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(a) Medicare-
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(1) IN GENERAL- Section 1861 of the Social
Security Act (42 U.S.C. 1395x) is amended--
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(A) in subsection (s)(2)--
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(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:
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‘(FF) advance care planning consultation (as
defined in subsection (hhh)(1));’; and
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(B) by adding at the end the following new
subsection:
‘Advance Care
Planning Consultation
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‘(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:
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‘(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--
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‘(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).
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‘(ii) The Secretary shall limit the
requirement for explanations under clause (i) to
consultations furnished in a State--
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‘(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).
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‘(iii) A program for orders for life
sustaining treatment for a States described in
this clause is a program that--
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‘(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.
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‘(2) A practitioner described in this paragraph
is--
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‘(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.
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‘(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--
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‘(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.
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‘(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--
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‘(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--
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(A) in paragraph (1)--
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(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:
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‘(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)’.
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(4) EFFECTIVE DATE- The amendments made by
this subsection shall apply to consultations
furnished on or after January 1, 2011.
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(b) Expansion of Physician Quality Reporting
Initiative for End of Life Care-
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(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-
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‘(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.’.
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(c) Inclusion of Information in Medicare & You
Handbook-
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(1) MEDICARE & YOU HANDBOOK-
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(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:
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(i) An explanation of advance care
planning and advance directives,
including--
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(I) living wills;
(II) durable
power of attorney;
(III) orders of
life-sustaining treatment; and
(IV)
health care proxies.
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(ii) A description of Federal and
State resources available to assist
individuals and their families with
advance care planning and advance
directives, including--
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(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.
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(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.
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