---
kind: "section"
citation: "42 U.S.C. § 299b–36"
title: "42"
title_heading: "The Public Health and Welfare"
number: "299b–36"
heading: "Program to facilitate shared decisionmaking"
release: "119-102"
url: "https://uscodex.org/usc/42/299b-36"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter VII — Agency for Healthcare Research and Quality"
  - "Part D — Health Care Quality Improvement"
  - "Subpart 2 — health care quality improvement programs"
---

# §299b–36. Program to facilitate shared decisionmaking

- (a) **Purpose—** The purpose of this section is to facilitate collaborative processes between patients, caregivers or authorized [representatives](/usc/42/3058f.md?p=5), and clinicians that engages[^1] the patient, caregiver or authorized [representative](/usc/42/3058f.md?p=5) in decisionmaking, provides[^2] patients, caregivers or authorized [representatives](/usc/42/3058f.md?p=5) with information about trade-offs among [treatment](/usc/42/11851.md?p=11) options, and facilitates[^3] the incorporation of patient preferences and values into the medical plan.
- (b) **Definitions—** In this section:
  - (1) **Patient decision aid—** The term “patient decision aid” means an educational tool that helps patients, caregivers or authorized [representatives](/usc/42/3058f.md?p=5) understand and communicate their beliefs and preferences related to their [treatment](/usc/42/11851.md?p=11) options, and to decide with their [health care provider](/usc/42/300jj.md?p=3) what [treatments](/usc/42/11851.md?p=11) are best for them based on their [treatment](/usc/42/11851.md?p=11) options, scientific evidence, circumstances, beliefs, and preferences.
  - (2) **Preference sensitive care—** The term “preference sensitive care” means [medical care](/usc/42/300gg–91.md?p=a-2) for which the clinical evidence does not clearly support one [treatment](/usc/42/11851.md?p=11) option such that the appropriate course of [treatment](/usc/42/11851.md?p=11) depends on the values of the patient or the preferences of the patient, caregivers or authorized [representatives](/usc/42/3058f.md?p=5) regarding the benefits, harms and scientific evidence for each [treatment](/usc/42/11851.md?p=11) option, the[^4] use of such care should depend on the informed patient choice among clinically appropriate [treatment](/usc/42/11851.md?p=11) 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—** For purposes of supporting consensus-based [standards](/usc/42/1320d.md?p=7) for [patient decision aids](#b-1) for [preference sensitive care](#b-2) and a certification process for [patient decision aids](#b-1) for use in the Federal health [programs](/usc/42/274l–1.md?p=4) and by other interested parties, the [Secretary](/usc/42/201.md?p=c) shall have in effect a contract with the entity with a contract under [section 1395aaa of this title](/usc/42/1395aaa.md). Such contract shall provide that the entity perform the duties described in [paragraph (2)](#c-2).
    - (B) **Timing for first contract—** As soon as practicable after March 23, 2010, the [Secretary](/usc/42/201.md?p=c) shall enter into the first contract under [subparagraph (A)](#c-1-A).
    - (C) **Period of contract—** A contract under [subparagraph (A)](#c-1-A) shall be for a period of 18 months (except such contract may be renewed after a subsequent bidding process).
  - (2) **Duties—** The following duties are described in this paragraph:
    - (A) **Develop and identify standards for patient decision aids—** The entity shall synthesize evidence and convene a broad range of experts and key stakeholders to develop and identify consensus-based [standards](/usc/42/1320d.md?p=7) to evaluate [patient decision aids](#b-1) for [preference sensitive care](#b-2).
    - (B) **Endorse patient decision aids—** The entity shall review [patient decision aids](#b-1) and develop a certification process whether[^5] [patient decision aids](#b-1) meet the [standards](/usc/42/1320d.md?p=7) developed and identified under [subparagraph (A)](#c-2-A). The entity shall give priority to the review and certification of [patient decision aids](#b-1) for [preference sensitive care](#b-2).
- (d) **Program to develop, update and produce patient decision aids to assist health care providers and patients—**
  - (1) **In general—** The [Secretary](/usc/42/201.md?p=c), acting through the [Director](/usc/42/299c–7.md?p=3), and in coordination with heads of other relevant [agencies](/usc/42/299c–7.md?p=2), such as the [Director](/usc/42/299c–7.md?p=3) of the Centers for Disease Control and Prevention and the [Director](/usc/42/299c–7.md?p=3) of the National Institutes of Health, shall establish a [program](/usc/42/274l–1.md?p=4) to award grants or contracts—
    - (A) to develop, update, and produce [patient decision aids](#b-1) for [preference sensitive care](#b-2) to assist [health care providers](/usc/42/300jj.md?p=3) in educating patients, caregivers, and authorized [representatives](/usc/42/3058f.md?p=5) concerning the relative safety, relative effectiveness (including possible health outcomes and impact on functional status), and relative cost of [treatment](/usc/42/11851.md?p=11) or, where appropriate, palliative care options;
    - (B) to test such materials to ensure such materials are balanced and evidence based in aiding [health care providers](/usc/42/300jj.md?p=3) and patients, caregivers, and authorized [representatives](/usc/42/3058f.md?p=5) to make informed decisions about patient care and can be easily incorporated into a broad array of practice settings; and
    - (C) to educate providers on the use of such materials, including through academic curricula.
  - (2) **Requirements for patient decision aids—** [Patient decision aids](#b-1) developed and produced pursuant to a grant or contract under [paragraph (1)](#d-1)—
    - (A) shall be designed to engage patients, caregivers, and authorized [representatives](/usc/42/3058f.md?p=5) in informed decisionmaking with [health care providers](/usc/42/300jj.md?p=3);
    - (B) shall present up-to-date clinical evidence about the risks and benefits of [treatment](/usc/42/11851.md?p=11) options in a form and manner that is age-appropriate and can be adapted for patients, caregivers, and authorized [representatives](/usc/42/3058f.md?p=5) from a variety of cultural and educational backgrounds to reflect the varying needs of consumers and diverse levels of health literacy;
    - (C) shall, where appropriate, explain why there is a lack of evidence to support one [treatment](/usc/42/11851.md?p=11) option over another; and
    - (D) shall address health care decisions across the age span, including those affecting vulnerable populations including [children](/usc/42/256e.md?p=g-2).
  - (3) **Distribution—** The [Director](/usc/42/299c–7.md?p=3) shall ensure that [patient decision aids](#b-1) produced with grants or contracts under this section are available to the public.
  - (4) **Nonduplication of efforts—** The [Director](/usc/42/299c–7.md?p=3) shall ensure that the activities under this section of the [Agency](/usc/42/299c–7.md?p=2) and other [agencies](/usc/42/299c–7.md?p=2), including the Centers for Disease Control and Prevention and the National Institutes of Health, are free of unnecessary duplication of effort.
- (e) **Grants to support shared decisionmaking implementation—**
  - (1) **In general—** The [Secretary](/usc/42/201.md?p=c) shall establish a [program](/usc/42/274l–1.md?p=4) to provide for the phased-in development, implementation, and evaluation of shared decisionmaking using [patient decision aids](#b-1) to meet the objective of improving the understanding of patients of their medical [treatment](/usc/42/11851.md?p=11) options.
  - (2) **Shared decisionmaking resource centers—**
    - (A) **In general—** The [Secretary](/usc/42/201.md?p=c) shall provide grants for the establishment and support of Shared Decisionmaking Resource Centers (referred to in this subsection as “Centers”) to provide technical assistance to providers and to develop and disseminate best [practices](/usc/42/17061.md?p=19) and other information to support and accelerate adoption, implementation, and effective use of [patient decision aids](#b-1) and shared decisionmaking by providers.
    - (B) **Objectives—** The objective of a Center is to enhance and promote the adoption of [patient decision aids](#b-1) and shared decisionmaking through—
      - (i) providing assistance to eligible providers with the implementation and effective use of, and [training](/usc/42/285e–2.md?p=b-2) on, [patient decision aids](#b-1); and
      - (ii) the dissemination of best [practices](/usc/42/17061.md?p=19) and research on the implementation and effective use of [patient decision aids](#b-1).
  - (3) **Shared decisionmaking participation grants—**
    - (A) **In general—** The [Secretary](/usc/42/201.md?p=c) shall provide grants to [health care providers](/usc/42/300jj.md?p=3) for the development and implementation of shared decisionmaking techniques and to assess the use of such techniques.
    - (B) **Preference—** In order to facilitate the use of best [practices](/usc/42/17061.md?p=19), the [Secretary](/usc/42/201.md?p=c) shall provide a preference in making grants under this subsection to [health care providers](/usc/42/300jj.md?p=3) who participate in [training](/usc/42/285e–2.md?p=b-2) by Shared Decisionmaking Resource Centers or comparable [training](/usc/42/285e–2.md?p=b-2).
    - (C) **Limitation—** [Funds](/usc/42/12854.md?p=3) under this paragraph shall not be used to purchase or implement use of [patient decision aids](#b-1) other than those certified under the process identified in [subsection (c)](#c).
  - (4) **Guidance—** The [Secretary](/usc/42/201.md?p=c) may issue guidance to eligible grantees under this subsection on the use of [patient decision aids](#b-1).
- (f) **Funding—** For purposes of carrying out this section there are authorized to be appropriated such sums as may be necessary for fiscal year 2010 and each subsequent fiscal year.

## Footnotes

[^1]: So in original. Probably should be “engage”.
[^2]: So in original. Probably should be “provide”.
[^3]: So in original. Probably should be “facilitate”.
[^4]: So in original. Probably should be “option. The”.
[^5]: So in original.

## Source credit

(July 1, 1944, ch. 373, title IX, § 936, as added Pub. L. 111–148, title III, § 3506, Mar. 23, 2010, 124 Stat. 527.)

## Notes

### Editorial Notes

### Prior Provisions

A prior section 936 of act July 1, 1944, was renumbered section 946 and is classified to section 299c–5 of this title.