[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1334 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  1st Session
                                S. 1334

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

                             June 12, 2017

  Mr. Warner (for himself, Mr. Isakson, Ms. Baldwin, Ms. Collins, Ms. 
 Klobuchar, and Mrs. Capito) 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 ``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 serious, chronic progressive, or 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.'';
            (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 serious, chronic 
                progressive, or 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.''.
            (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 
serious, chronic progressive, or 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, or 
                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).
                                 <all>