H.R 3962 Passed - Voluntary Advance Care Planning Consultation
Posted Nov 08 2009 10:01pm
H.R. 3962 [ PDF ] was passed by the House of Representatives last night. While much of the focus is rightly on Division A of the bill: "AFFOR DAB LE HE ALTH CARE CHOICES," I wanted to flag a few provisions in Division B of the bill: "MEDI CARE AND MEDICAID IMPROVEMENTS."
First the general structure of this Division of the bill is divided as follows. Within the red highlighted section is section 1233 of the bill: "Voluntary Advance Care Planning Consultation." The details, of course, will be within HHS regulations that will be issued after the bill is signed by the President.
TITLE I--IMPROVING HEALTHCARE VALUE
Subtitle A--Provisions Related to Medicare Part A
Subtitle B--Provisions Related to Part B
Subtitle C--Provisions Related to Medicare Parts A and B
Subtitle D--Medicare Advantage Reforms
Subtitle E--Improvements to Medicare Part D
Subtitle F--Medicare Rural Access Protections
TITLE II--MEDICARE BENEFICIARY IMPROVEMENTS
Subtitle A--Improving and Simplifying Financial Assistance for Low Income Medicare Beneficiaries
Subtitle B--Reducing Health Disparities
Subtitle C--Miscellaneous Improvements
TITLE III--PROMOTING PRIMARY CARE, MENTALHEALTH SERVICES, AND COORDINATED CARE
TITLE IV--QUALITY
Subtitle A--Comparative Effectiveness Research
Subtitle B--Nursing Home Transparency
Subtitle C--Quality Measurements
Subtitle D--Physician Payments Sunshine Provision
Subtitle E--Public Reporting on Health Care-Associated Infections
TITLE V--MEDICARE GRADUATE MEDICAL EDUCATION
TITLE VI--PROGRAM INTEGRITY
Subtitle A--Increased Funding to Fight Waste, Fraud, and Abuse
Subtitle B--Enhanced Penalties for Fraud and Abuse
Subtitle C--Enhanced Program and Provider Protections
Subtitle D--Access to Information Needed to Prevent Fraud, Waste, and Abuse
TITLEVII--MEDICAID AND CHIP
TITLE VIII--REVENUE-RELATED PROVISIONS
TITLE IX--MISCELLANEOUS PROVISIONS
SEC. 1233. VOLUNTARY ADVANCE CARE PLANNING CONSULTATION.
(a) In General- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
(1) in subsection (s)(2)--
(A) by striking `and' at the end of subparagraph (DD);
(B) by adding `and' at the end of subparagraph (EE); and
(C) by adding at the end the following new subparagraph:
`(FF) voluntary advance care planning consultation (as defined in subsection (hhh)(1));'; and
(2) by adding at the end the following new subsection:
`Voluntary Advance Care Planning Consultation
`(hhh)(1) Subject to paragraphs (3) and (4), the term `voluntary advance care planning consultation' means an optional consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning. Such consultation may include the following, as specified by the Secretary:
`(A) An explanation by the practitioner of advance care planning, including a review of key questions and considerations, advance directives (including living wills and durable powers of attorney) and their uses.
`(B) An explanation by the practitioner of the role and responsibilities of a health care proxy and 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.
`(C) An explanation by the practitioner of physician orders regarding life sustaining treatment or similar orders, in States where such orders or similar orders exist.
`(2) A practitioner described in this paragraph is--
`(A) a physician (as defined in subsection (r)(1)); and
`(B) another health care professional (as specified by the Secretary and who has the authority under State law to sign orders for life sustaining treatments, such as a nurse practitioner or physician assistant).
`(3) An individual may receive the voluntary advance care planning care planning consultation provided for under this subsection no more than once every 5 years unless there is a significant change in the health or health-related condition of the individual.
`(4) 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 effectively communicates the individual's preferences regarding life sustaining treatment, is signed and dated by a practitioner, and is in a form that permits it to be followed by health care professionals across the continuum of care.'.
(b) Construction- The voluntary advance care planning consultation described in section 1861(hhh) of the Social Security Act, as added by subsection (a), shall be completely optional. Nothing in this section shall--
(1) require an individual to complete an advance directive, an order for life sustaining treatment, or other advance care planning document;
(2) require an individual to consent to restrictions on the amount, duration, or scope of medical benefits an individual is entitled to receive under this title; or
(3) encourage the promotion of suicide or assisted suicide.
(c) 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),'.
(d) Frequency Limitation- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (N), by striking `and' at the end;
(B) in subparagraph (O) by striking the semicolon at the end and inserting `, and'; and
(C) by adding at the end the following new subparagraph:
`(P) in the case of voluntary advance care planning consultations (as defined in paragraph (1) of section 1861(hhh)), which are performed more frequently than is covered under such section;'; and
(2) in paragraph (7), by striking `or (K)' and inserting `(K), or (P)'.
(e) Effective Date- The amendments made by this section shall apply to consultations furnished on or after January 1, 2011.
SEC. 1233. VOLUNTARY ADVANCE CARE PLANNING CONSULTATION.
(a) In General- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
(1) in subsection (s)(2)--
(A) by striking `and' at the end of subparagraph (DD);
(B) by adding `and' at the end of subparagraph (EE); and
(C) by adding at the end the following new subparagraph:
`(FF) voluntary advance care planning consultation (as defined in subsection (hhh)(1));'; and
`Voluntary Advance Care Planning Consultation(2) by adding at the end the following new subsection:
`(hhh)(1) Subject to paragraphs (3) and (4), the term `voluntary advance care planning consultation' means an optional consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning. Such consultation may include the following, as specified by the Secretary:
`(A) An explanation by the practitioner of advance care planning, including a review of key questions and considerations, advance directives (including living wills and durable powers of attorney) and their uses.
`(B) An explanation by the practitioner of the role and responsibilities of a health care proxy and 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.
`(C) An explanation by the practitioner of physician orders regarding life sustaining treatment or similar orders, in States where such orders or similar orders exist.
`(2) A practitioner described in this paragraph is--
`(A) a physician (as defined in subsection (r)(1)); and
`(B) another health care professional (as specified by the Secretary and who has the authority under State law to sign orders for life sustaining treatments, such as a nurse practitioner or physician assistant).
`(3) An individual may receive the voluntary advance care planning care planning consultation provided for under this subsection no more than once every 5 years unless there is a significant change in the health or health-related condition of the individual.
`(4) 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 effectively communicates the individual's preferences regarding life sustaining treatment, is signed and dated by a practitioner, and is in a form that permits it to be followed by health care professionals across the continuum of care.'.
(b) Construction- The voluntary advance care planning consultation described in section 1861(hhh) of the Social Security Act, as added by subsection (a), shall be completely optional. Nothing in this section shall--
(1) require an individual to complete an advance directive, an order for life sustaining treatment, or other advance care planning document;
(2) require an individual to consent to restrictions on the amount, duration, or scope of medical benefits an individual is entitled to receive under this title; or
(3) encourage the promotion of suicide or assisted suicide.
(c) 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),'.
(d) Frequency Limitation- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (N), by striking `and' at the end;
(B) in subparagraph (O) by striking the semicolon at the end and inserting `, and'; and
(C) by adding at the end the following new subparagraph:
`(P) in the case of voluntary advance care planning consultations (as defined in paragraph (1) of section 1861(hhh)), which are performed more frequently than is covered under such section;'; and
(2) in paragraph (7), by striking `or (K)' and inserting `(K), or (P)'.
(e) Effective Date- The amendments made by this section shall apply to consultations furnished on or after January 1, 2011.