,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #fgba  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #ae1 #bjbe   
,mr4 ,murphy 7= himself & ,mr4 ,?ompson 
( ,cali=nia7 introduc$ ! foll[+ bill2   
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committee 
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
enc\rage ,m$ic>e b5efici>ies to         
volunt>ily adopt advance directives     
guid+ ! m$ical c>e !y receive4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,m$ic>e ,advance ,plann+ = ,c>e ,act or 
! ,,map = ,c>e ,act4  #b4 ,m$ic>e       
,advance ,directive ,c]tification       
,program ,"p ,b ( title ,,xviii ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;j et seq47 is am5d$ by add+ at !  
end ! foll[+ new section3  #ahdi4       
,m$ic>e ,advance ,directive             

,c]tification ,program  7a7 ,9 g5]al    
7#a7 ,e/abli%m5t ( ,program ,! ,secret>y
 %all e/abli% & implem5t an ,advance    
,directive ,c]tification ,program 79 ?is
 section ref]r$ to z ! ,program7 "u :i* 
! ,secret>y %all enc\rage eligible      
b5efici>ies to adopt & ma9ta9 c]tifi$   
advance directives to guide ! deliv]y ( 
heal? c>e to su* b5efici>ies4 ,!        
,secret>y %all implem5t ! ,program n    
lat] ?an #e ye>s aft] ! date ( enactm5t 
( ?is section4  7#b7 ,def9itions ,9 ?is 
section3  7,a7 ,c]tifi$ advance         
directive ,! t]m c]tifi$ advance        
directive means an electronically /or$  
writt5 in/ruction by an eligible        
b5efici>y1 su* z a liv+ w or durable p[]
 ( attorney = heal? c>e1 recogniz$ "u   
,/ate law 7:e!r /atutory or z recogniz$ 
by ! c\rts ( ! ,/ate7 & relat+ to !     
provision ( su* c>e :5 ! individual is  
incapacitat$ t-- 7i7 provides           
in/ructions t outl9e ! k9d ( m$ical     
treatm5ts & c>e t su* b5efici>y w\ld    
want or n want "u p>ticul> conditions1 &

 may also include ! id5tification ( a   
heal? c>e proxy or legal repres5tative  
to make m$ical treatm5t decisions = !   
b5efici>y if ! b5efici>y becomes unable 
to make or communicate ^? decisions on  
_! own2 &  7ii7 is (f]$ by an entity t  
has receiv$ accr$itation f ! ,secret>y  
"u subsection 7c74  7,b7 ,eligible      
b5efici>y ,! t]m eligible b5efici>y     
means an individual entitl$ to1 or      
enroll$ = b5efits1 "u "p ,a or enroll$ =
 b5efits "u ?is "p4  7,c7 ,program      
p>ticipant ,! t]m ,program p>ticipant   
means an eligible b5efici>y :o is       
enroll$ 9 ! ,program4  7#c7 ,volunt>y   
p>ticipation ,an eligible b5efici>y :o  
has regi/]$ a c]tifi$ advance directive 
) a advance directive v5dor accr$it$ "u 
subsection 7c7 may dis5roll & t]m9ate   
su* directive at any "t4  7#d7 ,be/     
practices ,9 e/abli%+ & implem5t+ !     
,program1 ! ,secret>y %all consid] be/  
practices-- 7,a7 )9 exi/+ advance       
directive regi/ry te*nologies1 programs1
 & sy/ems1 includ+ web-bas$ or cl\d-bas$

 advance directive te*nologies--  7i7   
:i* may utilize "t & date /amps1 video1 
or o!r innovative measures to protect ! 
au!nticity1 improve ! quality (1 &      
enhance ! security ( su* directives2 &  
7ii7 :i* may utilize secure email &     
messag+ te*nologies & nationally        
recogniz$ heal? c>e in=mation te*nology 
/&>ds to improve ! accessibility &      
int]op]ability ( su* directives2 &  7,b7
 = educat+ b5efici>ies on ways to-- 7i7 
communicate _! au!nticat$ wi%es to      
applicable family memb]s1 legal         
repres5tatives1 & provid]s or heal? c>e 
proxies1 includ+ ?r\gh ! use ( email or 
o!r mail =mats2 &  7ii7 access c]tifi$  
advance directives1 includ+ ?r\gh ! use 
( mobile devices4  7#e7 ,/ate law ,!    
provisions ( ?is section %all n preempt 
any ,/ate or local law requirem5t gov]n+
 advance directives4  7#f7  ,display (  
/atutory & alt]native advance directive 
=ms  ,"u ! ,program1 ! ,secret>y %all   
provide1 on ! ,int]net website ( !      
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices1    

l9ks to /atutory advance directive =ms  
7z describ$ 9 subsection 7d77#a77;,c771 
alt]native advance directive =ms 7z     
describ$ 9 subsection 7d77#a77;,d771 & a
 ,/ate-by-,/ate index to su* =ms to all[
 a ,program p>ticipant to create1 adopt1
 modify1 & t]m9ate a c]tifi$ advance    
directive ) any cont5t p]mitt$ or       
requir$ "u ?is section1 & 9 any =m      
au?oriz$ by a ,/ate4  7b7 ,enrollm5t 9 !
 ,program & regi/ration ( advance       
directives  7#a7 ,requir$ in=mation ,9  
addition to su* o!r in=mation z !       
,secret>y det]m9es is appropriate1 a    
,program p>ticipant seek+ to regi/] a   
c]tifi$ advance directive "u ! ,program 
%all indicate :]e ! advance directive is
 ma9ta9$ or h[ x may be access$4  7#b7  
,notification reg>d+ ,program ,dur+ !   
annual1 coord9at$ election p]iod "u     
section #ahea7;e77#c71 ! ,secret>y %all 
notify ea* eligible b5efici>y ( !       
,program4  7#c7 ,privacy & security     
7,a7 ,9 g5]al ,! ,secret>y %all ensure t
 all aspects ( ! enrollm5t & regi/ration

 sy/em comply ) ! ,f$]al regulations    
7conc]n+ ! privacy & security (         
individually id5tifiable heal?          
in=mation7 promulgat$ "u ! ,heal?       
,insurance ,portability & ,acc\ntability
 ,act ( #aiif subject to ! access       
au?oriz$ "u subsection 7c77#b77;,e7 & 9 
accordance ) subsection 7c77#b77;,f74   
7,b7 ,access ,! ,secret>y %all utilize  
/&>diz$ data protections & privacy      
/&>ds1 includ+ ! ,f$]al regulations     
describ$ 9 subp>agraph 7,a71 to ensure t
 ! regi/ration record ( a ,program      
p>ticipant c only be access$ by--  7i7 !
 ,program p>ticipant1 ?r\gh ! process   
e/abli%$ "u subsection 7c77#b77;,b72    
7ii7 ^? au?oriz$ to access ! c]tifi$    
advance directive "u subsection         
7c77#b77;,e72 &  7iii7 provid]s (       
s]vices & suppli]s p>ticipat+ "u ?is    
title :o furni% items or s]vices to !   
,program p>ticipant1 ?r\gh a process    
e/abli%$ by ! ,secret>y4  7c7           
,accr$itation  7#a7 ,9 g5]al  7,a7      
,accr$itation by ! ,secret>y ,"u !      

,program1 ! ,secret>y %all--  7i7       
accr$it advance directive v5dors & o!r  
entities provid+ advance directives t   
meet ! accr$itation crit]ia e/abli%$ "u 
p>agraph 7#b7 & any o!r crit]ia det]m9$ 
appropriate by ! ,secret>y2 &  7ii7     
e/abli% a process :]eby advance         
directive v5dors & o!r entities provid+ 
advance directives may obta9            
accr$itation "u ?is subsection4  7,b7   
,accr$itation by advance directive      
accr$itation organization ,! ,secret>y  
may contract ) an advance directive     
accr$itation organization to accr$it    
advance directive v5dors & o!r entities 
"u subp>agraph 7,a77i74  7#b7           
,accr$itation crit]ia ,! ,secret>y1 9   
consultation ) ! ,comptroll] ,g5]al ( ! 
,unit$ ,/ates1 %all e/abli% accr$itation
 crit]ia = advance directive v5dors &   
o!r entities provid+ advance directives 
to be c]tifi$ "u ! ,program4 ,su*       
crit]ia %all consi/ ( ea* ( ! foll[+3   
7,a7 ,c]tifi$ advance directives ,!     
advance directive v5dor or o!r entity   

%all agree to (f] c]tifi$ advance       
directives to eligible b5efici>ies4     
7,b7 ,proc$ures = enrollm5t  7i7 ,9     
g5]al ,! advance directive v5dor or o!r 
entity %all e/abli% proc$ures t--  7,i7 
all[ = a ,program p>ticipant to-- 7aa7  
enroll 9 & dis5roll f ! ,program2 &     
7bb7 regi/] or update a c]tifi$ advance 
directive adopt$ by ! p>ticipant2 &     
7,,ii7 ensure t a ,program p>ticipant is
 able to--  7aa7 create1 adopt1 modify1 
update1 am5d1 or t]m9ate a c]tifi$      
advance directive 9 a timely & secure   
mann]2  7bb7 update previ\sly regi/]$   
in=mation2 &  7cc7 indicate t a         
previ\sly regi/]$ c]tifi$ advance       
directive has be5 t]m9at$4  7ii7 ,onl9e 
enrollm5t & regi/ration ,! proc$ures    
e/abli%$ pursuant to clause 7i7 %all    
ensure t su* enrollm5t & regi/ration is 
available ?r\gh an onl9e process1 or o!r
 means det]m9$ appropriate by ! advance 
directive v5dor or o!r entity4  7,c7    
,quality review  7i7 ,9 g5]al ,=        
purposes ( det]m9+ compliance ) !       

requirem5ts ( ?is section1 ! advance    
directive v5dor or o!r entity %all      
comply ) an annual quality review to be 
conduct$ by ! ,secret>y4  7ii7 ,en=cem5t
 ,if ! ,secret>y det]m9es t an advance  
directive v5dor or o!r entity is n 9    
compliance ) ! requirem5ts ( ?is        
section1 ! ,secret>y %all remove any    
c]tifi$ advance directive ( su* advance 
directive v5dor or o!r entity f !       
,int]net website ( ! ,c5t]s = ,m$ic>e   
,m$icaid ,s]vices4  7,d7 ,use ( /atutory
 & alt]native advance directive =ms ,!  
advance directive v5dor or o!r entity   
%all all[ a ,program p>ticipant to-- 7i7
 access1 complete1 modify1 & adopt any  
advance directive =ms describ$ 9        
subp>agraphs 7,c7 & 7,d7 ( subsection   
7d77#a72 &  7ii7 se>* = su* =ms by      
,/ate4  7,e7 ,access ,! advance         
directive v5dor or o!r entity %all--    
7i7 provide ne> real-"t onl9e access to 
! c]tifi$ advance directive ( a ,program
 p>ticipant = purposes ( view+ & %>+ su*
 advance directive1 includ+ communicat+ 

! c]tifi$ advance directive & ! ,program
 p>ticipant's au!nticat$ wi%es us+      
nationally recogniz$ /&>ds = securely   
transf]r+ s5sitive data specifi$ by !   
,secret>y to-- 7,i7 ! ,program          
p>ticipant2  7,,ii7 any family memb]1   
legal repres5tative1 or heal? c>e proxy 
legally designat$ by ! p>ticipant2 &    
7,,iii7 a provid] ( s]vices or suppli] t
 furni%es items or s]vices to !         
p>ticipant2 &  7ii7 at ! reque/ ( !     
,program p>ticipant or any family memb]1
 legal repres5tative1 or heal? c>e proxy
 legally designat$ by ! ,program        
p>ticipant1 provide a h>d copy ( !      
c]tifi$ advance directive ( ! ,program  
p>ticipant to a provid] ( s]vices or    
suppli]4  7,f7 ,privacy protections  7i7
 ,9 g5]al ,! advance directive v5dor or 
o!r entity %all comply ) ! ,f$]al       
regulations 7conc]n+ ! privacy (        
individually id5tifiable heal?          
in=mation7 promulgat$ "u section        
#bfd7;c7 ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    

#aiif1 subject to ! access au?oriz$ "u  
subp>agraph 7,e74  7ii7 ,access ,su*    
v5dor or entity %all comply ) /&>diz$   
data protections & privacy /&>ds1       
includ+ ! ,f$]al ,regulations describ$ 9
 clause 7i71 to ensure t ! cont5t ( a   
,program p>ticipant's c]tifi$ advance   
directive is own$ & ma9ta9$ by !        
p>ticipant & c only be access$ by ^?    
au?oriz$ to access ! advance directive  
"u subp>agraph 7,e74  7,g7 ,security &  
te/+ ,! advance directive v5dor or o!r  
entity %all c]tify t--  7i7 all data    
managem5t & data transf] elem5ts involv$
 9 adopt+1 ma9ta9+1 & access+ a c]tifi$ 
advance directive ( a ,program          
p>ticipant-- 7,i7 h successfully pass$  
rigor\s indep5d5t te/+ reg>d+ /&>ds (   
timel9ess1 accuracy1 & effici5cy2 &     
7,,ii7 meet widely accept$ indu/ry      
security /&>ds 7z det]m9$ by !          
,secret>y72 &  7ii7 ! sy/em t provides  
access to a c]tifi$ advance directive ( 
a ,program p>ticipant has pass$ real-"t 
te/s simulat+ a reali/ic volume (       

,program p>ticipants1 _! family memb]s1 
legal repres5tatives1 & legally         
designat$ heal? c>e proxies1 provid]s ( 
s]vices1 & suppli]s access+ su*         
directives simultane\sly4  7,h7         
,b5efici>y surveys  7i7 ,9 g5]al ,!     
advance directive v5dor or o!r entity   
%all adm9i/] an annual survey ( ,program
 p>ticipants on ! in=mation describ$ 9  
clause 7ii7 & submit ! results ( su*    
survey to ! ,secret>y4  7ii7 ,in=mation 
,! in=mation describ$ 9 ?is clause1 )   
respect to a ,program p>ticipant & a    
c]tifi$ advance directive ( su*         
p>ticipant1 is ! foll[+3  7,i7 ,:e!r !  
p>ticipant _h to pay any ?ird p>ty = !  
creation1 /orage1 or retrieval ( !      
c]tifi$ advance directive4  7,,ii7 ,:e!r
 ! p>ticipant _h a heal? c>e enc\nt] or 
em]g5cy t requir$ ! location1 access1   
retrieval1 or consultation ( ! c]tifi$  
advance directive & if s1 :e!r ! c]tifi$
 advance directive 0 accessible onl9e & 
9 ne> real-"t1 z requir$ "u ?is section4
  7,,iii7 ,:e!r ! c]tifi$ advance       

directive 0 suffici5tly cle> &          
actionable4  7,,iv7 ,:e!r m$ical        
p]sonnel foll[$ ! c]tifi$ advance       
directive4  7,i7 ,process = comply+ )   
,/ate law ,! advance directive v5dor or 
o!r entity %all enable a ,program       
p>ticipant us+ _! s]vices to complete a 
c]tifi$ advance directive t fully       
complies ) ! law gov]n+ advance         
directives ( ! applicable ,/ate4  7,j7  
,access 9 cases ( dispute ov] treatm5t  
7i7 ,special access ,! advance directive
 v5dor or o!r entity %all e/abli% a     
process :]eby1 ) respect to a ,program  
p>ticipant1 an int]e/$ individual       
describ$ 9 clause 7ii7 may obta9 access 
to ! c]tifi$ advance directive ( !      
,program p>ticipant = ! purposes ( view+
 & %>+ su* advance directive :5--  7,i7 
! provisions ( ! c]tifi$ advance        
directive h come into =ce "u ! law ( !  
applicable ,/ate because ! ,program     
p>ticipant has become incapable ( mak+  
heal? c>e decisions on _! own or "u o!r 
circum/ances provid$ "u ,/ate law2 &    

7,,ii7 at lea/ #a p]son describ$ 9      
clause 7ii7 is que/ion+ or disput+ !    
provision1 )hold+1 or )drawal ( m$ical  
treatm5t1 food1 or fluids ) respect to !
 ,program p>ticipant4  7ii7 ,int]e/$    
individuals  7,i7 ,9 g5]al ,an int]e/$  
individual describ$ 9 ?is clause1 )     
respect to a ,program p>ticipant1 is--  
7aa7 any individual :o is a memb] ( any 
class ( p]sons :o1 "u ! law ( !         
applicable ,/ate1 w\ld pot5tially be    
eligible to s]ve z a heal? c>e decision 
mak] = ! ,program p>ticipant if an      
advance directive _h n be5 execut$1     
reg>dless ( :e!r ano!r individual w\ld h
 high] priority = su* eligibility2 or   
7bb7 if ! law ( ! applicable ,/ate does 
n designate a p]son or class ( p]sons   
describ$ 9 item 7aa71 any individual    
relat$ )9 ! ?ird degree ( consangu9ity  
or aff9ity to ! ,program p>ticipant     
id5tifi$ by ! ,program p>ticipant 9 !   
c]tifi$ advance directive4  7,,ii7      
,p]iodic update ,9 ! case t ! law ( !   
applicable ,/ate does n designate a     

p]son or class ( p]sons describ$ 9      
subclause 7,i77aa7 & ! ,program         
p>ticipant has id5tifi$ 9 a c]tifi$     
advance directive an individual )9 !    
?ird degree ( consangu9ity or aff9ity ( 
su* p>ticipant1 ! advance directive     
v5dor or o!r entity %all annually dur+ !
 annual1 coord9at$ election p]iod "u    
section #ahea7;e77#c7 prompt ! ,program 
p>ticipant to update su* individual4    
7d7 ,education & outrea*  7#a7 ,9 g5]al 
,! ,secret>y %all-- 7,a7 include a      
/atem5t describ$ 9 p>agraph 7#c7 9 !    
notice describ$ 9 section #ahjd7;a7 &   
provide = ! inclusion ( su* /atem5t on !
 ,int]net website ( ! ,c5t]s = ,m$ic>e  
,m$icaid ,s]vices2  7,b7 communicate !  
b5efits ( electronic advance directives 
s]vices1 z !y become available2  7,c7   
provide = ! inclusion1 "u ! head+       
,/atutory ,advance ,directive ,=ms1 (   
any relevant =ms1 :e!r m&atory or       
optional1 specifi$ 9 ! /atutes or       
regulations ( ,/ates to be display$ on a
 su* website2  7,d7 provide = !         

inclusion1 "u ! head+ ,alt]native       
,advance ,directive ,=ms1 on su*        
website1 & 9 accordance ) p>agraph      
7#b7-- 7i7 ( o!r advance directive =ms  
submitt$ to ! ,secret>y by individuals &
 gr\ps 9 an electronic =mat specifi$ by 
! ,secret>y = :i* ! submitt+ entity     
includes1 = ea* =m submitt$1 an op9ion  
by an attorney lic5s$ to practice 9 !   
relevant ,/ate demon/rat+ t ! submitt$  
=m complies ) ! law ( t ,/ate2 &  7ii7 (
 ! foll[+ disclaim]1 :i* %all be        
prom95tly po/$ on ! website3 ,?is       
website includes = y\r consid]ation     
alt]native advance directive =ms        
submitt$ by individuals or gr\ps        
reflect+ diff]5t p]spectives on advance 
heal? c>e decisions :i* y may wi% to    
review be=e complet+ y\r own advance    
directive42 &  7,e7 provide = !         
inclusion ( a us]-fri5dly index on !    
website by ,/ate &1 9 ! case ( !        
,alt]native ,advance ,directive ,=ms1 by
 ! "n ( ! individual or gr\p :o provid$ 
ea* alt]native advance directive1 s t a 

us] may readily access ^? /atutory &    
alt]native =ms4  7#b7 ,alt]native       
advance directive =ms  7,a7 ,9 g5]al ,= 
purposes ( p>agraph 7#a77;,d71 ! foll[+ 
%all apply3 7i7 ,n lat] ?an #fj days    
aft] receiv+ an alt]native advance      
directive =m submitt$ "u su* p>agraph1 !
 ,secret>y %all ei!r po/ ! submitt$ =m  
on ! ,int]net website ( ! ,c5t]s =      
,m$ic>e  ,m$icaid ,s]vices or provide to
 ! submitt+ entity an explanation ( !   
basis = ! ,secret>y's det]m9ation t !   
submitt$ =m does n comply ) relevant    
,/ate or ,f$]al law1 :i* det]m9ation    
%all be subject to judicial review "u   
section #gjb ( title #e ( ! ,unit$      
,/ates ,code4  7ii7 ,! ,secret>y %all   
ei!r remove or refuse to po/ any        
submitt$ =m if provid$ ) an (ficial     
det]m9ation by ! attorney g5]al ( !     
applicable ,/ate t ! =m is n 9          
compliance ) ,/ate law1 subject to      
applicable ,/ate law describ$ 9         
subp>agraph 7,b74  7,b7 ,/ate law       
describ$ ,= purposes ( subp>agraph 7,a71

 ,/ate law describ$ 9 ?is subp>agraph   
is--  7i7 a rul+ by a c\rt ( !          
applicable ,/ate1 or by a ,f$]al c\rt   
apply+ t ,/ate's law1 subject to        
subsequ5t rul+s by a c\rt or c\rts )    
au?ority to sup]c$e t rul+2 or  7ii7 a  
/atute or regulation ( ! applicable     
,/ate t provides = a specific proc$ure =
 (ficially det]m9+ :e!r p>ticul> advance
 directive =ms comply ) ,/ate law4  7#c7
 ,/atem5t ,= purposes ( p>agraph        
7#a77;,a71 ! /atem5t describ$ 9 ?is     
p>agraph is a /atem5t ( ! reasons :y    
b5efici>ies may want to consid] advance 
directives1 a sugge/ion = ! b5efici>y to
 c>efully consid] decisions reg>d+      
advance directives1 & ref]5ces to       
res\rces ab\t advance directives4  7e7  
,advance directive in=mation 9 ,m$ic>e  
enrollm5t =ms ,aft] ! ,secret>y         
implem5ts ! ,program1 ! ,secret>y %all  
include on ea* application = enrollm5t (
 an individual 9 "p ,a1 ?is "p1 or "p ,c
 a l9k to an ,int]net website ) res\rces
 to assi/ 9 complet+ an advance         

directive4  4