,,ii #aafth ,,congress #ast ,session ,s4 #fah ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #bh1 #bjai,mr4 ,coons 7for himself1 ,mr4 ,cassidy1 ,mr4 ,barrasso1 and ,mr4 ,bennet7 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 encourage ,medicare beneficiaries to voluntarily adopt advance directives guiding the medical care they receive4 #a4 ,short title ,this ,act may be cited as the ,medicare ,choices ,empowerment and ,protection ,act4 #b4 ,medicare advance directive certification program ,part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by adding at the end the following new section3 #ahdi4 ,medicare advance directive certification program 7a7 ,in general 7#a7 ,establishment of ,program ,the ,secretary shall establish and implement an ,advance ,directive ,certification ,program 7in this section referred to as the ,program7 under which the ,secretary shall encourage eligible beneficiaries to adopt and maintain certified advance directives to guide the delivery of health care to such beneficiaries4 ,the ,secretary shall implement the ,program not later than #c years after the date of enactment of this section4 7#b7 ,definitions ,in this section3 7,a7 ,certified advance directive ,the term certified advance directive means any electronically stored statement by an eligible beneficiary which-- 7i7 provides instructions that outline the kind of medical treatments and care that such beneficiary would want or not want under particular conditions1 and may also include the identification of a health care proxy or legal representative to make medical treatment decisions for the beneficiary if the beneficiary becomes unable to make or communicate those decisions2 7ii7 is executed in accordance with the law governing advance directives of the ,state involved2 and 7iii7 is offered by an entity that has received accreditation from the ,secretary under this section4 7,b7 ,eligible ,beneficiary ,the term eligible beneficiary means an individual enrolled under this part4 7#c7 ,voluntary ,participation in the ,program shall be voluntary with respect to the eligible beneficiary and an eligible beneficiary who has registered a certified advance directive under the ,program may terminate such directive at any time4 ,nothing in this section shall require an eligible beneficiary to adopt or maintain a certified advance directive4 7#d7 ,best practices ,in establishing and implementing the ,program1 the ,secretary shall consider-- 7,a7 best practices within existing advance directive registry technologies1 programs1 and systems1 including web-based or cloud-based advance directive technologies-- 7i7 which may utilize time and date stamps1 video1 or other innovative measures to protect the authenticity1 improve the quality1 and enhance the security of such directives2 and 7ii7 which may utilize secure email and messaging technologies and nationally recognized health care information technology standards to improve the accessibility and interoperability of such directives2 and 7,b7 best practices for educating beneficiaries on means for communicating beneficiaries' authenticated wishes to applicable family members1 legal representatives1 providers or health care proxies1 including the use of email or other mail formats as well as access through mobile devices 7as defined by the ,secretary74 7#e7 ,enrollment and disenrollment ,the ,secretary shall establish procedures for eligible beneficiaries to enroll and disenroll under the ,program4 ,such procedures shall ensure that enrollment and disenrollment is available through an online process4 ,the ,secretary shall also establish procedures to ensure ,program participants can update or amend an advance directive in a timely and secure manner4 7#f7 ,state ,law ,this section shall in no way supercede1 abrogate1 or otherwise interfere with ,state law governing advance directives4 ,under the ,program1 the ,secretary shall establish a process under which the ,secretary is required to verify that digital advance directive vendors or other entities providing a digital advance directive participating in the program enable those using their services to complete advance directives that fully comply with the law governing advance directives of the ,state involved4 7#g7 ,display of ,statutory and ,alternative ,advance ,directive ,forms ,under the ,program1 the ,centers for ,medicare ,medicaid ,services shall provide1 through a clearinghouse website1 links to statutory and alternative advance directive forms and a ,state-by-,state index to such forms to allow a beneficiary to create1 adopt1 modify1 and terminate an advance directive with any content permitted or required1 and in any form authorized by a ,state1 in accordance with the requirements of subparagraphs 7,c7 through 7,e7 of subsection 7e77#a7 and subsection 7e77#b74 7#h7 ,access in ,cases of ,dispute over ,treatment ,under the ,program3 7,a7 ,special ,access ,the ,secretary shall establish a process whereby1 with respect to a beneficiary with a certified advance directive1 a person described in subparagraph 7,b7 may obtain access to the beneficiary's advance directive for the purposes of viewing and sharing such advance directive when-- 7i7 the provisions of the advance directive have come into force under the applicable ,state's law because the beneficiary has become incapable of making health care decisions or under other circumstances provided under ,state law2 and 7ii7 at least one person described in subparagraph 7,b7 is questioning or disputing the provision1 withholding1 or withdrawal of medical treatment1 food1 or fluids with respect to the beneficiary4 7,b7 ,interested ,individuals ,a person described in this subparagraph1 with respect to a beneficiary1 is-- 7i7 any individual who is a member of any class of persons who1 under the applicable ,state's law1 would potentially be eligible to serve as a health care decision maker for the beneficiary if an advance directive had not been executed regardless of whether higher priority for such eligibility would be accorded to another individual or individuals2 and 7ii7 if the applicable ,state's law does not designate persons or classes of persons described in clause 7i71 any person related within the third degree of consanguinity or affinity to the beneficiary4 7b7 ,registration 7#a7 ,in general ,the ,secretary shall establish procedures for an eligible beneficiary to register such beneficiary's adoption of a certified advance directive under the ,program4 ,such procedures shall ensure that registration is available through an online process4 ,the ,secretary shall also establish procedures to ensure ,program participants can update previously registered information that is no longer accurate and indicate that an advance directive has been terminated4 7#b7 ,required information ,in addition to such other information as the ,secretary may deem appropriate1 an eligible beneficiary seeking to register a certified advance directive under the ,program shall indicate where the advance directive is maintained or how it may be accessed4 7#c7 ,registration periods ,the procedures established under paragraph 7#a7 shall provide that registration under the ,program shall occur during-- 7,a7 an eligible beneficiary's initial enrollment under an ,,ma plan under part ,c as described in paragraph 7#a7 of section #ahea7;e72 and 7,b7 the annual1 coordinated election period under paragraph 7#c7 of such section4 7#d7 ,privacy and security 7,a7 ,in general ,the ,secretary shall ensure that all aspects of the registration system comply with the ,federal regulations 7concerning the privacy of individually identifiable health information7 promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif subject to the access authorized under subsection 7a77#h71 in accordance with subsection 7c77#b77;,e74 7,b7 ,access ,the ,secretary shall utilize standardized data protections and privacy standards1 including the ,federal regulations described in paragraph 7#a71 to ensure that the registration record of an eligible beneficiary can only be accessed by-- 7i7 the beneficiary1 through the process established under paragraph 7#a72 7ii7 those authorized to access the advance directive under subsection 7a77#h7 and subsection 7c77#b77;,e72 and 7iii7 providers of services and suppliers participating under this title1 through a process established by the ,secretary4 7c7 ,accreditation 7#a7 ,in general ,under the ,program1 the ,secretary shall-- 7,a7 grant accreditation to advance directive vendors and other entities providing advance directives that meet the accreditation criteria established under paragraph 7#b72 and 7,b7 establish a process whereby advance directive vendors and other entities providing advance directives may obtain accreditation under this subsection4 7#b7 ,accreditation criteria ,the ,secretary1 in consultation with the ,general ,accounting ,office1 shall establish accreditation criteria for advance directive vendors and other entities providing advance directives that seek to offer advance directives to be certified under the ,program4 ,such criteria shall consist of the following3 7,a7 ,process for adopting advance directive ,the advance directive vendor or other entity providing an advance directive shall allow a beneficiary to create1 adopt1 modify1 and terminate an advance directive through an online process4 7,b7 ,vendors ,the advance directive vendor or other entity providing an advance directive shall comply with an annual quality review to be conducted by the ,secretary4 7,c7 ,use of statutory and alternative advance directive forms ,the advance directive vendor or other entity providing an advance directive shall enable a beneficiary to access1 complete1 modify1 and adopt any advance directive applicable to the ,state indicated by the beneficiary who is posted as provided under subparagraphs 7,c7 through 7,e7 of subsection 7e77#a7 and of subsection 7e77#b74 7,d7 ,access ,the advance directive vendor or other entity providing an advance directive shall maintain advance directives in such a way that-- 7i7 an eligible beneficiary who has adopted an advance directive with such vendor or entity and any family member1 legal representative1 or health care proxy legally designated by such beneficiary has direct1 has near real-time online access to the beneficiary's advance directive for purposes of viewing and sharing such advance directive1 including communication of the advance directive and corresponding beneficiary's wishes using nationally recognized health care information technology data content and data transport standards specified by the ,secretary2 7ii7 in the case of an eligible beneficiary who has adopted an advance directive with such vendor or entity or any family member1 legal representative1 or health care proxy legally designated by such beneficiary who is unable or unwilling to use the online access under subparagraph 7,a71 such individual is able to obtain a hard copy of the beneficiary's advance directive for the purposes of viewing and sharing such advance directive2 and 7iii7 providers of services and suppliers participating under this title have near real-time online access to the advance directive of an eligible beneficiary who has adopted an advance directive with such vendor or entity1 including communication of the advance directive and corresponding beneficiary's wishes through secure email and messaging technologies and nationally recognized health care information technology standards specified by the ,secretary to improve the accessibility and interoperability of such directives4 7,e7 ,privacy protections 7i7 ,in general ,the advance directive vendor or other entity providing an advance directive shall comply with the ,federal regulations 7concerning the privacy of individually identifiable health information7 promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note71 subject to the access authorized under subparagraph 7,d7 and subsection 7a77#h74 7ii7 ,access ,such vendor or entity shall utilize standardized data protections and privacy standards1 including the ,federal regulations described in clause 7i71 to ensure that the content of an eligible beneficiary's advance directive is owned and maintained by the beneficiary and can only be accessed by those authorized to access the advance directive under subparagraph 7,d7 and subsection 7a77#h74 7,f7 ,security and testing ,the advance directive vendor or other entity providing an advance directive shall certify that-- 7i7 all data management and data transfer elements involved in adopting1 maintaining1 and accessing the advance directive have successfully passed rigorous independent testing regarding standards of timeliness1 accuracy1 and efficiency2 7ii7 the data management and data transfer elements involved in adopting1 maintaining1 and accessing the advance directive meet widely accepted industry security standards2 and 7iii7 the system that provides access to the advance directive has passed real-time tests simulating a realistic volume of beneficiaries and providers accessing advance directives simultaneously4 7,g7 ,certified advance directives ,the advance directive vendor or other entity providing an advance directive shall agree to offer certified advance directives 7as defined in subsection 7a77#b77;,a774 7,h7 ,beneficiary ,surveys 7i7 ,in general ,the advance directive vendor or other entity providing an advance directive shall agree to administer annual beneficiary surveys on the information described in clause 7ii7 and submit the results of such surveys to the ,centers for ,medicare ,medicaid ,services4 7ii7 ,information ,the information described in this clause1 with respect to an annual beneficiary survey and certified advance directive of a beneficiary1 is the following3 7,i7 ,whether the beneficiary had to pay any third party for the creation1 storage1 or retrieval of the certified advance directive4 7,,ii7 ,whether the beneficiary had a health care encounter or emergency that required the location1 access1 retrieval1 or consultation of the certified advance directive and if so1 whether the certified advance directive was accessible in online and in near real-time1 as required under this section4 7,,iii7 ,whether the certified advance directive was actionable4 7,,iv7 ,whether medical personnel followed the certified advance directive4 7d7 ,incentive 7#a7 ,in general ,the ,secretary shall make a one-time payment of the amount specified in paragraph 7#b7 to each eligible beneficiary who adopts a certified advance directive and registers such directive with the ,program4 7#b7 ,amount 7,a7 ,in general ,for purposes of paragraph 7#a71 the amount specified in this paragraph is-- 7i7 for a beneficiary who registers a certified advance directive with the ,program in #bjai1 #ge2 or 7ii7 for a beneficiary who registers a certified advance directive with the ,program in a subsequent year1 the amount specified in this paragraph for the preceding year increased by the percentage increase in the ,chained ,consumer ,price ,index for ,all ,urban ,consumers 7as published by the ,bureau of ,labor ,statistics of the ,department of ,labor7 over the preceding year4 7,b7 ,rounding ,if any amount determined under subparagraph 7,a7 is not a multiple of #aj cents1 such amount shall be rounded to the nearest multiple of #aj cents4 7#c7 ,funding ,for purposes of carrying out this subsection1 the ,secretary shall provide for the transfer1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 of such sums as the ,secretary determines necessary4 7#d7 ,administration ,the ,secretary shall1 through a full notice and comment rulemaking process1 establish procedures for-- 7,a7 making the incentive payment directly to the eligible beneficiary or a personal account maintained by the beneficiary at a financial institution that has been designated by the beneficiary1 and ensuring that no other entity receives the payment on the beneficiary's behalf2 and 7,b7 ensuring that a beneficiary does not receive an incentive payment under this section more than once4 7e7 ,education and outreach 7#a7 ,in general ,the ,secretary shall provide for-- 7,a7 the inclusion of the statement set forth in paragraph 7#c7 in the ,medicare and ,you handbook under section #ahjd and on a clearinghouse website linked to the ,internet website of the ,centers for ,medicare ,medicaid ,services2 7,b7 the promotion of the benefits of electronic advance directives services1 as they become available1 through the use of mass communications and other means2 7,c7 the inclusion1 under the heading ,statutory ,advance ,directive ,forms1 of any relevant forms1 whether mandatory or optional1 specified in the statues or regulations of the ,states to be displayed on a clearinghouse website2 7,d7 the inclusion1 under the heading ,alternative ,advance ,directive ,forms1 on a separate clearinghouse website1 and in accordance with paragraph 7#b7-- 7i7 of other advance directive forms submitted to the ,secretary by individuals and groups in an electronic format specified by the ,secretary for which the submitting entity includes1 for each form submitted1 an opinion by an attorney licensed to practice in the relevant ,state demonstrating that the submitted form complies with the law of that ,state2 and 7ii7 of the following disclaimer1 which shall be prominently posted on the website3 ,this website includes for your consideration alternative advance directive forms submitted by individuals or groups reflecting different perspectives on advance health care decisions which you may wish to review before completing your own advance directive42 and 7,e7 the inclusion of a user-friendly index on the clearinghouse website by ,state and1 in the case of the ,alternative ,advance ,directive ,forms1 by the name of the provider1 so that a user may readily access those statutory and alternative forms4 7#b7 ,alternative advance directive forms 7,a7 ,in general ,for purposes of paragraph 7#a77;,d71 the following shall apply3 7i7 ,not later than #fj days after receiving an advance directive form submitted under such paragraph1 the ,secretary shall either post the submitted form on a clearinghouse website or provide to the submitting entity a detailed explanation of the basis for the ,secretary's determination that the submitted form does not comply with relevant ,state or ,federal law1 which determination shall be subject to judicial review under section #gjb of title #e of the ,united ,states ,code2 and 7ii7 the ,secretary shall either remove or refuse to post any submitted form if provided with an official determination by the ,attorney ,general of the applicable ,state that the form is not in compliance with ,state law1 subject to applicable ,state law described in subparagraph 7,b74 7,b7 ,state law described ,for purposes of subparagraph 7,a71 ,state law described in this subparagraph is-- 7i7 a ruling by a court of the applicable ,state1 or by a ,federal court applying that ,state's law1 subject to subsequent rulings by a court or courts with authority to supercede that ruling2 or 7ii7 a statute or regulation of the applicable ,state that provides for a specific procedure for officially determining whether particular advance directive forms comply with ,state law4 7#c7 ,statement ,for purposes of paragraph 7#a77;,a71 the statement included in this paragraph is the following statement1 with appropriate insertions in the bracketed segments updated at least annually3 ,,why ,,you ,,may ,,want ,,to ,,consider ,,an ,,advance ,,directive ,do you ever worry what would happen if you became unable to make health care decisions for yourself because of an illness or injury8 ,do you hold certain values and beliefs with respect to your medical treatment that you would want to be upheld if you were unable to convey them yourself8 ,that's what an advance directive is for4 ,you can use it to give directions for your health care providers and family about your health care wishes that are to be followed if you are no longer able to speak for yourself4 ,you can also name someone you trust1 like a family member or friend1 to give health care directions for you when you can't do so yourself4,you should consider carefully who to choose to speak for you and what directions you want to give to ensure your representative clearly reflects your own values and treatment preferences4 ,you should not feel pressured to violate your own values and preferences1 and you are entitled to implement them without discrimination based on age or degree of disability4 ,there are many resources to help you4,by choosing the name of a ,state at ,,insert name of webpage for the index provided in paragraph 7#a77;,e7 of this subsection and its ,,url 7and1 on the clearinghouse website1 include a hyperlink to it71 you can find sample advance directives for that ,state4 ,you can see any sample or required forms given in ,state law1 as well as others from individuals or groups with different viewpoints on advance health care decisions which you may wish to review before completing your own advance directive4,below is contact information for the accredited vendor in your ,state who will arrange for your advance directive to be confidentially kept online1 where it can be seen by doctors who are treating you so they are made aware of your wishes4 ,you can also give permission to certain other people1 like family members or friends1 you want to be able to get a copy of your advance directive4 ,if a disagreement about your treatment develops1 depending on your ,state's law certain other people may also be allowed to see it4,this vendor can also help you create an advance directive online or with paper documents1 if you wish4 ,online directives allow you to change or cancel one that no longer fits with your wishes in a more timely manner4,,insert1 name and contact information for currently accredited advance directive vendor 7and1 on the clearinghouse website1 hyperlinks to their website74,although any adult who is capable of doing so can use these resources to complete an advance directive at any time1 ,medicare beneficiaries are particularly encouraged to do so when enrolling in ,medicare or during the annual enrollment period when you can choose among different ,medicare health insurance alternatives4,in addition1 some ,medicare ,advantage plans or supplemental insurance plans may offer a financial incentive or other additional benefits for creating an advance directive online4,by completing an advance directive you can not only make it more likely that your wishes about health care will be known if you are unable to tell them at the time1 but also spare family1 friends1 and doctors the difficulty of trying to figure out what you would have wanted4 ,these are matters of the highest importance that can affect life-or-death decisions1 as well as your future comfort and well-being4 ,you are encouraged to think about them carefully1 and give serious consideration to recording your wishes in an advance directive4 4