5t &         
implem5tation ( a national uni=m policy 
on advance directives4 ,sec4 #bjb4 ,,gao
 /udy & report on e/abli%m5t ( national 
advance directive regi/ry2 o!r /udies4  
#b4 ,def9itions ,9 ?is ,act3 7#a7       
,advance c>e plann+ ,! t]m advance c>e  
plann+ means ! process ( discussion (   
c>e 9 ! ev5t t an individual is unable  
to make treatm5t decisions on _! own    
behalf1 cl>ification ( relat$ values &  
goals1 & embodim5t ( pref]5ces &        
decision mak+ ?r\gh writt5 docum5ts &   
m$ical ord]s4  7#b7 ,advance directive  
,! t]m advance directive means a writt5 
or o!rwise record$ in/ruction1 su* z a  
liv+ w or durable p[] ( attorney = heal?

 c>e1 recogniz$ "u ! law ( ! ,/ate 9 :i*
 x 0 execut$ 7:e!r /atutory or z        
recogniz$ by ! c\rts ( ! ,/ate7 & relat+
 to ! provision ( su* c>e :5 !          
individual is incapacitat$4  7#c7       
,c]tifi$ *apla9 ,! t]m c]tifi$ *apla9   
means a memb] ( cl]gy :o has met !      
requirem5ts "u ! ,common ,qualifications
 & ,compet5cies = ,pr(essional ,*apla9s 
& is bo>d c]tifi$ by a national *apla9cy
 organization4  7#d7 ,,*ip ,! t]m ,,*ip 
means ! ,/ate ,*ildr5's ,heal?          
,insurance ,program "u title ,,xxi ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acig;aa et seq47  7#e7 ,end-(-life c>e 
,! t]m end-(-life c>e means all aspects 
( c>e ( a pati5t ) a pot5tially fatal   
condition1 & includes c>e t is focus$ on
 prep>ations = an imp5d+ dea?4  7#f7    
,heal? c>e ag5t ,! t]m heal? c>e ag5t   
means ! p]son1 designat$ 9 a heal? c>e  
p[] ( attorney1 :o is select$ to make   
m$ical decisions on behalf ( ! p]son :o 
execut$ su* p[] ( attorney1 9 ! case (  
incapacity ( su* p]son :o execut$ ! p[] 

( attorney4  7#g7 ,heal? c>e p[] (      
attorney ,! t]m heal? c>e p[] ( attorney
 means a legal docum5t t id5tifies !    
heal? c>e ag5t ( ! p]son execut+ su*    
docum5t4  7#h7 ,liv+ w ,! t]m liv+ w    
means a writt5 docum5t or a video       
/atem5t ab\t ! k9ds ( m$ical c>e or o!r 
c>e a p]son does or does n want "u c]ta9
 specific conditions1 9 ! ev5t t su*    
p]son no long] is able to express ^?    
wi%es4  7#i7 ,m$icaid ,! t]m ,m$icaid   
means ! program e/abli%$ "u title ,,xix 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif et seq474  7#aj7 ,m$ic>e
 ,! t]m ,m$ic>e means ! program e/abli%$
 "u title ,,xviii ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acie et seq474     
7#aa7 ,ord]s = life-su/a9+ treatm5t ,!  
t]m ord]s = life-su/a9+ treatm5t means a
 set ( portable m$ical ord]s 7su* z     
physician ord]s = life-su/a9+ treatm5t  
or simil> portable m$ical ord]s7 t      
address key m$ical decisions consi/5t ) 
! pati5t's goals ( c>e & results f a    
cl9ical process design$ to facilitate   

%>$1 in=m$ m$ical decision mak+ &       
communication betwe5 qualifi$ heal? c>e 
pr(essionals & pati5ts ) s]i\s1         
progressive illness or frailty4  7#ab7  
,qualifi$ heal? c>e provid] ,! t]m      
qualifi$ heal? c>e provid] means a      
m$ical doctor1 doctor ( o/eopa?y1 nurse1
 physician assi/ant1 nurse practition]1 
social work]1 home heal? aide1          
palliative c>e pr(essional1 community   
heal? work]1 community heal? educator1  
or individual 9 a simil> position1 z    
designat$ by ! ,secret>y4  7#ac7        
,secret>y ,! t]m ,secret>y means !      
,secret>y ( ,heal? & ,human ,s]vices4   
,i ,advance c>e plann+  ,a ,consum]     
education  #aja4 ,advance c>e plann+    
guidel9es ,x is ! s5se ( ! ,s5ate t1 to 
! ext5t practicable1 advance c>e plann+ 
%\ld-- 7#a7 occur ) an individual & su* 
individual's heal? c>e ag5t1 prim>y     
cl9ician1 o!r au?oriz$ decisionmak]1 or 
memb]s ( ! entire int]discipl9>y heal?  
c>e team2  7#b7 be record$ & updat$ z   
ne$$2 &  7#c7 all[ = flexible decision  

mak+ 9 ! context ( ! pati5t's m$ical    
situation1 9 accordance ) be/ practice  
guidel9es provid$ by ! ,secret>y4  #ajb4
 ,national public education campaign    
7a7 ,national public education campaign 
7#a7 ,9 g5]al ,n lat] ?an ,janu>y #a1   
#bjba1 ! ,secret>y1 act+ ?r\gh !        
,director ( ! ,c5t]s = ,disease ,control
 & ,prev5tion & 9 consultation ) public 
& private entities1 %all1 directly or   
?r\gh grants1 contracts1 or int]ag5cy   
agreem5ts1 develop & implem5t a national
 campaign to in=m ! public ( !          
importance ( advance c>e plann+ & ( an  
individual's "r to direct & p>ticipate 9
 heal? c>e decisions affect+ su*        
individual4  7#b7 ,cont5t ( educational 
campaign ,! national public education   
campaign e/abli%$ "u p>agraph 7#a7      
%all--  7,a7 employ ! use ( v>i\s m$ia1 
includ+ social m$ia plat=ms & televis$  
public s]vice ann\ncem5ts2  7,b7 provide
 culturally & l+ui/ically appropriate   
in=mation2  7,c7 be conduct$ cont9u\sly 
ov] a p]iod ( n less ?an #e ye>s2  7,d7 

id5tify & promote ! advance c>e plann+  
in=mation available on ! int]net        
websites ( ! ,dep>tm5t ( ,heal? & ,human
 ,s]vice's ,national ,cle>+h\se =       
,long-,t]m ,c>e ,in=mation1 !           
,adm9i/ration = ,*ildr5 & ,families1 !  
,adm9i/ration = ,community ,liv+1 & !   
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices2    
7,e7 address ! importance ( individuals 
speak+ to family memb]s1 heal? c>e      
proxies1 & qualifi$ heal? c>e provid]s z
 "p ( an ongo+ dialogue reg>d+ heal? c>e
 *oices2  7,f7 address ! ne$ =          
individuals to use portable1            
int]op]able1 & accessible me?ods to     
communicate _! heal? c>e decisions ?r\gh
 a v>iety ( means1 us+ legally          
effectuat$ docum5ts t express _! heal?  
c>e decisions 9 ! =m ( advance          
directives 7includ+ liv+ wills1 ord]s = 
life-su/a9+ treatm5t1 & durable p[]s (  
attorney = heal? c>e72  7,g7 raise      
public aw>5ess reg>d+ ! availability (  
hospice & palliative c>e & ! quality (  
life b5efits ( e>ly use ( su* s]vices2  

7,h7 enc\rage individuals to speak )    
qualifi$ heal? c>e pr(essionals ab\t _! 
options & int5tions = end-(-life c>e2 & 
7,i7 adh]e to evid5ce-bas$ rese>* on !  
mo/ effective ways to communicate !     
necessity & b5efits ( advance c>e       
plann+4  7#c7 ,evaluation ,n lat] ?an   
,july #a1 #bjbc1 ! ,secret>y %all report
 to ! appropriate committees ( ,congress
 on ! effectiv5ess ( ! public education 
campaign "u ?is section1 & include 9 su*
 report any recomm5dations t ! ,secret>y
 det]m9es appropriate reg>d+ ! ne$ =    
cont9uation ( legislative or            
adm9i/rative *anges to facilitate *ang+ 
public aw>5ess1 attitudes1 & behaviors  
reg>d+ advance c>e plann+4  7#d7        
,au?orization ( appropriations ,!re are 
au?oriz$ to be appropriat$ su* sums z   
may be necess>y to c>ry out ?is section4
  7b7 ,repeal ,section #dgea7;d7 ( !    
,omnibus ,budget ,reconciliation ,act ( 
#aiij 7#db ,u4,s4,c4 #acif;a note2      
,public ,law #aja-ejh7 is repeal$4  ,b  
,provid] education  #aaa4 ,public       

provid] advance c>e plann+ website  7a7 
,developm5t ,n lat] ?an ,janu>y #a1     
#bjbb1 ! ,secret>y1 act+ ?r\gh !        
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices & ! ,director ( !     
,ag5cy = ,heal?c>e ,rese>* & ,quality1  
%all e/abli% an1 or exp& ^u an exi/+1   
int]net website = provid]s "u ,m$ic>e1  
,m$icaid1 ,,*ip1 ! ,indian ,heal?       
,s]vice 7includ+ contract provid]s71 &  
o!r qualifi$ heal? c>e provid]s1 includ+
 qualifi$ heal? c>e provid]s receiv+    
assi/ance "u ! ,old] ,am]icans ,act (   
#aife 7#db ,u4,s4,c4 #cjjb et seq47 to  
s]ve old] individuals1 on ea*           
individual's "r to make decisions       
conc]n+ m$ical c>e1 includ+ ! "r to     
accept or refuse m$ical or surgical     
treatm5t1 & engage 9 advance c>e plann+4
  7b7 ,ma9t5ance ,! int]net website     
describ$ 9 subsection 7a7 %all be       
ma9ta9$ & publiciz$ by ! ,secret>y on an
 ongo+ basis4  7c7 ,cont5t ,! int]net   
website %all include cont5t1 tools1 &   
res\rces necess>y to d ! foll[+3 7#a7   

,in=m qualifi$ heal? c>e provid]s &     
c]tifi$ *apla9s ab\t ! advance directive
 requirem5ts "u ! heal? c>e programs    
describ$ 9 subsection 7a7 & ,/ate &     
,f$]al laws & regulations relat$ to     
advance c>e plann+4  7#b7 ,educate      
qualifi$ heal? c>e provid]s & c]tifi$   
*apla9s ab\t advance c>e plann+ quality 
improvem5t activities4  7#c7 ,provide   
assi/ance to qualifi$ heal? c>e provid]s
 to--  7,a7 integrate advance c>e plann+
 docum5ts into electronic heal? records2
 &  7,b7 develop & dissem9ate advance   
c>e plann+ in=mational mat]ials =       
pati5ts4  7#d7 ,in=m qualifi$ heal? c>e 
provid]s ab\t advance c>e plann+ cont9u+
 education requirem5ts & opportunities4 
7#e7 ,enc\rage qualifi$ heal? c>e       
provid]s to discuss advance c>e plann+ )
 pati5ts ( all ages1 z appropriate4     
7#f7 ,assi/ qualifi$ heal? c>e provid]s 
& c]tifi$ *apla9s 9 und]/&+ ! cont9uum (
 end-(-life c>e s]vices & supports      
available to pati5ts1 includ+ palliative
 c>e & hospice4  7#g7 ,in=m qualifi$    

heal? c>e provid]s ( be/ practices =    
discuss+ end-(-life c>e ) pati5ts :o h a
 s]i\s or t]m9al diagnosis or prognosis 
& _! lov$ ones4  #aab4 ,advance c>e     
curricula pilot program  7a7 ,9 g5]al ,!
 ,secret>y1 9 consultation ) appropriate
 pr(essional associations1 %all e/abli% 
a pilot program by :i* ! ,secret>y aw>ds
 grants to eligible entities = purposes 
( support+ su* entities 9 e/abli%+      
end-(-life tra9+ requirem5ts 9 !        
entities' applicable degree programs4   
7b7 ,eligibility ,to be eligible to     
p>ticipate 9 ! pilot program "u ?is     
section1 an entity %all--  7#a7 be a    
s*ool ( m$ic9e1 s*ool ( o/eopa?ic       
m$ic9e1 a physician assi/ant education  
program 7z def9$ 9 section #gii;,b7#c7 (
 ! ,public ,heal? ,s]vice ,act 7#db     
,u4,s4,c4 #biep7#c7771 a s*ool ( alli$  
heal? 7z def9$ 9 section #gii;,b7#d7 ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #biep7#d7771 a s*ool ( nurs+1 
a s*ool ( social "w1 a graduate m$ical  
education program accr$it$ by !         

,accr$itation ,c\ncil = ,graduate       
,m$ical ,education or ! ,am]ican        
,o/eopa?ic ,association1 or o!r s*ool1 z
 ! ,secret>y det]m9es appropriate2  7#b7
 be /aff$ by tea*+ heal? pr(essionals :o
 h exp]i5ce or tra9+ 9 palliative       
m$ic9e2  7#c7 provide tra9+ 9 palliative
 m$ic9e ?r\gh a v>iety ( s]vice         
rotations1 su* z consultation s]vices1  
acute c>e s]vices1 ext5d$ c>e           
facilities1 ambulatory c>e &            
compreh5sive evaluation units1 hospice1 
home heal?1 & community c>e programs2   
7#d7 develop specific p]=mance-bas$     
measures to evaluate ! compet5cy (      
tra9ees2 &  7#e7 ensure t by n lat] ?an 
! end ( ! #b-ye> p]iod beg9n+ on ! date 
( enactm5t ( ?is ,act1 pr(essionals :o  
are applicable faculty at ! entity1 or  
o!rs z det]m9$ appropriate by !         
,secret>y1 %all be (f]$ retra9+ 9       
hospice & palliative m$ic9e4  7c7 ,tra9+
 ,eligible entities p>ticipat+ 9 ! pilot
 program "u ?is section %all require    
m9imum tra9+ = tra9ees t includes--     

7#a7 tra9+ 9 h[ to discuss & help       
pati5ts & _! lov$ ones ) advance c>e    
plann+2  7#b7 ) respect to tra9ees :o w 
"w ) *ildr51 specializ$ p$iatric tra9+2 
7#c7 tra9+ 9 ! cont9uum ( end-(-life    
s]vices & supports1 includ+ palliative  
c>e & hospice2  7#d7 tra9+ 9 h[ to      
discuss end-(-life c>e ) dy+ pati5ts &  
_! lov$ ones2  7#e7 m$ical & legal      
issues tra9+ associat$ ) end-(-life c>e2
  7#f7 tra9+ 9 l+ui/ic & cultural       
compet5cy2 &  7#g7 9 ! case ( a graduate
 m$ical education program accr$it$ by ! 
,accr$itation ,c\ncil = ,graduate       
,m$ical ,education or ! ,am]ican        
,o/eopa?ic ,association1 a longitud9al  
compon5t ( at lea/ #f mon?s4  7d7       
,reports ,ea* recipi5t ( a grant "u ?is 
section %all report to ! ,secret>y on ! 
outcomes ( ! program )9 #ah mon?s (     
receipt ( ! f9al allotm5t ( grant funds4
 ,n lat] ?an #a ye> aft] receipt ( all  
su* reports1 ! ,secret>y %all submit to 
,congress a report compil+ su* results f
 all grant recipi5ts4  7e7 ,au?orization

 ( appropriations ,!re are au?oriz$ to  
be appropriat$ su* sums z may be        
necess>y to c>ry out ?is section4  #aac4
 ,developm5t ( core end-(-life c>e      
quality measures across ea* relevant    
provid] sett+  7a7 ,9 g5]al ,!          
,secret>y1 act+ ?r\gh ! ,director ( !   
,ag5cy = ,heal?c>e ,rese>* & ,quality 79
 ?is section ref]r$ to z ! ,director7 & 
9 consultation ) ! ,adm9i/rator ( !     
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices1    
%all require ! developm5t ( specific    
end-(-life quality measures = ea*       
relevant qualifi$ heal? c>e provid]     
sett+1 z id5tifi$ by ! ,director1 9     
accordance ) ! requirem5ts ( subsection 
7b74  7b7 ,requirem5ts ,= purposes (    
subsection 7a71 ! requirem5ts specifi$ 9
 ?is subsection are ! foll[+3 7#a7      
,selection ( ! specific measure or      
measures = an id5tifi$ provid] sett+    
%all be bas$ on an assessm5t ( :at is   
likely to h ! greate/ positive impact on
 quality ( end-(-life c>e 9 t sett+1 &  
made 9 consultation ) affect$ provid]s1 

pati5ts1 & private organizations1 t h   
develop$ su* measures4  7#b7 ,! measures
 may be /ructure-ori5t$1 process-ori5t$1
 or outcome-ori5t$1 z det]m9$           
appropriate by ! ,director1 & %all be   
pati5t-ori5t$4  7#c7 ,! ,director %all  
ensure t report+ requirem5ts relat$ to  
su* measures--  7,a7 are impos$         
consi/5tly ) o!r applicable laws &      
regulations1 & 9 a mann] t takes into   
acc\nt exi/+ measures1 ! ne$s ( pati5t  
populations1 ! specific s]vices provid$1
 & ! pot5tial adm9i/rative burd5 to     
provid]s2 &  7,b7 include demographic   
in=mation to acc\nt = race1 e?nicity1   
age1 & g5d]1 & o!r appropriate          
categories4  7#d7 ,n lat] ?an-- 7,a7    
,janu>y #a1 #bjbb1 ! ,secret>y %all     
dissem9ate ! report+ requirem5ts to all 
affect$ provid]s & provide = a #fj-;day 
p]iod = public comm5t2 &  7,b7 ,janu>y  
#a1 #bjbc1 initial report+ by heal? c>e 
provid]s relat+ to ! measures %all beg94
  #aad4 ,cont9u+ education = qualifi$   
heal? c>e provid]s  7a7 ,9 g5]al ,n lat]

 ?an ,janu>y #a1 #bjba1 ! ,secret>y1    
act+ ?r\gh ! ,adm9i/rator ( ! ,heal?    
,res\rces & ,s]vices ,adm9i/ration1 %all
 develop or enhance new & exi/+         
curricula on advance c>e plann+ &       
end-(-life c>e = cont9u+ education t    
,/ates may adopt = qualifi$ heal? c>e   
provid]s4  7b7 ,consultation ,9 c>ry+   
out subsection 7a71 ! ,secret>y1 act+   
?r\gh ! ,adm9i/rator ( ! ,heal?         
,res\rces & ,s]vices ,adm9i/ration1 may 
consult ) qualifi$ heal? c>e provid]s1  
applicable pr(essional cl9ician         
associations1 in/itutions ( high]       
education1 ,/ate bo>ds ( m$ic9e & nurs+1
 & o!r pr(essionals1 z ! ,secret>y      
det]m9es appropriate4  7c7 ,cont5t ,!   
cont9u+ education curriculum develop$ or
 enhanc$ "u subsection 7a7 %all1 at a   
m9imum1 include--  7#a7 a description ( 
! mean+ & importance ( advance c>e      
plann+2  7#b7 a description ( advance   
c>e plann+ docum5ts1 includ+ liv+ wills 
& durable p[]s ( attorney1 & ! use ( su*
 directives2  7#c7 ! appropriate use (  

ord]s = scope ( treatm5t2  7#d7 c\nsel+ 
skills = :5 & h[ to introduce & engage 9
 advance c>e plann+ ) pati5ts & _! lov$ 
ones2  7#e7 palliative c>e pr9ciples &  
approa*es to c>e2  7#f7 ! cont9uum (    
end-(-life s]vices & supports1 includ+  
palliative c>e & hospice2 &  7#g7 !     
importance ( introduc+ palliative c>e & 
hospice e>ly 9 illness 9 ord] to improve
 quality ( life4  ,c ,m$ic>e am5dm5ts   
#aba4 ,p]man5t ext5sion ( au?orization =
 use ( teleheal? to conduct face-to-face
 enc\nt] prior to rec]tification (      
eligibility = hospice c>e ,section      
#ahad7;a77#g77;,d77i77,,ii7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acie;f7a77#g77;,d77i77,,ii77 is am5d$  
by ins]t+ & aft] aft] dur+4  #abb4      
,improvem5ts to advance c>e plann+ ?r\gh
 teleheal? ,section #ahcd7m7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciem7m77 is am5d$-- 7#a7 9 p>agraph   
7#b77;,b77i71 9 ! matt] prec$+ subclause
 7,i71 by /rik+ & p>agraph 7#f77;,c7 &  
ins]t+ 1 p>agraph 7#f77;,c71 & p>agraph 

7#i77;,b72  7#b7 9 p>agraph 7#d77;,c7-- 
7,a7 9 clause 7i71 9 ! matt] prec$+     
subclause 7,i71 by /rik+ & 7#g7 & ins]t+
 7#g71 & 7#i72 &  7,b7 9 clause         
7ii77,x71 by ins]t+ or p>agraph 7#i7    
be=e ! p]iod2 &  7#c7 by add+ at ! end !
 foll[+ new p>agraph3  7#i7 ,treatm5t ( 
advance c>e plann+ s]vices ,!           
requirem5ts describ$ 9 p>agraph         
7#d77;,c77i7 %all n apply ) respect to  
teleheal? s]vices furni%$ on or aft]    
,janu>y #a1 #bjba1 = purposes ( furni%+ 
advance c>e plann+ s]vices1 z det]m9$ by
 ! ,secret>y4  4  ,,ii ,reports1 rese>*1
 & evaluations  #bja4 ,/udy & report by 
! ,secret>y reg>d+ ! e/abli%m5t &       
implem5tation ( a national uni=m policy 
on advance directives  7a7 ,/udy  7#a7  
,9 g5]al ,! ,secret>y1 act+ ?r\gh !     
,(fice ( ! ,assi/ant ,secret>y = ,plann+
 & ,evaluation1 %all conduct a /udy to  
evaluate ! b>ri]s to e/abli%+ &         
implem5t+ a national uni=m policy on    
advance directives & :at ne$s to be done
 to ov]come ^? b>ri]s4  7#b7 ,matt]s    

/udi$ ,! matt]s /udi$ by ! ,secret>y "u 
p>agraph 7#a7 %all include issues       
conc]n+-- 7,a7 family satisfaction t a  
pati5t's wi%es1 z /at$ 9 ! pati5t's     
advance directive1 7 c>ri$ out2  7,b7 ! 
usability1 accessibility1               
int]op]ability1 & portability ( advance 
directives1 includ+ cases involv+ !     
transf] ( an individual f "o heal? c>e  
sett+ to ano!r2  7,c7 ! feasibility (   
e/abli%+ an optional1 national advance  
directive =m deem$ valid by any heal?   
c>e entity or qualifi$ heal? c>e provid]
 p>ticipat+ 9 ,m$ic>e1 ,m$icaid1 or     
,,*ip1 reg>dless ( ,/ate law2 &  7,d7   
,/ate v>iations 9 advance directive laws
 t are relevant to ! e/abli%m5t &       
implem5tation ( a national uni=m policy 
( advance directives4  7b7 ,report to   
,congress ,n lat] ?an #b ye>s aft] !    
date ( enactm5t ( ?is ,act1 ! ,secret>y 
%all submit to ,congress a report on !  
/udy conduct$ "u subsection 7a71 toge!r 
) recomm5dations = su* legislation &    
adm9i/rative actions z ! ,secret>y      

consid]s appropriate4  7c7 ,consultation
 ,9 conduct+ ! /udy & develop+ ! report 
"u ?is section1 ! ,secret>y %all consult
 ) relevant /akehold]s & o!r int]e/$    
p>ties4  #bjb4 ,,gao /udy & report on   
e/abli%m5t ( national advance directive 
regi/ry2 o!r /udies  7a7 ,/udy & report 
on e/abli%m5t ( national advance        
directive regi/ry  7#a7 ,/udy ,!        
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all conduct a /udy on ! feasibility ( a
 national regi/ry = advance directives1 
tak+ into consid]ation ! con/ra9ts      
creat$ by ! privacy provisions enact$ z 
a result ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    
#aiif 7,public ,law #ajd-aia74  7#b7    
,report ,n lat] ?an #ah mon?s aft] !    
date ( enactm5t ( ?is ,act1 !           
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ,congress a report on !  
/udy conduct$ "u subsection 7a7 toge!r )
 recomm5dations = su* legislation &     
adm9i/rative action z ! ,comptroll]     
,g5]al ( ! ,unit$ ,/ates det]m9es to be 

appropriate4  7b7 ,,onc /udy ,!         
,national ,coord9ator ( ! ,(fice ( !    
,national ,coord9ator = ,heal?          
,in=mation ,te*nology %all conduct a    
/udy on ! feasibility & impact on       
advance c>e plann+ ( requir+ t          
electronic heal? record v5dors seek+    
c]tification h a prom95t & easily       
visible field = /or+ & %>+ advance c>e  
plann+ docum5ts & relat$ cl9ical notes4 
7c7 ,,onc demon/ration programs ,!      
,national ,coord9ator = ,heal?          
,in=mation ,te*nology1 9 collaboration )
 ! ,director ( ! ,national ,in/itute (  
,/&>ds & ,te*nology1 %all initiate #b   
demon/ration programs to e/abli% be/    
practices & recomm5d$ /&>ds to support--
 7#a7 usability1 portability1 &         
int]op]ability ( advance directives t   
are accessible to individuals1          
cl9icians1 & o!r au?oriz$ individuals2 &
  7#b7 ! use ( electronic signatures1   
electronic au!ntication ( witnesses1 &  
electronic not>ization to effectuate    
advance directives4  7d7 ,additional    

/udy ,! ,comptroll] ,g5]al ( ! ,unit$   
,/ates %all conduct a /udy & submit a   
report to ,congress on ! incid5ce (     
heal? c>e1 te/s1 surg]ies1 drugs1 & o!r 
s]vices paid provid$ by qualifi$ heal?  
c>e provid]s & paid = by ! ,f$]al       
,gov]nm5t or ! pati5t & t 7 n ! pref]5ce
 ( ! pati5t or ! au?oriz$ heal? c>e ag5t
 ( ! pati5t4