42 U.S.C. § 299b–36 — Program to facilitate shared decisionmaking

(a) Purpose. This section aims to create a collaborative process between patients (or their caregivers/representatives) and clinicians — one that involves the patient in decisions, explains the trade-offs among treatment options, and builds the patient's preferences and values into the care plan. (b) Definitions (1) Patient decision aid. An educational tool that helps patients (or caregivers/representatives) understand and share their beliefs and preferences about treatment, and decide with their provider which treatment fits best, based on the options, the evidence, their situation, and their beliefs and preferences. (2) Preference sensitive care. Medical care where the evidence doesn't clearly favor one treatment, so the right choice depends on the patient's values or the patient's/caregiver's preferences about each option's benefits, harms, and evidence — meaning the care used should depend on the patient's informed choice among the medically reasonable options. (c) Establishment of independent standards for patient decision aids for preference sensitive care (1) Contract with entity to establish standards and certify patient decision aids. (A) In general. To support agreed-on standards for patient decision aids and a certification process for using them in federal health programs and elsewhere, the Secretary must contract with the entity holding the section 1395aaa contract to do the duties in (2). (B) Timing for first contract. The Secretary must sign the first such contract as soon as practical after March 23, 2010. (C) Period of contract. Each contract lasts 18 months, and may be renewed after a new bidding process. (2) Duties. (A) Develop and identify standards for patient decision aids. The entity must gather evidence and bring together experts and stakeholders to build agreed-on standards for evaluating patient decision aids for preference sensitive care. (B) Endorse patient decision aids. The entity must review patient decision aids and build a process to certify whether they meet those standards, prioritizing decision aids for preference sensitive care. (d) Program to develop, update and produce patient decision aids to assist health care providers and patients (1) In general. The Secretary, through the Director and coordinating with other agency heads (like the CDC and NIH Directors), must run a grant or contract program to: (A) Develop, update, and produce patient decision aids for preference sensitive care, helping providers educate patients about the relative safety, effectiveness (including health outcomes and function), and cost of treatment or palliative care options. (B) Test these materials to confirm they are balanced, evidence-based, useful for informed decisions, and easy to use across many practice settings. (C) Train providers to use these materials, including through academic coursework. (2) Requirements for patient decision aids. Aids made under this grant program must: (A) Be designed to help patients make informed decisions together with their providers. (B) Present up-to-date evidence on risks and benefits, in an age-appropriate form that can be adapted for different cultures, education levels, and health literacy. (C) Where relevant, explain why the evidence doesn't favor one treatment over another. (D) Cover health decisions across all ages, including for vulnerable groups like children. (3) Distribution. The Director must make sure these decision aids are available to the public. (4) Nonduplication of efforts. The Director must ensure the Agency's work here and similar work by agencies like the CDC and NIH don't unnecessarily overlap. (e) Grants to support shared decisionmaking implementation (1) In general. The Secretary must run a program to gradually develop, implement, and evaluate shared decisionmaking using patient decision aids, aiming to help patients better understand their treatment options. (2) Shared Decisionmaking Resource Centers. (A) In general. The Secretary must fund Shared Decisionmaking Resource Centers to give providers technical assistance and to develop and spread best practices that speed up adoption and effective use of patient decision aids and shared decisionmaking. (B) Objectives. A Center's job is to promote adoption of patient decision aids and shared decisionmaking by helping eligible providers implement and get trained on decision aids, and by spreading best practices and research on using them well. (3) Shared decisionmaking participation grants. (A) In general. The Secretary must give grants to health care providers to develop, use, and assess shared decisionmaking techniques. (B) Preference. The Secretary must favor providers who trained with a Shared Decisionmaking Resource Center or similar training, to promote best practices. (C) Limitation. Grant money cannot be used to buy or use patient decision aids that aren't certified under the process in (c). (4) Guidance. The Secretary may issue guidance to grantees on using patient decision aids. (f) Funding. Congress may appropriate whatever funds are needed for fiscal year 2010 and every year after to carry out this section.