,,ii  #aahth ,,congress  #b;d ,session  
,s4 #didi  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,august #a1    
#bjbd,mr4 ,blumenthal introduced the    
following bill2 which was read twice and
 referred to the ,committee on ,health1 
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to improve end-of-life care4   
#a4 ,short title  7a7 ,short title ,this
 ,act may be cited as the ,compassionate
 ,care ,act4  7b7 ,table of contents    
,the table of contents of this ,act is  
as follows3 ,sec4 #a4 ,short title4,sec4
 #b4 ,definitions4,,title ,i--,advance  
care planning,subtitle ,a--,consumer    
education,sec4 #aja4 ,advance care      
planning guidelines4,sec4 #ajb4         
,national public education              
campaign4,subtitle ,b--,provider        
education,sec4 #aaa4 ,public provider   
advance care planning website4,sec4     
#aab4 ,advance care curricula pilot     
program4,sec4 #aac4 ,development of core
 end-of-life care quality measures      
across each relevant provider           

setting4,sec4 #aad4 ,continuing         
education for qualified health care     
providers4,subtitle ,c--,medicare       
amendments,sec4 #aba4 ,permanent        
extension of authorization for use of   
telehealth to conduct face-to-face      
encounter prior to recertification of   
eligibility for hospice care4,sec4 #abb4
 ,improvements to advance care planning 
through telehealth4,,title              
,,ii--,reports1 research1 and           
evaluations,sec4 #bja4 ,study and report
 by the ,secretary regarding the        
establishment and implementation of a   
national uniform policy on advance      
directives4,sec4 #bjb4 ,,gao study and  
report on establishment of national     
advance directive registry2 other       
studies4  #b4 ,definitions ,in this     
,act3 7#a7 ,advance care planning ,the  
term advance care planning means the    
process of discussion of care in the    
event that an individual is unable to   
make treatment decisions on their own   
behalf1 clarification of related values 

and goals1 and embodiment of preferences
 and decision-making through written    
documents and medical orders4  7#b7     
,advance directive ,the term advance    
directive means a written or otherwise  
recorded instruction1 such as a living  
will or durable power of attorney for   
health care1 recognized under the law of
 the ,state in which it was executed    
7whether statutory or as recognized by  
the courts of the ,state7 and relating  
to the provision of such care when the  
individual is incapacitated4  7#c7      
,certified chaplain ,the term certified 
chaplain means a member of clergy who   
has met the requirements under the      
,common ,qualifications and             
,competencies for ,professional         
,chaplains and is board certified by a  
national chaplaincy organization4  7#d7 
,,chip ,the term ,,chip means the ,state
 ,children's ,health ,insurance ,program
 under title ,,xxi of the ,social       
,security ,act 7#db ,u4,s4,c4 #acig;aa  
et seq474  7#e7 ,end-of-life care ,the  

term end-of-life care means all aspects 
of care of a patient with a potentially 
fatal condition1 and includes care that 
is focused on preparations for an       
impending death4  7#f7 ,health care     
agent ,the term health care agent means 
the person1 designated in a health care 
power of attorney1 who is selected to   
make medical decisions on behalf of the 
person who executed such power of       
attorney1 in the case of incapacity of  
such person who executed the power of   
attorney4  7#g7 ,health care power of   
attorney ,the term health care power of 
attorney means a legal document that    
identifies the health care agent of the 
person executing such document4  7#h7   
,living will ,the term living will means
 a written document or a video statement
 about the kinds of medical care or     
other care a person does or does not    
want under certain specific conditions1 
in the event that such person no longer 
is able to express those wishes4  7#i7  
,medicaid ,the term ,medicaid means the 

program established under title ,,xix of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acif et seq474  7#aj7        
,medicare ,the term ,medicare means the 
program established under title ,,xviii 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acie et seq474  7#aa7 ,orders
 for life-sustaining treatment ,the term
 orders for life-sustaining treatment   
means a set of portable medical orders  
7such as physician orders for           
life-sustaining treatment or similar    
portable medical orders7 that address   
key medical decisions consistent with   
the patient's goals of care and results 
from a clinical process designed to     
facilitate shared1 informed medical     
decisionmaking and communication between
 qualified health care professionals and
 patients with serious1 progressive     
illness or frailty4  7#ab7 ,qualified   
health care provider ,the term qualified
 health care provider means a medical   
doctor1 doctor of osteopathy1 nurse1    
physician assistant1 nurse practitioner1

 social worker1 home health aide1       
palliative care professional1 community 
health worker1 community health         
educator1 or individual in a similar    
position1 as designated by the          
,secretary4  7#ac7 ,secretary ,the term 
,secretary means the ,secretary of      
,health and ,human ,services4  ,i       
,advance care planning  ,a ,consumer    
education  #aja4 ,advance care planning 
guidelines ,it is the sense of the      
,senate that1 to the extent practicable1
 advance care planning should-- 7#a7    
occur with an individual and such       
individual's health care agent1 primary 
clinician1 other authorized             
decisionmaker1 or members of the entire 
interdisciplinary health care team2     
7#b7 be recorded and updated as needed2 
and  7#c7 allow for flexible            
decisionmaking in the context of the    
patient's medical situation1 in         
accordance with best practice guidelines
 provided by the ,secretary4  #ajb4     
,national public education campaign  7a7

 ,national public education campaign    
7#a7 ,in general ,not later than        
,january #a1 #bjbd1 the ,secretary1     
acting through the ,director of the     
,centers for ,disease ,control and      
,prevention and in consultation with    
public and private entities1 shall1     
directly or through grants1 contracts1  
or interagency agreements1 develop and  
implement a national campaign to inform 
the public of the importance of advance 
care planning and of an individual's    
right to direct and participate in      
health care decisions affecting such    
individual4  7#b7 ,content of           
educational campaign ,the national      
public education campaign established   
under paragraph 7#a7 shall-- 7,a7 employ
 the use of various media1 including    
social media platforms and televised    
public service announcements2  7,b7     
provide culturally and linguistically   
appropriate information2  7,c7 be       
conducted continuously over a period of 
not less than #e years2  7,d7 identify  

and promote the advance care planning   
information available on the ,internet  
,websites of the ,department of ,health 
and ,human ,service's ,national         
,clearinghouse for ,long-,term ,care    
,information1 the ,administration for   
,children and ,families1 the            
,administration for ,community ,living1 
and the ,centers for ,medicare          
,medicaid ,services2  7,e7 address the  
importance of individuals speaking to   
family members1 health care proxies1 and
 qualified health care providers as part
 of an ongoing dialogue regarding health
 care choices2  7,f7 address the need   
for individuals to use portable1        
interoperable1 and accessible methods to
 communicate their health care decisions
 through a variety of means1 using      
legally effectuated documents that      
express their health care decisions in  
the form of advance directives          
7including living wills1 orders for     
life-sustaining treatment1 and durable  
powers of attorney for health care72    

7,g7 raise public awareness regarding   
the availability of hospice and         
palliative care and the quality of life 
benefits of early use of such services2 
7,h7 encourage individuals to speak with
 qualified health care professionals    
about their options and intentions for  
end-of-life care2 and  7,i7 adhere to   
evidence-based research on the most     
effective ways to communicate the       
necessity and benefits of advance care  
planning4  7#c7 ,evaluation ,not later  
than ,july #a1 #bjbf1 the ,secretary    
shall report to the appropriate         
committees of ,congress on the          
effectiveness of the public education   
campaign under this section1 and include
 in such report any recommendations that
 the ,secretary determines appropriate  
regarding the need for continuation of  
legislative or administrative changes to
 facilitate changing public awareness1  
attitudes1 and behaviors regarding      
advance care planning4  7#d7            
,authorization of appropriations ,there 

are authorized to be appropriated such  
sums as may be necessary to carry out   
this section4  7b7 ,repeal ,section     
#dgea7;d7 of the ,omnibus ,budget       
,reconciliation ,act of #aiij 7#db      
,u4,s4,c4 #acif;a note2 ,public ,law    
#aja-ejh7 is repealed4  ,b ,provider    
education  #aaa4 ,public provider       
advance care planning website  7a7      
,development ,not later than ,january   
#a1 #bjbe1 the ,secretary1 acting       
through the ,administrator of the       
,centers for ,medicare  ,medicaid       
,services and the ,director of the      
,agency for ,healthcare ,research and   
,quality1 shall establish an1 or expand 
upon an existing1 internet website for  
providers under ,medicare1 ,medicaid1   
,,chip1 the ,indian ,health ,service    
7including contract providers71 and     
other qualified health care providers1  
including qualified health care         
providers receiving assistance under the
 ,older ,americans ,act of #aife 7#db   
,u4,s4,c4 #cjjb et seq47 to serve older 

individuals1 on each individual's right 
to make decisions concerning medical    
care1 including the right to accept or  
refuse medical or surgical treatment1   
and engage in advance care planning4    
7b7 ,maintenance ,the internet website  
described in subsection 7a7 shall be    
maintained and publicized by the        
,secretary on an ongoing basis4  7c7    
,content ,the internet website shall    
include content1 tools1 and resources   
necessary to do the following3 7#a7     
,inform qualified health care providers 
and certified chaplains about the       
advance directive requirements under the
 health care programs described in      
subsection 7a7 and ,state and ,federal  
laws and regulations related to advance 
care planning4  7#b7 ,educate qualified 
health care providers and certified     
chaplains about advance care planning   
quality improvement activities4  7#c7   
,provide assistance to qualified health 
care providers to-- 7,a7 integrate      
advance care planning documents into    

electronic health records2 and  7,b7    
develop and disseminate advance care    
planning informational materials for    
patients4  7#d7 ,inform qualified health
 care providers about advance care      
planning continuing education           
requirements and opportunities4  7#e7   
,encourage qualified health care        
providers to discuss advance care       
planning with patients of all ages1 as  
appropriate4  7#f7 ,assist qualified    
health care providers and certified     
chaplains in understanding the continuum
 of end-of-life care services and       
supports available to patients1         
including palliative care and hospice4  
7#g7 ,inform qualified health care      
providers of best practices for         
discussing end-of-life care with        
patients who have a serious or terminal 
diagnosis or prognosis and their loved  
ones4  #aab4 ,advance care curricula    
pilot program  7a7 ,in general ,the     
,secretary1 in consultation with        
appropriate professional associations1  

shall establish a pilot program by which
 the ,secretary awards grants to        
eligible entities for purposes of       
supporting such entities in establishing
 end-of-life training requirements in   
the entities' applicable degree         
programs4  7b7 ,eligibility ,to be      
eligible to participate in the pilot    
program under this section1 an entity   
shall-- 7#a7 be a school of medicine1   
school of osteopathic medicine1 a       
physician assistant education program   
7as defined in section #gii;,b7#c7 of   
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #biep7#c7771 a school of      
allied health 7as defined in section    
#gii;,b7#d7 of the ,public ,health      
,service ,act 7#db ,u4,s4,c4            
#biep7#d7771 a school of nursing1 a     
school of social work1 a graduate       
medical education program accredited by 
the ,accreditation ,council for         
,graduate ,medical ,education or the    
,american ,osteopathic ,association1 or 
other school1 as the ,secretary         

determines appropriate2  7#b7 be staffed
 by teaching health professionals who   
have experience or training in          
palliative medicine2  7#c7 provide      
training in palliative medicine through 
a variety of service rotations1 such as 
consultation services1 acute care       
services1 extended care facilities1     
ambulatory care and comprehensive       
evaluation units1 hospice1 home health1 
and community care programs2  7#d7      
develop specific performance-based      
measures to evaluate the competency of  
trainees2 and  7#e7 ensure that by not  
later than the end of the #b-year period
 beginning on the date of enactment of  
this ,act1 professionals who are        
applicable faculty at the entity1 or    
others as determined appropriate by the 
,secretary1 shall be offered retraining 
in hospice and palliative medicine4  7c7
 ,training ,eligible entities           
participating in the pilot program under
 this section shall require minimum     
training for trainees that includes--   

7#a7 training in how to discuss and help
 patients and their loved ones with     
advance care planning2  7#b7 with       
respect to trainees who will work with  
children1 specialized pediatric         
training2  7#c7 training in the         
continuum of end-of-life services and   
supports1 including palliative care and 
hospice2  7#d7 training in how to       
discuss end-of-life care with dying     
patients and their loved ones2  7#e7    
medical and legal issues training       
associated with end of life care2  7#f7 
training in linguistic and cultural     
competency2 and  7#g7 in the case of a  
graduate medical education program      
accredited by the ,accreditation        
,council for ,graduate ,medical         
,education or the ,american ,osteopathic
 ,association1 a longitudinal component 
of at least #f months4  7d7 ,reports    
,each recipient of a grant under this   
section shall report to the ,secretary  
on the outcomes of the program within   
#ah months of receipt of the final      

allotment of grant funds4 ,not later    
than #a year after receipt of all such  
reports1 the ,secretary shall submit to 
,congress a report compiling such       
results from all grant recipients4  7e7 
,authorization of appropriations ,there 
are authorized to be appropriated such  
sums as may be necessary to carry out   
this section4  #aac4 ,development of    
core end-of-life care quality measures  
across each relevant provider setting   
7a7 ,in general ,the ,secretary1 acting 
through the ,director of the ,agency for
 ,healthcare ,research and ,quality 7in 
this section referred to as the         
,director7 and in consultation with the 
,administrator of the ,centers for      
,medicare  ,medicaid ,services1 shall   
require the development of specific     
end-of-life quality measures for each   
relevant qualified health care provider 
setting1 as identified by the ,director1
 in accordance with the requirements of 
subsection 7b74  7b7 ,requirements ,for 
purposes of subsection 7a71 the         

requirements specified in this          
subsection are the following3 7#a7      
,selection of the specific measure or   
measures for an identified provider     
setting shall be based on an assessment 
of what is likely to have the greatest  
positive impact on quality of           
end-of-life care in that setting1 and   
made in consultation with affected      
providers1 patients1 and private        
organizations1 that have developed such 
measures4  7#b7 ,the measures may be    
structure-oriented1 process-oriented1 or
 outcome-oriented1 as determined        
appropriate by the ,director1 and shall 
be patient-oriented4  7#c7 ,the         
,director shall ensure that reporting   
requirements related to such measures-- 
7,a7 are imposed consistently with other
 applicable laws and regulations1 and in
 a manner that takes into account       
existing measures1 the needs of patient 
populations1 the specific services      
provided1 and the potential             
administrative burden to providers2 and 

7,b7 include demographic information to 
account for race1 ethnicity1 age1 and   
gender1 and other appropriate           
categories4  7#d7 ,not later than-- 7,a7
 ,january #a1 #bjbd1 the ,secretary     
shall disseminate the reporting         
requirements to all affected providers  
and provide for a #fj-;day period for   
public comment2 and  7,b7 ,january #a1  
#bjbf1 initial reporting by health care 
providers relating to the measures shall
 begin4  #aad4 ,continuing education for
 qualified health care providers  7a7   
,in general ,not later than ,january #a1
 #bjbd1 the ,secretary1 acting through  
the ,administrator of the ,health       
,resources and ,services                
,administration1 shall develop or       
enhance new and existing curricula on   
advance care planning and end-of-life   
care for continuing education that      
,states may adopt for qualified health  
care providers4  7b7 ,consultation ,in  
carrying out subsection 7a71 the        
,secretary1 acting through the          

,administrator of the ,health ,resources
 and ,services ,administration1 may     
consult with qualified health care      
providers1 applicable professional      
clinician associations1 institutions of 
higher education1 ,state boards of      
medicine and nursing1 and other         
professionals1 as the ,secretary        
determines appropriate4  7c7 ,content   
,the continuing education curriculum    
developed or enhanced under subsection  
7a7 shall1 at a minimum1 include-- 7#a7 
a description of the meaning and        
importance of advance care planning2    
7#b7 a description of advance care      
planning documents1 including living    
wills and durable powers of attorney1   
and the use of such directives2  7#c7   
the appropriate use of orders for scope 
of treatment2  7#d7 counseling skills   
for when and how to introduce and engage
 in advance care planning with patients 
and their loved ones2  7#e7 palliative  
care principles and approaches to care2 
7#f7 the continuum of end-of-life       

services and supports1 including        
palliative care and hospice2 and  7#g7  
the importance of introducing palliative
 care and hospice early in illness in   
order to improve quality of life4  ,c   
,medicare amendments  #aba4 ,permanent  
extension of authorization for use of   
telehealth to conduct face-to-face      
encounter prior to recertification of   
eligibility for hospice care ,section   
#ahad7;a77#g77;,d77i77,,ii7 of the      
,social ,security ,act 7#db ,u4,s4,c4   
#acie;f7a77#g77;,d77i77,,ii77 is amended
 by striking during the emergency period
 and all that follows through ending on 
,december #ca1 #bjbd and inserting the  
following3 during and after the         
emergency period described in section   
#aace7;g77#a77;,b74  #abb4 ,improvements
 to advance care planning through       
telehealth ,section #ahcd7m7 of the     
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77 is amended-- 7#a7 in         
paragraph 7#d77;,c7-- 7,a7 in clause    
7i71 in the matter preceding subclause  

7,i71 by striking and 7#g7 and inserting
 7#g71 and 7#aj72 and  7,b7 in clause   
7ii77,x71 by inserting or paragraph     
7#aj7 before the period2 and  7#b7 by   
adding at the end the following new     
paragraph3  7#aj7 ,treatment of advance 
care planning services ,the geographic  
requirements described in paragraph     
7#d77;,c77i7 shall not apply with       
respect to telehealth services furnished
 on or after ,january #a1 #bjbd1 for    
purposes of furnishing advance care     
planning services1 as determined by the 
,secretary4  4  ,,ii ,reports1 research1
 and evaluations  #bja4 ,study and      
report by the ,secretary regarding the  
establishment and implementation of a   
national uniform policy on advance      
directives  7a7 ,study  7#a7 ,in general
 ,the ,secretary1 acting through the    
,office of the ,assistant ,secretary for
 ,planning and ,evaluation1 shall       
conduct a study to evaluate the barriers
 to establishing and implementing a     
national uniform policy on advance      

directives and what needs to be done to 
overcome those barriers4  7#b7 ,matters 
studied ,the matters studied by the     
,secretary under paragraph 7#a7 shall   
include issues concerning-- 7,a7 family 
satisfaction that a patient's wishes1 as
 stated in the patient's advance        
directive1 were carried out2  7,b7 the  
usability1 accessibility1               
interoperability1 and portability of    
advance directives1 including cases     
involving the transfer of an individual 
from one health care setting to another2
  7,c7 the feasibility of establishing  
an optional1 national advance directive 
form deemed valid by any health care    
entity or qualified health care provider
 participating in ,medicare1 ,medicaid1 
or ,,chip1 regardless of ,state law2 and
  7,d7 ,state variations in advance     
directive laws that are relevant to the 
establishment and implementation of a   
national uniform policy of advance      
directives4  7b7 ,report to congress    
,not later than #b years after the date 

of enactment of this ,act1 the          
,secretary shall submit to ,congress a  
report on the study conducted under     
subsection 7a71 together with           
recommendations for such legislation and
 administrative actions as the          
,secretary considers appropriate4  7c7  
,consultation ,in conducting the study  
and developing the report under this    
section1 the ,secretary shall consult   
with relevant stakeholders and other    
interested parties4  #bjb4 ,,gao study  
and report on establishment of national 
advance directive registry2 other       
studies  7a7 ,study and report on       
establishment of national advance       
directive registry  7#a7 ,study ,the    
,comptroller ,general of the ,united    
,states shall conduct a study on the    
feasibility of a national registry for  
advance directives1 taking into         
consideration the constraints created by
 the privacy provisions enacted as a    
result of the ,health ,insurance        
,portability and ,accountability ,act of

 #aiif 7,public ,law #ajd-aia74  7#b7   
,report ,not later than #ah months after
 the date of enactment of this ,act1 the
 ,comptroller ,general of the ,united   
,states shall submit to ,congress a     
report on the study conducted under     
subsection 7a7 together with            
recommendations for such legislation and
 administrative action as the           
,comptroller ,general of the ,united    
,states determines to be appropriate4   
7b7 ,,onc ,study ,the ,national         
,coordinator of the ,office of the      
,national ,coordinator for ,health      
,information ,technology shall conduct a
 study on the feasibility and impact on 
advance care planning of requiring that 
electronic health record vendors seeking
 certification have a prominent and     
easily visible field for storing and    
sharing advance care planning documents 
and related clinical notes4  7c7 ,,onc  
demonstration programs ,the ,national   
,coordinator for ,health ,information   
,technology1 in collaboration with the  

,director of the ,national ,institute of
 ,standards and ,technology1 shall      
initiate #b demonstration programs to   
establish best practices and recommended
 standards to support-- 7#a7 usability1 
portability and interoperability of     
advance directives that are accessible  
to individuals1 clinicians1 and other   
authorized individuals2 and  7#b7 the   
use of electronic signatures1 electronic
 authentication of witnesses1 and       
electronic notarization to effectuate   
advance directives4  7d7 ,additional    
study ,the ,comptroller ,general of the 
,united ,states shall conduct a study   
and submit a report to ,congress on the 
incidence of health care1 tests1        
surgeries1 drugs1 and other services    
paid provided by qualified health care  
providers and paid for by the ,federal  
,government or the patient and that were
 not the preference of the patient or   
the authorized health care agent of the 
patient4