No official summary available for this bill.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 3473 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 3473
To amend title XVIII of the Social Security Act to encourage Medicare
beneficiaries to voluntarily adopt advance directives guiding the
medical care they receive.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 15, 2025
Mr. Cassidy (for himself and Mr. Coons) 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 encourage Medicare
beneficiaries to voluntarily adopt advance directives guiding the
medical care they receive.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Advance Planning for Care
Act'' or the ``MAP for Care Act''.
SEC. 2. MEDICARE ADVANCE DIRECTIVE CERTIFICATION PROGRAM.
Part B of title XVIII of the Social Security Act (42 U.S.C. 1395j
et seq.) is amended by adding at the end the following new section:
``medicare advance directive certification program
``Sec. 1849. (a) In General.--
``(1) Establishment of program.--The Secretary shall
establish and implement an Advance Directive Certification
Program (in this section referred to as the `Program') under
which the Secretary shall encourage eligible beneficiaries to
adopt and maintain certified advance directives to guide the
delivery of health care to such beneficiaries. The Secretary
shall implement the Program not later than 5 years after the
date of enactment of this section.
``(2) Definitions.--In this section:
``(A) Certified advance directive.--The term
`certified advance directive' means an electronically
stored written instruction by an eligible beneficiary,
such as a living will or durable power of attorney for
health care, recognized under State law (whether
statutory or as recognized by the courts of the State)
and relating to the provision of such care when the
individual is incapacitated that--
``(i) provides instructions that outline
the kind of medical treatments and care that
such beneficiary would want or not want under
particular conditions, and may also include the
identification of a health care proxy or legal
representative to make medical treatment
decisions for the beneficiary if the
beneficiary becomes unable to make or
communicate those decisions on their own; and
``(ii) is offered by an entity that has
received accreditation from the Secretary under
subsection (c).
``(B) Eligible beneficiary.--The term `eligible
beneficiary' means an individual entitled to, or
enrolled for benefits, under part A or enrolled for
benefits under this part.
``(C) Program participant.--The term `Program
participant' means an eligible beneficiary who is
enrolled in the Program.
``(3) Voluntary participation.--An eligible beneficiary who
has registered a certified advance directive with a advance
directive vendor accredited under subsection (c) may disenroll
and terminate such directive at any time.
``(4) Best practices.--In establishing and implementing the
Program, the Secretary shall consider best practices--
``(A) within existing advance directive registry
technologies, programs, and systems, including web-
based or cloud-based advance directive technologies--
``(i) which may utilize time and date
stamps, video, or other innovative measures to
protect the authenticity, improve the quality
of, and enhance the security of such
directives; and
``(ii) which may utilize secure email and
messaging technologies and nationally
recognized health care information technology
standards to improve the accessibility and
interoperability of such directives; and
``(B) for educating beneficiaries on ways to--
``(i) communicate their authenticated
wishes to applicable family members, legal
representatives, and providers or health care
proxies, including through the use of email or
other mail formats; and
``(ii) access certified advance directives,
including through the use of mobile devices.
``(5) State law.--The provisions of this section shall not
preempt any State or local law requirement governing advance
directives.
``(6) Display of statutory and alternative advance
directive forms.--Under the Program, the Secretary shall
provide, on the Internetwebsite of the Centers for Medicare &
Medicaid Services, links to statutory advance directive forms
(as described in subsection (d)(1)(C)), alternative advance
directive forms (as described in subsection (d)(1)(D)), and a
State-by-State index to such forms to allow a Program
participant to create, adopt, modify, and terminate a certified
advance directive with any content permitted or required under
this section, and in any form authorized by a State.
``(b) Enrollment in the Program and Registration of Advance
Directives.--
``(1) Required information.--In addition to such other
information as the Secretary determines is appropriate, a
Program participant seeking to register a certified advance
directive under the Program shall indicate where the advance
directive is maintained or how it may be accessed.
``(2) Notification regarding program.--During the annual,
coordinated election period under section 1851(e)(3), the
Secretary shall notify each eligible beneficiary of the
Program.
``(3) Privacy and security.--
``(A) In general.--The Secretary shall ensure that
all aspects of the enrollment and registration system
comply with the Federal regulations (concerning the
privacy and security of individually identifiable
health information) promulgated under the Health
Insurance Portability and Accountability Act of 1996
subject to the access authorized under subsection
(c)(2)(E) and in accordance with subsection (c)(2)(F).
``(B) Access.--The Secretary shall utilize
standardized data protections and privacy standards,
including the Federal regulations described in
subparagraph (A), to ensure that the registration
record of a Program participant can only be accessed
by--
``(i) the Program participant, through the
process established under subsection (c)(2)(B);
``(ii) those authorized to access the
certified advance directive under subsection
(c)(2)(E); and
``(iii) providers of services and suppliers
participating under this title who furnish
items or services to the Program participant,
through a process established by the Secretary.
``(c) Accreditation.--
``(1) In general.--
``(A) Accreditation by the secretary.--Under the
Program, the Secretary shall--
``(i) accredit advance directive vendors
and other entities providing advance directives
that meet the accreditation criteria
established under paragraph (2) and any other
criteria determined appropriate by the
Secretary; and
``(ii) establish a process whereby advance
directive vendors and other entities providing
advance directives may obtain accreditation
under this subsection.
``(B) Accreditation by advance directive
accreditation organization.--The Secretary may contract
with an advance directive accreditation organization to
accredit advance directive vendors and other entities
under subparagraph (A)(i).
``(2) Accreditation criteria.--The Secretary, in
consultation with the Comptroller General of the United States,
shall establish accreditation criteria for advance directive
vendors and other entities providing advance directives to be
certified under the Program. Such criteria shall consist of
each of the following:
``(A) Certified advance directives.--The advance
directive vendor or other entity shall agree to offer
certified advance directives to eligible beneficiaries.
``(B) Procedures for enrollment.--
``(i) In general.--The advance directive
vendor or other entity shall establish
procedures that--
``(I) allow for a Program
participant to--
``(aa) enroll in and
disenroll from the Program; and
``(bb) register or update a
certified advance directive
adopted by the participant; and
``(II) ensure that a Program
participant is able to--
``(aa) create, adopt,
modify, update, amend, or
terminate a certified advance
directive in a timely and
secure manner;
``(bb) update previously
registered information; and
``(cc) indicate that a
previously registered certified
advance directive has been
terminated.
``(ii) Online enrollment and
registration.--The procedures established
pursuant to clause (i) shall ensure that such
enrollment and registration is available
through an online process, or other means
determined appropriate by the advance directive
vendor or other entity.
``(C) Quality review.--
``(i) In general.--For purposes of
determining compliance with the requirements of
this section, the advance directive vendor or
other entity shall comply with an annual
quality review to be conducted by the
Secretary.
``(ii) Enforcement.--If the Secretary
determines that an advance directive vendor or
other entity is not in compliance with the
requirements of this section, the Secretary
shall remove any certified advance directive of
such advance directive vendor or other entity
from the Internet website of the Centers for
Medicare & Medicaid Services.
``(D) Use of statutory and alternative advance
directive forms.--The advance directive vendor or other
entity shall allow a Program participant to--
``(i) access, complete, modify, and adopt
any advance directive forms described in
subparagraphs (C) and (D) of subsection (d)(1);
and
``(ii) search for such forms by State.
``(E) Access.--The advance directive vendor or
other entity shall--
``(i) provide near real-time online access
to the certified advance directive of a Program
participant for purposes of viewing and sharing
such advance directive, including communicating
the certified advance directive and the Program
participant's authenticated wishes using
nationally recognized standards for securely
transferring sensitive data specified by the
Secretary to--
``(I) the Program participant;
``(II) any family member, legal
representative, or health care proxy
legally designated by the participant;
and
``(III) a provider of services or
supplier that furnishes items or
services to the participant; and
``(ii) at the request of the Program
participant or any family member, legal
representative, or health care proxy legally
designated by the Program participant, provide
a hard copy of the certified advance directive
of the Program participant to a provider of
services or supplier.
``(F) Privacy protections.--
``(i) In general.--The advance directive
vendor or other entity shall comply with the
Federal regulations (concerning the privacy of
individually identifiable health information)
promulgated under section 264(c) of the Health
Insurance Portability and Accountability Act of
1996, subject to the access authorized under
subparagraph (E).
``(ii) Access.--Such vendor or entity shall
comply with standardized data protections and
privacy standards, including the Federal
Regulations described in clause (i), to ensure
that the content of a Program participant's
certified advance directive is owned and
maintained by the participant and can only be
accessed by those authorized to access the
advance directive under subparagraph (E).
``(G) Security and testing.--The advance directive
vendor or other entity shall certify that--
``(i) all data management and data transfer
elements involved in adopting, maintaining, and
accessing a certified advance directive of a
Program participant--
``(I) have successfully passed
rigorous independent testing regarding
standards of timeliness, accuracy, and
efficiency; and
``(II) meet widely accepted
industry security standards (as
determined by the Secretary); and
``(ii) the system that provides access to a
certified advance directive of a Program
participant has passed real-time tests
simulating a realistic volume of Program
participants, their family members, legal
representatives, and legally designated health
care proxies, providers of services, and
suppliers accessing such directives
simultaneously.
``(H) Beneficiary surveys.--
``(i) In general.--The advance directive
vendor or other entity shall administer an
annual survey of Program participants on the
information described in clause (ii) and submit
the results of such survey to the Secretary.
``(ii) Information.--The information
described in this clause, with respect to a
Program participant and a certified advance
directive of such participant, is the
following:
``(I) Whether the participant had
to pay any third party for the
creation, storage, or retrieval of the
certified advance directive.
``(II) Whether the participant had
a health care encounter or emergency
that required the location, access,
retrieval, or consultation of the
certified advance directive and if so,
whether the certified advance directive
was accessible online and in near real-
time, as required under this section.
``(III) Whether the certified
advance directive was sufficiently
clear and actionable.
``(IV) Whether medical personnel
followed the certified advance
directive.
``(I) Process for complying with state law.--The
advance directive vendor or other entity shall enable a
Program participant using their services to complete a
certified advance directive that fully complies with
the law governing advance directives of the applicable
State.
``(J) Access in cases of dispute over treatment.--
``(i) Special access.--The advance
directive vendor or other entity shall
establish a process whereby, with respect to a
Program participant, an interested individual
described in clause (ii) may obtain access to
the certified advance directive of the Program
participant for the purposes of viewing and
sharing such advance directive when--
``(I) the provisions of the
certified advance directive have come
into force under the law of the
applicable State because the Program
participant has become incapable of
making health care decisions on their
own or under other circumstances
provided under State law; and
``(II) at least 1 person described
in clause (ii) is questioning or
disputing the provision, withholding,
or withdrawal of medical treatment,
food, or fluids with respect to the
Program participant.
``(ii) Interested individuals.--
``(I) In general.--An interested
individual described in this clause,
with respect to a Program participant,
is--
``(aa) any individual who
is a member of any class of
persons who, under the law of
the applicable State, would
potentially be eligible to
serve as a health care decision
maker for the Program
participant if an advance
directive had not been
executed, regardless of whether
another individual would have
higher priority for such
eligibility; or
``(bb) if the law of the
applicable State does not
designate a person or class of
persons described in item (aa),
any individual related within
the third degree of
consanguinity or affinity to
the Program participant
identified by the Program
participant in the certified
advance directive.
``(II) Periodic update.--In the
case that the law of the applicable
State does not designate a person or
class of persons described in subclause
(I)(aa) and the Program participant has
identified in a certified advance
directive an individual within the
third degree of consanguinity or
affinity of such participant, the
advance directive vendor or other
entity shall annually during the
annual, coordinated election period
under section 1851(e)(3) prompt the
Program participant to update such
individual.
``(d) Education and Outreach.--
``(1) In general.--The Secretary shall--
``(A) include a statement described in paragraph
(3) in the notice described in section 1804(a) and
provide for the inclusion of such statement on the
Internet website of the Centers for Medicare & Medicaid
Services;
``(B) communicate the benefits of electronic
advance directives services, as they become available;
``(C) provide for the inclusion, under the heading
`Statutory Advance Directive Forms', of any relevant
forms, whether mandatory or optional, specified in the
statutes or regulations of States to be displayed on a
such website;
``(D) provide for the inclusion, under the heading
`Alternative Advance Directive Forms', on such website,
and in accordance with paragraph (2)--
``(i) of other advance directive forms
submitted to the Secretary by individuals and
groups in an electronic format specified by the
Secretary for which the submitting entity
includes, for each form submitted, an opinion
by an attorney licensed to practice in the
relevant State demonstrating that the submitted
form complies with the law of that State; and
``(ii) of the following disclaimer, which
shall be prominently posted on the website:
`This website includes for your consideration
alternative advance directive forms submitted
by individuals or groups reflecting different
perspectives on advance health care decisions
which you may wish to review before completing
your own advance directive.'; and
``(E) provide for the inclusion of a user-friendly
index on the such website by State and, in the case of
the `Alternative Advance Directive Forms', by the name
of the individual or group who provided each
alternative advance directive, so that a user may
readily access those statutory and alternative forms.
``(2) Alternative advance directive forms.--
``(A) In general.--For purposes of paragraph
(1)(D), the following shall apply:
``(i) Not later than 60 days after
receiving an alternative advance directive form
submitted under such paragraph, the Secretary
shall either post the submitted form on the
Internet website of the Centers for Medicare &
Medicaid Services or provide to the submitting
entity an explanation of the basis for the
Secretary's determination that the submitted
form does not comply with relevant State or
Federal law, which determination shall be
subject to judicial review under section 702 of
title 5 of the United States Code.
``(ii) The Secretary shall either remove or
refuse to post any submitted form if provided
with an official determination by the attorney
general of the applicable State that the form
is not in compliance with State law, subject to
applicable State law described in subparagraph
(B).
``(B) State law described.--For purposes of
subparagraph (A), State law described in this
subparagraph is--
``(i) a ruling by a court of the applicable
State, or by a Federal court applying that
State's law, subject to subsequent rulings by a
court or courts with authority to supercede
that ruling; or
``(ii) a statute or regulation of the
applicable State that provides for a specific
procedure for officially determining whether
particular advance directive forms comply with
State law.
``(3) Statement.--For purposes of paragraph (1)(A), the
statement described in this paragraph is a statement of the
reasons why beneficiaries may want to consider advance
directives, a suggestion for the beneficiary to carefully
consider decisions regarding advance directives, and references
to resources about advance directives.
``(e) Advance Directive Information in Medicare Enrollment Forms.--
After the Secretary implements the Program, the Secretary shall include
on each application for enrollment of an individual in part A, this
part, or part C a link to an Internet website with resources to assist
in completing an advance directive.''.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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