; and ; and (B) by inserting after subparagraph (Y) the following new subparagraph: (Z) in the case of hospitals, skilled nursing facilities, home health agencies, and hospice programs, to assure that documented care plans include any advance directives or portable treatment orders made while the individual received care by the provider and that such plan is sent to the individual’s primary care provider upon discharge and any facility to which the individual is transferred. . (2) Effective Date The amendments made by this subsection shall apply to agreements entered into or renewed on or after January 1, 2019. (b) HHS study and report (1) Study The Secretary of Health and Human Services shall conduct a study on the extent to which hospitals, skilled nursing facilities, hospice programs, home health agencies, and providers of advance care planning services work with individuals to— (A) engage in a care planning process; (B) thoroughly and completely document the care planning process in the medical record and to update the care plan on a regular basis; (C) complete documents necessary to support the treatment and care plan, such as portable treatment orders and advance directives; (D) provide services and support that are free from discrimination based on advanced age, disability status, or diagnosis, including serious, chronic progressive, or advanced illness; and (E) provide documentation necessary to carry out the treatment plan to— (i) subsequent providers or facilities