Sec. 211. Medicare, Medicaid, and CHIP coverage

1,898 words·~9 min read·/bill/113/s/3009/is/section-211

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended— in subsection (s)(2)— by striking and at the end of subparagraph (EE); by adding and at the end of subparagraph (FF); and by adding at the end the following new subparagraph: advance care planning consultation (as defined in subsection (iii)(1)); ; and by adding at the end the following new subsection: 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 subparagraphs

(A)and

(B)of paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following: An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to. An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses. An explanation by the practitioner of the role and responsibilities of a health care proxy. 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). 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. Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include— 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; the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and 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). The Secretary may limit the requirement for explanations under clause

(i)to consultations furnished in States, localities, or other geographic areas in which orders described in such clause have been widely adopted. A practitioner described in this paragraph is— a physician (as defined in subsection (r)(1)); and a nurse practitioner or physician's assistant who has the authority under State law to sign orders for life sustaining treatments. 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). An advance care planning consultation with respect to an individual shall 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. A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order. 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— 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) and is in a form that permits it to stay with the patient and be followed by health care professionals and providers across the continuum of care, including home care, hospice, long-term care, community and assisted living residences, skilled nursing facilities, inpatient rehabilitation facilities, hospitals, and emergency medical services; effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual; is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); is portable across care settings; and may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual. 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— the intensity of medical intervention if the patient is pulseless, apneic, or has serious cardiac or pulmonary problems; the individual’s desire regarding transfer to a hospital or remaining at the current care setting; the use of antibiotics; and the use of artificially administered nutrition and hydration. . Section 1848(j)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(j)(3) ) is amended by inserting (2)(GG), after (including administration of the health risk assessment), . Section 1862(a) of the Social Security Act ( 42 U.S.C. 1395y(a) ) is amended— in paragraph (1)— in subparagraph (O), by striking and at the end; in subparagraph (P), by striking the semicolon at the end and inserting , and ; and by adding at the end the following new subparagraph: in the case of advance care planning consultations (as defined in section 1861(iii)(1)), which are performed more frequently than is covered under such section; ; and in paragraph (7), by striking or

(P)and inserting (P), or

(Q). The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2016. Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended in the matter preceding clause

(i)by striking and

(28)and inserting (28), and

(29). Section 1905 of such Act ( 42 U.S.C. 1396d ) is amended— in subsection (a)— in paragraph (28), by striking and at the end; by redesignating paragraph

(29)as paragraph (30); and by inserting after paragraph

(28)the following new paragraph: advance care planning consultations (as defined in subsection (ee)); ; and by adding at the end the following: For purposes of subsection (a)(29), 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: An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to. An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses. An explanation by the practitioner of the role and responsibilities of a health care proxy. 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). 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. Subject to clause (ii), an explanation of orders for life sustaining treatments or similar orders, which shall include— 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; the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and 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). The Secretary may limit the requirement for explanations under clause

(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 nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program. A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order. For purposes of this subsection, the term orders regarding life sustaining treatment has the meaning given that term in section 1861(iii)(5). . Section 2110(a) of the Social Security Act (42 U.S.C. 1397jj) is amended— by redesignating paragraph

(28)as paragraph (29); and by inserting after paragraph (27), the following: Advance care planning consultations (as defined in section 1905(ee)). . Section 2103 of such Act ( 42 U.S.C. 1397cc ), is amended— in subsection (a), in the matter preceding paragraph (1), by striking and

(7)and inserting (7), and

(9); and in subsection (c), by adding at the end the following: The child health assistance provided to a targeted low-income child shall include coverage of advance care planning consultations (as defined in section 1905(ee) and at the same payment rate as the rate that would apply to such a consultation under the State plan under title XIX). . Section 2102(a)(7)(B) of such Act (42 U.S.C. 1397bb(a)(7)(B)) is amended by striking section 2103(c)(5) and inserting paragraphs

(5)and

(9)of section 2103(c) . Section 1866(f)(3) of the Social Security Act ( 42 U.S.C. 1395cc(f)(3) ) is amended by striking means and all that follows through the period and inserting means a living will, medical directive, health care power of attorney, durable power of attorney, or other written statement by a competent individual that is recognized under State law and indicates the individual's wishes regarding medical treatment in the event of future incompetence. Such term includes an advance health care directive and a health care directive recognized under State law. . Section 1902(w)(4) of such Act ( 42 U.S.C. 1396a(w)(4) ) is amended by striking means and all that follows through the period and inserting means a living will, medical directive, health care power of attorney, durable power of attorney, or other written statement by a competent individual that is recognized under State law and indicates the individual's wishes regarding medical treatment in the event of future incompetence. Such term includes an advance health care directive and a health care directive recognized under State law. . The amendments made by this section take effect January 1, 2015.

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