[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2797 Introduced in House (IH)]
<DOC>
115th CONGRESS
1st Session
H. R. 2797
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 HOUSE OF REPRESENTATIVES
June 7, 2017
Mr. Blumenauer (for himself and Mr. Roe of Tennessee) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to 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 ``Patient Choice and
Quality Care Act of 2017''.
(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. Advanced illness care and management model.
Sec. 4. Quality measurement development and implementation.
Sec. 5. Enhancing coverage of advance care planning services.
Sec. 6. Advance care planning support tools.
Sec. 7. Advance directives.
Sec. 8. Additional requirements for facilities.
Sec. 9. Grants for increasing public awareness and training.
Sec. 10. Advance Care Planning Advisory Council.
Sec. 11. Annual report on Medicare decedents.
Sec. 12. 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 98 million, or 1 in 5 Americans, by 2040.
(2) As Americans live longer and healthier lives, they also
face increased incidence of multiple serious or chronic
progressive conditions and advanced illness as they age.
(3) Americans with serious, chronic progressive, or
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 serious, chronic progressive, or
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
serious, chronic progressive, or 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 serious, chronic
progressive, or advanced illness.
(7) Hospice and palliative care programs offer patients and
families appropriate and patient-centered care, delivered by an
interdisciplinary care team. These programs should serve as
models for advanced illness care delivery.
(8) Individuals have the well-established right to accept
or reject medical treatment that is offered and all individuals
should be afforded the opportunity to fully participate in
decisions related to their health care.
(9) Too often, individuals with serious, chronic
progressive, or 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.
(10) Providing high-quality advanced care planning services
and supports to individuals with serious, chronic progressive,
or advanced illness will protect and preserve their dignity and
ensure care is aligned with an individual's goals, values, and
stated preferences.
SEC. 3. ADVANCED ILLNESS CARE AND MANAGEMENT MODEL.
Section 1115A of the Social Security Act (42 U.S.C. 1315a) is
amended--
(1) in subsection (b)(2)(A), by adding at the end the
following new sentence: ``The models selected under this
subparagraph shall include the model described in subsection
(h), which shall be implemented by not later than 1 year after
the date of the enactment of the Patient Choice and Quality
Care Act of 2017.''; and
(2) by adding at the end the following new subsection:
``(h) Advanced Illness Care and Management Model.--
``(1) Model.--
``(A) In general.--The model described in this
subparagraph is a model under which payments are made
under title XVIII to applicable providers that furnish
advanced illness care and management services,
including care coordination and palliative care
services, to eligible individuals with serious, chronic
progressive, or advanced illness in order to test the
use of targeted advanced illness management and early
use of palliative care under the Medicare program.
``(B) Voluntary.--Participation under the model
shall be voluntary with respect to both eligible
individuals and applicable providers.
``(C) Requirements.--
``(i) Hospice provider.--At least one
applicable provider selected for participation
under the model shall be a hospice program (as
defined in section 1861(dd)(2)).
``(ii) Comparison.--The Secretary shall
establish the model in such a manner as will
permit the comparison of outcomes for eligible
individuals participating under the model and
eligible individuals who are not so
participating.
``(iii) Incorporation into existing
models.--In addition to operating the model
independently, the Secretary shall incorporate
the model into existing models related to the
Medicare program, such as models involving
accountable care organizations, bundled
payments, and value based purchasing
arrangements, and other coordinated care models
as the Secretary determines to be appropriate.
``(2) Payments.--Under the model, the Secretary shall
establish payment amounts for advanced illness care and
management services that is targeted to eligible individuals
with a serious, chronic progressive, or advanced illness. The
payments may include payments under a fee schedule, capitated
payments, bundled payments, value-based purchasing agreements,
and other payment mechanisms determined appropriate by the
Secretary.
``(3) Advanced illness care and management services
defined.--In this subsection, the term `advanced illness care
and management services' means the following services, as
appropriate for the individual's illness and stage of illness:
``(A) 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.
``(B) 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 or
medical incapacity.
``(C) Assisting the individual in defining and
articulating goals of care, values, and preferences.
``(D) Providing the individual with and discussing
information about the benefits and burdens of relevant
ranges 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.
``(E) 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.
``(F) 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 and actionable; and
``(ii) that is in 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.
``(G) Referrals to providers, including medical and
social service providers, who deliver care consistent
with the plan.
``(H) Providing culturally and educationally
appropriate training for the individual and family
caregivers to support their ability to carry out the
plan.
``(I) A multidimensional assessment of the
individual's strengths and limitations.
``(J) An assessment of the individual's paid and
unpaid supports, including family caregivers.
``(K) Comprehensive medication review and
management (including, if appropriate, counseling and
self-management support).
``(L) Visits to the patient in all sites of care
(including the home, a hospital, and a nursing home) as
needed to respond appropriately to problems and
concerns.
``(M) Additional services, consistent with the care
plan, that the interdisciplinary team believes would
assist the eligible individual and family caregivers in
more effectively managing their health condition.
``(N) 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.
``(O) Care coordination and communication across
health care and social service settings and providers,
including involvement of the interdisciplinary team to
evaluate quality and address concerns over time.
``(P) Such other palliative and other services that
the Secretary determines appropriate.
``(4) Applicable provider defined.--In 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 services through an
interdisciplinary team; and
``(B) meets such other requirements the Secretary
may determine to be appropriate.
``(5) Eligible individual defined.--In this subsection, the
term `eligible individual' means an individual who--
``(A) 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;
``(B) resides at home or in an institutional
setting, whichever is consistent with their personal
goals and preferences; and
``(C) meets at least one of the following:
``(i) The individual 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 is caused by one or more
serious or life threatening conditions or
frailty and that is not associated with an
acute or post-operative condition.
``(ii) The individual is diagnosed with a
serious, chronic progressive or advanced
illness that--
``(I) has a strong negative impact
on the individual's quality of life and
functioning in life roles, independent
of its impact on mortality; or
``(II) is burdensome in symptoms,
treatments or caregiver stress.
``(iii) The individual is diagnosed with--
``(I) metastatic or locally
advanced cancer;
``(II) Alzheimer's disease or
another progressive dementia;
``(III) late-stage neuromuscular
disease;
``(IV) late-stage diabetes;
``(V) late-stage kidney, liver,
heart, gastrointestinal,
cerebrovascular, or lung disease; or
``(VI) age-related physical
debility.
``(iv) The individual meets other criteria
determined appropriate by the Secretary.
``(6) Interdisciplinary team.--
``(A) In general.--Subject to subparagraph (B), in
this subsection, the term `interdisciplinary team'
means a group that--
``(i) includes at least--
``(I) one physician who is board
certified in geriatrics, internal
medicine, or family medicine;
``(II) one physician, advance
practice registered nurse, or physician
assistant, who is a palliative
specialist (defined as having a
certification in hospice and palliative
care) or who has at least one year's
experience providing hospice or
palliative care;
``(III) one nurse; and
``(IV) one social worker;
``(ii) may include a chaplain, minister, or
pastoral counselor;
``(iii) may include other direct care
personnel (including pharmacists, dieticians,
physical therapists, occupational therapists,
and psychotherapists); and
``(iv) meets requirements that may be
established by the Secretary.
``(B) Additional member at the request of the
eligible individual.--An applicable provider shall
offer to the eligible 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 applicable 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 interdisciplinary team
member at the individual's (or legally authorized
representative's) request.''.
SEC. 4. QUALITY MEASUREMENT DEVELOPMENT AND IMPLEMENTATION.
(a) Facilitation of Increased Coordination and Alignment Between
the Public and Private Sector With Respect to Quality Measures
Regarding Advanced Illness, Palliative, and End-of-Life Care.--
(1) In general.--Section 1890(b) of the Social Security Act
(42 U.S.C. 1395aaa(b)) is amended by inserting after paragraph
(3) the following new paragraph:
``(4) Increased coordination and alignment between the
public and private sector with respect to quality measures
regarding advanced illness, palliative, and end-of-life care.--
``(A) In general.--The entity shall facilitate
increased coordination and alignment between the public
and private sector with respect to quality measures
regarding advanced illness, palliative, and end-of-life
care across the care settings and programs described in
this section and across other services and care
settings under this title, as appropriate.
``(B) Environmental scan.--The entity shall conduct
an environmental scan of measures, measure concepts,
and preferred practices for advanced illness,
palliative, and end-of-life care used in both the
private and public sectors and from multiple settings
of care. Such scan shall include a review of the
following:
``(i) The process of eliciting and
documenting patient (and, where relevant and
appropriate, family caregiver or legally
authorized representative) goals, preferences,
and values regarding care and treatment,
including the articulation of goals for end-of-
life care that adequately reflect how the
patient wants to live.
``(ii) The effectiveness, patient-
centeredness (and, where relevant, family
caregiver-centeredness), and adequacy of care
plans, including documentation of individual
goals, preferences, and values.
``(iii) Agreement and consistency among--
``(I) the patient's goals,
preferences, and values;
``(II) any documented care plan;
and
``(III) the care delivered.
``(iv) Timely and appropriate referral to
hospice care.
``(C) Identification and prioritization of
measures.--The entity shall, based on the scan
conducted under subparagraph (B), identify and
prioritize measures, measure concepts, and preferred
practices, that are aligned across settings of care,
condition, and patient population.
``(D) Report.--Not later than 18 months after the
date of enactment of this paragraph, the entity shall
submit to the Secretary a report containing the
findings of the entity with respect to the
environmental scan under subparagraph (B) and the
identification and prioritization of measures, measure
concepts, and preferred practices under subparagraph
(C).''.
(b) Study and Report on NIH Development of Additional Measures
Related to Care Planning.--Section 1890A of the Social Security Act (42
U.S.C. 1395aaa-1) is amended by adding at the end the following new
subsection:
``(g) Study and Report on NIH Development of Additional Measures
Related to Care Planning.--
``(1) Study.--The Secretary, in consultation with the
Palliative Care Research Cooperative Group, the National
Institute of Nursing Research, and the Office of End-of-Life
and Palliative Care Research of the National Institutes of
Health shall conduct a study regarding the development of
measures related to--
``(A) concordance of care between the wishes of an
individual and the treatment received by the
individual, including documentation of such wishes in
the medical record;
``(B) understanding the population with serious,
chronic progressive, or advanced illness that would
benefit from palliative care and advance care planning
services; and
``(C) appropriate transitions to hospice care.
``(2) Report.--Not later than December 31, 2019, the
Secretary shall submit to Congress a report containing the
results of the study conducted under paragraph (1).''.
(c) Medicare Physician Fee Schedule.--Section 1848(s)(1) of the
Social Security Act (42 U.S.C. 1395w-4(s)(1)) is amended by adding at
the end the following new subparagraph:
``(G) Clinical care measures relating to palliative
and end-of-life care.--Beginning after the completion
of the environmental scan under section 1890(b)(4)(B),
within one or more appropriate quality domains, the
Secretary shall, in consultation with the entity with a
contract under section 1890(a), establish appropriate
clinical care measures relating to palliative and end-
of-life care, including at least one measure for each
of the areas studied under subparagraphs (A), (B), and
(C) of section 1890A(g)(1).''.
(d) Post-Acute Care.--Section 1899B of the Social Security Act (42
U.S.C. 1395lll) is amended--
(1) in subsection (a)(2)(E)(i)--
(A) in subclause (IV), by striking ``and'' at the
end;
(B) in subclause (V), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(VI) with respect to the domain
described in subsection (c)(1)(F)
(relating to end-of-life care)--
``(aa) for PAC providers
described in clauses (ii),
(iii), and (iv) of paragraph
(2)(A), October 1, 2020; and
``(bb) for PAC providers
described in clauses (i) of
such paragraph, January 1,
2021.''; and
(2) in subsection (c)(1), by adding at the end the
following new subparagraph:
``(F) The effectiveness, patient-centeredness (and,
where relevant, family caregiver-centeredness), and
adequacy of care plans and communications relating to
such plans, including--
``(i) documentation of a patient's goals,
preferences, and values;
``(ii) agreement and consistency with
respect to care among--
``(I) the patient's goals,
preferences, and values;
``(II) any documented care plan;
and
``(III) the care delivered; and
``(iii) timely and appropriate referral to
hospice care.''.
(e) Medicare Advantage.--Section 1852(e)(3) of the Social Security
Act (42 U.S.C. 1395w-22(e)(3)) is amended by adding at the end the
following new subparagraph:
``(C) Palliative and end-of-life care.--The
Secretary, in consultation with the National Committee
for Quality Assurance, shall prioritize the development
of standards for palliative and end-of-life care,
including transition to hospice care, with respect to
Medicare Advantage organizations under this part for
use under the quality improvement program under
paragraph (1) that are the equivalent of such standards
in quality programs applicable to providers of services
and suppliers under the original Medicare fee-for-
service program under parts A and B.''.
(f) Alternative Payment Models.--Section 1899(b)(3)(C) of the
Social Security Act (42 U.S.C. 1395jjj(b)(3)(C)) is amended--
(1) by striking ``standards.--The Secretary'' and inserting
``standards.--
``(i) In general.--The Secretary''; and
(2) by adding at the end the following new clause:
``(ii) Palliative and end-of-life care.--
The Secretary, in consultation with the entity
with a contract under section 1890(a), shall
ensure that quality performance standards
established under this subparagraph include
measures that apply to palliative and end-of-
life care, including transition to hospice
care.''.
SEC. 5. ENHANCING COVERAGE OF ADVANCE CARE PLANNING SERVICES.
(a) Definition.--Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended by adding at the end the following new subsection:
``Advance Care Planning Services
``(jjj)(1) The term `advance care planning services' means services
identified as of the date of enactment of this subsection as Current
Procedural Terminology (CPT) codes 99497 and 99498, and such codes as
subsequently modified, that are furnished by a physician or other
eligible practitioner (as determined by the Secretary).
``(2) For purposes of paragraph (1), the term `eligible
practitioner' includes, in addition to a practitioner eligible to bill
such CPT codes as of the date of enactment of this subsection, an
individual who--
``(A) is a clinical social worker (as defined in subsection
(hh)(1)); and
``(B) possesses--
``(i) a relevant care planning certification; or
``(ii) experience providing care planning
conversations or similar services, as defined by the
Secretary, in the course of their work.''.
(b) No Application of Coinsurance or Deductible.--
(1) Amount.--Section 1833(a)(1) of the Social Security Act
(42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and (BB)'' and inserting
``(BB)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (CC) with respect to advance
care planning services (as defined in section
1861(jjj)(1)), the amounts paid shall be 100 percent of
the lesser of the actual charge for the services or the
amount determined under the fee schedule established
under section 1848(b).''.
(2) Waiver of application of deductible.--The first
sentence of section 1833(b) of the Social Security Act (42
U.S.C. 1395l(b)) is amended--
(A) by striking ``and'' before ``(10)''; and
(B) by inserting before the period the following:
``, and (11) such deductible shall not apply with
respect to advance care planning services (as defined
in section 1861(jjj)(1))''.
(c) Effective Date.--The amendment made by this subsection shall
apply to advance care planning services furnished on or after January
1, 2018.
SEC. 6. ADVANCE CARE PLANNING SUPPORT TOOLS.
(a) Inclusion of Advance Care Planning Materials in the Medicare &
You Handbook.--
(1) In general.--Section 1804(a) of the Social Security Act
(42 U.S.C. 1395b-2(a)) is amended--
(A) in paragraph (2), by striking ``and'' at the
end;
(B) in paragraph (3), by striking the period at the
end and inserting a semicolon; and
(C) 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 serious,
chronic progressive, or advanced illness, including
disease modifying options, palliative care that
supports individuals from the onset of 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.''.
(2) Effective date.--The amendments made by this section
shall apply to notices distributed on or after January 1, 2018.
(b) Advance Care Planning Standards for Electronic Health
Records.--
(1) In general.--Notwithstanding section 3004(b)(3) of the
Public Health Service Act (42 U.S.C. 300jj-14(b)(3)), not later
than 4 years after the date of the enactment of this Act, the
Secretary of Health and Human Services shall adopt, by rule,
standards for a qualified electronic health record (as defined
in section 3000(13) of such Act (42 U.S.C. 300jj(13))), with
respect to organizing patient communications with health care
providers about care goals and to provide one-click access to
the following:
(A) The patient's current advance directive (as
defined in section 1866(f)(3) of the Social Security
Act (42 U.S.C. 1395cc(f)(3))), as applicable.
(B) The patient's current order for life-sustaining
treatment (described in section 9(d)(3)(B)), as
applicable.
(C) Documentation of advance care planning
discussion between the patient and the provider.
(2) Treatment of standards.--A standard adopted under
paragraph (1) shall be treated as a standard adopted under
section 3004 of the Public Health Service Act (42 U.S.C. 300jj-
14) for purposes of certifying qualified electronic health
records pursuant to section 3001(c)(5) of such Act (42 U.S.C.
300jj-11(c)(5)).
SEC. 7. ADVANCE DIRECTIVES.
(a) Portability.--Section 1866(f) of the Social Security Act (42
U.S.C. 1395cc(f)) is amended by adding at the end the following new
paragraph:
``(5)(A) An advance directive validly executed outside the State in
which such directive is presented may be given effect by a provider of
services or organization to the same extent as an advance directive
validly executed under the law of the State in which it is presented.
``(B) In the absence of knowledge to the contrary, a physician or
other health care provider or organization may presume that a written
advance health care directive or similar instrument, regardless of
where executed, is valid.
``(C) The provisions of this paragraph shall preempt any State law
on advance directive portability to the extent such law is inconsistent
with such provisions.
``(D) Nothing in the paragraph shall be construed to--
``(i) authorize the administration of health care treatment
otherwise prohibited by the laws of the State in which the
directive is presented;
``(ii) require a provider of services or an organization to
act in a manner contrary to its religious or moral convictions;
``(iii) apply to a request or directive ordering a
sterilization or abortion or ordering withdrawal of treatment
from a pregnant woman if continued treatment can reasonably be
expected to bring her child to live birth;
``(iv) 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 or portable
treatment order; or
``(v) permit the Secretary to seek civil penalties,
including exclusion from participation in the program under
this title or the program under title XIX, against a provider
or organization if the provider or organization--
``(I) 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
``(II) exercised its right of conscience in
accordance with clause (ii) or (iv).''.
(b) Clarification With Respect to Advance Directives.--Paragraph
(2) of section 7 of the Assisted Suicide Funding Restriction Act of
1997 (42 U.S.C. 14406) is amended to read as follows:
``(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 individuals, such as by
assisted suicide, euthanasia, or mercy killing.''.
(c) GAO Study on Health Care Decisionmaking Laws and Barriers to
the Use of Advance Directives.--
(1) Study.--The Comptroller General of the United States
shall conduct a study that examines the use, portability, and
electronic storage of advance directives and that identifies
barriers towards adopting, using, and following advance
directives in the clinical setting. Such examination shall
include issues that remain unresolved after the Stage 3
Meaningful Use final rule, including barriers and solutions to
finding and accessing advance care planning documents, best
practices for alerting eligible providers to the presence of an
advance care plan, and best practices for transmitting advance
care plans across sites of care.
(2) Report.--Not later than 1 year after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report on the study conducted under paragraph (1)
and shall include in the report such recommendations regarding
improving advance health care planning as the Comptroller
General deems appropriate.
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 (Y), by striking the period at
the end and inserting ``; and''; and
(B) 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
documented care plans include any advance directives or
portable treatment orders made while the individual received
care by the provider and that such plan is sent to the
individual's primary care provider upon discharge and any
facility to which the individual is transferred.''.
(2) Effective date.--The amendments made by this subsection
shall apply to agreements entered into or renewed on or after
January 1, 2019.
(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
providers of advance care planning services work with
individuals to--
(A) engage in a care planning process;
(B) thoroughly and completely document the care
planning process in the medical record and to update
the care plan on a regular basis;
(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 are free from
discrimination based on advanced age, disability
status, or diagnosis, including serious, chronic
progressive, 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, 2021, 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 AND TRAINING.
(a) Material and Resources Development.--The Secretary of Health
and Human Services (referred to in this section as the ``Secretary''),
in consultation with the Advance Care Planning Advisory Council
(established in section 10), may award grants to public or private
entities (including, as appropriate, States, political subdivisions of
States, medical schools, nursing schools, health care systems, faith-
based organizations, and religious educational institutions), or a
consortium of any such entities, to develop online training modules,
decision support tools, and instructional materials for individuals,
family caregivers, and health care providers that include--
(1) with respect to healthy individuals, the importance
of--
(A) identifying an individual who will make
treatment decisions in the event of future cognitive
incapacity;
(B) discussing values and goals relevant to serious
injury or illness; and
(C) 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;
(2) with respect to individuals with serious, chronic
progressive, or advanced illness, the importance of--
(A) articulating goals of care;
(B) understanding prognosis and typical disease
trajectory;
(C) evaluating treatment options in light of goals
of care;
(D) developing a treatment plan; and
(E) 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;
(3) the role and effective use of State and other advance
directive forms and portable treatment orders;
(4) the range of services for individuals facing serious,
chronic progressive, or advanced illness, including advance
care planning services, palliative care, and hospice care; and
(5) with respect to providers of advance care planning,
advance illness care, hospice care, and palliative care in
hospital, hospice, home, community, and long-term care
settings, material to assist in--
(A) developing and implementing programs and
initiatives to train and educate individuals;
(B) providing training and continuing education to
individuals who will provide advance care planning
services or palliative care in the hospital, hospice,
home, community, and long-term care settings; and
(C) developing curricula or teaching materials
related to advance care planning or palliative care in
such settings.
(b) Establishment and Maintenance of Web- and Telephone-Based
Resources.--
(1) In general.--The Secretary may award grants to public
or private entities (including States, political subdivisions
of States, faith-based organizations, and religious educational
institutions), or a consortium of any such entities, to
establish and maintain an Internet website and telephone
hotline to disseminate resources developed under subsection (a)
and materials for faith communities designed by the Department
of Health and Human Services Center for Faith-Based and
Neighborhood Partnerships.
(2) Ability to sustain activities.--In determining whether
to award a grant under paragraph (1), the Secretary shall take
into account the ability of an entity to sustain the activities
described in paragraph (1) beyond the initial grant period.
(c) National Public Education Campaign.--The Secretary may award
grants to public or private entities (including States, political
subdivisions of States, faith-based organizations, and religious
educational institutions) 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 this section.
(d) Orders for Life-Sustaining Treatment.--
(1) In general.--The Secretary may award grants to eligible
entities for the purposes of carrying out the activities under
paragraph (2).
(2) Authorized activities.--Activities funded through a
grant under this section for an area may include--
(A) establishing and operating a National Resource
Center on POLST Programs to provide--
(i) technical assistance and professional
training to programs for orders for life-
sustaining treatment;
(ii) analysis and dissemination of best
practices in implementing program for orders
for life-sustaining treatment;
(iii) voluntary standards for the
establishment and operation of program for
orders for life-sustaining treatment; and
(iv) compilations and summaries of recently
conducted research and other resources relevant
to program for orders for life-sustaining
treatment;
(B) developing such a program for the area that
includes hospitals, home care, hospice, long-term care,
community and assisted living residences, skilled
nursing facilities, and emergency medical services
within a State; and
(C) 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, training of health care professionals, or
establishing an orders for life-sustaining treatment
registry.
(3) Definitions.--In this subsection--
(A) the term ``eligible entity'' means--
(i) an academic medical center, a medical
school, a State health department, a State
medical association, a multistate task force, a
hospital, or a health system capable of
administering a program for physician orders
regarding life-sustaining treatment for a
State; or
(ii) any other health care agency or entity
as the Secretary determines appropriate; and
(B) the term ``program for orders for life-
sustaining treatment'' means a program that, regardless
of its name--
(i) implements a clinical process designed
to facilitate shared, informed medical
decisionmaking and communication between health
care professionals and patients with serious,
progressive illness or frailty and results in a
set of medical orders that--
(I) are consistent with the
national standard as reflected by the
National POLST Paradigm, representing
health care providers, organizations,
and stakeholders;
(II) are portable and honored
across care settings; and
(III) address key medical decisions
consistent with the patient's goals of
care; and
(ii) is guided by a coalition of
stakeholders, such as patient advocacy groups
and representatives from across the continuum
of health care services, disability rights
advocates, senior advocates, emergency medical
services, long-term care, medical associations,
hospitals, home health, hospice, palliative
care, nursing associations, the State agency
responsible for senior and disability services,
faith-based groups, and the State department of
health.
(e) Authorization of Appropriations.--
(1) In general.--There are authorized to be appropriated to
the Secretary, for purposes of awarding grants under this
section, $50,000,000 for the period of fiscal years 2018
through 2022.
(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. ADVANCE CARE PLANNING ADVISORY COUNCIL.
(a) Establishment.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall establish within
the Office of the Secretary an advisory committee to be known as the
Advance Care Planning Advisory Council (in this section referred to as
the ``Council'').
(b) Duties.--
(1) Mission.--The Council shall advise the Secretary
regarding the compilation, development, and dissemination of
resources for developed with grants awarded under section 9.
(2) Responsibilities.--Responsibilities of the council
include the following:
(A) Ensuring that resources provided contain
unbiased information about the range of options
available to individuals with serious, chronic
progressive, advanced, or terminal illness, including
information about conventional, curative treatments,
palliative care, and hospice care.
(B) Developing strategies for increasing public
understanding about serious, chronic progressive, and
advanced illness and the important role advance care
planning can play in documenting an individual's wishes
for medical care for loved ones in the event that the
individual cannot communicate such wishes.
(C) Compiling information for dissemination
regarding existing advance care planning models
including POLST, advance directives, and healthcare
proxies.
(D) Promoting interagency coordination and
minimizing overlap regarding advance care planning,
including opportunities to coordinate efforts between
the Federal agencies and external stakeholders.
(E) Identifying and evaluating cross-cutting issues
such as pediatric end-of-life care and advance care
planning access issues.
(c) Membership.--
(1) In general.--The Council shall be composed of up to 15
members appointed by the Secretary from among qualified
individuals who are not officers or employees of the Federal
Government.
(2) Groups.--The members of the Council shall include the
following:
(A) At least 3 members with clinical training and
an expertise in palliative care, advanced illness, or
end-of-life care.
(B) At least 3 members from patient and family
advocacy groups.
(C) At least 3 members from religious or spiritual
organizations.
(D) Other members from interested stakeholder
groups with a proven expertise in palliative, chronic,
advanced, or end-of-life care.
(d) Applicability of FACA.--The Council shall be treated as an
advisory committee subject to the Federal Advisory Committee Act (5
U.S.C. App.).
SEC. 11. ANNUAL REPORT ON MEDICARE DECEDENTS.
The Secretary of Health and Human Services shall issue for each
fiscal year (beginning no later than fiscal year 2018) an annual report
that analyzes the circumstances of Medicare beneficiaries who died
during the fiscal year covered by such report. Such analysis shall
include at least the following with respect to such decedents:
(1) Information on the care or payor settings (such as
under part A or part C of Medicare) at the time of death.
(2) Information on the demographic characteristics of such
decedents.
(3) Information on the geographic distribution of such
decedents.
(4) An evaluation of the Medicare claims data for such
decedents for services furnished in the last year of life,
including an analysis of the setting of care for decedents who
had more than one chronic illness at the time of death.
(5) Such other information as the Secretary deems
appropriate.
SEC. 12. 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).
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