---
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"
date: "2026-07-12"
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, and clinicians that engages[^1] the patient, caregiver or authorized representative in decisionmaking, provides[^2] patients, caregivers or authorized representatives 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 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/42/300aa–33.md?p=1) 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 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 for patient decision aids for preference sensitive care and a certification process for patient decision aids 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 to evaluate patient decision aids for preference sensitive care.
    - (B) **Endorse patient decision aids—** The entity shall review patient decision aids and develop a certification process whether[^5] patient decision aids meet the standards developed and identified under [subparagraph (A)](#c-2-A). The entity shall give priority to the review and certification of patient 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](/usc/42/201.md?p=c), acting through the [Director](/usc/42/11851.md?p=5), and in coordination with heads of other relevant [agencies](/usc/42/8262.md?p=1), such as the [Director](/usc/42/11851.md?p=5) of the Centers for Disease Control and Prevention and the [Director](/usc/42/11851.md?p=5) 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 for preference sensitive care to assist [health care providers](/usc/42/300aa–33.md?p=1) in educating patients, caregivers, and authorized representatives 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/42/300aa–33.md?p=1) and patients, caregivers, and authorized representatives to make informed decisions about patient care and can be easily incorporated into a broad array of practice settings; and
    - (C) to educate [providers](/usc/42/299b–21.md?p=8) on the use of such materials, including through academic curricula.
  - (2) **Requirements for patient decision aids—** Patient decision aids 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 in informed decisionmaking with [health care providers](/usc/42/300aa–33.md?p=1);
    - (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 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.
  - (3) **Distribution—** The [Director](/usc/42/11851.md?p=5) shall ensure that patient decision aids produced with grants or contracts under this section are available to the public.
  - (4) **Nonduplication of efforts—** The [Director](/usc/42/11851.md?p=5) shall ensure that the activities under this section of the [Agency](/usc/42/8262.md?p=1) and other [agencies](/usc/42/8262.md?p=1), 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 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](/usc/42/299b–21.md?p=8) 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 and shared decisionmaking by [providers](/usc/42/299b–21.md?p=8).
    - (B) **Objectives—** The objective of a Center is to enhance and promote the adoption of patient decision aids and shared decisionmaking through—
      - (i) providing assistance to eligible [providers](/usc/42/299b–21.md?p=8) with the implementation and effective use of, and training on, patient decision aids; 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.
  - (3) **Shared decisionmaking participation grants—**
    - (A) **In general—** The [Secretary](/usc/42/201.md?p=c) shall provide grants to [health care providers](/usc/42/300aa–33.md?p=1) 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/42/300aa–33.md?p=1) who participate in training by Shared Decisionmaking Resource Centers or comparable training.
    - (C) **Limitation—** Funds under this paragraph shall not be used to purchase or implement use of patient decision aids 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.
- (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.