H.R. 3200 America's Affordable Health Choices Act of 2009 (Introduced in House)
SEC. 1233.
ADVANCE CARE PLANNING CONSULTATION
ADVANCE CARE PLANNING CONSULTATION
(a) Medicare-
(1) IN
GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
(A) in
subsection (s)(2)--
(i) by
striking ‘and’ at the end of subparagraph (DD);
(ii)
by adding ‘and’ at the end of subparagraph (EE); and
(iii)
by adding at the end the following new subparagraph:
‘(FF)
advance care planning consultation (as defined in subsection (hhh)(1));’; and
(B) by
adding at the end the following new subsection:
‘Advance Care
Planning Consultation
‘(hhh)(1)
Subject to paragraphs (3) and (4), the term ‘advance care planning
consultation’ means a consultation between the individual and a practitioner
described in paragraph (2) regarding advance care planning, if, subject to
paragraph (3), the individual involved has not had such a consultation within
the last 5 years. Such consultation shall include the following:
‘(A) An
explanation by the practitioner of advance care planning, including key
questions and considerations, important steps, and suggested people to talk to.
‘(B) An
explanation by the practitioner of advance directives, including living wills
and durable powers of attorney, and their uses.
‘(C) An
explanation by the practitioner of the role and responsibilities of a health
care proxy.
‘(D) The
provision by the practitioner of a list of national and State-specific
resources to assist consumers and their families with advance care planning,
including the national toll-free hotline, the advance care planning
clearinghouses, and State legal service organizations (including those funded
through the Older Americans Act of 1965).
‘(E) An
explanation by the practitioner of the continuum of end-of-life services and
supports available, including palliative care and hospice, and benefits for
such services and supports that are available under this title.
‘(F)(i)
Subject to clause (ii), an explanation of orders regarding life sustaining
treatment or similar orders, which shall include--
‘(I)
the reasons why the development of such an order is beneficial to the
individual and the individual’s family and the reasons why such an order should
be updated periodically as the health of the individual changes;
‘(II)
the information needed for an individual or legal surrogate to make informed
decisions regarding the completion of such an order; and
‘(III)
the identification of resources that an individual may use to determine the
requirements of the State in which such individual resides so that the
treatment wishes of that individual will be carried out if the individual is
unable to communicate those wishes, including requirements regarding the designation
of a surrogate decisionmaker (also known as a health care proxy).
‘(ii) The
Secretary shall limit the requirement for explanations under clause (i) to
consultations furnished in a State--
‘(I)
in which all legal barriers have been addressed for enabling orders for life
sustaining treatment to constitute a set of medical orders respected across all
care settings; and
‘(II)
that has in effect a program for orders for life sustaining treatment described
in clause (iii).
‘(iii) A
program for orders for life sustaining treatment for a States described in this
clause is a program that--
‘(I) ensures such orders are
standardized and uniquely identifiable throughout the State;
‘(II)
distributes or makes accessible such orders to physicians and other health
professionals that (acting within the scope of the professional’s authority
under State law) may sign orders for life sustaining treatment;
‘(III)
provides training for health care professionals across the continuum of care
about the goals and use of orders for life sustaining treatment; and
‘(IV) is guided by a coalition of
stakeholders includes representatives from emergency medical services,
emergency department physicians or nurses, state long-term care association,
state medical association, state surveyors, agency responsible for senior
services, state department of health, state hospital association, home health
association, state bar association, and state hospice association.
‘(2) A
practitioner described in this paragraph is--
‘(A) a
physician (as defined in subsection (r)(1)); and
‘(B) a
nurse practitioner or physician’s assistant who has the authority under State
law to sign orders for life sustaining treatments.
‘(3)(A) An
initial preventive physical examination under subsection (WW), including any
related discussion during such examination, shall not be considered an advance
care planning consultation for purposes of applying the 5-year limitation under
paragraph (1).
‘(B) An
advance care planning consultation with respect to an individual may be
conducted more frequently than provided under paragraph (1) if there is a
significant change in the health condition of the individual, including
diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or
terminal diagnosis or life-threatening injury, or upon admission to a skilled
nursing facility, a long-term care facility (as defined by the Secretary), or a
hospice program.
‘(4) A
consultation under this subsection may include the formulation of an order
regarding life sustaining treatment or a similar order.
‘(5)(A) For
purposes of this section, the term ‘order regarding life sustaining treatment’
means, with respect to an individual, an actionable medical order relating to the
treatment of that individual that--
‘(i) is
signed and dated by a physician (as defined in subsection (r)(1)) or another
health care professional (as specified by the Secretary and who is acting
within the scope of the professional’s authority under State law in signing
such an order, including a nurse practitioner or physician assistant) and is in
a form that permits it to stay with the individual and be followed by health
care professionals and providers across the continuum of care;
‘(ii)
effectively communicates the individual’s preferences regarding life sustaining
treatment, including an indication of the treatment and care desired by the
individual;
‘(iii) is
uniquely identifiable and standardized within a given locality, region, or State
(as identified by the Secretary); and
‘(iv) may
incorporate any advance directive (as defined in section 1866(f)(3)) if
executed by the individual.
‘(B) The level
of treatment indicated under subparagraph (A)(ii) may range from an indication
for full treatment to an indication to limit some or all or specified
interventions. Such indicated levels of treatment may include indications
respecting, among other items--
‘(i) the
intensity of medical intervention if the patient is pulse less, apneic, or has
serious cardiac or pulmonary problems;
‘(ii) the
individual’s desire regarding transfer to a hospital or remaining at the
current care setting;
‘(iii) the
use of antibiotics; and
‘(iv) the use of artificially
administered nutrition and hydration.’.
(2)
PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by
inserting ‘(2)(FF),’ after ‘(2)(EE),’.
(3)
FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is
amended--
(A) in
paragraph (1)--
(i) in subparagraph (N), by striking ‘and’ at the end;
(ii) in subparagraph (O) by striking the semicolon at the end and
inserting ‘, and’; and
(iii) by adding at the end the following new subparagraph:
‘(P)
in the case of advance care planning consultations (as defined in section
1861(hhh)(1)), which are performed more frequently than is covered under such
section;’; and
(B) in
paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’.
(4)
EFFECTIVE DATE- The amendments made by this subsection shall apply to
consultations furnished on or after January 1, 2011.
(b) Expansion
of Physician Quality Reporting Initiative for End of Life Care-
(1) Physician’S QUALITY REPORTING
INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C.
1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:
‘(3)
Physician’S QUALITY REPORTING INITIATIVE-
‘(A)
IN GENERAL- For purposes of reporting data on quality measures for covered
professional services furnished during 2011 and any subsequent year, to the
extent that measures are available, the Secretary shall include quality measures
on end of life care and advanced care planning that have been adopted or
endorsed by a consensus-based organization, if appropriate. Such measures shall
measure both the creation of and adherence to orders for life-sustaining
treatment.
‘(B)
PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register
proposed quality measures on end of life care and advanced care planning that
the Secretary determines are described in subparagraph (A) and would be appropriate
for eligible professionals to use to submit data to the Secretary. The
Secretary shall provide for a period of public comment on such set of measures
before finalizing such proposed measures.’.
(c) Inclusion
of Information in Medicare & You Handbook-
(1)
MEDICARE & YOU HANDBOOK-
(A) IN
GENERAL- Not later than 1 year after the date of the enactment of this Act, the
Secretary of Health and Human Services shall update the online version of the
Medicare & You Handbook to include the following:
(i) An explanation of advance care planning and advance directives,
including--
(I) living wills;
(II) durable power of attorney;
(III) orders of life-sustaining treatment; and
(IV) health care proxies.
(ii) A description of Federal and State resources available to assist
individuals and their families with advance care planning and advance
directives, including--
(I) available State legal service organizations to assist individuals
with advance care planning, including those organizations that receive funding
pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);
(II) website links or addresses for State-specific advance directive
forms; and
(III) any additional information, as determined by the Secretary.
(B)
UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the
information described in subparagraph (A) in all paper and electronic versions
of the Medicare & You Handbook that are published on or after the date that
is 1 year after the date of the enactment of this Act.
See the full text of H.R. 3200 at OpenCongress.org
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