1.Short title; table of
contents
(a)This Act may be cited
as the Advance Planning and
Compassionate Care Act of 2009
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I—Advance Care Planning
Subtitle A—Consumer and Provider Education
Part I—Consumer Education
SUBPART A—National initiatives
Sec. 101. Advance care planning telephone hotline.
Sec. 102. Advance care planning information
clearinghouses.
Sec. 103. Advance care planning toolkit.
Sec. 104. National public education campaign.
Sec. 105. Update of Medicare and Social Security
handbooks.
Sec. 106. Authorization of appropriations.
SUBPART B—State and local initiatives
Sec. 111. Financial assistance for advance care
planning.
Sec. 112. Grants for programs for orders regarding life
sustaining treatment.
Part II—Provider Education
Sec. 121. Public provider advance care planning
website.
Sec. 122. Continuing education for physicians and
nurses.
Subtitle B—Portability of Advance Directives; Health
Information Technology
Sec. 131. Portability of advance directives.
Sec. 132. State advance directive registries; driver's license
advance directive notation.
Sec. 133. GAO study and report on establishment of national
advance directive registry.
Subtitle C—National Uniform Policy on Advance Care
Planning
Sec. 141. Study and report by the Secretary regarding the
establishment and implementation of a national uniform policy on advance
directives.
TITLE II—Compassionate Care
Subtitle A—Workforce development
Part I—Education and training
Sec. 201. National Geriatric and Palliative Care Services
Corps.
Sec. 202. Exemption of palliative medicine fellowship training
from Medicare graduate medical education caps.
Sec. 203. Medical school curricula.
Subtitle B—Coverage under Medicare, Medicaid, and CHIP
Part I—Coverage of advance care planning
Sec. 211. Medicare, Medicaid, and CHIP coverage.
Part II—Hospice
Sec. 221. Adoption of MedPAC hospice payment methodology
recommendations.
Sec. 222. Removing hospice inpatient days in setting per diem
rates for critical access hospitals.
Sec. 223. Hospice payments for dual eligible individuals
residing in long-term care facilities.
Sec. 224. Delineation of respective care responsibilities of
hospice programs and long-term care facilities.
Sec. 225. Adoption of MedPAC hospice program eligibility
certification and recertification recommendations.
Sec. 226. Concurrent care for children.
Sec. 227. Making hospice a required benefit under Medicaid and
CHIP.
Sec. 228. Medicare Hospice payment model demonstration
projects.
Sec. 229. MedPAC studies and reports.
Sec. 230. HHS Evaluations.
Subtitle C—Quality Improvement
Sec. 241. Patient satisfaction surveys.
Sec. 242. Development of core end-of-life care quality measures
across each relevant provider setting.
Sec. 243. Accreditation of hospital-based palliative care
programs.
Sec. 244. Survey and data requirements for all Medicare
participating hospice programs.
Subtitle D—Additional reports, research, and
evaluations
Sec. 251. National Center on Palliative and End-of-Life
Care.
Sec. 252. National Mortality Followback Survey.
Sec. 253. Demonstration projects for use of telemedicine
services in advance care planning.
Sec. 254. Inspector General investigation of fraud and
abuse.
Sec. 255. GAO study and report on provider adherence to advance
directives.
2.In this Act:
(1)The term advance care planning means the
process of—
(A)determining an
individual’s priorities, values and goals for care in the future when the
individual is no longer able to express his or her wishes;
(B)engaging family
members, health care proxies, and health care providers in an ongoing dialogue
about—
(i)the
individual’s wishes for care;
(ii)what the future
may hold for people with serious illnesses or injuries;
(iii)how individuals,
their health care proxies, and family members want their beliefs and
preferences to guide care decisions; and
(iv)the
steps that individuals and family members can take regarding, and the resources
available to help with, finances, family matters, spiritual questions, and
other issues that impact seriously ill or dying patients and their families;
and
(C)executing and
updating advance directives and appointing a health care proxy.
(2)The term advance directive means a living
will, medical directive, health care power of attorney, durable power of
attorney, or other written statement by a competent individual that is
recognized under State law and indicates the individual's wishes regarding
medical treatment in the event of future incompetence. Such term includes an
advance health care directive and a health care directive recognized under
State law.
(3)The
term CHIP means the program established under title XXI of the
Social Security Act (42 U.S.C. 1397aa et seq.).
(4)The
term end-of-life care means all aspects of care of a patient with
a potentially fatal condition, and includes care that is focused on specific
preparations for an impending death.
(5)Health care
power of attorneyThe term health care power of
attorney means a legal document that identifies a health care proxy or
decision maker for a patient who has the authority to act on the patient’s
behalf when the patient is unable to communicate his or her wishes for medical
care on matters that the patient specifies when he or she is competent. Such
term includes a durable power of attorney that relates to medical care.
(6)The term living will means a legal
document—
(A)used to specify
the type of medical care (including any type of medical treatment, including
life-sustaining procedures if that person becomes permanently unconscious or is
otherwise dying) that an individual wants provided or withheld in the event the
individual cannot speak for himself or herself and cannot express his or her
wishes; and
(B)that requires a
physician to honor the provisions of upon receipt or to transfer the care of
the individual covered by the document to another physician that will honor
such provisions.
(7)The
term Medicaid means the program established under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.).
(8)The
term Medicare means the program established under title XVIII of
the Social Security Act (42 U.S.C. 1395 et seq.).
(9)Orders for
life-sustaining treatmentThe term orders for
life-sustaining treatment means a process for focusing a patients'
values, goals, and preferences on current medical circumstances and to
translate such into visible and portable medical orders applicable across care
settings, including home, long-term care, emergency medical services, and
hospitals.
(10)The term palliative care means
interdisciplinary care for individuals with a life-threatening illness or
injury relating to pain and symptom management and psychological, social, and
spiritual needs and that seeks to improve the quality of life for the
individual and the individual's family.
(11)The
term Secretary means the Secretary of Health and Human
Services.
<enum>I</enum><header>Advance Care
Planning</header>
<subtitle id="H2DDD451F9AC343CBBA8FE0A26969C453"><enum>A</enum><header>Consumer and
Provider Education</header>
<part id="HA867E0DFA7B1449F859C955E6C7A825E"><enum>I</enum><header>Consumer
Education</header>
<subpart id="HDB55486436C249A39C17911E4B344837"><enum>A</enum><header>National
initiatives</header>
<section id="HFED95823772849F9A9FE4B30B285DA42"><enum>101.</enum><header>Advance care
planning telephone hotline</header>
<subsection id="H669164B73B7D4FAF8A392969B07C755D"><enum>(a)</enum><header>In
General</header><text>Not later than January 1, 2011, the Secretary, acting
through the Director of the Centers for Disease Control and Prevention, shall
establish and operate directly, or by grant, contract, or interagency
agreement, a 24-hour toll-free telephone hotline to provide consumer
information regarding advance care planning, including—</text>
<paragraph id="H1A66190AE2CD4C378E5888297E79D163"><enum>(1)</enum><text>an explanation of
advanced care planning and its importance;</text>
</paragraph><paragraph id="H7E5F847CE53C498095805BA33360138A"><enum>(2)</enum><text>issues to be
considered when developing an individual's advance care plan;</text>
</paragraph><paragraph id="H66A08CFD94B44512B9931386F8F3BB64"><enum>(3)</enum><text>how to establish
an advance directive;</text>
</paragraph><paragraph id="H829BFE2DFA7042A59B5D9797AC073067"><enum>(4)</enum><text>procedures to help
ensure that an individual's directives for end-of-life care are
followed;</text>
</paragraph><paragraph id="HB0F8BCE6B3C143EAAF8270088E17502B"><enum>(5)</enum><text>Federal and
State-specific resources for assistance with advance care planning; and</text>
</paragraph><paragraph id="H8E617662E097441CBCA55432B54B19E4"><enum>(6)</enum><text>hospice and
palliative care (including their respective purposes and services).</text>
</paragraph></subsection><subsection id="HA92A2511A95F4C2890FF1D6446AD4865"><enum>(b)</enum><header>Establishment</header><text>In
carrying out the requirements under subsection (a), the Director of the Centers
for Disease Control and Prevention may designate an existing 24-hour toll-free
telephone hotline or, if no such service is available or appropriate, establish
a new 24-hour toll-free telephone hotline.</text>
</subsection></section><section id="H739E6BE4675B4306A4B2F979257B4BAD"><enum>102.</enum><header>Advance care
planning information clearinghouses</header>
<subsection id="HFA92734E96C34CB19A1E4EC5757B4AF1"><enum>(a)</enum><header>Expansion of
National Clearinghouse for Long-Term Care Information</header>
<paragraph id="H8EEFE8B52A3A4DF08F025D33C5D6DB4B"><enum>(1)</enum><header>Development</header><text>Not
later than January 1, 2010, the Secretary shall develop an online clearinghouse
to provide comprehensive information regarding advance care planning.</text>
</paragraph><paragraph id="H553D2143661B4790BB3BD29F865C1CCD"><enum>(2)</enum><header>Maintenance</header><text>The
advance care planning clearinghouse, which shall be clearly identifiable and
available on the homepage of the Department of Health and Human Service's
National Clearinghouse for Long-Term Care Information website, shall be
maintained and publicized by the Secretary on an ongoing basis.</text>
</paragraph><paragraph id="H3BD33C1D8B6743B1AA902EC20A1602D5"><enum>(3)</enum><header>Content</header><text>The
advance care planning clearinghouse shall include—</text>
<subparagraph id="HE0CBCD8870EE49B7B25F214920E72B2D"><enum>(A)</enum><text>any relevant
content contained in the national public education campaign required under
section 104;</text>
</subparagraph><subparagraph id="HDF3F88BB43104769825780E50082EED1"><enum>(B)</enum><text>content
addressing—</text>
<clause id="H5C6D563C9BBD435F9F1C24F03C32DC0C"><enum>(i)</enum><text>an
explanation of advanced care planning and its importance;</text>
</clause><clause id="H5DB8C5DBC561447B8977065060F17E32"><enum>(ii)</enum><text>issues to be
considered when developing an individual's advance care plan;</text>
</clause><clause id="HE92AAE2886514FE1870B09424E0539B2"><enum>(iii)</enum><text>how to establish
an advance directive;</text>
</clause><clause id="H5210DD2EB20E4C6FB53177B00079FD42"><enum>(iv)</enum><text>procedures to
help ensure that an individual's directives for end-of-life care are followed;
and</text>
</clause><clause id="HF518A0F71E8D47C8A64C5C8B7C90E906"><enum>(v)</enum><text>hospice and
palliative care (including their respective purposes and services);</text>
</clause></subparagraph><subparagraph id="H24BD74BF7A1C4C268AEEED772937B47A"><enum>(C)</enum><text>available Federal
and State-specific resources for assistance with advance care planning,
including—</text>
<clause id="HF051946EEF6643028A8E7F5DD0B8746E"><enum>(i)</enum><text>contact
information for any State public health departments that are responsible for
issues regarding end-of-life care;</text>
</clause><clause id="HBB301F2EF58544C4947094532AE6C818"><enum>(ii)</enum><text>contact
information for relevant legal service organizations, including those funded
under the Older Americans Act of 1965 (42 U.S.C. 3001 et seq.); and</text>
</clause><clause id="HDADC0A36B2BC46559FC08A63AC29BD51"><enum>(iii)</enum><text>advance
directive forms for each State; and</text>
</clause></subparagraph><subparagraph id="HA41EE1712C0E4DFEACAAED0F908C2302"><enum>(D)</enum><text>any additional
information, as determined by the Secretary.</text>
</subparagraph></paragraph></subsection><subsection id="H1FBA72F129E44C8C8A0E129ADAE25029"><enum>(b)</enum><header>Establishment of
pediatric advance care planning clearinghouse</header>
<paragraph id="H27C5456F80B042F38F14535FAA2F150A"><enum>(1)</enum><header>Development</header><text>Not
later than January 1, 2011, the Secretary, in consultation with the Assistant
Secretary for Children and Families of the Department of Health and Human
Services, shall develop an online clearinghouse to provide comprehensive
information regarding pediatric advance care planning.</text>
</paragraph><paragraph id="HE9BE24D6B5ED41ECBDF37498BB378820"><enum>(2)</enum><header>Maintenance</header><text>The
pediatric advance care planning clearinghouse, which shall be clearly
identifiable on the homepage of the Administration for Children and Families
website, shall be maintained and publicized by the Secretary on an ongoing
basis.</text>
</paragraph><paragraph id="H21F948AD48DC43B8A9C1DF5657AA9151"><enum>(3)</enum><header>Content</header><text>The
pediatric advance care planning clearinghouse shall provide advance care
planning information specific to children with life-threatening illnesses or
injuries and their families.</text>
</paragraph></subsection></section><section id="H2081F12114DE445D8F17B45269DCCA16"><enum>103.</enum><header>Advance care
planning toolkit</header>
<subsection id="H02F76170773449E68666D1137E5A73BE"><enum>(a)</enum><header>Development</header><text>Not
later than July 1, 2010, the Secretary, in consultation with the Director of
the Centers for Disease Control and Prevention, shall develop an online advance
care planning toolkit.</text>
</subsection><subsection id="HDB6C47F5FA764B35810E09FBD3A3D83B"><enum>(b)</enum><header>Maintenance</header><text>The
advance care planning toolkit, which shall be available in English, Spanish,
and any other languages that the Secretary deems appropriate, shall be
maintained and publicized by the Secretary on an ongoing basis and made
available on the following websites:</text>
<paragraph id="H4C57539C28EA47679B3BE8F360994F03"><enum>(1)</enum><text>The Centers for
Disease Control and Prevention.</text>
</paragraph><paragraph id="H5BC80E60322D4B96AD1B0CF002443AAA"><enum>(2)</enum><text>The Department of
Health and Human Service's National Clearinghouse for Long-Term Care
Information.</text>
</paragraph><paragraph id="HA218AC892F4A48AE92E514B3ACEB6DC4"><enum>(3)</enum><text>The Administration
for Children and Families.</text>
</paragraph></subsection><subsection id="HB1384AD2929443B6A3209B36358E926D"><enum>(c)</enum><header>Content</header><text>The
advance care planning toolkit shall include content addressing—</text>
<paragraph id="H0C8E2D07804240B3BD646819E9D970F6"><enum>(1)</enum><text>common issues and
questions regarding advance care planning, including individuals and resources
to contact for further inquiries;</text>
</paragraph><paragraph id="H1BA230D89F764EED86B3CE0F985E054A"><enum>(2)</enum><text>advance directives
and their uses, including living wills and durable powers of attorney;</text>
</paragraph><paragraph id="HC118A1B11CBA491E97E5A6E04BEFAD8C"><enum>(3)</enum><text>the roles and
responsibilities of a health care proxy;</text>
</paragraph><paragraph id="H21E2242DA2F3479C8C01AA08995651C2"><enum>(4)</enum><text>Federal and
State-specific resources to assist individuals and their families with advance
care planning, including—</text>
<subparagraph id="HE98DB0BF58D141D7A38C31F7A6031634"><enum>(A)</enum><text>the advance care
planning toll-free telephone hotline established under section 101;</text>
</subparagraph><subparagraph id="HA424A2FF86624AF0956ECF0AA0100BBD"><enum>(B)</enum><text>the advance care
planning clearinghouses established under section 102;</text>
</subparagraph><subparagraph id="HEA2059A35C1149D999E42EE0D012C69B"><enum>(C)</enum><text>the advance care
planning toolkit established under this section;</text>
</subparagraph><subparagraph id="H18CFA0EF5B3E4DDA883892C713509DC4"><enum>(D)</enum><text>available State
legal service organizations to assist individuals with advance care planning,
including those organizations that receive funding pursuant to the Older
Americans Act of 1965 (42 U.S.C. 3001 et seq.); and</text>
</subparagraph><subparagraph id="H4026E4C6AE7E4DDCBB22CBA5421791AC"><enum>(E)</enum><text>website links or
addresses for State-specific advance directive forms; and</text>
</subparagraph></paragraph><paragraph id="H054B99FD01824B50933E921D7F7F105F"><enum>(5)</enum><text>any additional
information, as determined by the Secretary.</text>
</paragraph></subsection></section><section id="HF173B3DF2DF74FFDBBCA302255893BAC"><enum>104.</enum><header>National public
education campaign</header>
<subsection commented="no" display-inline="no-display-inline" id="HA81735FE46834211AA3FC0B7CEC69A29"><enum>(a)</enum><header display-inline="yes-display-inline">National public education campaign</header>
<paragraph commented="no" display-inline="no-display-inline" id="H9130709190B4477595945BF1538FE49F"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Not later than
January 1, 2011, the Secretary, acting through the Director of the Centers for
Disease Control and Prevention, shall, directly or through grants, contracts,
or interagency agreements, 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 their health care decisions.</text>
</paragraph><paragraph id="H139B765AF9C249A98D12E39DAD3385DD"><enum>(2)</enum><header>Content of
Educational Campaign</header><text>The national public education campaign
established under paragraph (1) shall—</text>
<subparagraph id="H670E8441958E4496B04CC585FB824702"><enum>(A)</enum><text>employ the use of
various media, including regularly televised public service
announcements;</text>
</subparagraph><subparagraph id="HD49BE15308AF45F88716703372BC21F6"><enum>(B)</enum><text>provide culturally
and linguistically appropriate information;</text>
</subparagraph><subparagraph id="HF874065955754D16A90E75DD3BC1122C"><enum>(C)</enum><text>be conducted
continuously over a period of not less than 5 years;</text>
</subparagraph><subparagraph id="HC2FC4993937B437CBF55B0D4115FD0A4"><enum>(D)</enum><text>identify and
promote the advance care planning information available on the Department of
Health and Human Service's National Clearinghouse for Long-Term Care
Information website and Administration for Children and Families website, as
well as any other relevant Federal or State-specific advance care planning
resources;</text>
</subparagraph><subparagraph id="H425C27255E6A4596BB80EDD3C54CFC0B"><enum>(E)</enum><text>raise public
awareness of the consequences that may result if an individual is no longer
able to express or communicate their health care decisions;</text>
</subparagraph><subparagraph id="H2BCB275F21004EE5A78694E346465C0A"><enum>(F)</enum><text>address the
importance of individuals speaking to family members, health care proxies, and
health care providers as part of an ongoing dialogue regarding their health
care choices;</text>
</subparagraph><subparagraph id="H1ABC653778554E7E92A9E02791B968D6"><enum>(G)</enum><text>address the need
for individuals to obtain readily available legal documents that express their
health care decisions through advance directives (including living wills,
comfort care orders, and durable powers of attorney for health care);</text>
</subparagraph><subparagraph id="H20CC85B65EA44C8EABEDF33B957CDE9E"><enum>(H)</enum><text>raise public
awareness regarding the availability of hospice and palliative care; and</text>
</subparagraph><subparagraph id="H80CEB8D3799D4913A4BA118B9E6A5488"><enum>(I)</enum><text>encourage
individuals to speak with their physicians about their options and intentions
for end-of-life care.</text>
</subparagraph></paragraph><paragraph id="HAC077912066043CEAEE44ED0F0950CD0"><enum>(3)</enum><header>Evaluation</header>
<subparagraph id="HBC1A363FBB864A8580F9F6747B8CD637"><enum>(A)</enum><header>In
General</header><text>Not later than July 1, 2013, the Secretary, acting
through the Director of the Centers for Disease Control and Prevention, shall
conduct a nationwide survey to evaluate whether the national campaign conducted
under this subsection has achieved its goal of changing public awareness,
attitudes, and behaviors regarding advance care planning.</text>
</subparagraph><subparagraph id="H1CF1F50747CB418586FF202CA1F1B6AD"><enum>(B)</enum><header>Baseline
Survey</header><text>In order to evaluate the effectiveness of the national
campaign, the Secretary shall conduct a baseline survey prior to implementation
of the campaign.</text>
</subparagraph><subparagraph id="H0A3DE11CF5A641CBB17CCE4ACC921492"><enum>(C)</enum><header>Reporting
Requirement</header><text>Not later than December 31, 2013, the Secretary shall
report the findings of such survey, as well as any recommendations that the
Secretary determines appropriate regarding the need for continuation or
legislative or administrative changes to facilitate changing public awareness,
attitudes, and behaviors regarding advance care planning, to the appropriate
committees of the Congress.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H32C4EF02D1794EF5A779B4C9E31935FD"><enum>(b)</enum><header>Repeal</header><text display-inline="yes-display-inline">Section 4751(d) of the Omnibus Budget
Reconciliation Act of 1990 (42 U.S.C. 1396a note; Public Law 101–508) is
repealed.</text>
</subsection></section><section id="H48EF2E95EE8E4739B5475F6A75FC55D7"><enum>105.</enum><header>Update of
Medicare and Social Security handbooks</header>
<subsection id="HD688B2712E634C4B99DC57E0E2C287F1"><enum>(a)</enum><header>Medicare &
You handbook</header>
<paragraph id="HD4494113B10D45938B9CF9EBE4A078BE"><enum>(1)</enum><header>In
general</header><text>Not later than 60 days after the date of enactment of
this Act, the Secretary shall update the online version of the <quote>Planning
Ahead</quote> section of the Medicare & You Handbook to include—</text>
<subparagraph id="H23D6ADB09E93462998E8118AE39D84A4"><enum>(A)</enum><text>an explanation of
advance care planning and advance directives, including—</text>
<clause id="H096D726ADD124D92B260FAB6101185A5"><enum>(i)</enum><text>living
wills;</text>
</clause><clause id="H3F1D3497009B4EF186166A7F2AEBC81A"><enum>(ii)</enum><text>health care
proxies; and</text>
</clause><clause id="H03A2621D87494FB6B8DE563E0A735CE6"><enum>(iii)</enum><text>after-death
directives;</text>
</clause></subparagraph><subparagraph id="H61A146D9FC564428A11FE99A7CAE0934"><enum>(B)</enum><text>Federal and
State-specific resources to assist individuals and their families with advance
care planning, including—</text>
<clause id="H47C5337E365743F888873F1729883A31"><enum>(i)</enum><text>the
advance care planning toll-free telephone hotline established under section
101;</text>
</clause><clause id="H894DF445DA544C06ADFDAB0B3D81A945"><enum>(ii)</enum><text>the
advance care planning clearinghouses established under section 102;</text>
</clause><clause id="H465CC735F272410AB73FDAFF3E9217CB"><enum>(iii)</enum><text>the advance care
planning toolkit established under section 103;</text>
</clause><clause id="HDA1D2083D2F5499FB89C8788C6CA1087"><enum>(iv)</enum><text>available State
legal service organizations to assist individuals with advance care planning,
including those organizations that receive funding pursuant to the Older
Americans Act of 1965 (42 U.S.C. 3001 et seq.); and</text>
</clause><clause id="HA7D5E883D501414DAA8E49701BEED2C0"><enum>(v)</enum><text>website links or
addresses for State-specific advance directive forms; and</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H9BC3B59399F84A638BC8690E5E3600DE"><enum>(C)</enum><text>any additional
information, as determined by the Secretary.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H26AA52DC064645939FB780E551CD0780"><enum>(2)</enum><header>Update of paper
and subsequent versions</header><text>The Secretary shall include the
information described in paragraph (1) in all paper and electronic versions of
the Medicare & You Handbook that are published on or after the date that is
60 days after the date of enactment of this Act.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H61F3883E8B93491790F87F9739AD6BBB"><enum>(b)</enum><header>Social Security
handbook</header><text>The Commissioner of Social Security shall—</text>
<paragraph commented="no" display-inline="no-display-inline" id="H4AD3F17703F74E84AD3E514472F5FB33"><enum>(1)</enum><text>not later than 60
days after the date of enactment of this Act, update the online version of the
Social Security Handbook for beneficiaries to include the information described
in subsection (a)(1); and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H09E38B8132FE486086BDB40C69E1B111"><enum>(2)</enum><text>include such
information in all paper and online versions of such handbook that are
published on or after the date that is 60 days after the date of enactment of
this Act.</text>
</paragraph></subsection></section><section id="H714625755B5F4E1F92163C3CC88B3476"><enum>106.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">There is
authorized to be appropriated for the period of fiscal years 2010 through
2014—</text>
<paragraph id="H9069CCE947054F47A805B0C52C617C3E"><enum>(1)</enum><text display-inline="yes-display-inline">$195,000,000 to the Secretary to carry out
sections 101, 102, 103, 104 and 105(a); and</text>
</paragraph><paragraph id="H3B7CA03E895043C783C0DABC146836E9"><enum>(2)</enum><text display-inline="yes-display-inline">$5,000,000 to the Commissioner of Social
Security to carry out section 105(b).</text>
</paragraph></section></subpart><subpart id="H805913C788FB4D349336696E4D54252F"><enum>B</enum><header>State and local
initiatives</header>
<section id="H9EB7BE9B89BD40C09CF91EB1D40E3BBB"><enum>111.</enum><header>Financial
assistance for advance care planning</header>
<subsection id="H7446F45898C74BD8A72988F72B9659D4"><enum>(a)</enum><header>Legal assistance
for advance care planning</header>
<paragraph id="HB91656D6DCE44447BC8427A8BD78B3F9"><enum>(1)</enum><header>Definition of
recipient</header><text>Section 1002(6) of the Legal Services Corporation Act
(42 U.S.C. 2996a(6)) is amended by striking <quote>clause (A) of </quote> and
inserting <quote>subparagraph (A) or (B) of</quote>.</text>
</paragraph><paragraph id="HD4D2002326504E49AC1E80573FEF2C20"><enum>(2)</enum><header>Advance care
planning</header><text>Section 1006 of the Legal Services Corporation Act (42
U.S.C. 2996e) is amended—</text>
<subparagraph id="H9575FF5E16F5499BBB3E79F01AF1ADBB"><enum>(A)</enum><text>in subsection
(a)(1)—</text>
<clause id="HFEBAF75F9FB84A1F9818ECB0A57C5DDB"><enum>(i)</enum><text>by
striking <quote>title, and (B) to make</quote> and inserting the following:
“title;</text>
<quoted-block display-inline="no-display-inline" id="H7C47412BB00D4A4EBEF0DCEFE2D5428E" style="OLC">
<subparagraph id="HB1B9587C8D084E3DA96E0482FABA07FE" indent="up1"><enum>(C)</enum><text>to
make</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause><clause id="H4BFA9F8A0FD44AE2A076ABE6A8C954AE"><enum>(ii)</enum><text>by
inserting after subparagraph (A) the following:</text>
<quoted-block display-inline="no-display-inline" id="HA0BD4EF483E24547BCA05E36A8C66A31" style="OLC">
<subparagraph id="HFFED01306A0B42ED8A1AD005BA97043B" indent="up1"><enum>(B)</enum><text>to provide financial assistance, and
make grants and contracts, as described in subparagraph (A), on a competitive
basis for the purpose of providing legal assistance in the form of advance care
planning (as defined in section 3 of the <short-title>Advance Planning and Compassionate Care Act of
2009</short-title>, and including providing information about State-specific
advance directives, as defined in that section) for eligible clients under this
title, including providing such planning to the family members of eligible
clients and persons with power of attorney to make health care decisions for
the clients; and</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="HB5BC0356A7E2402E8C61309B07890D8C"><enum>(B)</enum><text>in subsection (b),
by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H8AE77615A6C8427D835601478B534C28" style="OLC">
<paragraph id="HD0C5FD318B1C4C4FB8D22C88A8D3A83F" indent="up1"><enum>(2)</enum><text>Advance care planning provided in
accordance with subsection (a)(1)(B) shall not be construed to violate the
Assisted Suicide Funding Restriction Act of 1997 (42 U.S.C. 14401 et
seq.).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H5BF38D715E8541E4B3D4781DA37994B3"><enum>(3)</enum><header>Reports</header><text>Section
1008(a) of the Legal Services Corporation Act (42 U.S.C. 2996g(a)) is amended
by adding at the end the following: <quote>The Corporation shall require such a
report, on an annual basis, from each grantee, contractor, or other recipient
of financial assistance under section 1006(a)(1)(B).</quote>.</text>
</paragraph><paragraph id="HB0B683C4498B4754B32367774A37B003"><enum>(4)</enum><header>Authorization of
appropriations</header><text>Section 1010 of the Legal Services Corporation Act
(42 U.S.C. 2996i) is amended—</text>
<subparagraph id="H0312A4BF2D9946A496F8BB919E8B0989"><enum>(A)</enum><text>in subsection
(a)—</text>
<clause id="H61AE911E5C1C42A99C10D00C148D0513"><enum>(i)</enum><text>by
striking <quote>(a)</quote> and inserting <quote>(a)(1)</quote>;</text>
</clause><clause id="HEE53DB4FFE2E4DE78961E1751608E82A"><enum>(ii)</enum><text>in
the last sentence, by striking <quote>Appropriations for that purpose</quote>
and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="H3A5A9D4B22E2481F8C43666B1089EC43" style="OLC">
<paragraph id="H781F2B3487F248AAB0C3EED2F40F8564" indent="up1"><enum>(3)</enum><text>Appropriations for a purpose
described in paragraph (1) or (2)</text>
</paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause><clause id="H91686FD77B9447E08CB69E2E77D17A53"><enum>(iii)</enum><text>by
inserting before paragraph (3) (as designated by clause (ii)) the
following:</text>
<quoted-block display-inline="no-display-inline" id="HA75127046A444A5CB0F802C475C58959" style="OLC">
<paragraph id="HA5E87233D349472C9D874D1C3F318B70" indent="up1"><enum>(2)</enum><text>There are authorized to be
appropriated to carry out section 1006(a)(1)(B), $10,000,000 for each of fiscal
years 2010, 2011, 2012, 2013, and 2014.</text>
</paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="H6BF0D625003940B888FBA136973AA74A"><enum>(B)</enum><text>in subsection (d),
by striking <quote>subsection (a)</quote> and inserting <quote>subsection
(a)(1)</quote>.</text>
</subparagraph></paragraph><paragraph id="H9514E1574E9F4EAE940943EF7DBA2E4D"><enum>(5)</enum><header>Effective
date</header><text>This subsection and the amendments made by this subsection
take effect July 1, 2010.</text>
</paragraph></subsection><subsection id="H549C674B1907413FA9E8DAD11C0CDA6A"><enum>(b)</enum><header>State health
insurance assistance programs</header>
<paragraph id="H908F8FE29B65497F85173EB458DEBF2E"><enum>(1)</enum><header>In
general</header><text>The Secretary shall use amounts made available under
paragraph (3) to award grants to States for State health insurance assistance
programs receiving assistance under section 4360 of the Omnibus Budget
Reconciliation Act of 1990 to provide advance care planning services to
Medicare beneficiaries, personal representatives of such beneficiaries, and the
families of such beneficiaries. Such services shall include information
regarding State-specific advance directives and ways to discuss individual care
wishes with health care providers.</text>
</paragraph><paragraph id="H2C930DD1DA0D49C5BFFCE2B74C06DC81"><enum>(2)</enum><header>Requirements</header>
<subparagraph id="HF6CC619857424EE49931AD6C96A65625"><enum>(A)</enum><header>Award of
grants</header><text>In making grants under this subsection for a fiscal year,
the Secretary shall satisfy the following requirements:</text>
<clause id="H7368BEE0F113470CA3814DD84AAA3A37"><enum>(i)</enum><text>Two-thirds of the
total amount of funds available under paragraph (3) for a fiscal year shall be
allocated among those States approved for a grant under this section that have
adopted the Uniform Health-Care Decisions Act drafted by the National
Conference of Commissioners on Uniform State Laws and approved and recommended
for enactment by all States at the annual conference of such commissioners in
1993.</text>
</clause><clause id="HB3E48DC650AF4BAA86CCA7CB578C3229"><enum>(ii)</enum><text>One-third of the
total amount of funds available under paragraph (3) for a fiscal year shall be
allocated among those States approved for a grant under this section that have
adopted a uniform form for orders regarding life sustaining treatment as
defined in section 1861(hhh)(5) of the Social Security Act (as amended by
section 211 of this Act) or a comparable approach to advance care
planning.</text>
</clause></subparagraph><subparagraph id="H3695CAF2E010408FB9A0809BF1630551"><enum>(B)</enum><header>Work plan;
report</header><text>As a condition of being awarded a grant under this
subsection, a State shall submit the following to the Secretary:</text>
<clause id="HC3E0541F84904C899F0C0E829D791E42"><enum>(i)</enum><text>An
approved plan for expending grant funds.</text>
</clause><clause id="HA8DF2783131D485DA0BE657A1C5E72C7"><enum>(ii)</enum><text>For
each fiscal year for which the State is paid grant funds under this subsection,
an annual report regarding the use of the funds, including the number of
Medicare beneficiaries served and their satisfaction with the services
provided.</text>
</clause></subparagraph><subparagraph id="HE7EE4DF7460D4767BB900FAFAA1667F4"><enum>(C)</enum><header>Limitation</header><text>No
State shall be paid funds from a grant made under this subsection prior to July
1, 2010.</text>
</subparagraph></paragraph><paragraph id="H04A9A45714B54944A93D1A21A38B8A8F"><enum>(3)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated to the
Secretary to the Centers for Medicare & Medicaid Services Program
Management Account, $12,000,000 for each of fiscal years 2010 through 2014 for
purposes of awarding grants to States under paragraph (1).</text>
</paragraph></subsection><subsection id="HFCAB1F924E2244B6AE107692E8582A78"><enum>(c)</enum><header>Medicaid
transformation grants for advance care planning</header><text>Section 1903(z)
of the Social Security Act (42 U.S.C. 1396b(z)) is amended—</text>
<paragraph id="HC0CBF1AFFD5F436DB789BCD279A7740A"><enum>(1)</enum><text>in paragraph (2),
by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H1AED5E0110D945EA85A419CE7B30CF21" style="OLC">
<subparagraph id="HED9885CDF7FD41479E0D70B80D1CB9A5"><enum>(G)</enum><text>Methods for
improving the effectiveness and efficiency of medical assistance provided under
this title by making available to individuals enrolled in the State plan or
under a waiver of such plan information regarding advance care planning (as
defined in section 3 of the <short-title>Advance Planning
and Compassionate Care Act of 2009</short-title>), including at time of
enrollment or renewal of enrollment in the plan or waiver, through providers,
and through such other innovative means as the State determines
appropriate.</text>
</subparagraph><after-quoted-block>;
</after-quoted-block></quoted-block>
</paragraph><paragraph id="H69F4175BECD045349D7F4ABCD3BABF4D"><enum>(2)</enum><text>in paragraph (3),
by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HD680A6B1E8534320A70B13D8096303DE" style="OLC">
<subparagraph id="H8B8E6957E54F4B16BD2200516A60CF13"><enum>(D)</enum><header>Work plan
required for award of advance care planning grants</header><text>Payment to a
State under this subsection to adopt the innovative methods described in
paragraph (2)(G) is conditioned on the State submitting to the Secretary an
approved plan for expending the funds awarded to the State under this
subsection.</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="HC9D713C65D5348B3A333F22A71A363D0"><enum>(3)</enum><text>in paragraph
(4)—</text>
<subparagraph id="HFD5012A4D971490495F01E9CF2EE40C7"><enum>(A)</enum><text>in subparagraph
(A)—</text>
<clause id="HA0D72669D9CA485F9346A899D5C53DF1"><enum>(i)</enum><text>in
clause (i), by striking <quote>and</quote> at the end;</text>
</clause><clause id="H3C040F4AD5FF46A386E35614777011E8"><enum>(ii)</enum><text>in
clause (ii), by striking the period at the end and inserting <quote>;
and</quote>; and</text>
</clause><clause id="H11DCE2BE42CC44CD9EACD3C2BBEE02B8"><enum>(iii)</enum><text>by
inserting after clause (ii), the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H4F4B21305F734BF0A51849F06169B00D" style="OLC">
<clause id="HFCC54F13D071485FAB06EC35EA7654E5"><enum>(iii)</enum><text>$20,000,000 for
each of fiscal years 2010 through 2014.</text>
</clause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="H9887F70288FA4983A3675FA702FB09B0"><enum>(B)</enum><text>by striking
subparagraph (B), and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="H7873F112DD3F4D33A908695918C08E6F" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="H51119DD91C1248CF8E175A43B86714F6"><enum>(B)</enum><header display-inline="yes-display-inline">Allocation of funds</header><text display-inline="yes-display-inline">The Secretary shall specify a method for
allocating the funds made available under this subsection among States awarded
a grant for fiscal year 2010, 2011, 2012, 2013, or 2014. Such method shall
provide that—</text>
<clause commented="no" display-inline="no-display-inline" id="H3D23585E6B0348B190F6C3D6FC387813"><enum>(i)</enum><text display-inline="yes-display-inline">100 percent of such funds for each of
fiscal years 2010 through 2014 shall be awarded to States that design programs
to adopt the innovative methods described in paragraph (2)(G); and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H24E6745798E642B191E01340B3063D51"><enum>(ii)</enum><text>in no event shall
a payment to a State awarded a grant under this subsection for fiscal year 2010
be made prior to July 1,
2010.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection id="HAEB1D2311A2A4374984BDE5A28701E92"><enum>(d)</enum><header>Advance care
planning community training grants</header>
<paragraph id="HF0CB995417C5485791FB10C0D6ABC805"><enum>(1)</enum><header>In
general</header><text>The Secretary shall use amounts made available under
paragraph (3) to award grants to area agencies on aging (as defined in section
102 of the Older Americans Act of 1965 (42 U.S.C. 3002)).</text>
</paragraph><paragraph id="HC6FD373D46F0405A86019D15C831C8D7"><enum>(2)</enum><header>Requirements</header>
<subparagraph id="HD13E9181E73C4F208EB92167CCBA3275"><enum>(A)</enum><header>Use of
funds</header><text>Funds awarded to an area agency on aging under this
subsection shall be used to provide advance care planning education and
training opportunities for local aging service providers and
organizations.</text>
</subparagraph><subparagraph commented="no" id="H0EE9CE6165CF4A4F8F02B9A6ED866C93"><enum>(B)</enum><header>Work plan;
report</header><text>As a condition of being awarded a grant under this
subsection, an area agency on aging shall submit the following to the
Secretary:</text>
<clause commented="no" id="H4DC64ACBD46B48A6A1DBAFE8DF906232"><enum>(i)</enum><text>An approved plan
for expending grant funds.</text>
</clause><clause commented="no" id="H281B0BE8B1DA4922B7C18C81608042A4"><enum>(ii)</enum><text>For each fiscal
year for which the agency is paid grant funds under this subsection, an annual
report regarding the use of the funds, including the number of Medicare
beneficiaries served and their satisfaction with the services provided.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HD0FAC1B9C20549FA888BAD0ABCB7C0AD"><enum>(C)</enum><header>Limitation</header><text>No
area agency on aging shall be paid funds from a grant made under this
subsection prior to July 1, 2010.</text>
</subparagraph></paragraph><paragraph id="HA3C48D7A951F44AF945B425527C6AD51"><enum>(3)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated to the
Secretary to the Centers for Medicare & Medicaid Services Program
Management Account, $12,000,000 for each of fiscal years 2010 through 2014 for
purposes of awarding grants to area agencies on aging under paragraph
(1).</text>
</paragraph></subsection><subsection id="H1FAD327D71EC4F548913AB8E5CDB08A6"><enum>(e)</enum><header>Nonduplication
of activities</header><text>The Secretary shall establish procedures to ensure
that funds made available under grants awarded under this section or pursuant
to amendments made by this section supplement, not supplant, existing Federal
funding, and that such funds are not used to duplicate activities carried out
under such grants or under other federally funded programs.</text>
</subsection></section><section id="H15C6052CEEB640849CD07B371B073E26"><enum>112.</enum><header>Grants for
programs for orders regarding life sustaining treatment</header>
<subsection id="HF6632E820E814DCEA7F431F3D44DFB05"><enum>(a)</enum><header>In
general</header><text>The Secretary shall make grants to eligible entities for
the purpose of—</text>
<paragraph id="HB4799289F48446688A85ED34E2F5E458"><enum>(1)</enum><text display-inline="yes-display-inline">establishing new programs for orders
regarding life sustaining treatment in States or localities;</text>
</paragraph><paragraph id="HE6CAF73760B044E58F1D8490D75C9CCD"><enum>(2)</enum><text>expanding or
enhancing an existing program for orders regarding life sustaining treatment in
States or localities; or</text>
</paragraph><paragraph id="H85E7C744BE1C47A09CA0900D0A8E7D60"><enum>(3)</enum><text>providing a
clearinghouse of information on programs for orders for life sustaining
treatment and consultative services for the development or enhancement of such
programs.</text>
</paragraph></subsection><subsection id="H452BE5AFFFE6484FABA32577BAFC4BF8"><enum>(b)</enum><header>Authorized
activities</header><text>Activities funded through a grant under this section
for an area may include—</text>
<paragraph id="H8071709C656A4F7EBC398F259447A2D4"><enum>(1)</enum><text>developing such a
program for the area that includes home care, hospice, long-term care,
community and assisted living residences, skilled nursing facilities, inpatient
rehabilitation facilities, hospitals, and emergency medical services within the
area;</text>
</paragraph><paragraph id="HA04907D9696248DCB6972E4B79F3CDED"><enum>(2)</enum><text>securing
consultative services and advice from institutions with experience in
developing and managing such programs; and</text>
</paragraph><paragraph id="HB35BAF9AAF7A40BBBCC83C295E53EBAE"><enum>(3)</enum><text>expanding an
existing program for orders regarding life sustaining treatment to serve more
patients or enhance the quality of services, including educational services for
patients and patients' families or training of health care
professionals.</text>
</paragraph></subsection><subsection id="H63DB9B7661DB4DB28EA9651EACB2E78D"><enum>(c)</enum><header>Distribution of
funds</header><text>In funding grants under this section, the Secretary shall
ensure that, of the funds appropriated to carry out this section for each
fiscal year—</text>
<paragraph id="H0625A37DF9824AE38C092738CDED6F26"><enum>(1)</enum><text display-inline="yes-display-inline">at least two-thirds are used for
establishing or developing new programs for orders regarding life sustaining
treatment; and</text>
</paragraph><paragraph id="H78F480CDA25B43EEB4CC0C73FCBC3746"><enum>(2)</enum><text display-inline="yes-display-inline">one-third is used for expanding or
enhancing existing programs for orders regarding life sustaining
treatment.</text>
</paragraph></subsection><subsection id="H85DFB7134DFE4D2393DA2EEFE451B903"><enum>(d)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="H0DC08E941BF745A2A6DA679CBC1BF91E"><enum>(1)</enum><text>The term
<term>eligible entity</term> includes—</text>
<subparagraph id="H2EB0615FD2A7479D852C62AE4D2D219D"><enum>(A)</enum><text display-inline="yes-display-inline">an academic medical center, a medical
school, a State health department, a State medical association, a multi-State
taskforce, a hospital, or a health system capable of administering a program
for orders regarding life sustaining treatment for a State or locality;
or</text>
</subparagraph><subparagraph id="H99EE7D93D71641A38A025BFC350B6126"><enum>(B)</enum><text>any other health
care agency or entity as the Secretary determines appropriate.</text>
</subparagraph></paragraph><paragraph id="H04529CDCB8034CEAACAD611CBA39A924"><enum>(2)</enum><text>The term
<term>order regarding life sustaining treatment</term> has the meaning given
such term in section 1861(hhh)(5) of the Social Security Act, as added by
section 211.</text>
</paragraph><paragraph id="H6DDABAFBDE47450EBEB30E12B29BDFD8"><enum>(3)</enum><text>The term
<term>program for orders regarding life sustaining treatment</term> means, with
respect to an area, a program that supports the active use of orders regarding
life sustaining treatment in the area.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H95271478D0794626A7742C0B601E490A"><enum>(e)</enum><header>Authorization of
appropriations</header><text>To carry out this section, there are authorized to
be appropriated such sums as may be necessary for each of the fiscal years 2009
through 2014.</text>
</subsection></section></subpart></part><part id="H30D737FD89B64B328946FAA0EFE0ED19"><enum>II</enum><header>Provider
Education</header>
<section id="H5DF9547C1586493990CDA4959DA6D77D"><enum>121.</enum><header>Public provider
advance care planning website</header>
<subsection id="H32B4380E0278475791582FBEAF99B281"><enum>(a)</enum><header>Development</header><text>Not
later than January 1, 2010, the Secretary, acting through the Administrator of
the Centers for Medicare & Medicaid Services and the Director of the Agency
for Healthcare Research and Quality, shall establish a website for providers
under Medicare, Medicaid, the Children's Health Insurance Program, the Indian
Health Service (include contract providers) and other public health providers
on each individual's right to make decisions concerning medical care, including
the right to accept or refuse medical or surgical treatment, and the existence
of advance directives.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H56158ED6A31D4762828C3A81A89922DD"><enum>(b)</enum><header>Maintenance</header><text>The
website, shall be maintained and publicized by the Secretary on an ongoing
basis.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H2BC137FA561B4117A762A8B05B01822F"><enum>(c)</enum><header>Content</header><text>The
website shall include content, tools, and resources necessary to do the
following:</text>
<paragraph id="HD6661776FF0244D9BE8D4646A1D564D4"><enum>(1)</enum><text>Inform providers
about the advance directive requirements under the health care programs
described in subsection (a) and other State and Federal laws and regulations
related to advance care planning.</text>
</paragraph><paragraph id="HCB6B092510ED4A3EB6CEEC2611BF9481"><enum>(2)</enum><text>Educate providers
about advance care planning quality improvement activities.</text>
</paragraph><paragraph id="HF690C0A23DF44BDAA608AF21E5B4705B"><enum>(3)</enum><text>Provide assistance
to providers to—</text>
<subparagraph id="HAABF9863EC95431BB26DBF20AA0625FE"><enum>(A)</enum><text>integrate advance
directives into electronic health records, including oral directives;
and</text>
</subparagraph><subparagraph id="H55DC91E58F7045CAB5D9146A05AC85C8"><enum>(B)</enum><text>develop and
disseminate advance care planning informational materials for their
patients.</text>
</subparagraph></paragraph><paragraph id="H227C11600C5B469A9EC30AA5900C992A"><enum>(4)</enum><text>Inform providers
about advance care planning continuing education requirements and
opportunities.</text>
</paragraph><paragraph id="H8E61E8F0E17A45B09DB4667EA79C8464"><enum>(5)</enum><text>Encourage
providers to discuss advance care planning with their patients of all
ages.</text>
</paragraph><paragraph id="HFA158522ECC64495A611F4D80EA67A04"><enum>(6)</enum><text>Assist providers'
understanding of the continuum of end-of-life care services and supports
available to patients, including palliative care and hospice.</text>
</paragraph><paragraph id="H8469DE6A18FE4321972DCEB8C55D6AB3"><enum>(7)</enum><text>Inform providers
of best practices for discussing end-of-life care with dying patients and their
loved ones.</text>
</paragraph></subsection></section><section id="HC6CA27DC6FA2475CB0BB160566057AAE"><enum>122.</enum><header>Continuing
education for physicians and nurses</header>
<subsection id="HF333D2325EEA40C19FD4E43251653231"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Not later than
January 1, 2012, the Secretary, acting through the Director of Health Resources
and Services Administration, shall develop, in consultation with health care
providers and State boards of medicine and nursing, a curriculum for continuing
education that States may adopt for physicians and nurses on advance care
planning and end-of-life care.</text>
</subsection><subsection id="HF68D4FF04FDD48D8BC81696687B25BDF"><enum>(b)</enum><header>Content</header>
<paragraph id="H49D696D2E82B4B91B3D6FD6AE1BF12DB"><enum>(1)</enum><header>In
general</header><text>The continuing education curriculum developed under
subsection (a) for physicians and nurses shall, at a minimum, include—</text>
<subparagraph id="H8F85786D96D7459B8F5B642672B8247A"><enum>(A)</enum><text>a description of
the meaning and importance of advance care planning;</text>
</subparagraph><subparagraph id="H45E06EA199B44A0F858624C3E2DD98AE"><enum>(B)</enum><text>a description of
advance directives, including living wills and durable powers of attorney, and
the use of such directives;</text>
</subparagraph><subparagraph id="H26EAA56F446740ACA4DB42CB18BD2BA1"><enum>(C)</enum><text>palliative care
principles and approaches to care; and</text>
</subparagraph><subparagraph id="H8C5A35F47B404C4A98D34431B6E60217"><enum>(D)</enum><text>the continuum of
end-of-life services and supports, including palliative care and
hospice.</text>
</subparagraph></paragraph><paragraph id="HD3B3D276DB494683BADE4B0F158EBCDB"><enum>(2)</enum><header>Additional
content for physicians</header><text>The continuing education curriculum for
physicians developed under subsection (a) shall include instruction on how to
conduct advance care planning with patients and their loved ones.</text>
</paragraph></subsection></section></part></subtitle><subtitle id="H4B96DC4F5EA94655970572D300D1894F"><enum>B</enum><header>Portability of
Advance Directives; Health Information Technology</header>
<section id="H127DFFBB1FE9498C92FDF3B1C44214A3"><enum>131.</enum><header>Portability of
advance directives</header>
<subsection commented="no" display-inline="no-display-inline" id="H272F4FD1978B4380BE8E201F7D622327"><enum>(a)</enum><header display-inline="yes-display-inline">Medicare</header><text display-inline="yes-display-inline">Section 1866(f) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395cc(f)) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="HBF91974726FA4707A91AAA0140F0266C"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (1)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HA7D843FE2D384BA4B9A8D503286FD933"><enum>(A)</enum><text display-inline="yes-display-inline">in subparagraph (B), by inserting
<quote>and if presented by the individual, to include the content of such
advance directive in a prominent part of such record</quote> before the
semicolon at the end;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H7C2A50CBDA27495DA15FF31997762FC3"><enum>(B)</enum><text display-inline="yes-display-inline">in subparagraph (D), by striking
<quote>and</quote> after the semicolon at the end;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HF21E7E2031FB4365B3CEA4827C6DE445"><enum>(C)</enum><text display-inline="yes-display-inline">in subparagraph (E), by striking the period
at the end and inserting <quote>; and</quote>; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HE8BFB9F9F9CB4FB697ACB738AB0BED21"><enum>(D)</enum><text display-inline="yes-display-inline">by inserting after subparagraph (E) the
following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HFB76CEDF9C4A47398CFCC0D28CC32897" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="HD69BB554278A4F06B30E1B18A9BC5467" indent="up1"><enum>(F)</enum><text display-inline="yes-display-inline">to provide each individual with the
opportunity to discuss issues relating to the information provided to that
individual pursuant to subparagraph (A) with an appropriately trained
professional.</text>
</subparagraph><after-quoted-block>;</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HD8ABBD1865E7462C9455E40BB8CC8C15"><enum>(2)</enum><text display-inline="yes-display-inline">in paragraph (3), by striking <quote>a
written</quote> and inserting <quote>an</quote>; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HEC77E1B7A6DB453B865851B9D966CE17"><enum>(3)</enum><text display-inline="yes-display-inline">by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HFDAD522F84D94A83B59FE834A3A9E6E3" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="HB1F0A18FDA334A83A7C36748FA842A0D" indent="up1"><enum>(5)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H4837929CFE514912BCDC0C4B751FC415"><enum>(A)</enum><text display-inline="yes-display-inline">An advance directive validly executed
outside of the State in which such advance directive is presented by an adult
individual to a provider of services, a Medicare Advantage organization, or a
prepaid or eligible organization shall be given the same effect by that
provider or organization as an advance directive validly executed under the law
of the State in which it is presented would be given effect.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H92B5A2C0145A432D9CE882B7315ED769" indent="up1"><enum>(B)</enum><clause commented="no" display-inline="yes-display-inline" id="H7B7CE45371F04CE3A8DD8D21AB0BDC88"><enum>(i)</enum><text display-inline="yes-display-inline">The definition of an advanced directive
shall also include actual knowledge of instructions made while an individual
was able to express the wishes of such individual with regard to health
care.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H604A34EBDA984633B85F303F084B383E" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">For purposes of clause (i), the term
<term>actual knowledge</term> means the possession of information of an
individual’s wishes communicated to the health care provider orally or in
writing by the individual, the individual’s medical power of attorney
representative, the individual’s health care surrogate, or other individuals
resulting in the health care provider’s personal cognizance of these wishes.
Other forms of imputed knowledge are not actual knowledge.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H1B0E5E06D34B42279CF0AC10EBEB7353" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">The provisions of this paragraph shall
preempt any State law to the extent such law is inconsistent with such
provisions. The provisions of this paragraph shall not preempt any State law
that provides for greater portability, more deference to a patient’s wishes, or
more latitude in determining a patient’s
wishes.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HCC46ED186F4A4DE5A0EE16D9EE533C6C"><enum>(b)</enum><header display-inline="yes-display-inline">Medicaid</header><text display-inline="yes-display-inline">Section 1902(w) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1396a(w)) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="H218EBB8E211D4CA4A27F10900AFB9FC4"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (1)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H9EC160A661B9444F8C3AAD3C498A6F87"><enum>(A)</enum><text display-inline="yes-display-inline">in subparagraph (B)—</text>
<clause commented="no" display-inline="no-display-inline" id="H6AE789752EB6496AA0DB44F7E24E3CFE"><enum>(i)</enum><text display-inline="yes-display-inline">by striking <quote>in the individual’s
medical record</quote> and inserting <quote>in a prominent part of the
individual’s current medical record</quote>; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H6F0C1259133B4F4AB6F286CBA11E9EBE"><enum>(ii)</enum><text display-inline="yes-display-inline">by inserting <quote>and if presented by the
individual, to include the content of such advance directive in a prominent
part of such record</quote> before the semicolon at the end;</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H0FCD4CDA0B7C4F8E98C81AD63188C9E5"><enum>(B)</enum><text display-inline="yes-display-inline">in subparagraph (D), by striking
<quote>and</quote> after the semicolon at the end;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H6E8CFFBA9EA24DF9967371D6833AD81A"><enum>(C)</enum><text display-inline="yes-display-inline">in subparagraph (E), by striking the period
at the end and inserting <quote>; and</quote>; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H0429249134A040BEAD78CE158A618B27"><enum>(D)</enum><text display-inline="yes-display-inline">by inserting after subparagraph (E) the
following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H0E7F7570516F488F9876656A41E2A73A" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="H25B92C6714E64CC09283BAD3C6205833" indent="up1"><enum>(F)</enum><text display-inline="yes-display-inline">to provide each individual with the
opportunity to discuss issues relating to the information provided to that
individual pursuant to subparagraph (A) with an appropriately trained
professional.</text>
</subparagraph><after-quoted-block>;</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H14773F84AF074FC4A8CED2450EE8F8A6"><enum>(2)</enum><text display-inline="yes-display-inline">in paragraph (4), by striking <quote>a
written</quote> and inserting <quote>an</quote>; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H8C1FE201BDF049FF81B85B84A7ED378C"><enum>(3)</enum><text display-inline="yes-display-inline">by adding at the end the following
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H050B2A2BCA0341838D6CE3033569B80E" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="H534B5244E294488CAEC6AAD0D0A5B07E" indent="up1"><enum>(6)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H4CABBADCC0AD466B83BD4BFA107DB89F"><enum>(A)</enum><text display-inline="yes-display-inline">An advance directive validly executed
outside of the State in which such advance directive is presented by an adult
individual to a provider or organization shall be given the same effect by that
provider or organization as an advance directive validly executed under the law
of the State in which it is presented would be given effect.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H9FED58E4656246E0840E932C6DBE6853" indent="up1"><enum>(B)</enum><clause commented="no" display-inline="yes-display-inline" id="HEA014457F6DC4EA19499AE375F1E6F42"><enum>(i)</enum><text display-inline="yes-display-inline">The definition of an advance directive
shall also include actual knowledge of instructions made while an individual
was able to express the wishes of such individual with regard to health
care.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H3F5766304FCE4D4FAFBD78347DFE6CED" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">For purposes of clause (i), the term
<term>actual knowledge</term> means the possession of information of an
individual’s wishes communicated to the health care provider orally or in
writing by the individual, the individual’s medical power of attorney
representative, the individual’s health care surrogate, or other individuals
resulting in the health care provider’s personal cognizance of these wishes.
Other forms of imputed knowledge are not actual knowledge.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H81C5354644174548B3C96756186ED19C" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">The provisions of this paragraph shall
preempt any State law to the extent such law is inconsistent with such
provisions. The provisions of this paragraph shall not preempt any State law
that provides for greater portability, more deference to a patient’s wishes, or
more latitude in determining a patient’s
wishes.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HABC9F5989E77496387D083DDF776CDC9"><enum>(c)</enum><header>CHIP</header><text>Section
2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is
amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="HEE7C704A7E77488CABBFC03271D5DFFE"><enum>(1)</enum><text>by redesignating
subparagraphs (E) through (L) as subparagraphs (D) through (M), respectively;
and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H25AE867D62294E0FB792C5B7D0EF377A"><enum>(2)</enum><text>by inserting after
subparagraph (D) the following:</text>
<quoted-block display-inline="no-display-inline" id="HE142062A8B7E450F9EB994440E66CC11" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="HE8046870904947A2B901B0586BACD34C"><enum>(E)</enum><text>Section 1902(w)
(relating to advance
directives).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H9AE8212D123047FBA990397BAEA64894"><enum>(d)</enum><header display-inline="yes-display-inline">Study and report regarding
implementation</header>
<paragraph commented="no" display-inline="no-display-inline" id="H63A1B58F19274986AABA9FF58608723A"><enum>(1)</enum><header display-inline="yes-display-inline">Study</header><text display-inline="yes-display-inline">The Secretary shall conduct a study
regarding the implementation of the amendments made by subsections (a) and
(b).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H88999F0CE298471E822AC2539460BD1D"><enum>(2)</enum><header display-inline="yes-display-inline">Report</header><text display-inline="yes-display-inline">Not later than 18 months after the date of
enactment of this Act, the Secretary shall submit to Congress a report on the
study conducted under paragraph (1), together with recommendations for such
legislation and administrative actions as the Secretary considers
appropriate.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H3B7415432FC34E31A74FE40231E97589"><enum>(e)</enum><header display-inline="yes-display-inline">Effective dates</header>
<paragraph commented="no" display-inline="no-display-inline" id="HCAE8B78481914B18BECB136DC8A6C489"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Subject to paragraph (2), the amendments
made by subsections (a), (b), and (c) shall apply to provider agreements and
contracts entered into, renewed, or extended under title XVIII of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395 et
seq.), and to State plans under title XIX of such Act (42 U.S.C. 1396 et seq.)
and State child health plans under title XXI of such Act (42 U.S.C. 1397aa et
seq.), on or after such date as the Secretary specifies, but in no case may
such date be later than 1 year after the date of enactment of this Act.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HD97528F4705B4A26940FDCA9EC531042"><enum>(2)</enum><header display-inline="yes-display-inline">Extension of effective date for state law
amendment</header><text display-inline="yes-display-inline">In the case of a
State plan under title XIX of the <act-name parsable-cite="SSA">Social Security
Act</act-name> or a State child health plan under title XXI of such Act which
the Secretary determines requires State legislation in order for the plan to
meet the additional requirements imposed by the amendments made by subsections
(b) and (c), the State plan shall not be regarded as failing to comply with the
requirements of such title solely on the basis of its failure to meet these
additional requirements before the first day of the first calendar quarter
beginning after the close of the first regular session of the State legislature
that begins after the date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year legislative
session, each year of the session is considered to be a separate regular
session of the State legislature.</text>
</paragraph></subsection></section><section id="H9F0B3B36115F4953925AE82CC721AE7A"><enum>132.</enum><header>State advance
directive registries; Driver's license advance directive notation</header><text display-inline="no-display-inline">Part P of title III of the Public Health
Service Act (42 U.S.C. 280g) is amended—</text>
<paragraph id="H1000B32CEB8840F8B06C662F12C1F494"><enum>(1)</enum><text>by redesignating
section 399R (as inserted by section 2 of Public Law 110–373) as section
399S;</text>
</paragraph><paragraph id="HF33AF65828944E26B962035E23E531A7"><enum>(2)</enum><text>by redesignating
section 399R (as inserted by section 3 of Public Law 110–374) as section 399T;
and</text>
</paragraph><paragraph id="H66B23930BE10428284F5A161073B6B2E"><enum>(3)</enum><text>by adding at the
end the following:</text>
<quoted-block display-inline="no-display-inline" id="H1EB078481C17443C82AC1B316FB7FCCE" style="OLC">
<section id="H684942A372214A47B97054B0326E401D"><enum>399U.</enum><header>State advance
directive registries</header>
<subsection id="HCEA5CAFC84304250BE0700046AFC62DF"><enum>(a)</enum><header>State advance
directive registry</header><text>In this section, the term <term>State advance
directive registry</term> means a secure, electronic database that—</text>
<paragraph id="H35A223D79E274959B198350E92F22A7C"><enum>(1)</enum><text>is available free
of charge to residents of a State; and</text>
</paragraph><paragraph id="HBB66EBE75D614D16855F929BDB1F82EB"><enum>(2)</enum><text>stores advance
directive documents and makes such documents accessible to medical service
providers in accordance with Federal and State privacy laws.</text>
</paragraph></subsection><subsection id="H8477B3ABAD5342C8B996EC31437930E2"><enum>(b)</enum><header>Grant
program</header><text>Beginning on July 1, 2010, the Secretary, acting through
the Director of the Centers for Disease Control and Prevention, shall award
grants on a competitive basis to eligible entities to establish and operate,
directly or indirectly (by competitive grant or competitive contract), State
advance directive registries.</text>
</subsection><subsection id="H89BF4F56AF12409D96E554D7C48DF7C4"><enum>(c)</enum><header>Eligible
entities</header>
<paragraph id="H62D57A897C87424DBC0B8F13A794CB5F"><enum>(1)</enum><header>In
general</header><text>To be eligible to receive a grant under this section, an
entity shall—</text>
<subparagraph id="H01C19C52F2064804A7E71FDB6EEEA563"><enum>(A)</enum><text>be a State
department of health; and</text>
</subparagraph><subparagraph id="H66B5041395514AE0B21458F64191C031"><enum>(B)</enum><text>submit to the
Director an application at such time, in such manner, and containing—</text>
<clause id="H1114B95EBD1146D7B0EE491B089CA193"><enum>(i)</enum><text>a
plan for the establishment and operation of a State advance directive registry;
and</text>
</clause><clause id="HAC49D7C33B8442938DE9F5BB00A22D9D"><enum>(ii)</enum><text>such other
information as the Director may require.</text>
</clause></subparagraph></paragraph><paragraph id="H6FD525E43B3C41589C1A4A12126E1379"><enum>(2)</enum><header>No requirement
of notation mechanism</header><text>The Secretary shall not require that an
entity establish and operate a driver's license advance directive notation
mechanism for State residents under section 399V to be eligible to receive a
grant under this section.</text>
</paragraph></subsection><subsection id="H3D8C1254BDCF44C7A89938056165B8C8"><enum>(d)</enum><header>Annual
report</header><text>For each year for which an entity receives an award under
this section, such entity shall submit an annual report to the Director on the
use of the funds received pursuant to such award, including the number of State
residents served through the registry.</text>
</subsection><subsection id="H5741BEACDD614468851F42967B9ED14B"><enum>(e)</enum><header>Authorization</header><text>There
is authorized to be appropriated to carry out this section $20,000,000 for
fiscal year 2010 and each fiscal year thereafter.</text>
</subsection></section><section id="H5EF9F24BA204446B8CEBEC22CC243AEE"><enum>399V.</enum><header>Driver's
license advance directive notation</header>
<subsection id="HE1960B04EA764D9582125F495E741A60"><enum>(a)</enum><header>In
general</header><text>Beginning July 1, 2010, the Secretary, acting through the
Director of the Centers for Disease Control and Prevention, shall award grants
on a competitive basis to States to establish and operate a mechanism for a
State resident with a driver's license to include a notice of the existence of
an advance directive for such resident on such license.</text>
</subsection><subsection id="H58F6AF6042BF42019F2448103A2DF374"><enum>(b)</enum><header>Eligibility</header><text>To
be eligible to receive a grant under this section, a State shall—</text>
<paragraph id="H7B732F9B6C914DBEB0FF31DA1CA31038"><enum>(1)</enum><text>establish and
operate a State advance directive registry under section 399U; and</text>
</paragraph><paragraph id="H00B38E5CAED0436AB7C2DCFF3C407419"><enum>(2)</enum><text>submit to the
Director an application at such time, in such manner, and containing—</text>
<subparagraph id="H74617CCB48F24E8EB70D59EAE2CDDF0B"><enum>(A)</enum><text>a plan that
includes a description of how the State will—</text>
<clause id="HD815C4AED89F46E1A6B6F55160A1CDE0"><enum>(i)</enum><text>disseminate
information about advance directives at the time of driver’s license
application or renewal;</text>
</clause><clause id="H59186AC0D16C469DBA4AB4F0A2F576A9"><enum>(ii)</enum><text>enable each State
resident with a driver's license to include a notice of the existence of an
advance directive for such resident on such license in a manner consistent with
the notice on such a license indicating a driver's intent to be an organ donor;
and</text>
</clause><clause id="H4309D713CB014A829D407DF1EB844F2D"><enum>(iii)</enum><text>coordinate with
the State department of health to ensure that, if a State resident has an
advance directive notice on his or her driver's license, the existence of such
advance directive is included in the State registry established under section
399U; and</text>
</clause></subparagraph><subparagraph id="H4B389702D2BA4DCEA4752F93349375D6"><enum>(B)</enum><text>any other
information as the Director may require.</text>
</subparagraph></paragraph></subsection><subsection id="H4E30584A0CD74DC1BF554383CD4D9C6E"><enum>(c)</enum><header>Annual
report</header><text>For each year for which a State receives an award under
this section, such State shall submit an annual report to the Director on the
use of the funds received pursuant to such award, including the number of State
residents served through the mechanism.</text>
</subsection><subsection id="HA607301B100B424DB2FAF82EBCDAFCB8"><enum>(d)</enum><header>Authorization</header><text>There
is authorized to be appropriated to carry out this section $50,000,000 for
fiscal year 2010 and each fiscal year
thereafter.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="HF1CEDCEA21E640609A19160096A5DFEF"><enum>133.</enum><header>GAO Study and
Report on Establishment of National Advance Directive Registry</header>
<subsection id="HAC7E116744CE4AA3B9FF13DBCD191F3A"><enum>(a)</enum><header>Study</header><text>The
Comptroller General of the United States shall conduct a study on the
feasibility of a national registry for advance directives, taking into
consideration the constraints created by the privacy provisions enacted as a
result of the Health Insurance Portability and Accountability Act of 1996
(Public Law 104–191).</text>
</subsection><subsection id="HA521F992E032409B86051AD7D7BDF88F"><enum>(b)</enum><header>Report</header><text>Not
later than 18 months after the date of enactment of this Act, the Comptroller
General of the United States shall submit to Congress a report on the study
conducted under subsection (a) together with recommendations for such
legislation and administrative action as the Comptroller General of the United
States determines to be appropriate.</text>
</subsection></section></subtitle><subtitle id="H9961FEF19CC24D5AA64C090B9AB9F167"><enum>C</enum><header>National Uniform
Policy on Advance Care Planning</header>
<section commented="no" display-inline="no-display-inline" id="H5420A903049E4040AD307A5E5CCB3926" section-type="subsequent-section"><enum>141.</enum><header display-inline="yes-display-inline">Study and report by the Secretary regarding
the establishment and implementation of a national uniform policy on advance
directives</header>
<subsection commented="no" display-inline="no-display-inline" id="H42534C864AA0495BAB18FEC716B3B50F"><enum>(a)</enum><header display-inline="yes-display-inline">Study</header>
<paragraph commented="no" display-inline="no-display-inline" id="H95D5521CDAE5444A981B77C573503585"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">The Secretary, acting through the Office of
the Assistant Secretary for Planning and Evaluation, shall conduct a thorough
study of all matters relating to the establishment and implementation of a
national uniform policy on advance directives for individuals receiving items
and services under titles XVIII, XIX, or XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395 et
seq.; 1396 et seq.; 1397aa et seq.).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H763420778C0848F19D0B8B243E4D7153"><enum>(2)</enum><header display-inline="yes-display-inline">Matters studied</header><text display-inline="yes-display-inline">The matters studied by the Secretary under
paragraph (1) shall include issues concerning—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HA4B64125415744BF8DC3DBFDFA8EBB57"><enum>(A)</enum><text display-inline="yes-display-inline">family satisfaction that a patient’s
wishes, as stated in the patient’s advance directive, were carried out;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H5F153854E3EB4E3896C577C05F5B2C79"><enum>(B)</enum><text display-inline="yes-display-inline">the portability of advance directives,
including cases involving the transfer of an individual from one health care
setting to another;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H2B42872F81FC4B51A4E1E51AB8704CF9"><enum>(C)</enum><text display-inline="yes-display-inline">immunity from civil liability and criminal
responsibility for health care providers that follow the instructions in an
individual’s advance directive that was validly executed in, and consistent
with the laws of, the State in which it was executed;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H2441E921765245F4B8F76B5CA8CF8287"><enum>(D)</enum><text display-inline="yes-display-inline">conditions under which an advance directive
is operative;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H796CFC42C8074AF5BFC3DC76DF34B536"><enum>(E)</enum><text display-inline="yes-display-inline">revocation of an advance directive by an
individual;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H2B8E1306E84B44FA95CFD2FE080F2866"><enum>(F)</enum><text display-inline="yes-display-inline">the criteria used by States for determining
that an individual has a terminal condition;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H81B2565EBA714CEAA958AED989B56B24"><enum>(G)</enum><text display-inline="yes-display-inline">surrogate decisionmaking regarding
end-of-life care;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HAEAA8D26954643CCB949EA5E195EC67A"><enum>(H)</enum><text display-inline="yes-display-inline">the provision of adequate palliative care
(as defined in paragraph (3)), including pain management;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H8672DAE77EBA49DA81E0866B8B2951CD"><enum>(I)</enum><text display-inline="yes-display-inline">adequate and timely referrals to hospice
care programs; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H212BF68C759244BA8AFE9196A43275F8"><enum>(J)</enum><text>the end-of-life
care needs of children and their families.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HB2AC5CC7BAC14FBDAB653E31D5B10D98"><enum>(3)</enum><header display-inline="yes-display-inline">Palliative care</header><text display-inline="yes-display-inline">For purposes of paragraph (2)(H), the term
<term>palliative care</term> means interdisciplinary care for individuals with
a life-threatening illness or injury relating to pain and symptom management
and psychological, social, and spiritual needs and that seeks to improve the
quality of life for the individual and the individual’s family.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H27CFA3AC7EC54283B32F03F3C261A404"><enum>(b)</enum><header display-inline="yes-display-inline">Report to congress</header><text display-inline="yes-display-inline">Not later than 18 months after the date of
enactment of this Act, the Secretary shall submit to Congress a report on the
study conducted under subsection (a), together with recommendations for such
legislation and administrative actions as the Secretary considers
appropriate.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H82150FC0BAA34787AE681C194FE16DA5"><enum>(c)</enum><header display-inline="yes-display-inline">Consultation</header><text display-inline="yes-display-inline">In conducting the study and developing the
report under this section, the Secretary shall consult with the Uniform Law
Commissioners, and other interested parties.</text>
</subsection></section></subtitle><enum>II</enum><header>Compassionate
Care</header>
<subtitle id="H3D58DB795EB24840BB34F57077CBA5E3"><enum>A</enum><header>Workforce
development</header>
<part id="H41C72057B25148A1BBDDE7191691B67B"><enum>I</enum><header>Education and
training</header>
<section id="H7F7E0F52C1EE44F6A95FB9F7099065C8"><enum>201.</enum><header>National
Geriatric and Palliative Care Services Corps</header><text display-inline="no-display-inline">Section 331 of the Public Health Service Act
(42 U.S.C. 254d) is amended—</text>
<paragraph id="H4812CE58B56E494ABA7509E2B5184E27"><enum>(1)</enum><text display-inline="yes-display-inline">by redesignating subsection (j) as
subsection (k); and</text>
</paragraph><paragraph id="HDC61FF1A70994DF28DFCE99D6B89281B"><enum>(2)</enum><text>by inserting after
subsection (i), the following:</text>
<quoted-block display-inline="no-display-inline" id="HC7483B25F357433EA771B621FAF92528" style="OLC">
<subsection id="H978BCF13FD54458AB8E79CA07D8E51C9"><enum>(j)</enum><header>National
Geriatric and Palliative Care Services Corps</header>
<paragraph id="H6F9A0B334E114B0B8C7033E830C3C60A"><enum>(1)</enum><header>Establishment</header><text>Not
later than January 1, 2012, the Secretary shall establish within the National
Health Service Corps a National Geriatric and Palliative Care Services Corps
(referred to in this subsection as the <quote>Corps</quote>) which shall
consist of—</text>
<subparagraph id="H70E6AC2B0755480B9CBBDE1D909F98F2"><enum>(A)</enum><text>such officers of
the Regular and Reserve Corps of the Service as the Secretary may
designate;</text>
</subparagraph><subparagraph id="H1C5D2D9E9F79439994E0EE767DCF2186"><enum>(B)</enum><text>such civilian
employees of the United States as the Secretary may appoint; and</text>
</subparagraph><subparagraph id="HAD7ECAAD8BC545D4BF91B7FA40EF33B5"><enum>(C)</enum><text>such other
individuals who are not employees of the United States.</text>
</subparagraph></paragraph><paragraph id="HCCE19E6C3B384348AE6D15A8039AFA2E"><enum>(2)</enum><header>Duties</header><text>The
Corps shall be utilized by the Secretary to provide geriatric and palliative
care services within health professional shortage areas.</text>
</paragraph><paragraph id="H02FE49669B064A87B0F7E81BD56A18B3"><enum>(3)</enum><header>Application of
provisions</header><text>The loan-forgiveness, scholarship, and direct
financial incentives programs provided for under this section shall apply to
physicians, nurses, and other health professionals (as identified by the
Secretary) with respect to the training necessary to enable such individuals to
become geriatric or palliative care specialists and provide geriatric and
palliative care services in health professional shortage areas.</text>
</paragraph><paragraph id="H199FD24806594FC1838A438B3AE7955A"><enum>(4)</enum><header>Report</header><text>Not
later than 6 months prior to the date on which the Secretary establishes the
Corps under paragraph (1), the Secretary shall submit to Congress a report
concerning the organization of the Corps, the application process for
membership in the Corps, and the funding necessary for the Corps (targeted by
profession and by
specialization).</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="H18D9A2731B2746768718FE99A880FE31"><enum>202.</enum><header>Exemption of
palliative medicine fellowship training from Medicare graduate medical
education caps</header>
<subsection id="H4713B6E5C3064D1BAC7FF6B832EADE4C"><enum>(a)</enum><header>Direct graduate
medical education</header><text>Section 1886(h)(4)(F) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395ww(h)(4)(F)) is amended—</text>
<paragraph id="HC97750893F7B4CB3A50B0ACBEEC062D4"><enum>(1)</enum><text>in clause (i), by
inserting <quote>clause (iii) and</quote> after <quote>subject to</quote>;
and</text>
</paragraph><paragraph id="H6016B5E21DE84F509F5BA9380482E80D"><enum>(2)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block act-name="Social Security Act" id="HFDFBEFE5C25F4F4F83029CC4571E33B1">
<clause id="H520FD35D32214BE19C04CDFC29857AD8"><enum>(iii)</enum><header>Increase
allowed for palliative medicine fellowship training</header><text>For cost
reporting periods beginning on or after January 1, 2011, in applying clause
(i), there shall not be taken into account full-time equivalent residents in
the field of allopathic or osteopathic medicine who are in palliative medicine
fellowship training that is approved by the Accreditation Council for Graduate
Medical
Education.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HF7D09C6089D048CEB900787A96FD3C5F"><enum>(b)</enum><header>Indirect Medical
Education</header><text>Section 1886(d)(5)(B) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395ww(d)(5)(B)) is amended by adding at the end the following new
clause:</text>
<quoted-block act-name="Social Security Act" id="HB1D5FA5EB16948668B51E038E15A6538" style="OLC">
<clause id="H8FAB6A4282F84002BE9F528529C49E56" indent="up2"><enum>(x)</enum><text>Clause (iii) of subsection (h)(4)(F)
shall apply to clause (v) in the same manner and for the same period as such
clause (iii) applies to clause (i) of such
subsection.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="H7FAE898E0CC045739295F76846989807"><enum>203.</enum><header>Medical school
curricula</header>
<subsection id="HAE9455BA40804326B19F3C2073A331D5"><enum>(a)</enum><header>In
general</header><text>The Secretary, in consultation with the Association of
American Medical Colleges, shall establish guidelines for the imposition by
medical schools of a minimum amount of end-of-life training as a requirement
for obtaining a Doctor of Medicine degree in the field of allopathic or
osteopathic medicine.</text>
</subsection><subsection id="HC28FE53DD685423D915B04C5049B693F"><enum>(b)</enum><header>Training</header><text>Under
the guidelines established under subsection (a), minimum training shall
include—</text>
<paragraph id="H3E4D450146394726A4F45A8AFFA2DFA7"><enum>(1)</enum><text>training in how to
discuss and help patients and their loved ones with advance care
planning;</text>
</paragraph><paragraph id="HC4274273444547788A00932279FA9DDF"><enum>(2)</enum><text>with respect to
students and trainees who will work with children, specialized pediatric
training;</text>
</paragraph><paragraph id="H9235F14568924BD5B27F3264F12C9E3E"><enum>(3)</enum><text>training in the
continuum of end-of-life services and supports, including palliative care and
hospice;</text>
</paragraph><paragraph id="HF9907C3B4E884AB28536CACDEEAE439B"><enum>(4)</enum><text>training in how to
discuss end-of-life care with dying patients and their loved ones; and</text>
</paragraph><paragraph id="H2128CB1921644CD6BAFEF3DA78F9B27D"><enum>(5)</enum><text>medical and legal
issues training.</text>
</paragraph></subsection><subsection id="HFDA792EF82E04708A507A4723FBCB361"><enum>(c)</enum><header>Distribution</header><text>Not
later than January 1, 2011, the Secretary shall disseminate the guidelines
established under subsection (a) to medical schools.</text>
</subsection><subsection id="HFEAD792DC216474182516C027892406C"><enum>(d)</enum><header>Compliance</header><text>Effective
beginning not later than July 1, 2012, a medical school that is receiving
Federal assistance shall be required to implement the guidelines established
under subsection (a). A medical school that the Secretary determines is not
implementing such guidelines shall not be eligible for Federal
assistance.</text>
</subsection></section></part></subtitle><subtitle id="H1964E9342B044715AFCD60455364AE1D"><enum>B</enum><header>Coverage under
Medicare, Medicaid, and CHIP </header>
<part id="H647E88CC36A84B34B69B934844ECD0A1"><enum>I</enum><header>Coverage of
advance care planning</header>
<section id="H8F774A08CFC947539A601ABEFC787576"><enum>211.</enum><header>Medicare,
Medicaid, and CHIP coverage</header>
<subsection id="HA9B981FB87B14F1EAE6934B35E5623FE"><enum>(a)</enum><header>Medicare</header>
<paragraph id="H781442AFF3B9460CA60F8EE6286220A0"><enum>(1)</enum><header>In
general</header><text>Section 1861 of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (42 U.S.C. 1395x) is amended—</text>
<subparagraph id="HFEAACBDD35D743D8A1547B268C71F6CA"><enum>(A)</enum><text>in subsection
(s)(2)—</text>
<clause id="H26727DF673F74212A7C57B0A29E11576"><enum>(i)</enum><text>by
striking <quote>and</quote> at the end of subparagraph (DD);</text>
</clause><clause id="H65D5D33A487442F4922A263C97747785"><enum>(ii)</enum><text>by
adding <quote>and</quote> at the end of subparagraph (EE); and</text>
</clause><clause id="HA885EDA7311847398DFD76D2F7F8683E"><enum>(iii)</enum><text>by
adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H0F0B7DEC0BDD41109D37DA44CEC824C9" style="traditional">
<subparagraph id="HCFCC85C945FD431FB40DE4F58EC38BEB"><enum>(FF)</enum><text>advance care
planning consultation (as defined in subsection
(hhh)(1));</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="HD76F0893312F49DF9B163CF6CA7FA09F"><enum>(B)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HED97A3F1E97740B68534BA224519EBB0" other-style="archaic" style="other">
<subsection id="H9309A024BB294A25B48A395F2D179496"><enum>(hhh)</enum><header>Advance care planning consultation</header><paragraph commented="no" display-inline="yes-display-inline" id="H66BFDFF0C61D43F48163A5C8AC568800"><enum>(1)</enum><text display-inline="yes-display-inline">Subject to paragraphs (3) and (4), the term
<term>advance care planning consultation</term> means a consultation between
the individual and a practitioner described in paragraph (2) regarding advance
care planning, if, subject to subparagraphs (A) and (B) of paragraph (3), the
individual involved has not had such a consultation within the last 5 years.
Such consultation shall include the following:</text>
<subparagraph id="HB0AE323D7BB94028AAD24DC54728F816" indent="up1"><enum>(A)</enum><text>An explanation by the practitioner of
advance care planning, including key questions and considerations, important
steps, and suggested people to talk to.</text>
</subparagraph><subparagraph id="H6707A301E5D24400BBDE5F6E8E34C143" indent="up1"><enum>(B)</enum><text>An explanation by the practitioner of
advance directives, including living wills and durable powers of attorney, and
their uses.</text>
</subparagraph><subparagraph id="H546B0BF5D79F4D63AF90468F26DF89C8" indent="up1"><enum>(C)</enum><text>An explanation by the practitioner of
the role and responsibilities of a health care proxy.</text>
</subparagraph><subparagraph id="HD09B4E93A9FA4CFF9A8086158BE424E7" indent="up1"><enum>(D)</enum><text>The provision by the practitioner of a
list of national and State-specific resources to assist consumers and their
families with advance care planning, including the national toll-free hotline,
the advance care planning clearinghouses, and State legal service organizations
(including those funded through the Older Americans Act).</text>
</subparagraph><subparagraph id="H2516B1D3282E4C3589A1B04A25849F40" indent="up1"><enum>(E)</enum><text>An explanation by the practitioner of
the continuum of end-of-life services and supports available, including
palliative care and hospice, and benefits for such services and supports that
are available under this title.</text>
</subparagraph><subparagraph commented="no" id="H5DA4121886544539878E5A9850B7D73B" indent="up1"><enum>(F)</enum><clause commented="no" display-inline="yes-display-inline" id="H06E193DA605A4E168146DDD86E9292F9"><enum>(i)</enum><text>Subject to clause (ii),
an explanation of orders regarding life sustaining treatment or similar orders,
which shall include—</text>
<subclause id="H72A5231FE9BD4BB18178DC2B37D41293" indent="up1"><enum>(I)</enum><text>the reasons why the development of
such an order is beneficial to the individual and the individual’s family and
the reasons why such an order should be updated periodically as the health of
the individual changes;</text>
</subclause><subclause id="HAA5824BC36A24EE28AC3872E67D3CCA4" indent="up1"><enum>(II)</enum><text display-inline="yes-display-inline">the information needed for an individual or
legal surrogate to make informed decisions regarding the completion of such an
order; and</text>
</subclause><subclause id="H4D8D4C5D8B9F4538931309766CF7E9C9" indent="up1"><enum>(III)</enum><text>the identification of resources
that an individual may use to determine the requirements of the State in which
such individual resides so that the treatment wishes of that individual will be
carried out if the individual is unable to communicate those wishes, including
requirements regarding the designation of a surrogate decision maker (also
known as a health care proxy).</text>
</subclause></clause><clause id="HDAA6E5DA386840C782593E70F5373260" indent="up1"><enum>(ii)</enum><text>The Secretary may limit the
requirement for explanations under clause (i) to consultations furnished in
States, localities, or other geographic areas in which orders described in such
clause have been widely adopted.</text>
</clause></subparagraph></paragraph><paragraph id="HA9E6A86A01CB4C099DBE47D89F2BD379" indent="up1"><enum>(2)</enum><text>A practitioner described in this
paragraph is—</text>
<subparagraph commented="no" id="HC373288DD51A4A6A97048065CAC6C77B"><enum>(A)</enum><text>a physician (as defined in subsection
(r)(1)); and</text>
</subparagraph><subparagraph commented="no" id="HE739240168FD4BCD814ED391FA021AAE"><enum>(B)</enum><text>a nurse practitioner or physician's
assistant who has the authority under State law to sign orders for life
sustaining treatments.</text>
</subparagraph></paragraph><paragraph id="HBD785FB378894398A7A264720BCC6F67" indent="up1"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="HE9A6232A16FF4DEFA317BC33276F5AB4"><enum>(A)</enum><text>An initial preventive
physical examination under subsection (ww), including any related discussion
during such examination, shall not be considered an advance care planning
consultation for purposes of applying the 5-year limitation under paragraph
(1).</text>
</subparagraph><subparagraph id="H45115FF160B64EEF859D3C3083C05B45" indent="up1"><enum>(B)</enum><text>An advance care planning consultation
with respect to an individual shall be conducted more frequently than provided
under paragraph (1) if there is a significant change in the health condition of
the individual, including diagnosis of a chronic, progressive, life-limiting
disease, a life-threatening or terminal diagnosis or life-threatening injury,
or upon admission to a skilled nursing facility, a long-term care facility (as
defined by the Secretary), or a hospice program.</text>
</subparagraph></paragraph><paragraph id="H6621D9295B154E9BADA61C4B12BA582F" indent="up1"><enum>(4)</enum><text>A consultation under this subsection
may include the formulation of an order regarding life sustaining treatment or
a similar order.</text>
</paragraph><paragraph id="H9438F6E2142C4B41B18F8125CCE00132" indent="up1"><enum>(5)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="HBCBDEB485B124D6FBC5D88F13CB2A00B"><enum>(A)</enum><text>For purposes of this
section, the term <term>order regarding life sustaining treatment</term> means,
with respect to an individual, an actionable medical order relating to the
treatment of that individual that—</text>
<clause id="H94938997407A4EAF81178282CC474F1A" indent="up1"><enum>(i)</enum><text>is signed and dated by a physician (as
defined in subsection (r)(1)) or another health care professional (as specified
by the Secretary and who is acting within the scope of the professional’s
authority under State law in signing such an order) and is in a form that
permits it to stay with the patient and be followed by health care
professionals and providers across the continuum of care, including home care,
hospice, long-term care, community and assisted living residences, skilled
nursing facilities, inpatient rehabilitation facilities, hospitals, and
emergency medical services;</text>
</clause><clause id="HEFFE609D411C47128D75EBA83150194F" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">effectively communicates the individual’s
preferences regarding life sustaining treatment, including an indication of the
treatment and care desired by the individual;</text>
</clause><clause id="HA40EC2D4D96043849D47C8072BF96C93" indent="up1"><enum>(iii)</enum><text display-inline="yes-display-inline">is uniquely identifiable and standardized
within a given locality, region, or State (as identified by the
Secretary);</text>
</clause><clause id="HAA75B99F1B7F45AEA4A404474DFBC5F9" indent="up1"><enum>(iv)</enum><text display-inline="yes-display-inline">is portable across care settings;
and</text>
</clause><clause id="H590588247E964366B65D42399096EF32" indent="up1"><enum>(v)</enum><text>may incorporate any advance directive
(as defined in section 1866(f)(3)) if executed by the individual.</text>
</clause></subparagraph><subparagraph id="H22D2808DF90847309B8361D6B8577D84" indent="up1"><enum>(B)</enum><text>The level of treatment indicated
under subparagraph (A)(ii) may range from an indication for full treatment to
an indication to limit some or all or specified interventions. Such indicated
levels of treatment may include indications respecting, among other
items—</text>
<clause id="H9CA72FA1F41E4291B881FBD64745204A"><enum>(i)</enum><text>the intensity of medical intervention
if the patient is pulseless, apneic, or has serious cardiac or pulmonary
problems;</text>
</clause><clause id="H9CBD2651DD47493C95198BF2FCE57122"><enum>(ii)</enum><text>the individual’s desire regarding
transfer to a hospital or remaining at the current care setting;</text>
</clause><clause id="H58F312A9528146589C0CAFF0E1F2FE27"><enum>(iii)</enum><text>the use of antibiotics; and</text>
</clause><clause id="HFEB226B3280543B18CDC2C62F11C0689"><enum>(iv)</enum><text>the use of artificially administered
nutrition and
hydration.</text>
</clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HB4BF52BB6401479291447642C9BB7B9F"><enum>(2)</enum><header>Payment</header><text display-inline="yes-display-inline">Section 1848(j)(3) of the Social Security
Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting <quote>(2)(FF),</quote>
after <quote>(2)(EE),</quote>.</text>
</paragraph><paragraph id="H71B9C25CDA1344728AEC280592F7167D"><enum>(3)</enum><header>Frequency
Limitation</header><text>Section 1862(a) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1395y(a)(1)) is
amended—</text>
<subparagraph id="H1DAC04FCF1214081994EC440A36B3824"><enum>(A)</enum><text>in paragraph
(1)—</text>
<clause id="H592A6DE88D6049C98843E3D500C1311F"><enum>(i)</enum><text>in
subparagraph (N), by striking <quote>and</quote> at the end;</text>
</clause><clause id="H34D9CED68C644D8A907AC174701E27A8"><enum>(ii)</enum><text>in
subparagraph (O) by striking the semicolon at the end and inserting <quote>,
and</quote>; and</text>
</clause><clause id="HC4E294C1FCCC43E2A500699C4F6DA77E"><enum>(iii)</enum><text>by
adding at the end the following new subparagraph:</text>
<quoted-block id="HB1C8E317D3184EB99F090A56EA458433" style="OLC">
<subparagraph id="HCB3C65E297D34D1BA78AC67404E87104" indent="up1"><enum>(P)</enum><text>in the case of advance care planning
consultations (as defined in section 1861(hhh)(1)), which are performed more
frequently than is covered under such
section;</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H0F359807BEE04A218D750D0F16DDD704"><enum>(B)</enum><text>in paragraph (7),
by striking <quote>or (K)</quote> and inserting <quote>(K), or
(P)</quote>.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H438AEB8AE0994E4E9EE66FDEF7A51F94"><enum>(4)</enum><header>Effective
Date</header><text>The amendments made by this subsection shall apply to
consultations furnished on or after January 1, 2011.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H7525965CB6DD4F43995EA575D7B79BF5"><enum>(b)</enum><header>Medicaid</header>
<paragraph commented="no" display-inline="no-display-inline" id="H9F0A8EE390FC4E15BD4A15E4D7E27C72"><enum>(1)</enum><header>Mandatory
benefit</header><text>Section 1902(a)(10)(A) of the Social Security Act (42
U.S.C. 1396a(a)(10)(A)) is amended in the matter preceding clause (i) by
striking <quote>and (21)</quote> and inserting <quote>, (21), and
(28)</quote>.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H4243B50ED1EF4DC3A3A1F9019EF083EE"><enum>(2)</enum><header>Medical
assistance</header><text>Section 1905 of such Act (42 U.S.C. 1396d) is
amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HB2E2D5D180734101A121A245A177C1B4"><enum>(A)</enum><text>in subsection
(a)—</text>
<clause commented="no" display-inline="no-display-inline" id="H6A16B3AE62A24CE9A8590AC4DE052668"><enum>(i)</enum><text>in paragraph (27),
by striking <quote>and</quote> at the end;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="HA6884C6821A34602A526996C1F410437"><enum>(ii)</enum><text>by redesignating
paragraph (28) as paragraph (29); and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H2F73497E57C544C7A37B9ABE34F1983A"><enum>(iii)</enum><text>by inserting
after paragraph (27) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HC8A660341C7643BF8B2CE03424908BD5" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="HAA00D7FD0AC94A2BB3BCC98DFECEAF0F"><enum>(28)</enum><text>advance care
planning consultations (as defined in subsection
(y));</text>
</paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H4DF12A7A6F094321B0626541A254CFC7"><enum>(B)</enum><text>by adding at the
end the following:</text>
<quoted-block display-inline="no-display-inline" id="H8819A15D4D3F4E54AE80FD06076D9EDC" style="OLC">
<subsection commented="no" display-inline="no-display-inline" id="H57F44EF7D0C3414999F0A043BA897000"><enum>(y)</enum><paragraph commented="no" display-inline="yes-display-inline" id="H5ADE3B7328E84AA7AA8BBBC480862800"><enum>(1)</enum><text>For purposes of
subsection (a)(28), the term <term>advance care planning consultation</term>
means a consultation between the individual and a practitioner described in
paragraph (2) regarding advance care planning, if, subject to paragraph (3),
the individual involved has not had such a consultation within the last 5
years. Such consultation shall include the following:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H23A3A5A62B524BA998EB63A28A0C39A8" indent="up1"><enum>(A)</enum><text>An explanation by the practitioner of
advance care planning, including key questions and considerations, important
steps, and suggested people to talk to.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HC2FDB75D59EB4741995EA9C2AF0D6FFF" indent="up1"><enum>(B)</enum><text>An explanation by the practitioner of
advance directives, including living wills and durable powers of attorney, and
their uses.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H084999E233B4436FA0BBE64DE3F4F6FD" indent="up1"><enum>(C)</enum><text>An explanation by the practitioner of
the role and responsibilities of a health care proxy.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HF6038030D93549CBAF28E2285FD2908E" indent="up1"><enum>(D)</enum><text>The provision by the practitioner of a
list of national and State-specific resources to assist consumers and their
families with advance care planning, including the national toll-free hotline,
the advance care planning clearinghouses, and State legal service organizations
(including those funded through the Older Americans Act).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HA8164648FA4F4706818BB8F3EFD5867A" indent="up1"><enum>(E)</enum><text>An explanation by the practitioner of
the continuum of end-of-life services and supports available, including
palliative care and hospice, and benefits for such services and supports that
are available under this title.</text>
</subparagraph><subparagraph commented="no" id="H50D80184FA5244E597E7DC6E55AA0F30" indent="up1"><enum>(F)</enum><clause commented="no" display-inline="yes-display-inline" id="HAB1FA91BD07346CDA06A916BE36B0EF4"><enum>(i)</enum><text>Subject to clause (ii),
an explanation of orders for life sustaining treatments or similar orders,
which shall include—</text>
<subclause id="HDE22808D9CD74D17BE64B177D7CF6236" indent="up1"><enum>(I)</enum><text>the reasons why the development of
such an order is beneficial to the individual and the individual’s family and
the reasons why such an order should be updated periodically as the health of
the individual changes;</text>
</subclause><subclause id="HA7C44EFFB9D745F48436ACA80C2569C2" indent="up1"><enum>(II)</enum><text display-inline="yes-display-inline">the information needed for an individual or
legal surrogate to make informed decisions regarding the completion of such an
order; and</text>
</subclause><subclause id="H147170A3A5924E4CA3980329D432E0EF" indent="up1"><enum>(III)</enum><text>the identification of resources
that an individual may use to determine the requirements of the State in which
such individual resides so that the treatment wishes of that individual will be
carried out if the individual is unable to communicate those wishes, including
requirements regarding the designation of a surrogate decision maker (also
known as a health care proxy).</text>
</subclause></clause><clause id="HF856C7E566904E90BC78F8142BBC64E1" indent="up1"><enum>(ii)</enum><text>The Secretary may limit the
requirement for explanations under clause (i) to consultations furnished in
States, localities, or other geographic areas in which orders described in such
clause have been widely adopted.</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HD7346FAD760A49BB8AC4C1155DC51FC3" indent="up1"><enum>(2)</enum><text>A practitioner described in this
paragraph is—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HAA32DCF3267249B4A816345670FF18E7"><enum>(A)</enum><text>a physician (as defined in section
1861(r)(1)); and</text>
</subparagraph><subparagraph commented="no" id="H82FCEEA4E5C34254A9152BB437F16864"><enum>(B)</enum><text>a nurse practitioner or physician's
assistant who has the authority under State law to sign orders for life
sustaining treatments.</text>
</subparagraph></paragraph><paragraph id="H3CAFB13E202349448D623380C252271F" indent="up1"><enum>(3)</enum><text>An advance care planning consultation
with respect to an individual shall be conducted more frequently than provided
under paragraph (1) if there is a significant change in the health condition of
the individual including diagnosis of a chronic, progressive, life-limiting
disease, a life-threatening or terminal diagnosis or life-threatening injury,
or upon admission to a nursing facility, a long-term care facility (as defined
by the Secretary), or a hospice program.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H1B447B0B3EC44118B1D0B53461A21896" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">A
consultation under this subsection may include the formulation of an order
regarding life sustaining treatment or a similar order.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H138F9AEFCB994CB7A5F0C496FDF3E1D9" indent="up1"><enum>(5)</enum><text display-inline="yes-display-inline">For purposes of this subsection, the term
<term>orders regarding life sustaining treatment</term> has the meaning given
that term in section
1861(hhh)(5).</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HE1E9B4F21C9D47C7BAC0A7F62B7ABE66"><enum>(c)</enum><header>CHIP</header>
<paragraph commented="no" display-inline="no-display-inline" id="HAF167C0498484205BD71ED8E2A110E07"><enum>(1)</enum><header>Child health
assistance</header><text>Section 2110(a) of the Social Security Act (42 U.S.C.
1397jj) is amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H0582A7B5301E4496BBE36DA82003BECA"><enum>(A)</enum><text>by redesignating
paragraph (28) as paragraph (29); and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HCAB1942C64DB4A988ECF7631BAD2652D"><enum>(B)</enum><text>by inserting after
paragraph (27), the following:</text>
<quoted-block display-inline="no-display-inline" id="HBA00DD0D46D44B0FB783633093E4BFC6" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="H4388347593C845A68FEC02CA60B069E4"><enum>(28)</enum><text>Advance care
planning consultations (as defined in section
1905(y)).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H83F605001B8045FDAA8A9E79299A36FE"><enum>(2)</enum><header>Mandatory
coverage</header>
<subparagraph id="H878BEE435E1344929A6118F01D8D05A6"><enum>(A)</enum><header>In
general</header><text>Section 2103 of such Act (42 U.S.C. 1397cc), is
amended—</text>
<clause id="HF5A129E857FF4DF097DC8BBD05B389D8"><enum>(i)</enum><text>in
subsection (a), in the matter preceding paragraph (1), by striking <quote>and
(7)</quote> and inserting <quote>(7), and (9)</quote>; and</text>
</clause><clause id="HE4E28A3C73044702B9996A7239454012"><enum>(ii)</enum><text>in
subsection (c), by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H05B8DD2E263D4A17855FA4CD79777D4A" style="OLC">
<paragraph id="H76109954ACC0466D88986E995ED59F26"><enum>(9)</enum><header>End-of-life
care</header><text>The child health assistance provided to a targeted
low-income child shall include coverage of advance care planning consultations
(as defined in section 1905(y) and at the same payment rate as the rate that
would apply to such a consultation under the State plan under title
XIX).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H4A00B293A3FD44A191AABC5F20218283"><enum>(B)</enum><header>Conforming
amendment</header><text>Section 2102(a)(7)(B) of such Act (42 U.S.C.
1397bb(a)(7)(B)) is amended by striking <quote>section 2103(c)(5)</quote> and
inserting <quote>paragraphs (5) and (9) of section 2103(c)</quote>.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HE8642A1D38A34416A8E35589020E761D"><enum>(d)</enum><header>Definition of
advance directive under Medicare, Medicaid, and CHIP</header>
<paragraph commented="no" display-inline="no-display-inline" id="H39586D0652FB43DBBEB4BE61878A34CC"><enum>(1)</enum><header>Medicare</header><text>Section
1866(f)(3) of the Social Security Act (42 U.S.C. 1395cc(f)(3)) is amended by
striking <quote>means</quote> and all that follows through the period and
inserting <quote>means a living will, medical directive, health care power of
attorney, durable power of attorney, or other written statement by a competent
individual that is recognized under State law and indicates the individual's
wishes regarding medical treatment in the event of future incompetence. Such
term includes an advance health care directive and a health care directive
recognized under State law.</quote>.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HF4874DB2F16447B0840328E66E2F1C9F"><enum>(2)</enum><header>Medicaid and
chip</header><text>Section 1902(w)(4) of such Act (42 U.S.C. 1396a(w)(4)) is
amended by striking <quote>means</quote> and all that follows through the
period and inserting <quote>means a living will, medical directive, health care
power of attorney, durable power of attorney, or other written statement by a
competent individual that is recognized under State law and indicates the
individual's wishes regarding medical treatment in the event of future
incompetence. Such term includes an advance health care directive and a health
care directive recognized under State law.</quote>.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H99578C03F68049B097BD96D1B1C0CE84"><enum>(e)</enum><header>Effective
date</header><text>The amendments made by this section take effect January 1,
2010.</text>
</subsection></section></part><part id="H36FB305A11C24284AAEDC5DDE7AB286F"><enum>II</enum><header>Hospice</header>
<section id="H41EF007739D04A64B73D40C5799CC221"><enum>221.</enum><header>Adoption of
MedPAC hospice payment methodology recommendations</header><text display-inline="no-display-inline">Section
1814(i) of the Social Security Act (42 U.S.C. 1395f(i)) is amended by adding at
the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H4329BADE26804D9C9531993E560E05AC" style="OLC">
<paragraph id="HD26E1894524B4D32A0EB75643B5DFB9D"><enum>(6)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H8E76B9CDAA544DA18CC720AA34E6B88C"><enum>(A)</enum><text display-inline="yes-display-inline">The Secretary shall conduct an evaluation
of the recommendations of the Medicare Payment Commission for reforming the
hospice care benefit under this title that are contained in chapter 6 of the
Commission's report entitled <quote>Report to Congress: Medicare Payment Policy
(March 2009)</quote>, including the impact that such recommendations if
implemented would have on access to care and the quality of care. In conducting
such evaluation, the Secretary shall take into account data collected in
accordance with section 263(b) of the <short-title>Advance
Planning and Compassionate Care Act of 2009</short-title>.</text>
</subparagraph><subparagraph id="H04E90FAF8D484F5FA978B4CD5DB4272C" indent="up1"><enum>(B)</enum><text>Based on the results of the
examination conducted under subparagraph (A), the Secretary shall make
appropriate refinements to the recommendations described in subparagraph (A).
Such refinements shall take into account—</text>
<clause id="HCAFC660AC24749A5930978F7C1800F5A"><enum>(i)</enum><text>the impact on patient populations
with longer that average lengths of stay;</text>
</clause><clause id="HD3338E9D5F8449F8A14578261BAB89E2"><enum>(ii)</enum><text>the impact on populations with
shorter that average lengths of stay; and</text>
</clause><clause id="H6037309C8FC64559B4780FAA078B14F6"><enum>(iii)</enum><text>the utilization patterns of
hospice providers in underserved areas, including rural hospices.</text>
</clause></subparagraph><subparagraph id="H9261CE810A0F40A381EE93D17B2D9EEE" indent="up1"><enum>(C)</enum><text>Not later than January 1, 2013, the
Secretary shall submit to Congress a report that contains a detailed
description of—</text>
<clause id="H19C2E0A723F74BD39FEFA0101F7184A6"><enum>(i)</enum><text>the refinements determined
appropriate by the Secretary under subparagraph (B);</text>
</clause><clause id="HF72DB906688F45839F4B02DC2EDF5014"><enum>(ii)</enum><text>the revisions that the Secretary
will implement through regulation under this title pursuant to subparagraph
(D); and</text>
</clause><clause id="H523B2471E72F4BBB9B1EBEE8F7F956A1"><enum>(iii)</enum><text>the revisions that the Secretary
determines require additional legislative action by Congress.</text>
</clause></subparagraph><subparagraph id="HF87C719631504BDDB28EF401B26EEEE3" indent="up1"><enum>(D)</enum><clause commented="no" display-inline="yes-display-inline" id="H8437FAF4E07241A99F1FC62E99AC8092"><enum>(i)</enum><text display-inline="yes-display-inline">The Secretary shall implement the
recommendations described in subparagraph (A), as refined under subparagraph
(B).</text>
</clause><clause id="HD949570909194268A0A7E4222FC4C32B" indent="up1"><enum>(ii)</enum><text>Subject to clause (iii), the
implementation of such recommendations shall apply to hospice care furnished on
or after January 1, 2014.</text>
</clause><clause id="HA8526344D8C845398FDEF871C9BF1933" indent="up1"><enum>(iii)</enum><text>The Secretary shall establish an
appropriate transition to the implementation of such recommendations.</text>
</clause></subparagraph><subparagraph id="HEF97E1D056CF4FA4BA790852BD1D7BBA" indent="up1"><enum>(E)</enum><text>For purposes of carrying out the
provisions of this paragraph, the Secretary shall provide for the transfer,
from the Federal Hospital Insurance Trust Fund under section 1817, of such sums
as may be necessary to the Centers for Medicare & Medicaid Services Program
Management
Account.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H8A27BF091DDD4F9481195C48ED5B6FBA"><enum>222.</enum><header>Removing
hospice inpatient days in setting per diem rates for critical access
hospitals</header><text display-inline="no-display-inline">Section 1814(l) of
the Social Security Act (42 U.S.C. 1395f(l)), as amended by section 4102(b)(2)
of the HITECH Act (Public Law 111–5), is amended by adding at the end the
following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H42F858BE2ACD45E4B1D35A996C3E7CA6" style="OLC">
<paragraph id="H16C49803ADD24EC08C2090E65752BA5F"><enum>(6)</enum><text display-inline="yes-display-inline">For cost reporting periods beginning on or
after January 1, 2011, the Secretary shall remove Medicare-certified hospice
inpatient days from the calculation of per diem rates for inpatient critical
access hospital services.</text>
</paragraph><after-quoted-block>.
</after-quoted-block></quoted-block>
</section><section id="H76E0DC9134A34431955D1E9E6860269E"><enum>223.</enum><header>Hospice
payments for dual eligible individuals residing in long-term care
facilities</header>
<subsection id="H47C7958C572A4EF4B6A1E8652B7BE24E"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1888 of the
Social Security Act (42 U.S.C. 1395yy) is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H8D1A834ECB86438AB636382B4CCBD6F7" style="OLC">
<subsection id="H240426347BC748D790B6102A03911477"><enum>(f)</enum><header>Payments for
dual eligible individuals residing in long-term care facilities</header><text display-inline="yes-display-inline">For cost reporting periods beginning on or
after January 1, 2011, the Secretary, acting through the Administrator of the
Centers for Medicare & Medicaid Services, shall establish procedures under
which payments for room and board under the State Medicaid plan with respect to
an applicable individual are made directly to the long-term care facility (as
defined by the Secretary for purposes of title XIX) the individual is a
resident of. For purposes of the preceding sentence, the term <term>applicable
individual</term> means an individual who is entitled to or enrolled for
benefits under part A or enrolled for benefits under part B and is eligible for
medical assistance for hospice care under a State plan under title
XIX.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H6690F52B88784EEAB42661DB1F5F3B2B"><enum>(b)</enum><header>State plan
requirement</header>
<paragraph id="HD4094B6DDE3F49A8946BA790FC9A74C1"><enum>(1)</enum><header>In
general</header><text>Section 1902(a) of the Social Security Act (42 U.S.C.
1396a(a)) is amended—</text>
<subparagraph id="HF75F377B74E44EBDB487F8F7FC1E2C63"><enum>(A)</enum><text>in paragraph (72),
by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="H47F03CE331BC42F6A64ECA9F95615FD1"><enum>(B)</enum><text>in paragraph (73),
by striking the period at the end and inserting <quote>; and</quote>;
and</text>
</subparagraph><subparagraph id="H78621DB8662B4F0DA1E234BAB1B87812"><enum>(C)</enum><text>by inserting after
paragraph (73) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H372B8BC5512F4E1B800DD233681AB6DC" style="OLC">
<paragraph id="H042E584AB57D4D4E88CFF86B0550866D"><enum>(74)</enum><text>provide that the
State will make payments for room and board with respect to applicable
individuals in accordance with section
1888(f).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HD0F254DFF4854D7082500593C05331A7"><enum>(2)</enum><header>Effective
date</header>
<subparagraph id="HD1B5A53607B640CAA18EE66375BC1843"><enum>(A)</enum><header>In
general</header><text>Except as provided in subparagraph (B), the amendments
made by paragraph (1) take effect on January 1, 2011.</text>
</subparagraph><subparagraph id="H9D54EFE1A67A459B9EB77A031B8462BF"><enum>(B)</enum><header>Extension of
effective date for state law amendment</header><text>In the case of a State
plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which
the Secretary determines requires State legislation in order for the plan to
meet the additional requirements imposed by the amendments made by paragraph
(1), the State plan shall not be regarded as failing to comply with the
requirements of such title solely on the basis of its failure to meet these
additional requirements before the first day of the first calendar quarter
beginning after the close of the first regular session of the State legislature
that begins after the date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year legislative
session, each year of the session is considered to be a separate regular
session of the State legislature.</text>
</subparagraph></paragraph></subsection></section><section id="HEA6A6C552AAB4766A9AE9F17674BE430"><enum>224.</enum><header>Delineation of
respective care responsibilities of hospice programs and long-term care
facilities</header><text display-inline="no-display-inline">Section 1888 of the
Social Security Act (42 U.S.C. 1395yy), as amended by section 223(a), is
amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H6EB567786861486EA998D1DE5D372F3E" style="OLC">
<subsection id="H140B5E9A30F7429AAFB3410BB835A6E1"><enum>(g)</enum><header>Delineation of
respective care responsibilities of hospice programs and long-term care
facilities</header><text>Not later than July 1, 2011, the Secretary, acting
through the Administrator of the Centers for Medicare & Medicaid Services,
shall delineate and enforce the respective care responsibilities of hospice
programs and long-term care facilities (as defined by the Secretary for
purposes of title XIX) with respect to individuals residing in such facilities
who are furnished hospice
care.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H8B10FF2F7AD54F9183715979D49089F6"><enum>225.</enum><header>Adoption of
MedPAC hospice program eligibility certification and recertification
recommendations</header><text display-inline="no-display-inline">In accordance
with the recommendations of the Medicare Payment Advisory Commission contained
in the March 2009 report entitled <quote>Report to Congress: Medicare Payment
Policy</quote>, section 1814(a)(7) of the Social Security Act (42 U.S.C.
1395f(a)(7)) is amended—</text>
<paragraph id="H0C060ADD005D4449AD0867F20973AE43"><enum>(1)</enum><text display-inline="yes-display-inline">in subparagraph (B), by striking
<quote>and</quote> at the end; and</text>
</paragraph><paragraph id="H5F7146326F004BB6822946112D7B8349"><enum>(2)</enum><text display-inline="yes-display-inline">by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H8AD58D1F943545AA95C6E2008F0FCF65" style="OLC">
<subparagraph id="H8B2D2FA362274A28A85C98FE7908DC1E"><enum>(D)</enum><text display-inline="yes-display-inline">on or after January 1, 2011—</text>
<clause id="H602E74A87731429A9A32076274BF9A97"><enum>(i)</enum><text display-inline="yes-display-inline">a hospice physician or advance practice
nurse visits the individual to determine continued eligibility of the
individual for hospice care prior to the 180th day recertification and each
subsequent recertification under subparagraph (A)(ii) and attests that such
visit took place (in accordance with procedures established by the Secretary,
in consultation with the Administrator of the Centers for Medicare &
Medicaid Services); and</text>
</clause><clause id="H1C2AEDDED10D4DDD89B30CF72FC3D8CB"><enum>(ii)</enum><text>any certification
or recertification under subparagraph (A) includes a brief narrative describing
the clinical basis for the individual’s prognosis (in accordance with
procedures established by the Secretary, in consultation with the Administrator
of the Centers for Medicare & Medicaid Services);
and</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="HED3196D5FC7B4DEDAC0C13E054152A8E"><enum>226.</enum><header>Concurrent care
for children</header>
<subsection id="HB91B654B177948BDB1DB5CD08DD126E0"><enum>(a)</enum><header>Permitting
Medicare hospice beneficiaries 18 years of age or younger To receive curative
care</header>
<paragraph commented="no" display-inline="no-display-inline" id="H14E821B86D3D43BFA141187301F096EB"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Section 1812 of the Social Security Act (42
U.S.C. 1395d) is amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H8C620DB94336494B8DAF1E9D0AC245E3"><enum>(A)</enum><text display-inline="yes-display-inline">in subsection (a)(4), by inserting
<quote>(subject to the second sentence of subsection (d)(2)(A))</quote> after
<quote>in lieu of certain other benefits</quote>; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HDA79A1CF778748798AF794C8677C3CB2"><enum>(B)</enum><text display-inline="yes-display-inline">in subsection (d)—</text>
<clause commented="no" display-inline="no-display-inline" id="HD13A3A118E304D65B0B5526F801B7AFE"><enum>(i)</enum><text display-inline="yes-display-inline">in paragraph (1), by inserting <quote> ,
subject to the second sentence of paragraph (2)(A), </quote> after
<quote>instead</quote>; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H0A5411B53FDC4533820DD0FB6B3D06F3"><enum>(ii)</enum><text display-inline="yes-display-inline">in paragraph (2)(A), by adding at the end
the following new sentence: <quote>Clause (ii)(I) shall not apply to an
individual who is 18 years of age or younger.</quote></text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H3B431B45B5D346A3B34A44431102A6CF"><enum>(2)</enum><header display-inline="yes-display-inline">Conforming amendment</header><text display-inline="yes-display-inline">Section 1862(a)(1)(C) of the Social
Security Act (42 U.S.C. 1395y(a)(1)(C)) is amended inserting <quote>subject to
the second sentence of section 1812(d)(2)(A), </quote> after <quote>hospice
care,</quote>.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HA512FAC576EF4B3D9CE762129F594838"><enum>(b)</enum><header>Application to
Medicaid and CHIP</header>
<paragraph commented="no" display-inline="no-display-inline" id="H71F7C6BD5D0248249F4E844DC4E2A7E2"><enum>(1)</enum><header>Medicaid</header><text>Section
1905(o)(1)(A) of the Social Security Act (42 U.S.C. 1395d(o)(1)(A)) is amended
by inserting <quote>(subject, in the case of an individual who is a child, to
the second sentence of such section)</quote> after <quote>section
1812(d)(2)(A)</quote>.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H444DD281C95148698237A78BFEEF942E"><enum>(2)</enum><header>CHIP</header><text>Section
2110(a)(23) of the Social Security Act (42 U.S.C. 1397jj(a)(23)) is amended by
inserting <quote>(concurrent, in the case of an individual who is a child, with
care related to the treatment of the individual's condition with respect to
which a diagnosis of terminal illness has been made)</quote> after
<quote>hospice care</quote>.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H4187357AD9164AE3BBB13183B98C6D60"><enum>(c)</enum><header display-inline="yes-display-inline">Effective
date</header><text display-inline="yes-display-inline">The amendments made by
this section shall apply to items and services furnished on or after January 1,
2011.</text>
</subsection></section><section id="HB1B2E3742E7F446DBCC485CB485BE40C"><enum>227.</enum><header>Making hospice
a required benefit under Medicaid and CHIP</header>
<subsection id="H47984D2116704F29A1EC3171380A13E4"><enum>(a)</enum><header>Mandatory
benefit</header>
<paragraph id="HF703489F7A3A4FFDA1ECABD9C2F0D328"><enum>(1)</enum><header>Medicaid</header>
<subparagraph id="H1DE433B3EAE643F2859721D8A5E92F68"><enum>(A)</enum><header>In
general</header><text>Section 1902(a)(10)(A) of the Social Security Act (42
U.S.C. 1396a(a)(10)(A)), as amended by section 211(b)(1), is amended in the
matter preceding clause (i) by inserting <quote>(18),</quote> after
<quote>(17),</quote>.</text>
</subparagraph><subparagraph id="H99BDA2A44B924596952584B57F41A261"><enum>(B)</enum><header>Conforming
amendment</header><text>Section 1902(a)(10)(C) of such Act (42 U.S.C.
1396a(a)(10)(C)) is amended—</text>
<clause id="H8596680CA42C40D5970EBA60843A5273"><enum>(i)</enum><text>in
clause (iii)—</text>
<subclause id="H230F635F8DE64CE592DEA5AE8C382818"><enum>(I)</enum><text>in subclause (I),
by inserting <quote>and hospice care</quote> after <quote>ambulatory
services</quote>; and</text>
</subclause><subclause id="HD9D521AF172A4AA29A33686E6F9B07AE"><enum>(II)</enum><text>in subclause
(II), by inserting <quote>and hospice care</quote> after <quote>delivery
services</quote>; and</text>
</subclause></clause><clause id="H952C6E9E0613402F9EC6D302274E7C10"><enum>(ii)</enum><text>in
clause (iv), by inserting <quote>and (18)</quote> after
<quote>(17)</quote>.</text>
</clause></subparagraph></paragraph><paragraph id="HC5CCCAC970194D06A3F5BEB1CEFFC919"><enum>(2)</enum><header>CHIP</header><text>Section
2103(c)(9) of such Act (42 U.S.C. 1397cc(c)(9)), as added by section
211(c)(2)(A), is amended by inserting <quote>and hospice care</quote> before
the period.</text>
</paragraph></subsection><subsection id="H28BD788293BF4E188F5A2FDA09B062A1"><enum>(b)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The amendments made
subsection (a) take effect on January 1, 2011.</text>
</subsection></section><section id="H71549EDAE0184CCBB1FBA53F165931F2"><enum>228.</enum><header>Medicare
Hospice payment model demonstration projects</header>
<subsection id="H1885ADE6B04D4970A17BFCF719FD66AB"><enum>(a)</enum><header>Establishment</header><text>Not
later than July 1, 2012, the Secretary, acting through the Administrator of the
Centers for Medicare & Medicaid Services and the Director of the Agency for
Healthcare Research and Quality, shall conduct demonstration projects to
examine ways to improve how the Medicare hospice care benefit predicts disease
trajectory. Projects shall include the following models:</text>
<paragraph id="H7AEA6CA12C08428C8C5B3119420B09C5"><enum>(1)</enum><text>Models that better
and more appropriately care for, and transition as needed, patients in their
last years of life who need palliative care, but do not qualify for hospice
care under the Medicare hospice eligibility criteria.</text>
</paragraph><paragraph id="H7022D99714154984804E0316229BB218"><enum>(2)</enum><text>Models that better
and more appropriately care for long-term patients who are not recertified in
hospice but still need palliative care.</text>
</paragraph><paragraph id="HA8F2D02BC8814EF3A0D6B21E37315480"><enum>(3)</enum><text>Any other models
determined appropriate by the Secretary.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H8DA2EB4E87614D668DE6D213DEDF1818"><enum>(b)</enum><header display-inline="yes-display-inline">Waiver authority</header><text display-inline="yes-display-inline">The Secretary may waive compliance of such
requirements of titles XI and XVIII of the <act-name parsable-cite="SSA">Social
Security Act</act-name> as the Secretary determines necessary to conduct the
demonstration projects under this section.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H3E01A604994349C2BBF9EF723803B551"><enum>(c)</enum><header display-inline="yes-display-inline">Reports</header><text display-inline="yes-display-inline">The Secretary shall submit to Congress
periodic reports on the demonstration projects conducted under this
section.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="H0A6D870C02F24E20BA64AC271D13A717"><enum>229.</enum><header>MedPAC studies
and reports</header>
<subsection id="HF6C7A8A4BA5E440B9B8FAF989F8F6C0F"><enum>(a)</enum><header>Study and report
regarding an alternative payment methodology for hospice care under the
Medicare program</header>
<paragraph commented="no" id="H4A0EE7EB031F4A4390170B1125B0E2FE"><enum>(1)</enum><header>Study</header><text>The
Medicare Payment Advisory Commission (in this section referred to as the
<quote>Commission</quote>) shall conduct a study on the establishment of a
reimbursement system for hospice care furnished under the Medicare program that
is based on diagnoses. In conducting such study, the Commission shall use data
collected under new provider data requirements. Such study shall include an
analysis of the following:</text>
<subparagraph id="HAB428346C0C143DEAC52B39A810543E6"><enum>(A)</enum><text>Whether such a
reimbursement system better meets patient needs and better corresponds with
provider resource expenditures than the current system.</text>
</subparagraph><subparagraph id="H499A820E71804165B9F6626F1036EF4C"><enum>(B)</enum><text>Whether such a
reimbursement system improves quality, including facilitating standardization
of care toward best practices and diagnoses-specific clinical pathways in
hospice.</text>
</subparagraph><subparagraph id="H3E3D29B8C87542778458DFE97C7B8FF8"><enum>(C)</enum><text>Whether such a
reimbursement system could address concerns about the blanket 6-month terminal
prognosis requirement in hospice.</text>
</subparagraph><subparagraph id="H86E101A1AF2F430A84B44C8009DC12EA"><enum>(D)</enum><text>Whether such a
reimbursement system is more cost effective than the current system.</text>
</subparagraph><subparagraph id="H0394645DBE644B9B8677312D1B436A73"><enum>(E)</enum><text>Any other areas
determined appropriate by the Commission.</text>
</subparagraph></paragraph><paragraph commented="no" id="H8FF47B1FA6734273ADB760D014F4854D"><enum>(2)</enum><header>Report</header><text>Not
later than June 15, 2013, the Commission shall submit to Congress a report on
the study conducted under subsection (a) together with recommendations for such
legislation and administrative action as the Commission determines
appropriate.</text>
</paragraph></subsection><subsection id="HECA0E76CEFF3410EB0D569FDAF0B513A"><enum>(b)</enum><header>Study and report
regarding rural hospice transportation costs under the Medicare
program</header>
<paragraph commented="no" id="HD8C63C1ED6E84DF0989DEB7F1C69B0A5"><enum>(1)</enum><header>Study</header><text>The
Commission shall conduct a study on rural Medicare hospice transportation
mileage to determine potential Medicare reimbursement changes to account for
potential higher costs.</text>
</paragraph><paragraph commented="no" id="H528CF8575D7D43ADAEAC4A64132BA341"><enum>(2)</enum><header>Report</header><text>Not
later than June 15, 2013, the Commission shall submit to Congress a report on
the study conducted under subsection (a) together with recommendations for such
legislation and administrative action as the Commission determines
appropriate.</text>
</paragraph></subsection><subsection id="H6B8D4D566F794173AB46D6D184FCB0EC"><enum>(c)</enum><header>Evaluation of
reimbursement disincentives To elect medicare hospice within the medicare
skilled nursing facility benefit</header>
<paragraph commented="no" id="HB02147E28BF549ECB8A82231384C41D0"><enum>(1)</enum><header>Study</header><text>The
Commission shall conduct a study to determine potential Medicare reimbursement
changes to remove Medicare reimbursement disincentives for patients in a
skilled nursing facility who want to elect hospice.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H07549127B5B3469A980B4FDFD15589C7"><enum>(2)</enum><header>Report</header><text>Not
later than June 15, 2013, the Commission shall submit to Congress a report on
the study conducted under subsection (a) together with recommendations for such
legislation and administrative action as the Commission determines
appropriate.</text>
</paragraph></subsection></section><section commented="no" id="H5830CDE5A3CB441787DE323376611620"><enum>230.</enum><header>HHS
Evaluations</header>
<subsection id="H45B3DC86FF80400C8DA6EFF2244C3F1D"><enum>(a)</enum><header>Evaluation of
access to hospice and hospital-based palliative care</header>
<paragraph id="H95CA20E17A714711A5E79490A69FDC02"><enum>(1)</enum><header>Evaluation</header><text display-inline="yes-display-inline">The Secretary, acting through the
Administrator of the Health Resources and Services Administration, shall
conduct an evaluation of geographic areas and populations underserved by
hospice and hospital-based palliative care to identify potential barriers to
access.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H358B1CACFEAE404B9C4274728D53592B"><enum>(2)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than December 31, 2012, the
Secretary shall report to Congress, on the evaluation conducted under
subsection (a) together with recommendations for such legislation and
administrative action as the Secretary determines appropriate to address
barriers to access to hospice and hospital-based palliative care.</text>
</paragraph></subsection><subsection id="HE0F58109923440C3A5F9C133925B4A10"><enum>(b)</enum><header>Evaluation of
awareness and use of hospice respite care under Medicare, Medicaid, and
CHIP</header>
<paragraph id="HB7C8269C11774957B84BAD6151AD26FF"><enum>(1)</enum><header>Evaluation</header><text display-inline="yes-display-inline">The Secretary, acting through the Director
of the Centers for Medicare & Medicaid Services, shall evaluate the
awareness and use of hospice respite care by informal caregivers of
beneficiaries under Medicare, Medicaid, and CHIP.</text>
</paragraph><paragraph id="HDCB364CA2177405BBD5DBDA053EFAE32"><enum>(2)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than December 31, 2010, the
Secretary shall report to Congress, on the evaluation conducted under
subsection (a) together with recommendations for such legislation and
administrative action as the Secretary determines appropriate to increase
awareness or use of hospice respite care under Medicare, Medicaid, and
CHIP.</text>
</paragraph></subsection></section></part></subtitle><subtitle id="HF01BA71BF42547EAB6973F41F50EE520"><enum>C</enum><header>Quality
Improvement</header>
<section commented="no" id="H1B93F73521464DA9BE37976EE41146C1"><enum>241.</enum><header>Patient
satisfaction surveys</header><text display-inline="no-display-inline">Not later
than January 1, 2012, the Secretary, acting through the Administrator of the
Centers for Medicare & Medicaid Services, shall establish a mechanism
for—</text>
<paragraph commented="no" id="H72BCA2865BF34BD98227E947E42F8F31"><enum>(1)</enum><text display-inline="yes-display-inline">collecting information from patients (or
their health care proxies or families members in the event patients are unable
to speak for themselves) in relevant provider settings regarding their care at
the end of life; and</text>
</paragraph><paragraph commented="no" id="H76F1228F95DC4EE8BDDB7BFC76EC1CBF"><enum>(2)</enum><text display-inline="yes-display-inline">incorporating such information in a timely
manner into mechanisms used by the Administrator to provide quality of care
information to consumers, including the Hospital Compare and Nursing Home
Compare websites maintained by the Administrator.</text>
</paragraph></section><section id="HA98AD9A22DB44D279B5A6F982195D9EC"><enum>242.</enum><header>Development of
core end-of-life care quality measures across each relevant provider
setting</header>
<subsection id="HA806E2BCE2E1472E861BED0BCC20594B"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary, acting
through the Administrator of the Agency for Healthcare Research and Quality (in
this section referred to as the <quote>Administrator</quote>) and in
consultation with the Director of the National Institutes of Health, shall
require specific end-of-life quality measures for each relevant provider
setting, as identified by the Administrator, in accordance with the
requirements of subsection (b).</text>
</subsection><subsection id="H0AA098FD6BC04A16B356EBEFEF77651D"><enum>(b)</enum><header>Requirements</header><text display-inline="yes-display-inline">For purposes of subsection (a), the
requirements specified in this subsection are the following:</text>
<paragraph id="H438DD081664346C09FCFF4233CD962A6"><enum>(1)</enum><text>Selection of the
specific measure or measures for an identified provider setting shall
be—</text>
<subparagraph id="HC7586C5192684AA38635EF32B2B62DBF"><enum>(A)</enum><text>based on an
assessment of what is likely to have the greatest positive impact on quality of
end-of-life care in that setting; and</text>
</subparagraph><subparagraph id="HCCDACE4C6C9A4E599C397B36E506CCCF"><enum>(B)</enum><text>made in
consultation with affected providers and public and private organizations, that
have developed such measures.</text>
</subparagraph></paragraph><paragraph id="H8ED971DB75A5435E85C880F8098A1FAD"><enum>(2)</enum><text>The measures may
be structure-oriented, process-oriented, or outcome-oriented, as determined
appropriate by the Administrator.</text>
</paragraph><paragraph id="H766DD3AB9250456CBE8C7AA25DDFB3B1"><enum>(3)</enum><text>The Administrator
shall ensure that reporting requirements related to such measures are imposed
consistent with other applicable laws and regulations, and in a manner that
takes into account existing measures, the needs of patient populations, and the
specific services provided.</text>
</paragraph><paragraph id="HC37E881C78FB419DBCC9084DD6CB2C70"><enum>(4)</enum><text display-inline="yes-display-inline">Not later than—</text>
<subparagraph id="H2ADAE7DA53C04183883891C4E0D4D73A"><enum>(A)</enum><text display-inline="yes-display-inline">April 1, 2011, the Secretary shall
disseminate the reporting requirements to all affected providers; and</text>
</subparagraph><subparagraph id="H1AB0FB95FF9F45F5A703C5F68E0EB210"><enum>(B)</enum><text display-inline="yes-display-inline">April 1, 2012, initial reporting relating
to the measures shall begin.</text>
</subparagraph></paragraph></subsection></section><section id="H7768E80F341A478EB02F35AEF34A1C0E"><enum>243.</enum><header>Accreditation
of Hospital-Based Palliative Care Programs</header>
<subsection id="H47C844914AC54397ADFF7A16AC74AB80"><enum>(a)</enum><header>In
General</header><text>The Secretary, acting through the Director of the Agency
for Healthcare Research and Quality, shall designate a public or private
agency, entity, or organization to develop requirements, standards, and
procedures for accreditation of hospital-based palliative care programs.</text>
</subsection><subsection id="H24DDD673A6A84C60BD3B423733FB01E3"><enum>(b)</enum><header>Reporting</header><text>Not
later than January 1, 2012, the Secretary shall prepare and submit a report to
Congress on the proposed accreditation process for hospital-based palliative
care programs.</text>
</subsection><subsection id="HF0D027AB85B84BB9BC63AF010BD3A5D2"><enum>(c)</enum><header>Accreditation</header><text>Not
later than July 1, 2012, the Secretary shall—</text>
<paragraph id="H08B4F5A68EFB4DEC901C10E03E5795D6"><enum>(1)</enum><text>establish and
promulgate standards and procedures for accreditation of hospital-based
palliative care programs; and</text>
</paragraph><paragraph id="H1EDA3C8956524985A64CA1FF46290BC6"><enum>(2)</enum><text>designate an
agency, entity, or organization that shall be responsible for certifying such
programs in accordance with the standards established under paragraph
(1).</text>
</paragraph></subsection><subsection id="H5EF0E02585934ABEB8BD9F72B2BE9BE4"><enum>(d)</enum><header>Definitions</header><text>For
the purposes of this section:</text>
<paragraph id="HB4AB57DAD796411295061F9D1C2AFF95"><enum>(1)</enum><text>The term
<term>hospital-based palliative care program</term> means a hospital-based
program that is comprised of an interdisciplinary team that specializes in
providing palliative care services and consultations in a variety of health
care settings, including hospitals, nursing homes, and home and community-based
services.</text>
</paragraph><paragraph id="HF0965BF0C3294E218B66BB821C36A1DD"><enum>(2)</enum><text>The term
<term>interdisciplinary team</term> means a group of health care professionals
(consisting of, at a minimum, a doctor, a nurse, and a social worker) that have
received specialized training in palliative care.</text>
</paragraph></subsection></section><section id="HF0E17E1B498B4775ACA90F20C3ECC8B0"><enum>244.</enum><header>Survey and data
requirements for all Medicare participating hospice programs</header>
<subsection id="HCE4E73A7108B4529BE6096A36536B213"><enum>(a)</enum><header>Hospice
surveys</header><text display-inline="yes-display-inline">Section 1861(dd) of
the Social Security Act (42 U.S.C. 1395x(dd)) is amended by adding at the end
the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H3EE8C5DF37A1475399D4289023D072D6" style="OLC">
<paragraph id="HAD875EA2FAED486DA1487C9DAD66035C" indent="up1"><enum>(6)</enum><text display-inline="yes-display-inline">In accordance with the recommendations of
the Medicare Payment Advisory Commission contained in the March 2009 report
entitled <quote>Report to Congress: Medicare Payment Policy</quote>, the
Secretary shall establish, effective July 1, 2010, the following survey
requirements for hospice programs:</text>
<subparagraph id="H4E9D09D2A7B045ECAAD92721FD9BD044"><enum>(A)</enum><text>Any hospice program seeking initial
certification under this title on or after that date shall be subject to an
initial survey by an appropriate State or local agency, or an approved
accreditation agency, not later than 6 months after the program first seeks
such certification.</text>
</subparagraph><subparagraph id="H11FEEAA6B8F84B338BA6B5056565B1B5"><enum>(B)</enum><text>All hospice programs certified for
participation under this title shall be subject to a standard survey by an
appropriate State or local agency, or an approved accreditation agency, at
least every 3 years after initially being so
certified.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HBC552BA395984132920E21A55DE20383"><enum>(b)</enum><header>Required hospice
resource inputs data</header><text>Section 1861(dd) of the Social Security Act
(42 U.S.C. 1395x(dd)), as amended by subsection (a), is amended—</text>
<paragraph id="H05592F7D31764860A3875FA8D90B7F9D"><enum>(1)</enum><text>in paragraph
(3)—</text>
<subparagraph id="H79946B7BF24F4C28AF2E4684228210EB"><enum>(A)</enum><text>in subparagraph
(F), by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="H67CAB48DEA924EF08781E6712139FA78"><enum>(B)</enum><text>by redesignating
subparagraph (G) as subparagraph (H); and</text>
</subparagraph><subparagraph id="HE929414B7F9944A5948212CB3F7353EE"><enum>(C)</enum><text>by inserting after
subparagraph (F) the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HD043F333552E4744BC90F74108B32B4D" style="OLC">
<subparagraph id="H283D9A67FE0549B0AC89468C85411B32" indent="up1"><enum>(G)</enum><text>to comply with the reporting
requirements under paragraph (7); and</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HB5580CE855C146CABFAA6EC1B9929882"><enum>(2)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H8A494EBD7B0F44E1A5F20013B42EE658" style="OLC">
<paragraph id="H7C2D54DB855B43ED8321E991BAAF46D2"><enum>(7)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H0BF90430081D44EB9B02624E30410D35"><enum>(A)</enum><text display-inline="yes-display-inline">In accordance with the recommendations of
the Medicare Payment Advisory Commission for additional data (as contained in
the March 2009 report entitled <quote>Report to Congress: Medicare Payment
Policy</quote>), beginning January 1, 2011, a hospice program shall report to
the Secretary, in such form and manner, and at such intervals, as the Secretary
shall require, the following data with respect to each patient visit:</text>
<clause id="HF5EDC53329204A6E9F2455DAB87A6AEA" indent="up1"><enum>(i)</enum><text display-inline="yes-display-inline">Visit type (such as admission, routine,
emergency, education for family, other).</text>
</clause><clause id="H07366E979C9644A28E01F5392868E674" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">Visit length.</text>
</clause><clause id="HBCF1FF0CC00543088E20F01B8A5654DF" indent="up1"><enum>(iii)</enum><text display-inline="yes-display-inline">Professional or paraprofessional
disciplines involved in the visit, including nurse, social worker, home health
aide, physician, nurse practitioner, chaplain or spiritual counselor,
counselor, dietician, physical therapist, occupational therapist, speech
language pathologist, music or art therapist, and including bereavement and
support services provided to a family after a patient’s death.</text>
</clause><clause id="H44A71FA4E90043CA83E594CE15300B9F" indent="up1"><enum>(iv)</enum><text display-inline="yes-display-inline">Drugs and other therapeutic interventions
provided.</text>
</clause><clause id="HA15EB2396032445B93BFB047101AD972" indent="up1"><enum>(v)</enum><text display-inline="yes-display-inline">Home medical equipment and other medical
supplies provided.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H789C97BBA9CE426BB4D6DA0F58710D32" indent="up1"><enum>(B)</enum><text>In collecting the data required under
subparagraph (A), the Secretary shall ensure that the data are reported in a
manner that allows for summarized cross-tabulations of the data by patients’
terminal diagnoses, lengths of stay, age, sex, and
race.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section></subtitle><subtitle id="HA1CF2BBBF7BC460B90455D3C18A128AC"><enum>D</enum><header>Additional
reports, research, and evaluations</header>
<section id="H30270C0463DE4B91BC9EFE8F4E85E166"><enum>251.</enum><header>National Center
on Palliative and End-of-Life Care</header><text display-inline="no-display-inline">Part E of title IV of the Public Health
Service Act (42 U.S.C. 287 et seq.) is amended by adding at the end the
following:</text>
<quoted-block display-inline="no-display-inline" id="H7AA5B4FEB609467190F8BF86577EA563" style="OLC">
<subpart id="HF995CF8CE2554DF19274EAD6D634B81C"><enum>7</enum><header>National Center on
Palliative and End-of-Life Care</header>
<section id="HB4D2D11EE43B42759FEDA96B4B4A9407"><enum>485J.</enum><header>National
Center On Palliative and End-of-Life Care</header>
<subsection id="H38D2B034F2554376AF635AA675522BA4"><enum>(a)</enum><header>Establishment</header><text>Not
later than July 1, 2011, there shall be established within the National
Institutes of Health, a National Center on Palliative and End-of-Life Care
(referred to in this section as the <quote>Center</quote>).</text>
</subsection><subsection id="H0770A98723DE4422A27F66FB026D38AF"><enum>(b)</enum><header>Purpose</header><text>The
general purpose of the Center is to conduct and support research relating to
palliative and end-of-life care interventions and approaches.</text>
</subsection><subsection id="HAC87BCD40B7C4EC3BE51A9B9DE17E750"><enum>(c)</enum><header>Activities</header><text>The
Center shall—</text>
<paragraph id="HF81EA5FEABA54657B27EDD6E9A523E7A"><enum>(1)</enum><text>develop and
continuously update a research agenda with the goal of—</text>
<subparagraph id="H4DA0D2DB39834CF2A18CB14716E77F1D"><enum>(A)</enum><text>providing a better
biomedical understanding of the end of life; and</text>
</subparagraph><subparagraph id="H968FC5F2559949A0A8BA738E19D7C1BD"><enum>(B)</enum><text>improving the
quality of care and life at the end of life; and</text>
</subparagraph></paragraph><paragraph id="HC38CC4E493014C87A9726383D4552252"><enum>(2)</enum><text>provide funding
for peer-review-selected extra- and intra-mural research that includes the
evaluation of existing, and the development of new, palliative and end-of-life
care interventions and
approaches.</text>
</paragraph></subsection></section></subpart><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H9D078815AAEB440DADACC5B90E6A860E"><enum>252.</enum><header>National
Mortality Followback Survey</header>
<subsection id="H91D6C1278C3F4FB09BF146272F255996"><enum>(a)</enum><header>In
general</header><text>Not later than December 31, 2010, and annually
thereafter, the Secretary, acting through the Director of the Centers for
Disease Control and Prevention, shall renew and conduct the National Mortality
Followback Survey (referred to in this section as the <quote>Survey</quote>) to
collect data on end-of-life care.</text>
</subsection><subsection id="H2FC93979C7C34F909D624955617B34FB"><enum>(b)</enum><header>Purpose</header><text>The
purpose of the Survey shall be to gain a better understanding of current
end-of-life care in the United States.</text>
</subsection><subsection id="H9E3095DD84264033B3DA9CDA594715FE"><enum>(c)</enum><header>Questions</header>
<paragraph id="H4DA7F4CCBF7B424384911FBF136CEDC5"><enum>(1)</enum><header>In
general</header><text>In conducting the Survey, the Director of the Centers for
Disease Control and Prevention shall, at a minimum, include the following
questions with respect to the loved one of a respondent:</text>
<subparagraph id="H1547C466DADB4DB6842681A2761DF667"><enum>(A)</enum><text>Did he or she have
an advance directive, and if so, when it was completed.</text>
</subparagraph><subparagraph id="H61D41DF8742B41F6B8961BA65E7DCCCA"><enum>(B)</enum><text>Did he or she have
an order for life-sustaining treatment, and if so, when was it
completed.</text>
</subparagraph><subparagraph id="HA99DE0B0CC1E4CBC97FA7A3485E7C41D"><enum>(C)</enum><text>Did he or she have
a durable power of attorney, and if so, when it was completed.</text>
</subparagraph><subparagraph id="H1DD0D47E0A094AFFA358EA7907E234C2"><enum>(D)</enum><text>Had he or she
discussed his or her wishes with loved ones, and if so, when.</text>
</subparagraph><subparagraph id="HA94C468D393C4D04AB6278652D264C9D"><enum>(E)</enum><text>Had he or she
discussed his or her wishes with his or her physician, and if so, when.</text>
</subparagraph><subparagraph id="HDEC4595F545A48BA980A10E470664C73"><enum>(F)</enum><text>In the opinion of
the respondent, was he or she satisfied with the care he or she received in the
last year of life and in the last week of life.</text>
</subparagraph><subparagraph id="H700E5739C0AC4169A4E5FD6998F45937"><enum>(G)</enum><text>Was he or she
cared for by hospice, and if so, when.</text>
</subparagraph><subparagraph id="H94D43DCB98594743900D26DBD9233723"><enum>(H)</enum><text>Was he or she
cared for by palliative care specialists, and if so, when.</text>
</subparagraph><subparagraph id="H14AB1E3EE47A414EBCAE5561818C7F2C"><enum>(I)</enum><text>Did he or she
receive effective pain management (if needed).</text>
</subparagraph><subparagraph id="H70FF8A9A3435430A86591BD98CB52D5A"><enum>(J)</enum><text>What was the
experience of the main caregiver (including if such caregiver was the
respondent), and whether he or she received sufficient support in this
role.</text>
</subparagraph></paragraph><paragraph id="HCF7D424C85F245F398E1A82C42D4140E"><enum>(2)</enum><header>Additional
questions</header><text>Additional questions to be asked during the Survey
shall be determined by the Director of the Centers for Disease Control and
Prevention on an ongoing basis with input from relevant research
entities.</text>
</paragraph></subsection></section><section id="H49255382AA07414BBA9AEDFE849B047D"><enum>253.</enum><header>Demonstration
Projects for Use of Telemedicine Services in Advance Care Planning</header>
<subsection id="HAFB493B59DCB4031BF265A6ECEF2D949"><enum>(a)</enum><header>In
General</header><text>Not later than July 1, 2013, the Secretary shall
establish a demonstration program to reimburse eligible entities for costs
associated with the use of telemedicine services (including equipment and
connection costs) to provide advance care planning consultations with
geographically distant physicians and their patients.</text>
</subsection><subsection id="HDBC92109E1D343A7A4143263D49E68E9"><enum>(b)</enum><header>Duration</header><text>The
demonstration project under this section shall be conducted for at least a
3-year period.</text>
</subsection><subsection id="HD7A480CDB15F49AFB45576BCC82D704D"><enum>(c)</enum><header>Definitions</header><text>For
purposes of this section:</text>
<paragraph id="H45F63AF2178E4876A35FC9624D5A34FA"><enum>(1)</enum><text>The term
<term>eligible entity</term> means a physician or an advance practice nurse who
provides services pursuant to a hospital-based palliative care program (as
defined in section 262(d)(1)).</text>
</paragraph><paragraph id="HFDFDFE8558B74A72918EE3209D8D0BC5"><enum>(2)</enum><text>The term
<term>geographically distant</term> has the meaning given that term by the
Secretary for purposes of conducting the demonstration program established
under this section.</text>
</paragraph><paragraph id="H54F75243D3604B03BDF0883D3309C3F0"><enum>(3)</enum><text>The term
<term>telemedicine services</term> means a service or consultation provided via
telecommunication equipment that allows an eligible entity to exchange or
discuss medical information with a patient or a health care professional at a
separate location through real-time videoconferencing, or a similar format, for
the purpose of providing health care diagnosis and treatment.</text>
</paragraph></subsection><subsection id="H9A0FB78989414CBB855AB7FC342F7776"><enum>(d)</enum><header>Funding</header><text>There
are authorized to be appropriated to the Secretary such sums as may be
necessary to carry out this section.</text>
</subsection></section><section id="H036DEE22143345E399222EE7BE2DC6A2"><enum>254.</enum><header>Inspector
General investigation of fraud and abuse</header><text display-inline="no-display-inline">In accordance with the recommendations of
the Medicare Payment Advisory Commission for additional data (as contained in
the March 2009 report entitled <quote>Report to Congress: Medicare Payment
Policy</quote>), the Secretary shall direct the Office of the Inspector General
of the Department of Health and Human Services to investigate, not later than
January 1, 2012, the following with respect to hospice benefit under Medicare,
Medicaid, and CHIP:</text>
<paragraph id="H22EE231A08764198A76E28BEF2733975"><enum>(1)</enum><text display-inline="yes-display-inline">The prevalence of financial relationships
between hospices and long-term care facilities, such as nursing facilities and
assisted living facilities, that may represent a conflict of interest and
influence admissions to hospice.</text>
</paragraph><paragraph id="H8E5085698EE14198A2009F55AFCE7729"><enum>(2)</enum><text display-inline="yes-display-inline">Differences in patterns of nursing home
referrals to hospice.</text>
</paragraph><paragraph id="H6645A1A228AB4882B11C0758983F6988"><enum>(3)</enum><text display-inline="yes-display-inline">The appropriateness of enrollment practices
for hospices with unusual utilization patterns (such as high frequency of very
long stays, very short stays, or enrollment of patients discharged from other
hospices).</text>
</paragraph><paragraph id="H7AE81B9D6A3E4FACAD3D9DCA271A148F"><enum>(4)</enum><text display-inline="yes-display-inline">The appropriateness of hospice marketing
materials and other admissions practices and potential correlations between
length of stay and deficiencies in marketing or admissions practices.</text>
</paragraph></section><section commented="no" display-inline="no-display-inline" id="HD134303255294C02A02A068BC4C71E0B" section-type="subsequent-section"><enum>255.</enum><header>GAO study and report
on provider adherence to advance directives</header><text display-inline="no-display-inline">Not later than January 1, 2012, the
Comptroller General of the United States shall conduct a study of the extent to
which providers comply with advance directives under the Medicare and Medicaid
programs and shall submit a report to Congress on the results of such study,
together with such recommendations for administrative or legislative changes as
the Comptroller General determines appropriate.</text>
</section></subtitle>