A BILL To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.
SEC. 240. DISSEMINATION OF ADVANCE CARE PLANNING INFORMATION.
(a) IN GENERAL.—The QHBP offering entity —
(d) PROHIBITION ON THE PROMOTION OF ASSISTED SUICIDE.—
(1) shall provide for the dissemination of information related to end-of-life planning to individuals seeking enrollment in Exchange-participating health benefits plans offered through the Exchange;
(2) shall present such individuals with—
(b) CONSTRUCTION.— Nothing in this section shall be construed—(2) shall present such individuals with—
(A) the option to establish advanced directives and physician’s orders for life sustaining treatment according to the laws of the State in which the individual resides; and
(B) information related to other planning tools; and
(3) shall not promote suicide, assisted suicide, euthanasia, or mercy killing. The information presented under paragraph (2) shall not presume the withdrawal of treatment and shall include end-of-life planning information that includes options to maintain all or most medical interventions.(B) information related to other planning tools; and
(1) to require an individual to complete an advanced directive or a physician’s order for life sustaining treatment or other end-of-life planning document;
(2) to require an individual to consent to restrictions on the amount, duration, or scope of medical benefits otherwise covered under a qualified health benefits plan; or
(3) to promote suicide, assisted suicide, euthanasia, or mercy killing.
(c) ADVANCED DIRECTIVE DEFINED.—In this section, the term ‘‘advanced directive’’ includes a living will, a comfort care order, or a durable power of attorney for health care.(2) to require an individual to consent to restrictions on the amount, duration, or scope of medical benefits otherwise covered under a qualified health benefits plan; or
(3) to promote suicide, assisted suicide, euthanasia, or mercy killing.
(d) PROHIBITION ON THE PROMOTION OF ASSISTED SUICIDE.—
(1) IN GENERAL.—Subject to paragraph (3), information provided to meet the requirements of subsection (a)(2) shall not include advanced directives or other planning tools that list or describe as an option suicide, assisted suicide, euthanasia, or mercy killing, regardless of legality.
(2) CONSTRUCTION.—Nothing in paragraph (1) shall be construed to apply to or affect any option to—
(2) CONSTRUCTION.—Nothing in paragraph (1) shall be construed to apply to or affect any option to—
(A) withhold or withdraw of medical treatment or medical care;
(B) withhold or withdraw of nutrition or hydration; and
(C) provide palliative or hospice care or use an item, good, benefit, or service furnished for the purpose of alleviating pain or discomfort, even if such use may increase the risk of death, so long as such item, good, benefit, or service is not also furnished for the purpose of causing, or the purpose of assisting in causing, death, for any reason.
(3) NO PREEMPTION OF STATE LAW.—Nothing in this section shall be construed to preempt or otherwise have any effect on State laws regarding advance care planning, palliative care, or end-of-life decision-making.(B) withhold or withdraw of nutrition or hydration; and
(C) provide palliative or hospice care or use an item, good, benefit, or service furnished for the purpose of alleviating pain or discomfort, even if such use may increase the risk of death, so long as such item, good, benefit, or service is not also furnished for the purpose of causing, or the purpose of assisting in causing, death, for any reason.
SEC. 1233. VOLUNTARY ADVANCE CARE PLANNING CONSULTATION.
(a) IN GENERAL.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—
(d) FREQUENCY LIMITATION.—Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended—
(1) in subsection (s)(2)—
‘‘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—(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: (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 ‘‘(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.’’.
(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),’’.(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.
(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
(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. 1442. DEVELOPMENT OF NEW QUALITY MEASURES; GAO EVALUATION OF DATA COLLECTION PROCESS FOR QUALITY MEASUREMENT. [see page 876]
