[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 1439 Introduced in Senate (IS)]

113th CONGRESS
  1st Session
                                S. 1439

To amend title XVIII of the Social Security Act to provide for advanced 
illness care coordination services for Medicare beneficiaries, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             August 1, 2013

Mr. Warner (for himself and Mr. Isakson) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for advanced 
illness care coordination services for Medicare beneficiaries, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Care Planning Act 
of 2013''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Improvement of advanced illness planning and coordination.
Sec. 4. Quality measurement development.
Sec. 5. Inclusion of advance care planning materials in the Medicare & 
                            You handbook.
Sec. 6. Care Planning Advisory Board.
Sec. 7. Improvement of policies related to the use and portability of 
                            advance directives.
Sec. 8. Additional requirements for facilities.
Sec. 9. Grants for increasing public awareness of advance care planning 
                            and advanced illness care.
Sec. 10. HHS study and report on the storage of advance directives.
Sec. 11. GAO study and report on the provisions of, and amendments made 
                            by, this Act.
Sec. 12. Consultation with the Care Planning Advisory Board.
Sec. 13. Rule of construction.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The population of the United States is estimated to age 
        rapidly, with the number of people over the age of 65 set to 
        double to more than 72,000,000, or 1 in 5 Americans, over the 
        next two decades.
            (2) Americans today are living longer and healthier lives 
        than ever before in the history of the United States yet are 
        also facing increased incidence of multiple serious conditions 
        as aging progresses.
            (3) Americans with advanced illness face a complicated and 
        fragmented system of care delivery that puts them at risk for 
        repeat hospitalizations, adverse drug reactions, and 
        conflicting medical advice that may be overwhelming to 
        individuals and families.
            (4) The progression of advanced illness leads to the need 
        for increasingly intensive decision support, health care 
        services, and support from family caregivers.
            (5) The complexity of care needed by individuals with 
        advanced illness may result in uncoordinated care, adverse 
        health outcomes, frustration, wasted time, and undue emotional 
        burdens on individuals and their family caregivers.
            (6) Numerous private sector leaders, including hospitals, 
        health systems, home health agencies, hospice programs, long-
        term care providers, employers, and other entities, have put in 
        place innovative solutions to provide more comprehensive and 
        coordinated care for Americans living with advanced illness.
            (7) Hospice programs, as one of the longest standing 
        Medicare care coordination benefits that offer a comprehensive 
        set of services via an interdisciplinary team working to 
        provide person- and family-centered care to the frailest and 
        most vulnerable individuals in our communities, can serve as a 
        model for advanced illness care delivery.
            (8) Palliative care programs that serve patients beginning 
        at diagnosis with advanced illness and provide care designed to 
        reduce the symptom burden of illness can serve as a model for 
        interdisciplinary team care planning based on the individual's 
        goals of care.
            (9) The Government of the United States, as the Nation's 
        largest purchaser of health care services, must learn from 
        these innovators and encourage health care providers to furnish 
        more supportive and comprehensive advanced illness care to 
        improve the efficacy and quality of health care delivered for 
        generations of Americans to come.
            (10) Health care providers who serve individuals with 
        advanced illness face complicated care systems and legal 
        concerns that may result in over- or under-treatment of 
        individuals with advanced illness.
            (11) Individuals have the well-established right to accept 
        or reject medical treatment that is offered, as well as the 
        well-established right to document their preferences for how 
        treatment decisions should be made if, at some point in the 
        future, they lose the ability to make health care decisions.
            (12) Too often, individuals with advanced illness do not 
        understand the conditions they are facing or their treatment 
        options, and they do not receive the information or support 
        they need to evaluate treatment options in light of their 
        personal goals and values and to document treatment plans in a 
        manner that allows providers and facilities to follow their 
        plans.
            (13) Providing quality services and planning support to 
        individuals with advanced illness will protect and preserve 
        their dignity.

SEC. 3. IMPROVEMENT OF ADVANCED ILLNESS PLANNING AND COORDINATION.

    (a) Medicare Coverage of Planning Services.--
            (1) Coverage.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (EE), by striking ``and'' at 
                the end;
                    (B) in subparagraph (FF), by inserting ``and'' at 
                the end; and
                    (C) by inserting after subparagraph (FF) the 
                following new paragraph:
                    ``(GG) planning services (as defined in subsection 
                (iii));''.
            (2) Services described.--Section 1861 of the Social 
        Security Act (42 U.S.C. 1395x) is amended by adding at the end 
        the following new subsection:

                          ``Planning Services

    ``(iii)(1)(A) The term `planning services' means a voluntary 
decisionmaking process that includes the elements described in 
paragraph (2) and is furnished to a planning services eligible 
individual by an applicable provider through an interdisciplinary team.
    ``(B) Planning services may only be furnished to a planning 
services eligible individual under this title once in each 12-month 
period.
    ``(2)(A) The elements described in this paragraph are the 
following:
            ``(i) One or more face-to-face encounters between one or 
        more members of the interdisciplinary team and the individual 
        and, at the individual's discretion, family caregivers, or, for 
        an individual who lacks decisionmaking capacity under State 
        law, the individual's legally authorized representative.
            ``(ii) The provision of information about the typical 
        trajectory of illnesses or conditions that affect the 
        individual, including foreseeable care decisions that may need 
        to be made at a future time when the individual is likely to be 
        unable to make decisions due to temporary or permanent 
        cognitive incapacity.
            ``(iii) Assisting the individual in defining and 
        articulating goals of care, values, and preferences.
            ``(iv) Providing the individual with (and discussing) 
        information about the benefits and burdens of a relevant range 
        of treatment options available to the individual, including 
        disease modifying or potentially curative treatment, palliative 
        care, which may be provided alone or in conjunction with 
        disease modifying treatment, and, when the individual may be 
        currently eligible or may become eligible for hospice care due 
        to disease progression, hospice care. An applicable provider 
        shall present and discuss relevant treatment options that may 
        help the individual to achieve goals of care and may not 
        exclude options based on an individual's age, disability 
        status, or the presence of advanced illness unless, in the 
        provider's clinical judgment, a treatment option will not 
        achieve the outcome sought by the individual.
            ``(v) Assisting the individual in evaluating treatment 
        options and approaches to care to identify those that most 
        closely align with the individual's goals of care, values, and 
        preferences.
            ``(vi) Preparing, and sharing with relevant providers, 
        documentation--
                    ``(I) that states the individual's goals of care, 
                preferences, and values, preferred decisionmaking 
                strategies, and a plan of care that is concrete, 
                achievable, and actionable; and
                    ``(II) that is in a paper or electronic format, on 
                State or locally recognized forms that are used for the 
                purpose of assuring that providers can follow the plan 
                across care settings, such as advance directives or 
                portable treatment orders.
            ``(vii) Referrals to providers, including medical and 
        social service providers, who deliver care consistent with the 
        plan.
            ``(viii) Providing culturally and educationally appropriate 
        training for the individual and family caregivers to support 
        their ability to carry out the plan.
    ``(B) Even when the individual's decisional capacity is impaired 
and another person or entity, such as an appointed agent, proxy, or 
surrogate, is exercising legal authority under State law governing 
decisionmaking on behalf of incapacitated individuals, the 
interdisciplinary team shall make a reasonable attempt to include the 
individual in the planning process.
    ``(3) For purposes of this subsection, the term `planning services 
eligible individual' means an individual that meets at least one of the 
following criteria:
            ``(A) The individual is diagnosed with metastatic or 
        locally advanced cancer.
            ``(B) The individual is diagnosed with Alzheimer's disease 
        or another progressive dementia.
            ``(C) The individual is diagnosed with late-stage 
        neuromuscular disease.
            ``(D) The individual is diagnosed with late-stage diabetes.
            ``(E) The individual is diagnosed with late-stage kidney, 
        liver, heart, gastrointestinal, cerebrovascular, or lung 
        disease.
            ``(F) The individual needs assistance with two or more 
        activities of daily living (defined as bathing, dressing, 
        eating, getting out of bed or a chair, mobility, and toileting) 
        that are caused by one or more progressive illnesses.
            ``(G) The individual meets other criteria determined 
        appropriate by the Secretary, including criteria that are 
        designed to identify individuals with a need for planning 
        services due to advancing illness or risk of decline in 
        cognitive function over time.
    ``(4) For purposes of this subsection, the term `applicable 
provider' means a hospice program (as defined in section 1861(dd)(2)) 
or other provider of services (as defined in section 1861(u)) or 
supplier (as defined in section 1861(d)) that--
            ``(A) furnishes planning services through an 
        interdisciplinary team; and
            ``(B) meets such other requirements the Secretary may 
        determine to be appropriate.
    ``(5)(A) For purposes of this subsection, the term 
`interdisciplinary team' means a group that--
            ``(i) includes--
                    ``(I) a core team of a physician or an advance 
                practice registered nurse, a social worker, a nurse; 
                and, subject to subparagraph (B), a chaplain, a 
                minister, or the individual's personal religious or 
                spiritual advisor; and
                    ``(II) when necessary to meet an individual's 
                planning needs, other professionals, which may include 
                a pharmacist, a licensed clinical social worker, and a 
                psychologist, either as ongoing team members or who may 
                be brought in as needed to address the individual's 
                planning needs; and
            ``(ii) meets requirements that may be established by the 
        Secretary.
    ``(B) An applicable provider furnishing planning services to a 
planning services eligible individual shall offer to the individual (or 
the individual's legally authorized representative when the individual 
has been found to lack decisional capacity) the opportunity to select 
either a chaplain affiliated with the provider, a minister, or personal 
religious or spiritual advisor who can help to represent the 
individual's goals, values, and preferences to serve as a core team 
member at the individual's (or legally authorized representative's) 
request.
    ``(C) The requirements established by the Secretary under 
subparagraph (A)(ii) shall include a requirement that interdisciplinary 
team members (except for the individuals's chosen minister or personal 
religious or spiritual advisor) have training and experience in 
delivering person-directed planning services and in team-based delivery 
of services for individuals with dementing illness and individuals with 
advanced illness.''.
            (3) Payment under physician fee schedule.--Section 
        1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) 
        is amended by inserting ``(2)(GG),'' after ``(2)(FF) (including 
        administration of the health risk assessment),''.
            (4) Frequency limitation.--Section 1862(a) of the Social 
        Security Act (42 U.S.C. 1395y(a)) is amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (O), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (P) by striking the 
                        semicolon at the end and inserting ``, and''; 
                        and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(Q) in the case of planning services (as defined 
                in section 1861(iii)(1)), which are furnished more 
                frequently than is covered under subparagraph (B) of 
                such section;''; and
                    (B) in paragraph (7), by striking ``or (P)'' and 
                inserting ``(P), or (Q)''.
            (5) Effective date.--The amendments made by this subsection 
        shall apply to services furnished on or after January 1, 2015.
    (b) Medicaid Coverage of Planning Services.--
            (1) In general.--Section 1905(a) of the Social Security Act 
        (42 U.S.C. 1396d(a)) is amended--
                    (A) by redesignating paragraph (29) as paragraph 
                (30);
                    (B) in paragraph (28), by striking at the end 
                ``and''; and
                    (C) by inserting after paragraph (28) the following 
                new paragraph:
            ``(29) planning services (as defined in section 1861(iii)); 
        and''.
            (2) Conforming amendment.--Section 1902(a)(10)(A) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by 
        striking ``and (28)'' and inserting ``, (28), and (29)''.
            (3) Effective date.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the amendments made by paragraphs (1) and (2) take 
                effect on January 1, 2015.
                    (B) Extension of effective date for state law 
                amendment.--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 paragraphs (1) and (2), 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 the 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.
    (c) Advanced Illness Care Coordination Services Project.--Section 
1115A(b)(2) of title XI of the Social Security Act (42 U.S.C. 
1315a(b)(2)) is amended--
            (1) in subparagraph (A), by adding at the end the following 
        new sentence: ``The models selected under this subparagraph 
        shall include the model described in subparagraph (D) and such 
        model shall be implemented by not later than December 31, 
        2015.''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Advanced illness care coordination services 
                model.--
                            ``(i) Model.--
                                    ``(I) In general.--The model 
                                described in this subparagraph is a 
                                model under which payments are made to 
                                applicable providers that furnish 
                                advanced illness care coordination 
                                services to eligible individuals.
                                    ``(II) Requirement.--At least one 
                                applicable provider selected for 
                                participation under the model shall be 
                                a hospice program (as defined in 
                                section 1861(dd)(2)).
                            ``(ii) Applicable provider.--In this 
                        subparagraph, the term `applicable provider' 
                        means a hospice program (as defined in section 
                        1861(dd)(2)) or other provider of services (as 
                        defined in section 1861(u)) or supplier (as 
                        defined in section 1861(d)) that--
                                    ``(I) furnishes advanced illness 
                                care coordination services through an 
                                interdisciplinary team (as defined in 
                                section 1861(iii)(5)); and
                                    ``(II) meets such other 
                                requirements the Secretary may 
                                determine to be appropriate.
                            ``(iii) Advanced illness care coordination 
                        services.--In this subparagraph, the term 
                        `advanced illness care coordination services' 
                        means the following services:
                                    ``(I) Planning services (as defined 
                                in section 1861(iii)).
                                    ``(II) A multi-dimensional 
                                assessment of the individual's 
                                strengths and limitations.
                                    ``(III) An assessment of the 
                                individual's formal and informal 
                                supports, including family caregivers.
                                    ``(IV) Comprehensive medication 
                                review and management (including, if 
                                appropriate, counseling and self-
                                management support).
                                    ``(V) In-home supportive services 
                                for the eligible individual and family 
                                caregivers consistent with the care 
                                plan.
                                    ``(VI) 24-hour access to emergency 
                                support in person or via telephone or 
                                telemedicine with the individual's 
                                medical record and care plan available 
                                to the responder.
                                    ``(VII) Coordination across health 
                                care and social service systems, 
                                including involvement of the 
                                interdisciplinary team to evaluate 
                                quality and address concerns.
                                    ``(VIII) Such other services as 
                                specified by the Secretary.
                            ``(iv) Eligible individual.--In this 
                        subparagraph, the term `eligible individual' 
                        means an individual who--
                                    ``(I) is entitled to, or enrolled 
                                for, benefits under part A of title 
                                XVIII and enrolled under part B of such 
                                title, but not enrolled under part C of 
                                such title; and
                                    ``(II) has the need for assistance 
                                with two or more activities of daily 
                                living (defined as bathing, dressing, 
                                eating, getting out of bed or a chair, 
                                mobility, and toileting) that are 
                                caused by one or more progressive 
                                conditions.''.

SEC. 4. QUALITY MEASUREMENT DEVELOPMENT.

    (a) In General.--Section 931(c)(2) of the Public Health Service Act 
(42 U.S.C. 299b-31(c)(2)) is amended--
            (1) by redesignating subparagraphs (I) and (J) as 
        subparagraphs (L) and (M), respectively; and
            (2) by inserting after subparagraph (H) the following new 
        subparagraphs:
                    ``(I) the process of eliciting and documenting 
                patient (and, where relevant and appropriate, family 
                caregiver) goals, preferences, and values from the 
                patient or from a legally authorized representative, 
                including the articulation of goals that accurately 
                reflect how the patient wants to live;
                    ``(J) the effectiveness, patient-centeredness (and, 
                where relevant, family caregiver-centeredness), and 
                accuracy of care plans, including documentation of 
                individual goals, preferences, and values;
                    ``(K) agreement and consistency among--
                            ``(i) the patient's goals, values, and 
                        preferences;
                            ``(ii) any documented care plan;
                            ``(iii) the treatment delivered; and
                            ``(iv) outcomes of treatment;''.
    (b) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary of Health and Human Services to carry out 
the amendments made by this section, $5,000,000 for fiscal year 2014. 
Amounts appropriated under the preceding sentence shall remain 
available until expended.

SEC. 5. INCLUSION OF ADVANCE CARE PLANNING MATERIALS IN THE MEDICARE & 
              YOU HANDBOOK.

    (a) In General.--Section 1804(a) of the Social Security Act (42 
U.S.C. 1395b-2(a)) is amended--
            (1) in paragraph (2), by striking ``and'' at the end;
            (2) in paragraph (3), by striking the period at the end and 
        inserting a semicolon; and
            (3) by inserting after paragraph (3) the following new 
        paragraphs:
            ``(4) information on--
                    ``(A) care planning;
                    ``(B) how individual goals, values, and preferences 
                should be considered in framing a care plan; and
                    ``(C) a range of approaches for treating advanced 
                illness, including disease modifying options, 
                palliative care that supports individuals from the 
                onset of advanced illness and can be provided at the 
                same time as all other care types, and hospice care; 
                and
            ``(5) information on documentation options for care 
        planning or advance care planning, including advance directives 
        and portable treatment orders.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to notices distributed on or after January 1, 2015.

SEC. 6. CARE PLANNING ADVISORY BOARD.

    (a) Establishment.--The Secretary of Health and Human Services 
shall establish the Care Planning Advisory Board (in this section 
referred to as the ``Advisory Board'').
    (b) Membership.--
            (1) In general.--The Advisory Board shall be composed of 15 
        members, to be appointed not later than 30 days after the date 
        of the enactment of this Act, as follows:
                    (A) The President of the United States shall 
                appoint 3 members.
                    (B) The majority leader of the Senate shall appoint 
                3 members.
                    (C) The minority leader of the Senate shall appoint 
                3 members.
                    (D) The Speaker of the House of Representatives 
                shall appoint 3 members.
                    (E) The minority leader of the House of 
                Representatives shall appoint 3 members.
            (2) Representation.--The membership of the Advisory Board 
        shall include individuals who (with a preference for 
        individuals who also are members of the group they are 
        appointed to represent)--
                    (A) represent the interests of--
                            (i) patient advocacy groups;
                            (ii) older adults;
                            (iii) individuals with cognitive or 
                        functional limitations;
                            (iv) family caregivers for individuals 
                        described in clause (ii) or (iii);
                            (v) palliative care and hospice providers;
                            (vi) researchers;
                            (vii) ethicists;
                            (viii) faith communities;
                            (ix) health care providers; and
                            (x) health care facilities;
                    (B) have demonstrated experience in dealing with 
                issues related to health care decisionmaking and health 
                care policy; and
                    (C) represent the health care interests and needs 
                of a variety of geographic areas and demographic 
                groups.
    (c) Duties.--The Advisory Board shall advise the Secretary on 
issues related to care planning, advanced illness coordination 
services, advance care planning, and documentation options, including 
how to--
            (1) assure that individuals with advanced illness receive 
        person- and family-centered care;
            (2) assist individuals with advanced illness to develop a 
        treatment plan that is formed around their goals, values, and 
        preferences, that is informed by research on disease 
        trajectory, and that includes a documented plan that is 
        realistic, actionable, and concrete, and that may include the 
        use of advance directives, portable treatment orders (where 
        appropriate), or other forms used in the State or locality;
            (3) develop and monitor a demonstration program that 
        includes an optimal service array to support individuals with 
        advanced illness with services designed to manage symptoms as 
        illness progresses;
            (4) provide health care that is consistent with 
        individuals' current treatment preferences or, for those whose 
        capacity to make decisions is impaired, with the individuals' 
        values and goals, and specific directions documented in advance 
        directives and portable treatment orders;
            (5) encourage provider participation in educational and 
        training activities addressing care planning, advanced illness 
        care, and advance care planning;
            (6) develop quality measures, including process, outcome, 
        and experience measures, that applicable providers should 
        report for planning services (as defined in section 1861(iii) 
        of the Social Security Act, as added by section 3);
            (7) determine the appropriate role for discharge planners 
        in educating individuals and their families about care planning 
        services, advance care planning, palliative care, hospice, 
        advance directives, portable treatment orders, and other 
        relevant services, supports, planning tools, and documentation 
        options;
            (8) develop and promote best practices in communications 
        about advanced illness between providers, individuals, and 
        family caregivers in different settings, including acute care 
        hospitals;
            (9) evaluate the feasibility of replacing life expectancy 
        in months with clinical criteria to determine eligibility for 
        hospice care; and
            (10) promote effective advance care planning and effective 
        and appropriate use of portable treatment orders.
    (d) Application of FACA.--The Federal Advisory Committee Act (5 
U.S.C. App.) shall apply to the Advisory Board.
    (e) Pay and Reimbursement.--
            (1) No compensation for members of advisory board.--Except 
        as provided in paragraph (2), a member of the Advisory Board 
        may not receive pay, allowances, or benefits by reason of their 
        service on the Board.
            (2) Travel expenses.--Each member shall receive travel 
        expenses, including per diem in lieu of subsistence under 
        subchapter I of chapter 57 of title 5, United States Code.
    (f) Report.--Not later than 3 years after the establishment of the 
Advisory Board, the Advisory Board shall submit to Congress a final 
report containing the findings and conclusions of the Advisory Board, 
together with recommendations for such legislation and administrative 
actions as the Advisory Board considers appropriate.
    (g) Termination.--The Advisory Board shall terminate 30 days after 
submitting the report under subsection (f).
    (h) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 7. IMPROVEMENT OF POLICIES RELATED TO THE USE AND PORTABILITY OF 
              ADVANCE DIRECTIVES.

    (a) Medicare.--Section 1866(f) of the Social Security Act (42 
U.S.C. 1395cc(f)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A)(i), by striking ``State 
                law'' and all that follows through ``medical care'' and 
                inserting ``relevant State and Federal law (whether 
                statutory or as recognized by the courts) to make 
                decisions concerning medical care'';
                    (B) by striking subparagraph (B);
                    (C) by redesignating subparagraphs (C), (D), and 
                (E) as subparagraphs (G), (H), and (I), respectively;
                    (D) by inserting after subparagraph (A) the 
                following new subparagraphs:
            ``(B) to document in a prominent part of the individual's 
        current medical record whether or not the individual has an 
        advance directive or portable treatment order, to request a 
        copy of the advance directive or portable treatment order, as 
        applicable, and if received, to include the copy (or the 
        content of the document or documents) in a prominent part of 
        such record;
            ``(C) to provide each individual with the opportunity to 
        discuss the information provided pursuant to subparagraph (A) 
        with an appropriately trained employee or volunteer of the 
        provider or organization;
            ``(D) for an individual with decisional capacity under 
        State law, to follow the individual's current treatment 
        instructions, as expressed in writing or through verbal or 
        nonverbal communications;
            ``(E) for an individual who lacks decisional capacity--
                    ``(i) to ensure that treatment decisions are made 
                in accordance with current preferences, values, and 
                goals of the individual, when possible to ascertain and 
                follow, and in accordance with current advance 
                directives and portable treatment orders that are valid 
                under State law where the care is delivered, and 
                instructions provided by legally authorized 
                representatives in accordance with State and Federal 
                law;
                    ``(ii) in the absence of a current advance 
                directive or portable treatment order that is valid 
                under State law where the care is delivered, to deliver 
                treatment based on credible evidence of the 
                individual's treatment preferences, goals, and values, 
                such as a current advance directive or portable 
                treatment order executed in another State or past 
                statements about treatment preferences; and
                    ``(iii) to reconcile actual or suspected 
                discrepancies among advance directives, portable 
                treatment orders, and other evidence in accordance with 
                State law, and, where State law is silent, to reconcile 
                discrepancies in the manner most likely to deliver 
                treatment that is consistent with the individual's 
                treatment preferences, goals, and values;
            ``(F) that specify narrow, but potentially recurring, 
        conditions or circumstances under which an advance directive, 
        portable treatment order, or treatment directions from an 
        individual or legally authorized representative would not be 
        followed, such as--
                    ``(i) where the validity or authenticity of a 
                document is in question;
                    ``(ii) where there is evidence that an individual's 
                preferences changed after the individual documented 
                preferences in an advance directive or portable 
                treatment order;
                    ``(iii) where the treatment sought by the 
                individual is not medically indicated; and
                    ``(iv) because of conscience objections in 
                accordance with paragraph (3);'';
                    (E) in subparagraph (H), as redesignated by 
                subparagraph (C), by striking ``State law'' and all 
                that follows through ``respecting'' and inserting 
                ``this section and relevant State and Federal law 
                (whether statutory or as recognized by the courts) 
                respecting'';
                    (F) in subparagraph (I), as redesignated by 
                subparagraph (C), by inserting ``and portable treatment 
                orders'' before the period at the end;
                    (G) in the flush matter at the end, by striking 
                ``(C)'' and inserting ``(G)''; and
                    (H) by adding at the end the following new 
                sentence: ``Nothing in subparagraph (D) or (E) shall be 
                construed to apply to sterilization or abortion.'';
            (2) by redesignating paragraphs (3) and (4) as paragraphs 
        (4) and (5), respectively;
            (3) by inserting after paragraph (2) the following new 
        paragraph:
    ``(3) Nothing in this section shall be construed to prohibit the 
application of a State law which allows for an objection on the basis 
of conscience for any health care provider or any agent of such 
provider which as a matter of conscience cannot implement an advance 
directive.'';
            (4) in paragraph (4), as redesignated by paragraph (2)--
                    (A) by striking ``written'';
                    (B) by striking ``State law'' and inserting ``State 
                or Federal law''; and
                    (C) by striking ``of the State'';
            (5) by redesignating paragraph (5), as redesignated by 
        paragraph (2), as paragraph (6);
            (6) by inserting after paragraph (4) the following new 
        paragraph:
    ``(5) In this subsection, the term `portable treatment order' means 
a treatment order designed to document a clinical process that includes 
shared, informed medical decisionmaking, that reflects the individual's 
goals of care and values, and that is designed to apply across care 
settings, including the home.''; and
            (7) by inserting after paragraph (6), as redesignated by 
        paragraph (6), the following new paragraph:
    ``(7) Nothing in this subsection shall permit the Secretary to seek 
civil penalties, including exclusion from participation in the program 
under this title or the program under title XIX, against an individual 
or entity if the individual or entity--
            ``(A) used reasonable efforts to deliver care that is 
        consistent with an individual's goals, preferences, and values 
        when addressing decisionmaking for an individual who lacks 
        decisional capacity; or
            ``(B) declined to furnish care in accordance with paragraph 
        (3).''.
    (b) Medicaid.--Section 1902(w) of the Social Security Act (42 
U.S.C. 1396a(w)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A)(i), by striking ``State 
                law'' and all that follows through ``medical care'' and 
                inserting ``relevant State and Federal law (whether 
                statutory or as recognized by the courts) to make 
                decisions concerning medical care'';
                    (B) by striking subparagraph (B);
                    (C) by redesignating subparagraphs (C), (D), and 
                (E) as subparagraphs (F), (G), and (H), respectively;
                    (D) by inserting after subparagraph (A) the 
                following new subparagraphs:
            ``(B) to document in a prominent part of the individual's 
        current medical record whether or not the individual has an 
        advance directive or portable treatment order, to request a 
        copy of the advance directive and or portable treatment order, 
        and if received, to include the copy (or the content of the 
        document or documents) in a prominent part of such record;
            ``(C) to provide each individual with the opportunity to 
        discuss the information provided pursuant to subparagraph (A) 
        with an appropriately trained personnel of the provider or 
        organization;
            ``(D) for an individual with decisional capacity under 
        State law, to follow the individual's current treatment 
        instructions, as expressed in writing or through verbal or non-
        verbal communications;
            ``(E) for an individual who lacks decisional capacity--
                    ``(i) to ensure that treatment decisions are made 
                in accordance with State law addressing legally 
                authorized representatives and advance directives;
                    ``(ii) in the absence of a current advance 
                directive or portable treatment order, to deliver 
                treatment based on credible evidence of the 
                individual's treatment preferences, goals, and values, 
                such as an advance directive or portable treatment 
                order executed in another State or past statements 
                about treatment preferences; and
                    ``(iii) to reconcile actual or suspected 
                discrepancies among advance directives, portable 
                treatment orders, and other evidence in accordance with 
                State law, and, where State law is silent, to reconcile 
                discrepancies in the manner most likely to deliver 
                treatment that is consistent with the individual's 
                treatment preferences, goals, and values;
            ``(F) that specify narrow, but potentially recurring, 
        conditions or circumstances under which an advance directive, 
        portable treatment order, or treatment directions from an 
        individual or legally authorized representative would not be 
        followed, such as--
                    ``(i) where the validity or authenticity of a 
                document is in question;
                    ``(ii) where there is evidence that an individual's 
                preferences changed after the individual documented 
                preferences in an advance directive or portable 
                treatment order;
                    ``(iii) where the treatment sought by the 
                individual is not medically indicated; and
                    ``(iv) because of conscience objections in 
                accordance with paragraph (3);'';
                    (E) in subparagraph (H), as redesignated by 
                subparagraph (C), by striking ``State law'' and all 
                that follows through ``respecting'' and inserting 
                ``this section and relevant State and Federal law 
                (whether statutory or as recognized by the courts) 
                respecting'';
                    (F) in subparagraph (I), as redesignated by 
                subparagraph (C), by inserting ``and portable treatment 
                orders'' before the period at the end;
                    (G) in the flush matter at the end, by striking 
                ``(C)'' and inserting ``(G)''; and
                    (H) by adding at the end the following new 
                sentence: ``Nothing in subparagraph (D) or (E) shall be 
                construed to apply to sterilization or abortion.''; and
            (2) in paragraph (4)--
                    (A) by striking ``written'';
                    (B) by striking ``State law'' and inserting ``State 
                or Federal law''; and
                    (C) by striking ``of the State'';
            (3) by redesignating paragraph (5) as paragraph (6);
            (4) by inserting after paragraph (4) the following new 
        paragraph:
    ``(5) In this subsection, the term `portable treatment order' means 
a treatment order designed to document a clinical process that includes 
shared, informed medical decisionmaking, that reflects the individual's 
goals of care and values, and that is designed to apply across care 
settings, including the home.''; and
            (5) by inserting after paragraph (6), as redesignated by 
        paragraph (3), the following new paragraph:
    ``(7) Nothing in this subsection shall permit the Secretary to seek 
civil penalties, including exclusion from participation in the program 
under this title or the program under title XVIII, against an 
individual or entity if the individual or entity--
            ``(A) used reasonable efforts to deliver care that is 
        consistent with an individual's goals, preferences, and values 
        when addressing decisionmaking for an individual who lacks 
        decisional capacity; or
            ``(B) declined to furnish care in accordance with paragraph 
        (3).''.
    (c) Clarification With Respect to Advance Directives.--Section 7 of 
the Assisted Suicide Funding Restriction Act of 1997 (42 U.S.C. 14406) 
is amended--
            (1) in paragraph (1), by striking ``or'' at the end; and
            (2) by striking paragraph (2) and inserting the following:
            ``(2) to require any provider or organization, or any 
        employee of such a provider or organization, to follow or be 
        bound by a request from an individual or legally authorized 
        representative, an advance directive, or a portable treatment 
        order that directs the purposeful causing of, or the purposeful 
        assisting in causing, the death of any individual, such as by 
        assisted suicide, euthanasia, or mercy killing; or
            ``(3) to allow discrimination against or imposition of 
        penalties on any provider or organization, or any employee of 
        such a provider or organization, that refuses, for any reason, 
        including an objection based on a religious, conscience, or 
        moral objection, to inform, counsel, or in any way participate 
        in the purposeful causing of, or the purposeful assisting in 
        causing, the death of any individual, such as by assisted 
        suicide, euthanasia, or mercy killing.''.
    (d) Effective Dates.--
            (1) In general.--Subject to paragraph (2), the amendments 
        made by subsections (a) and (b) shall apply to provider 
        agreements and contracts entered into, renewed, or extended 
        under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
        seq.), and to State plans under title XIX of such Act (42 
        U.S.C. 1396 et seq.), on or after such date as the Secretary of 
        Health and Human Services specifies, but in no case may such 
        date be later than 1 year after the date of the enactment of 
        this Act.
            (2) Extension of effective date for state law amendment.--
        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 of 
        Health and Human Services determines requires State legislation 
        in order for the plan to meet the additional requirements 
        imposed by the amendments made by subsection (b), 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 the 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.

SEC. 8. ADDITIONAL REQUIREMENTS FOR FACILITIES.

    (a) Requirements.--
            (1) In general.--Section 1866(a)(1) of the Social Security 
        Act (42 U.S.C. 1395cc(a)(1)) is amended--
                    (A) in subparagraph (V), by striking ``and'' at the 
                end;
                    (B) in subparagraph (W), as added by section 
                3005(1)(C) of the Patient Protection and Affordable 
                Care Act (Public Law 111-148), by redesignating such 
                subparagraph as subparagraph (X), moving such 
                subparagraph to follow subparagraph (V), moving such 
                subparagraph 2 ems to the left, and striking the period 
                at the end and inserting a comma;
                    (C) in subparagraph (W), as added by section 
                6406(b)(3) of the Patient Protection and Affordable 
                Care Act (Public Law 111-148), by redesignating such 
                subparagraph as subparagraph (Y), moving such 
                subparagraph to follow subparagraph (X), as added by 
                subparagraph (B), moving such subparagraph 2 ems to the 
                left, and striking the period at the end and inserting 
                ``, and''; and
                    (D) by inserting after subparagraph (Y) the 
                following new subparagraph:
            ``(Z) in the case of hospitals, skilled nursing facilities, 
        home health agencies, and hospice programs, to assure that 
        appropriate documentation of care plans made while the 
        individual received care by or through the provider (which may 
        include advance directives, portable orders, or other locally 
        appropriate documents) be completed prior to discharge to allow 
        the plan to be carried out after discharge.''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to agreements entered into or renewed on or after 
        January 1, 2015.
    (b) HHS Study and Report.--
            (1) Study.--The Secretary of Health and Human Services 
        shall conduct a study on the extent to which hospitals, skilled 
        nursing facilities, hospice programs, home health agencies, and 
        applicable providers of planning services under section 
        1861(iii) of the Social Security Act, as added by section 3(a), 
        work with individuals to--
                    (A) engage in a care planning process;
                    (B) thoroughly and completely document the care 
                planning process in the medical record;
                    (C) complete documents necessary to support the 
                treatment and care plan, such as portable treatment 
                orders and advance directives;
                    (D) provide services and support that is free from 
                discrimination based on advanced age, disability 
                status, or advanced illness; and
                    (E) provide documentation necessary to carry out 
                the treatment plan to--
                            (i) subsequent providers or facilities; and
                            (ii) the individual, their legally 
                        authorized representatives, and, where 
                        appropriate and relevant, their family 
                        caregiver.
            (2) Report.--Not later than January 1, 2018, the Secretary 
        of Health and Human Services shall submit to Congress a report 
        on the study conducted under paragraph (1) together with 
        recommendations for such legislation and administrative action 
        as the Secretary determines to be appropriate.

SEC. 9. GRANTS FOR INCREASING PUBLIC AWARENESS OF ADVANCE CARE PLANNING 
              AND ADVANCED ILLNESS CARE.

    (a) Material and Resources Development.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') is 
        authorized to award grants to entities described in subsection 
        (d) to develop online training modules, decision support tools, 
        and instructional materials for individuals, family caregivers, 
        and health care providers that include--
                    (A) for healthy individuals, the importance of--
                            (i) identifying an individual who will make 
                        treatment decisions in the event of future 
                        cognitive incapacity;
                            (ii) discussing values and goals relevant 
                        to catastrophic injury or illness; and
                            (iii) completing an advance directive 
                        that--
                                    (I) appoints a surrogate; and
                                    (II) documents goals and values and 
                                other information that should be 
                                considered in making treatment 
                                decisions;
                    (B) for individuals with advanced illness, the 
                importance of--
                            (i) articulating goals of care;
                            (ii) understanding prognosis and typical 
                        disease trajectory;
                            (iii) evaluating treatment options in light 
                        of goals of care;
                            (iv) developing a treatment plan; and
                            (v) documenting the treatment plan on 
                        advance directives, portable treatment orders, 
                        and other documentation forms used in the 
                        locality where the plan is to be executed;
                    (C) the role and effective use of State and other 
                advance directive forms and portable treatment orders; 
                and
                    (D) the range of services for individuals facing 
                advanced illness, including planning services, 
                palliative care, and hospice care.
            (2) Period.--Any grant awarded under paragraph (1) shall be 
        for a period of 3 years.
    (b) Establishment and Maintenance of Web- and Telephone-Based 
Resources.--
            (1) In general.--The Secretary is authorized to award 
        grants to entities described in subsection (d) to establish and 
        maintain a website and telephone hotline to disseminate 
        resources developed under subsection (a) and materials designed 
        by the Department of Health and Human Services Center for 
        Faith-Based and Neighborhood Partnerships for faith 
        communities.
            (2) Period.--Any grant awarded under paragraph (1) shall be 
        for a period of 5 years.
            (3) Ability to sustain activities.--The Secretary shall 
        take into account the ability of an entity to sustain the 
        activities described in paragraph (1) beyond the 5-year grant 
        period in determining whether to award a grant under paragraph 
        (1) to the entity.
    (c) National Public Education Campaign.--
            (1) In general.--The Secretary is authorized to award 
        grants to entities described in subsection (d) to conduct a 
        national public education campaign to raise public awareness of 
        advance care planning and advanced illness care, including the 
        availability of the resources created under subsections (a) and 
        (b).
            (2) Period.--Any grant awarded under paragraph (1) shall be 
        for a period of 5 years.
    (d) Eligible Entities.--Entities described in this subsection are 
public or private entities (including States or political subdivisions 
of a State, faith-based organizations, and religious educational 
institutions), or a consortium of any such entities.
    (e) Authorization of Appropriations.--
            (1) In general.--There are authorized to be appropriated to 
        the Secretary--
                    (A) for purposes of making grants under subsection 
                (a), $5,000,000 for fiscal year 2015, to remain 
                available until expended;
                    (B) for purposes of making grants under subsection 
                (b), $5,000,000 for fiscal year 2015, to remain 
                available until expended; and
                    (C) for purposes of making grants under subsection 
                (c), $5,000,000 for fiscal year 2015 to remain 
                available until expended.
            (2) Limitation.--None of the funds appropriated under 
        paragraph (1) shall be used to--
                    (A) develop a model advance directive;
                    (B) develop or employ a dollars-per-quality 
                adjusted life year (or similar measure that discounts 
                the value of a life because of an individual's 
                disability); or
                    (C) make a grant to a private entity that 
                advocates, promotes, or facilitates any item or 
                procedure for which funding is unavailable under the 
                Assisted Suicide Funding Restriction Act of 1997 
                (Public Law 105-12).

SEC. 10. HHS STUDY AND REPORT ON THE STORAGE OF ADVANCE DIRECTIVES.

    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study on State and regional activities with respect to 
storing completed advance directives and portable treatment orders. 
Such study shall include an analysis of the practicality and 
feasibility of establishing a national registry for completed advance 
directives and portable treatment orders, 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).
    (b) Report.--Not later than January 1, 2017, the Secretary of 
Health and Human Services shall submit to Congress a report on the 
study conducted under subsection (a) together with recommendations for 
such legislation and administrative action as the Secretary determines 
to be appropriate.

SEC. 11. GAO STUDY AND REPORT ON THE PROVISIONS OF, AND AMENDMENTS MADE 
              BY, THIS ACT.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall conduct a 
study on the provisions of, and amendments made by, this Act, including 
the quality (such as individual and family experience, individual 
understanding of treatment choices, and alignment among individual 
goals, values, and preferences, the documented care plan, treatment 
delivered, and treatment outcomes) associated with such provisions and 
such amendments.
    (b) Report.--Not later than January 1, 2018, the Comptroller 
General shall submit to Congress a report containing the results of the 
study conducted under subsection (a), together with recommendations for 
such legislation and administrative action as the Comptroller General 
determines appropriate.

SEC. 12. CONSULTATION WITH THE CARE PLANNING ADVISORY BOARD.

    The Secretary of Health and Human Services shall consult with the 
Care Planning Advisory Board established under section 6 in order to 
ensure that every activity carried out under the provisions of, and 
amendments made by, this Act will help individuals to--
            (1) receive education and care that is free from 
        discrimination based on advanced age, disability status, or 
        presence of advanced illness;
            (2) develop plans and receive care that is consistent with 
        each individual's goals, values and preferences; and
            (3) receive an explanation of a range of perspectives on 
        approaches for treating advanced illness, including disease 
        modifying options, palliative care that supports individuals 
        from the onset of advanced illness and can be provided at the 
        same time as all other care types, and hospice care.

SEC. 13. RULE OF CONSTRUCTION.

    Nothing in the provisions of, or the amendments made by, this Act 
shall be construed to limit the restrictions of, or to authorize the 
use of Federal funds for any service, material, or activity pertaining 
to an item or service or procedure for which funds are unavailable 
under, the Assisted Suicide Funding Restriction Act of 1997 (Public Law 
105-12).
                                 <all>