,i #aaith ,,congress #ast ,session ,h4 ,r4 #fgba ,,in ,,the ,,house ,,of ,,representatives ,december #ae1 #bjbe ,mr4 ,murphy 7for himself and ,mr4 ,thompson of ,california7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,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 ,advance ,planning for ,care ,act or the ,,map for ,care ,act4 #b4 ,medicare ,advance ,directive ,certification ,program ,part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;j 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 #e 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 an electronically stored written instruction by an eligible beneficiary1 such as a living will or durable power of attorney for health care1 recognized under ,state law 7whether statutory or as recognized by the courts of the ,state7 and relating to the provision of such care when the individual is incapacitated that-- 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 decisions on their own2 and 7ii7 is offered by an entity that has received accreditation from the ,secretary under subsection 7c74 7,b7 ,eligible beneficiary ,the term eligible beneficiary means an individual entitled to1 or enrolled for benefits1 under part ,a or enrolled for benefits under this part4 7,c7 ,program participant ,the term ,program participant means an eligible beneficiary who is enrolled in the ,program4 7#c7 ,voluntary participation ,an eligible beneficiary who has registered a certified advance directive with a advance directive vendor accredited under subsection 7c7 may disenroll and terminate such directive at any time4 7#d7 ,best practices ,in establishing and implementing the ,program1 the ,secretary shall consider best practices-- 7,a7 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 quality of1 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 for educating beneficiaries on ways to-- 7i7 communicate their authenticated wishes to applicable family members1 legal representatives1 and providers or health care proxies1 including through the use of email or other mail formats2 and 7ii7 access certified advance directives1 including through the use of mobile devices4 7#e7 ,state law ,the provisions of this section shall not preempt any ,state or local law requirement governing advance directives4 7#f7 ,display of statutory and alternative advance directive forms ,under the ,program1 the ,secretary shall provide1 on the ,internet website of the ,centers for ,medicare ,medicaid ,services1 links to statutory advance directive forms 7as described in subsection 7d77#a77;,c771 alternative advance directive forms 7as described in subsection 7d77#a77;,d771 and a ,state-by-,state index to such forms to allow a ,program participant to create1 adopt1 modify1 and terminate a certified advance directive with any content permitted or required under this section1 and in any form authorized by a ,state4 7b7 ,enrollment in the ,program and registration of advance directives 7#a7 ,required information ,in addition to such other information as the ,secretary determines is appropriate1 a ,program participant 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#b7 ,notification regarding ,program ,during the annual1 coordinated election period under section #ahea7;e77#c71 the ,secretary shall notify each eligible beneficiary of the ,program4 7#c7 ,privacy and security 7,a7 ,in general ,the ,secretary shall ensure that all aspects of the enrollment and registration system comply with the ,federal regulations 7concerning the privacy and security of individually identifiable health information7 promulgated under the ,health ,insurance ,portability and ,accountability ,act of #aiif subject to the access authorized under subsection 7c77#b77;,e7 and in accordance with subsection 7c77#b77;,f74 7,b7 ,access ,the ,secretary shall utilize standardized data protections and privacy standards1 including the ,federal regulations described in subparagraph 7,a71 to ensure that the registration record of a ,program participant can only be accessed by-- 7i7 the ,program participant1 through the process established under subsection 7c77#b77;,b72 7ii7 those authorized to access the certified advance directive under subsection 7c77#b77;,e72 and 7iii7 providers of services and suppliers participating under this title who furnish items or services to the ,program participant1 through a process established by the ,secretary4 7c7 ,accreditation 7#a7 ,in general 7,a7 ,accreditation by the ,secretary ,under the ,program1 the ,secretary shall-- 7i7 accredit advance directive vendors and other entities providing advance directives that meet the accreditation criteria established under paragraph 7#b7 and any other criteria determined appropriate by the ,secretary2 and 7ii7 establish a process whereby advance directive vendors and other entities providing advance directives may obtain accreditation under this subsection4 7,b7 ,accreditation by advance directive accreditation organization ,the ,secretary may contract with an advance directive accreditation organization to accredit advance directive vendors and other entities under subparagraph 7,a77i74 7#b7 ,accreditation criteria ,the ,secretary1 in consultation with the ,comptroller ,general of the ,united ,states1 shall establish accreditation criteria for advance directive vendors and other entities providing advance directives to be certified under the ,program4 ,such criteria shall consist of each of the following3 7,a7 ,certified advance directives ,the advance directive vendor or other entity shall agree to offer certified advance directives to eligible beneficiaries4 7,b7 ,procedures for enrollment 7i7 ,in general ,the advance directive vendor or other entity shall establish procedures that-- 7,i7 allow for a ,program participant to-- 7aa7 enroll in and disenroll from the ,program2 and 7bb7 register or update a certified advance directive adopted by the participant2 and 7,,ii7 ensure that a ,program participant is able to-- 7aa7 create1 adopt1 modify1 update1 amend1 or terminate a certified advance directive in a timely and secure manner2 7bb7 update previously registered information2 and 7cc7 indicate that a previously registered certified advance directive has been terminated4 7ii7 ,online enrollment and registration ,the procedures established pursuant to clause 7i7 shall ensure that such enrollment and registration is available through an online process1 or other means determined appropriate by the advance directive vendor or other entity4 7,c7 ,quality review 7i7 ,in general ,for purposes of determining compliance with the requirements of this section1 the advance directive vendor or other entity shall comply with an annual quality review to be conducted by the ,secretary4 7ii7 ,enforcement ,if the ,secretary determines that an advance directive vendor or other entity is not in compliance with the requirements of this section1 the ,secretary shall remove any certified advance directive of such advance directive vendor or other entity from the ,internet website of the ,centers for ,medicare ,medicaid ,services4 7,d7 ,use of statutory and alternative advance directive forms ,the advance directive vendor or other entity shall allow a ,program participant to-- 7i7 access1 complete1 modify1 and adopt any advance directive forms described in subparagraphs 7,c7 and 7,d7 of subsection 7d77#a72 and 7ii7 search for such forms by ,state4 7,e7 ,access ,the advance directive vendor or other entity shall-- 7i7 provide near real-time online access to the certified advance directive of a ,program participant for purposes of viewing and sharing such advance directive1 including communicating the certified advance directive and the ,program participant's authenticated wishes using nationally recognized standards for securely transferring sensitive data specified by the ,secretary to-- 7,i7 the ,program participant2 7,,ii7 any family member1 legal representative1 or health care proxy legally designated by the participant2 and 7,,iii7 a provider of services or supplier that furnishes items or services to the participant2 and 7ii7 at the request of the ,program participant or any family member1 legal representative1 or health care proxy legally designated by the ,program participant1 provide a hard copy of the certified advance directive of the ,program participant to a provider of services or supplier4 7,f7 ,privacy protections 7i7 ,in general ,the advance directive vendor or other entity 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 #aiif1 subject to the access authorized under subparagraph 7,e74 7ii7 ,access ,such vendor or entity shall comply with standardized data protections and privacy standards1 including the ,federal ,regulations described in clause 7i71 to ensure that the content of a ,program participant's certified advance directive is owned and maintained by the participant and can only be accessed by those authorized to access the advance directive under subparagraph 7,e74 7,g7 ,security and testing ,the advance directive vendor or other entity shall certify that-- 7i7 all data management and data transfer elements involved in adopting1 maintaining1 and accessing a certified advance directive of a ,program participant-- 7,i7 have successfully passed rigorous independent testing regarding standards of timeliness1 accuracy1 and efficiency2 and 7,,ii7 meet widely accepted industry security standards 7as determined by the ,secretary72 and 7ii7 the system that provides access to a certified advance directive of a ,program participant has passed real-time tests simulating a realistic volume of ,program participants1 their family members1 legal representatives1 and legally designated health care proxies1 providers of services1 and suppliers accessing such directives simultaneously4 7,h7 ,beneficiary surveys 7i7 ,in general ,the advance directive vendor or other entity shall administer an annual survey of ,program participants on the information described in clause 7ii7 and submit the results of such survey to the ,secretary4 7ii7 ,information ,the information described in this clause1 with respect to a ,program participant and a certified advance directive of such participant1 is the following3 7,i7 ,whether the participant had to pay any third party for the creation1 storage1 or retrieval of the certified advance directive4 7,,ii7 ,whether the participant 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 online and in near real-time1 as required under this section4 7,,iii7 ,whether the certified advance directive was sufficiently clear and actionable4 7,,iv7 ,whether medical personnel followed the certified advance directive4 7,i7 ,process for complying with ,state law ,the advance directive vendor or other entity shall enable a ,program participant using their services to complete a certified advance directive that fully complies with the law governing advance directives of the applicable ,state4 7,j7 ,access in cases of dispute over treatment 7i7 ,special access ,the advance directive vendor or other entity shall establish a process whereby1 with respect to a ,program participant1 an interested individual described in clause 7ii7 may obtain access to the certified advance directive of the ,program participant for the purposes of viewing and sharing such advance directive when-- 7,i7 the provisions of the certified advance directive have come into force under the law of the applicable ,state because the ,program participant has become incapable of making health care decisions on their own or under other circumstances provided under ,state law2 and 7,,ii7 at least #a person described in clause 7ii7 is questioning or disputing the provision1 withholding1 or withdrawal of medical treatment1 food1 or fluids with respect to the ,program participant4 7ii7 ,interested individuals 7,i7 ,in general ,an interested individual described in this clause1 with respect to a ,program participant1 is-- 7aa7 any individual who is a member of any class of persons who1 under the law of the applicable ,state1 would potentially be eligible to serve as a health care decision maker for the ,program participant if an advance directive had not been executed1 regardless of whether another individual would have higher priority for such eligibility2 or 7bb7 if the law of the applicable ,state does not designate a person or class of persons described in item 7aa71 any individual related within the third degree of consanguinity or affinity to the ,program participant identified by the ,program participant in the certified advance directive4 7,,ii7 ,periodic update ,in the case that the law of the applicable ,state does not designate a person or class of persons described in subclause 7,i77aa7 and the ,program participant has identified in a certified advance directive an individual within the third degree of consanguinity or affinity of such participant1 the advance directive vendor or other entity shall annually during the annual1 coordinated election period under section #ahea7;e77#c7 prompt the ,program participant to update such individual4 7d7 ,education and outreach 7#a7 ,in general ,the ,secretary shall-- 7,a7 include a statement described in paragraph 7#c7 in the notice described in section #ahjd7;a7 and provide for the inclusion of such statement on the ,internet website of the ,centers for ,medicare ,medicaid ,services2 7,b7 communicate the benefits of electronic advance directives services1 as they become available2 7,c7 provide for the inclusion1 under the heading ,statutory ,advance ,directive ,forms1 of any relevant forms1 whether mandatory or optional1 specified in the statutes or regulations of ,states to be displayed on a such website2 7,d7 provide for the inclusion1 under the heading ,alternative ,advance ,directive ,forms1 on such 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 provide for the inclusion of a user-friendly index on the website by ,state and1 in the case of the ,alternative ,advance ,directive ,forms1 by the name of the individual or group who provided each alternative advance directive1 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 alternative advance directive form submitted under such paragraph1 the ,secretary shall either post the submitted form on the ,internet website of the ,centers for ,medicare ,medicaid ,services or provide to the submitting entity an 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 ,code4 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 described in this paragraph is a statement of the reasons why beneficiaries may want to consider advance directives1 a suggestion for the beneficiary to carefully consider decisions regarding advance directives1 and references to resources about advance directives4 7e7 ,advance directive information in ,medicare enrollment forms ,after the ,secretary implements the ,program1 the ,secretary shall include on each application for enrollment of an individual in part ,a1 this part1 or part ,c a link to an ,internet website with resources to assist in completing an advance directive4 4