A bill to amend titles XVIII and XIX of the Social Security Act to promote the use of advance directives, and for other purposes

2008·0.45 MB·English

by  United States. Congress. House

CMSLibrary
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2DSESSION
I
ToamendtitlesX^^IIandXIXoftheSocialSecurityActtopromote
theuseofadvancedirectives,andforotherpurposes.
IN THE HOUSE OF REPRESENTATR^S
April3,2008
Mr. Le\^N (forhim.self, Mr. Castle, Mr. McDermott, Mr. KiLDEE, Mrs.
McCarthy of New York, Mi-. Moore of Kansas, Mr. Faiir, Ms.
DeLauro, Ms. Slaughter, Ms. Wasserman Schultz, Mr. George
MillerofCalifornia,Ms.HOOLEY,Mr.CUMMINGS,Mr.Blumenauer,
Mr. HiGGlNS, Mr. Wu, and Mr. Cohen) introducedthe followingbill;
whichwasreferredtotheCommitteeonEnergy-andCommerce
A
BILL
To amend titles XX-lII and XIX ofthe Social SecurityAct
to promote the use of advance directives, and for other
purposes.
1 BeitenactedbytheSenateandHouseofRepresenta-
2 tivesoftheUnitedStatesofAmericainCongressassembled,
3 SECTION1.SHORTTITLE;TABLEOFCONTENTS.
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4 (a) Short Title. This Act may be cited as the
5 "AdvanceDirectivePromotionActof2008".
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6 (b) Table ofContents. Thetableofcontentsof
7 thisActisasfollows:
See. 1. Shorttitle:tableofcontents.
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2
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Sec.2. Improvementof|)()liciesrelatedtotheuseandportabilityofadvance
directives.
Sec. 3. Medicarecoverageofanend-of-lifeplanning-consultationaspartofan
initialpreventivephysicalexamination.
Sec. 4. Nationalinformationhotlinefoi-end-of-lifedecisionmakingandhospice
care.
Sec. 5. Increasingawarenessoftheimportanceofend-of-lifeplanning.
1 SEC.2.IMPROVEMENTOFPOLICIESRELATEDTOTHEUSE
2 ANDPORTABILITYOFADVANCEDIRECTIVES.
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3 (a) Medicare. Section 1866(f) ofthe Social Seeu-
4 rityAct(42U.S.C. 1395ce(f))isamended—
5 (1)inparagraph (1)
6 (A) in subparagraph (B), by inserting
7 "and ifpresented by the indi\idual (or on be-
8 halfoftheindi^ddual), toincludethecontentof
9 such advance directive in a prominent part of
10 suchrecord"beforethesemicolonattheend;
11 (B) in subparagraph (D), by striking
12 "and" afterthesemicolonattheend;
13 (C) in subparagraph (E), by striking the
14 periodattheendandinserting";and"; and
15 (D) by inserting after subparagraph (E)
16 thefollowingnewsubparagraph:
17 "(F) to pro\ide each such indi\idual mth the
18 opportunitytodiscussissuesrelatingtotheinforma-
19 tionpro\adedtothatindi\'idualpursuanttosubpara-
20 graph (A) A\ith an appropriately trained profes-
21 sional.";
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1 (2) ill parac^raph (3), b}' striking "a WTitteii"
2 andinserting"an";and
3 (3) by adding- at the end the follo-wdng new
4 paragraph:
5 "(5)(A)Inadditiontotherequirementsofparagraph
6 (1), apro\'ider ofservices shall give effectto avahd ad-
7 vance directive executed outside the State in which such
8 directiveispresentedtothesameextentassuchprovider
9 would give effect to a valid advance directive executed
10 under the law of the State in which it is presented. In
11 theabsenceofknowledgetothecontrary^ suchapro^ider
12 maypresumethatsuchanadvancedirectiveexecutedout-
13 side the State in which it is presented is valid. Nothing
14 in thisparagraph shallbe construedto authorizethe ad-
15 ministrationofhealthcaretreatmentotherwiseprohibited
16 bythelawsoftheStateinwhichthedirectiveispresented.
17 "(B) Theprovisionsofthisparagraphshallpreempt
18 anyStatelawtotheextent such lawis inconsistent\^^th
19 suchpro\dsions.Thepro\isionsofthisparagraphshallnot
20 preempt any State law that pro\ides for greater port-
21 ability,moredeferencetoapatient'swishes,ormorelati-
22 tude in determining a patient's wishes \^ith respect to
23 healthcare.".
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24 (b) Medicaid. Section 1902(w) ofthe Social Secu-
25 rityAct(42U.S.C. 1396a(w))isamended—
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1 (1)inparagi'apli(1)
2 (A)illsubparao:i'apli(B)
3 (i) by striking^ "in the iiidi\idual's
4 medicalrecord" andinserting""inapromi-
5 nent part ofthe iiidi\iduars current med-
6 icalrecord";and
7 (ii) by inserting "and ifpresented by
8 the indi\idual (or on behalf of the indi-
9 Aadual), to include the content ofsuch ad-
10 vancedirectivein aprominentpartofsuch
11 record"beforethesemicolonattheend;
12 (B) in subparagraph (D), by striking
13 "and"afterthesemicolonattheend;
14 (C) in subparagraph (E), by striking the
15 periodattheendandinserting"; and";and
16 (D) by inserting after subparagraph (E)
17 thefollowingnewsubparagraph:
18 "(F) to provide each such indi\ddual with the
19 opportunitytodiscussissuesrelatingtotheinforma-
20 tionprovidedtothatindi\idualpursuanttosubpara-
21 graph (A) with an appropriately trained profes-
22 sional.";
23 (2) in paragraph (4), by striking "a WTitten"
24 andinserting"an"; and
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1 (3) by adding at the end the foUomng para-
2 graph:
3 "(6)(A)Inadditiontotherequirementsofparagraph
4 (1),aprovidershallgiveeffecttoavalidadvancedirective
5 executedoutsidethe Stateinwhich such directiveispre-
6 sentedtothesameextentassuchpro\iderwould giveef-
7 feet to a valid advance directive executed under the law
8 ofthe State in which it is presented. In the absence of
9 knowledge to the contrary', such a providermaypresume
10 thatsuchanadvancedirectiveexecutedoutsidetheState
11 inwliichitispresentedisvalid.Nothinginthisparagraph
12 shall be construed to authorize the administration of
13 healthcaretreatmentotherwiseprohibitedbythelawsof
14 theStateinwliichthedirectiveispresented.
15 "(B) Thepro\isionsofthisparagraph shallpreempt
16 anyStatelawtotheextent suchlawis inconsistentwith
17 suchpro\isions.Thepro\asionsofthisparagraphshallnot
18 preempt any State law that pro\'ides for gi-eater port-
19 ability, moredeferencetoapatient'swishes,ormorelati-
20 tude in determining a patient's \\ishes A\dth respect to
21 healthcare.".
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22 (e)Effectr^eDates.
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23 (1) In general. Subject to paragraph (2),
24 the amendments made by subsections (a) and (b)
25 shall applyto pro\'ider agreements entered into, re-
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1 newed, or extended under title XS'lII ofthe Social
2 SecurityAct (42 U.S.C. 1395 et seq.), and to State
3 plansunder titleXIXofsuchAct (42 U.S.C. 1396
4 et seq.), on or after such date as the Seeretar\^ of
5 HealthandHumanSer\dcesspecifies,butinnocase
6 may such date be later than 1 year after the date
7 ofenactmentofthisAct.
8 (2) Extension of effecti\^ date for
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9 state law amendrtent. In the case of a State
10 plan undertitleXIX ofthe Social SecurityAct (42
11 U.S.C. 1396 et seq.) which the Secretan^ ofHealth
12 andHumanSendeesdeterminesrequiresStatelegis-
13 lation in order for the plan to meet the additional
14 requirements imposed by the amendments made by
15 subsection (b), the State plan shah not be regarded
16 as failing to comply with the requirements of such
17 title solely on the basis ofits failure to meet these
18 additional requirements before the first day of the
19 first calendar quarter beginning after the close of
20 thefirstregularsession ofthe Statelegislaturethat
21 begins after the date ofenactment ofthis Act. For
22 purposes ofthe pre\ious sentence, in the case ofa
23 Statethathas a2-yearlegislative session, eachyear
24 ofthe session is consideredtobe a separate regular
25 sessionoftheStatelegislature.
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1 SEC. 3. MEDICARE COVERAGE OFANEND-OF-LIFE PLAN-
2 NINGCONSULTATIONASPARTOFANINITIAL
3 PREVENTIVEPHYSICALEXAMINATION.
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4 (a) In General. Section 1861(w) of the Social
5 SecurityAct(42U.S.C. 1395x(\\w))isamended
6 (1) ill paragi^aph (1), by striking "paragraph
7 (2)," and inserting "paragraph (2) and an end-of-
8 hfe planning consultation (as defined in paragraph
9 (3)),";and
10 (2) by adding at the end the folloA\ing new
11 paragraph:
12 "(3) For purposes ofparagraph (1), the term 'end-
13 of-life planning consultation' means a consultation be-
14 tweenthephysicianandanindi^^dualregarding
15 "(A) the importance of preparing advance di-
16 rectives in case an injurv'or illness causes the indi-
17 \idualtobeunabletomakehealthcaredecisions;
18 "(B) the situations in which an advance direc-
19 tiveisUkelytobereliedupon;
20 "(C) the reasons why the development of a
21 comprehensive end-of-life plan is beneficial and the
22 reasonswhysuch aplan should be updated periodi-
23 callyasthehealthoftheindi\idualchanges;
24 "(D) the identification ofresources that an in-
25 diAddual may use to determine the requirements of
26 the State in which such individual resides so that
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1 the treatment wslies ofthat indhidual will be ear-
2 ried out ifthe indi^^dllal is miable to communicate
3 those A\ishes, including requirements regarding the
4 designation of a surrogate decision maker (also
5 knomiasa healthcareprox}-);and
6 "(E) whether or not the physician iswillingto
7 followthe indi\iduarswishes as expressedin an ad-
8 vancedirective.".
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9 (b) Effectr^ Date. The amendments made by
10 thissectionshallapplytoinitialpreventivephysicalexami-
11 nationsfurnishedonorafterJanuarv«-1,72009.
12 SEC. 4. NATIONAL INFORMATION HOTLINE FOR END-OF-
13 LIFEDECISIONMAKINGANDHOSPICECARE.
14 TheSecretary'ofHealthandHumanSenices,acting
15 throughtheAdministratoroftheCentersforMedicare&
16 MedicaidSenices,shalloperatedirectly,orbygrant,con-
17 tract, or interagency agreement, out of funds otherwise
18 appropriatedtothe Secretars', a clearinghouse anda 24-
19 hour toll-free telephone hotline in order to pro\ide con-
20 sumerinformationaboutadvancedirectives(asdefinedin
21 section 1866(f)(3) ofthe Social SecurityAct (42 U.S.C.
22 1395cc(f)(3)),asamendedbysection2(a)),end-of-lifede-
23 cisionmaking, and available end-of-life and hospice care
24 senices. In carrvingout the preceding sentence, theAd-
25 ministrator may designate an existing clearinghouse and
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1 24-hoiirtoll-freetelephone hotlineor, ifno such entityis
2 appropriate,mayestabhsha newclearinghouse anda24-
3 hourtoll-freetelephonehotline.
4 SEC.5.INCREASINGAWARENESSOFTHEIMPORTANCEOF
5 END-OF-LIFEPLANNING.
6 TitleIIIofthePubhcHealthServiceAct(42 U.S.C.
7 241etseq.)isamendedbyaddingattheendthefollowing
8 newpart:
9 "PARTS—PROGRAMSTOINCREASEAWARENESS
10 OFADVANCEDIRECTIVEPLANNINGISSUES
11 "SEC. 399FF. ADVANCE DIRECTIVE EDUCATION CAM-
12 PAIGNS.
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13 "(a)AdvanceDiRECTrvEEducationCampaign.
14 The Seeretan' shall, directly or through gi^ants awarded
15 undersubsection (b), conducta nationalpubliceducation
16 campaign
17 "(1) to raise public awareness of the impor-
18 tanceofplanningforcareneartheendoflife;
19 "(2) to improve the public's understanding of
20 thevarious situations in which indi\iduals mayfmd
21 themselves if they become unable to express their
22 healthcarewishes;
23 "(3) to explain the need for readily available
24 legal documents that express an indi\iduars wishes,
25 through advance directives (including h\ing wills,
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I!CC725M-0S007LS-ie1bcr3uarriytyBlvd. 11
*Baltimore, Maryland 21244 10 3 flOTS DODDLTDT E
1 comfort care orders, and durablepowers ofattorney
2 forhealthcare); and
3 "(4) toeducatethepublic abouttheavailability
4 ofhospicecareandpalliativecare.
5 "(b)Gr.\nts.—
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6 "(1) In general. The Secretarv' shah use at
7 least 60 percent of the funds appropriated under
8 subsection (c) forthepurposeofawarding;grantsto
9 public ornonprofitprivate entities (including States
10 orpolitical subdi\isions ofa State), ora consortium
11 ofanyofsuchentities,forthepurposeofconducting
12 educationcampaignsundersubsection(a).
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13 "(2) Period. ^Aiiygrant awardedunderpara-
14 graph (1) shallbeforaperiodof3years.
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15 "(c) Authorization of Appropriations. There
16 areauthorizedtobeappropriatedtocarryoutthissection
17
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