Advance Directive Promotion Act of 2009 - Amends title XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to require a service provider, Medicare+Choice organization, or prepaid or eligible organization to include the content of an advanced directive in a prominent part of an individual's current medical record.
Requires a service provider to give effect to a valid advance directive executed outside the state in which such directive is presented to the same extent as such provider would give effect to a valid advance directive executed under the law of the state in which it is presented.
Requires an initial preventative physical examination to include an end-of-life planning consultation.
Directs the Secretary of Health and Human Services, acting through the Administrator of the Centers for Medicare & Medicaid Services, to operate a clearinghouse and a 24-hour toll free telephone hotline in order to provide consumer information about advance directives, end-of-life decisionmaking, and available end-of-life and hospice care services.
Amends the Public Health Service Act to direct the Secretary, directly or through grants to public or nonprofit private entities, to conduct a national public education campaign to increase awareness of advance directive planning.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3253 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 3253
To amend titles XVIII and XIX of the Social Security Act to promote the
use of advance directives, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 17, 2009
Mr. Levin (for himself, Mr. Blumenauer, Mr. Castle, Mr. Kind, Mr. Farr,
and Mr. Cohen) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to promote the
use of advance directives, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Advance Directive
Promotion Act of 2009''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Improvement of policies related to the use and portability of
advance directives.
Sec. 3. Medicare coverage of an end-of-life planning consultation as
part of an initial preventive physical
examination.
Sec. 4. National information hotline for end-of-life decisionmaking and
hospice care.
Sec. 5. Increasing awareness of the importance of end-of-life planning.
SEC. 2. IMPROVEMENT OF POLICIES RELATED TO THE USE AND PORTABILITY OF
ADVANCE DIRECTIVES.
(a) Medicare.--Section 1866(f) of the Social Security Act (42
U.S.C. 1395cc(f)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (B), by inserting ``and if
presented by the individual (or on behalf of the
individual), to include the content of such advance
directive in a prominent part of such record'' before
the semicolon at the end;
(B) in subparagraph (D), by striking ``and'' after
the semicolon at the end;
(C) in subparagraph (E), by striking the period at
the end and inserting ``; and''; and
(D) by inserting after subparagraph (E) the
following new subparagraph:
``(F) to provide each such individual with the opportunity
to discuss issues relating to the information provided to that
individual pursuant to subparagraph (A) with an appropriately
trained professional.'';
(2) in paragraph (3), by striking ``a written'' and
inserting ``an''; and
(3) by adding at the end the following new paragraph:
``(5)(A) In addition to the requirements of paragraph (1), a
provider of services shall give effect to a valid advance directive
executed outside the State in which such directive is presented to the
same extent as such provider would give effect to a valid advance
directive executed under the law of the State in which it is presented.
In the absence of knowledge to the contrary, such a provider may
presume that such an advance directive executed outside the State in
which it is presented is valid. Nothing in this paragraph shall be
construed to authorize the administration of health care treatment
otherwise prohibited by the laws of the State in which the directive is
presented.
``(B) The provisions of this paragraph shall preempt any State law
to the extent such law is inconsistent with such provisions. The
provisions of this paragraph shall not preempt any State law that
provides for greater portability, more deference to a patient's wishes,
or more latitude in determining a patient's wishes with respect to
health care.''.
(b) Medicaid.--Section 1902(w) of the Social Security Act (42
U.S.C. 1396a(w)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (B)--
(i) by striking ``in the individual's
medical record'' and inserting ``in a prominent
part of the individual's current medical
record''; and
(ii) by inserting ``and if presented by the
individual (or on behalf of the individual), to
include the content of such advance directive
in a prominent part of such record'' before the
semicolon at the end;
(B) in subparagraph (D), by striking ``and'' after
the semicolon at the end;
(C) in subparagraph (E), by striking the period at
the end and inserting ``; and''; and
(D) by inserting after subparagraph (E) the
following new subparagraph:
``(F) to provide each such individual with the opportunity
to discuss issues relating to the information provided to that
individual pursuant to subparagraph (A) with an appropriately
trained professional.'';
(2) in paragraph (4), by striking ``a written'' and
inserting ``an''; and
(3) by adding at the end the following paragraph:
``(6)(A) In addition to the requirements of paragraph (1), a
provider shall give effect to a valid advance directive executed
outside the State in which such directive is presented to the same
extent as such provider would give effect to a valid advance directive
executed under the law of the State in which it is presented. In the
absence of knowledge to the contrary, such a provider may presume that
such an advance directive executed outside the State in which it is
presented is valid. Nothing in this paragraph shall be construed to
authorize the administration of health care treatment otherwise
prohibited by the laws of the State in which the directive is
presented.
``(B) The provisions of this paragraph shall preempt any State law
to the extent such law is inconsistent with such provisions. The
provisions of this paragraph shall not preempt any State law that
provides for greater portability, more deference to a patient's wishes,
or more latitude in determining a patient's wishes with respect to
health care.''.
(c) Effective Dates.--
(1) In general.--Subject to paragraph (2), the amendments
made by subsections (a) and (b) shall apply to provider
agreements entered into, renewed, or extended under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.), and to
State plans under title XIX of such Act (42 U.S.C. 1396 et
seq.), on or after such date as the Secretary of Health and
Human Services specifies, but in no case may such date be later
than 1 year after the date of enactment of this Act.
(2) Extension of effective date for state law amendment.--
In the case of a State plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) which the Secretary of
Health and Human Services determines requires State legislation
in order for the plan to meet the additional requirements
imposed by the amendments made by subsection (b), the State
plan shall not be regarded as failing to comply with the
requirements of such title solely on the basis of its failure
to meet these additional requirements before the first day of
the first calendar quarter beginning after the close of the
first regular session of the State legislature that begins
after the date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year
legislative session, each year of the session is considered to
be a separate regular session of the State legislature.
SEC. 3. MEDICARE COVERAGE OF AN END-OF-LIFE PLANNING CONSULTATION AS
PART OF AN INITIAL PREVENTIVE PHYSICAL EXAMINATION.
(a) In General.--Section 1861(ww) of the Social Security Act (42
U.S.C. 1395x(ww)), as amended by section 101(b)(1) of the Medicare
Improvements for Patients and Providers Act of 2008 (Public Law 110-
275), is amended by amending paragraph (3) to read as follows:
``(3) For purposes of paragraph (1), the term `end-of-life
planning' means a consultation between the physician and an individual
regarding--
``(A) the importance of preparing advance directives in
case an injury or illness causes the individual to be unable to
make health care decisions;
``(B) an explanation of what constitutes an advance
directive, and the situations in which an advance directive is
likely to be relied upon;
``(C) the reasons why the development of a comprehensive
end-of-life plan is beneficial and the reasons why such a plan
should be updated periodically as the health of the individual
changes;
``(D) 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 decision maker (also known as a
health care proxy); and
``(E) whether or not the physician is willing to follow the
individual's wishes as expressed in an advance directive.''.
(b) Effective Date.--The amendments made by this section shall
apply to initial preventive physical examinations furnished on or after
January 1, 2010.
SEC. 4. NATIONAL INFORMATION HOTLINE FOR END-OF-LIFE DECISIONMAKING AND
HOSPICE CARE.
The Secretary of Health and Human Services, acting through the
Administrator of the Centers for Medicare & Medicaid Services, shall
operate directly, or by grant, contract, or interagency agreement, out
of funds otherwise appropriated to the Secretary, a clearinghouse and a
24-hour toll-free telephone hotline in order to provide consumer
information about advance directives (as defined in section 1866(f)(3)
of the Social Security Act (42 U.S.C. 1395cc(f)(3)), as amended by
section 2(a)), end-of-life decisionmaking, and available end-of-life
and hospice care services. In carrying out the preceding sentence, the
Administrator may designate an existing clearinghouse and 24-hour toll-
free telephone hotline or, if no such entity is appropriate, may
establish a new clearinghouse and a 24-hour toll-free telephone
hotline.
SEC. 5. INCREASING AWARENESS OF THE IMPORTANCE OF END-OF-LIFE PLANNING.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by adding at the end the following new part:
``PART S--PROGRAMS TO INCREASE AWARENESS OF ADVANCE DIRECTIVE PLANNING
ISSUES
``SEC. 399FF. ADVANCE DIRECTIVE EDUCATION CAMPAIGNS.
``(a) Advance Directive Education Campaign.--The Secretary shall,
directly or through grants awarded under subsection (b), conduct a
national public education campaign--
``(1) to raise public awareness of the importance of
planning for care near the end of life;
``(2) to improve the public's understanding of the various
situations in which individuals may find themselves if they
become unable to express their health care wishes;
``(3) to explain the need for readily available legal
documents that express an individual's wishes, through advance
directives (including living wills, comfort care orders, and
durable powers of attorney for health care); and
``(4) to educate the public about the availability of
hospice care and palliative care.
``(b) Grants.--
``(1) In general.--The Secretary shall use at least 60
percent of the funds appropriated under subsection (c) for the
purpose of awarding grants to public or nonprofit private
entities (including States or political subdivisions of a
State), or a consortium of any of such entities, for the
purpose of conducting education campaigns under subsection (a).
``(2) Period.--Any grant awarded under paragraph (1) shall
be for a period of 3 years.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $25,000,000.''.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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