; or (B) a guardianship or conservatorship. (15) Secretary The term Secretary refers to the Secretary of Health and Human Services or the designee of that Secretary. (16) Standard The term standard means a requirement. (17) State The term State means any of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, American Samoa, and any Indian Tribe. (18) Supported decisionmaking arrangement The term supported decisionmaking arrangement means an agreement or other arrangement, resulting from a series of relationships, practices, and shorter arrangements, of greater or lesser formality and intensity, designed to assist an individual in understanding, making, and communicating the individual’s own decisions in a way that does not impede the individual’s self-determination, including deciding— (A) who provides the individual with supports for the decisions; (B) in which areas of life the individual receives supports, including decisions about health, services received, finances, property, living arrangements, and work