H.R. 6721

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6721 Introduced in House (IH)]

<DOC>

119th CONGRESS
1st Session
H. R. 6721

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 HOUSE OF REPRESENTATIVES

December 15, 2025

Mr. Murphy (for himself and Mr. Thompson of California) 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 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 Internet website 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 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.''.
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