Simon Crosier Act
This bill requires hospitals and other health care providers, as a condition of Medicare and Medicaid participation, to have certain written policies and procedures in place that limit the implementation of do-not-resuscitate (DNR) orders for unemancipated minors in accordance with specified criteria.
Among other provisions, such policies and procedures must (1) require the informed consent of at least one parent and a reasonable attempt to contact the other parent before instituting a DNR order, (2) allow either parent to refuse to consent to a DNR order, and (3) allow a parent to transfer a minor to another facility after being informed of an intent to institute a DNR order.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6344 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 6344
To amend titles XVIII and XIX of the Social Security Act to require
providers of services and health maintenance organizations under the
Medicare and Medicaid programs to provide for certain policies to be in
place relating to do-not-resuscitate orders or similar physician's
orders for unemancipated minors receiving services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 9, 2023
Mr. LaTurner (for himself, Ms. Stefanik, Mr. Aderholt, Mr. Banks, Mr.
Smith of New Jersey, Mrs. Miller-Meeks, Ms. Letlow, Mr. Moore of Utah,
Mr. Rouzer, Mr. Mann, Mrs. Miller of Illinois, Mr. Sessions, Mr.
Rosendale, Mr. Babin, Mr. Fulcher, Mr. Duncan, Mr. Estes, Mr. Lamborn,
Ms. Van Duyne, Mrs. Bice, Mr. Valadao, and Mr. Bost) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to require
providers of services and health maintenance organizations under the
Medicare and Medicaid programs to provide for certain policies to be in
place relating to do-not-resuscitate orders or similar physician's
orders for unemancipated minors receiving services.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Simon Crosier Act''.
SEC. 2. MEDICARE AND MEDICAID REQUIREMENTS FOR CERTAIN POLICIES
RELATING TO DO-NOT-RESUSCITATE ORDERS OR SIMILAR
PHYSICIAN'S ORDERS.
(a) Medicare Provider Agreement Requirement.--
(1) In general.--Section 1866(f) of the Social Security Act
(42 U.S.C. 1395cc(f)) is amended by adding at the end the
following new paragraphs:
``(5) For purposes of subsection (a)(1)(Q) and sections
1819(c)(1)(E), 1833(s), 1852(i), 1876(c)(8), and 1891(a)(6),
the requirement of this subsection, in addition to paragraph
(1), is that a provider of services, MA organization, or
prepaid or eligible organization (as the case may be) maintain
the following written policies and procedures with respect to
all unemancipated minors receiving medical care by or through
the provider or organization (or prospective patient or
resident, with respect to the provider or organization, who is
an unemancipated minor):
``(A) A do-not-resuscitate order or similar
physician's order shall not be instituted, either
orally or in writing, unless at least one parent or
legal guardian of such unemancipated minor has first
been informed of the physician's intent to institute
such an order and a reasonable attempt has been made to
inform the other parent if the other parent is
reasonably available and has custodial or visitation
rights. Such information must be provided both orally
and in writing unless, in reasonable medical judgment,
the urgency of the decision requires reliance on only
providing the information orally. Oral provision of
such information shall include speaking to at least one
parent or legal guardian in person or on the telephone,
and shall not be limited to recorded voice messages.
Provision of such information shall include at least 72
hours of diligent efforts made by the physician or
provider to contact and notify at least one parent or
legal guardian. The provision of such information shall
be contemporaneously recorded in the medical record of
the unemancipated minor, specifying by whom and to whom
the information was given, the date and time of its
provision, and whether it was provided in writing. In
the case that only one parent has been informed, the
nature of reasonable attempts to inform the other
parent or the reason why such attempts were not made
shall be contemporaneously recorded in the medical
record of the unemancipated minor.
``(B) Either parent of the unemancipated minor or
the unemancipated minor's guardian may refuse consent
for a do-not-resuscitate order or similar physician's
order for the unemancipated minor, either in writing or
orally. Any such refusal of consent must be
contemporaneously recorded in the medical record of the
unemancipated minor. No do-not-resuscitate order or
similar physician's order shall be instituted either
orally or in writing if there has been such a refusal
of consent.
``(C) The provider shall not have the authority to
require the withholding or withdrawal of life-
sustaining procedures from an unemancipated minor over
the objection of the parent or legal guardian, unless
electronic brain, heart, and respiratory monitoring
activity conclusively establishes that the minor has
died. There shall be a presumption that the
continuation of life is in the minor's best interest.
``(D) Within 48 hours of being notified of the
intent to institute a do-not-resuscitate order or a
similar physician's order according to subparagraph
(A), a parent or legal guardian may request a transfer
of the unemancipated minor patient or resident to
another facility or discharge. If a transfer is
requested by a parent or legal guardian, the hospital
or health care facility under whose care the
unemancipated minor is admitted must continue provision
of artificial life-sustaining procedures and life-
sustaining artificial nutrition and hydration for a
minimum of 15 days after the transfer request has been
made known and make every reasonable effort to assist
the requesting parent or legal guardian in the transfer
process. The hospital or health care facility's duties
and financial obligations regarding transfer shall be
governed by existing state law, applicable rules or
regulations, hospital policy, and relevant third-party
payment contracts.
``(E) Upon the request of a patient or resident or
a prospective patient or resident, the provider of
services or organization shall disclose in writing any
policies relating to the patient or resident or the
services the patient or resident may receive involving
resuscitation or life-sustaining measures, including
any policies related to treatments deemed non-
beneficial, ineffective, futile or inappropriate,
within the provider of services or organization.
Nothing in this subparagraph shall require a provider
of services or organization to have a written policy
relating to or involving resuscitation, life-sustaining
or non-beneficial treatment for unemancipated minor
patients or adult patients, residents or wards.
``(6) In applying paragraph (5)(A), a determination based
on ``reasonable medical judgement'' shall not be solely based
on disability alone or the view that the life of a person with
a disability is of lower value or of lower quality than that of
a person without a disability regardless of whether the
person's disability is pre-existing or newly acquired and
therefore must not serve as the sole basis for the do-not-
resuscitate order or similar physician's order unless treatment
is determined to be physiologically futile and supported with
objective evidence that is documented in the patient's records
in writing.''.
(2) Conforming amendments.--
(A) Section 1866(a)(1)(Q) of the Social Security
Act (42 U.S.C. 1395cc(a)(1)(Q)) is amended--
(i) by striking ``requirement'' and
inserting ``requirements''; and
(ii) by inserting ``and certain do-not-
resuscitate orders or similar physician's
orders'' after ``advance directives''.
(B) Section 1819(c)(1)(E) of the Social Security
Act (42 U.S.C. 1395i-3(c)(1)(E)) is amended--
(i) by striking ``requirement'' and
inserting ``requirements''; and
(ii) by inserting ``and certain do-not-
resuscitate orders or similar physician's
orders'' after ``advance directives''.
(C) Section 1833(s) of the Social Security Act (42
U.S.C. 1395l(s)) is amended--
(i) by striking ``requirement'' and
inserting ``requirements''; and
(ii) by inserting ``and certain do-not-
resuscitate orders or similar physician's
orders'' after ``advance directives''.
(D) Section 1852(i) of the Social Security Act (42
U.S.C. 1395w-22(i)) is amended--
(i) by striking ``requirement'' and
inserting ``requirements''; and
(ii) by inserting ``and certain do-not-
resuscitate orders or similar physician's
orders'' after ``advance directives''.
(E) Section 1876(c)(8) of the Social Security Act
(42 U.S.C. 1395mm(c)(8)) is amended--
(i) by striking ``requirement'' and
inserting ``requirements''; and
(ii) by inserting ``and certain do-not-
resuscitate orders or similar physician's
orders'' after ``advance directives''.
(F) Section 1891(a)(6) of the Social Security Act
(42 U.S.C. 1395bbb(a)(6)) is amended--
(i) by striking ``requirement'' and
inserting ``requirements''; and
(ii) by inserting ``and certain do-not-
resuscitate orders or similar physician's
orders'' after ``advance directives''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to items and services furnished on or
after the date that is 90 days after the date of the enactment
of this Act.
(b) Medicaid State Plan Requirement.--
(1) In general.--Section 1902(w) of the Social Security Act
(42 U.S.C. 1396a(w)) is amended by adding at the end the
following new paragraphs:
``(6) For purposes of subsection (a)(57) and sections
1903(m)(1)(A) and 1919(c)(2)(E), the requirement of this
subsection, in addition to paragraph (1), is that a provider or
organization (as the case may be) maintain the following
written policies and procedures with respect to all
unemancipated minors receiving medical care by or through the
provider or organization (or prospective patient or resident,
with respect to the provider or organization, who is an
unemancipated minor):
``(A) A do-not-resuscitate order or similar
physician's order shall not be instituted, either
orally or in writing, unless at least one parent or
legal guardian of such unemancipated minor has first
been informed of the physician's intent to institute
such an order and a reasonable attempt has been made to
inform the other parent if the other parent is
reasonably available and has custodial or visitation
rights. Such information must be provided both orally
and in writing unless, in reasonable medical judgment,
the urgency of the decision requires reliance on only
providing the information orally. Oral provision of
such information shall include speaking to at least one
parent or legal guardian in person or on the telephone,
and shall not be limited to recorded voice messages.
Provision of such information shall include at least 72
hours of diligent efforts made by the physician or
provider to contact and notify at least one parent or
legal guardian. The provision of such information shall
be contemporaneously recorded in the medical record of
the unemancipated minor, specifying by whom and to whom
the information was given, the date and time of its
provision, and whether it was provided in writing. In
the case that only one parent has been informed, the
nature of reasonable attempts to inform the other
parent or the reason why such attempts were not made
shall be contemporaneously recorded in the medical
record of the unemancipated minor.
``(B) Either parent of the unemancipated minor or
the unemancipated minor's guardian may refuse consent
for a do-not-resuscitate order or similar physician's
order for the unemancipated minor, either in writing or
orally. Any such refusal of consent must be
contemporaneously recorded in the medical record of the
unemancipated minor. No do-not-resuscitate order or
similar physician's order shall be instituted either
orally or in writing if there has been such a refusal
of consent.
``(C) The provider shall not have the authority to
require the withholding or withdrawal of life-
sustaining procedures from an unemancipated minor over
the objection of the parent or legal guardian, unless
electronic brain, heart, and respiratory monitoring
activity conclusively establishes that the minor has
died. There shall be a presumption that the
continuation of life is in the minor's best interest.
``(D) Within 48 hours of being notified of the
intent to institute a do-not-resuscitate order or a
similar physician's order according to subparagraph
(A), a parent or legal guardian may request a transfer
of the unemancipated minor patient or resident to
another facility or discharge. If a transfer is
requested by a parent or legal guardian, the hospital
or health care facility under whose care the
unemancipated minor is admitted must continue provision
of artificial life-sustaining procedures and life-
sustaining artificial nutrition and hydration for a
minimum of 15 days after the transfer request has been
made known and make every reasonable effort to assist
the requesting parent or legal guardian in the transfer
process. The hospital or health care facility's duties
and financial obligations regarding transfer shall be
governed by existing state law, applicable rules or
regulations, hospital policy, and relevant third-party
payment contracts.
``(E) Upon the request of a patient or resident or
a prospective patient or resident, the provider of
services or organization shall disclose in writing any
policies relating to the patient or resident or the
services the patient or resident may receive involving
resuscitation or life-sustaining measures, including
any policies related to treatments deemed non-
beneficial, ineffective, futile or inappropriate,
within the provider of services or organization.
Nothing in this subparagraph shall require a provider
of services or organization to have a written policy
relating to or involving resuscitation, life-sustaining
or non-beneficial treatment for unemancipated minor
patients or adult patients, residents or wards.
``(7) In applying paragraph (6)(A), a determination based
on ``reasonable medical judgement'' shall not be solely based
on disability alone or the view that the life of a person with
a disability is of lower value or of lower quality than that of
a person without a disability regardless of whether the
person's disability is pre-existing or newly acquired and
therefore must not serve as the sole basis for the do-not-
resuscitate order or similar physician's order unless treatment
is determined to be physiologically futile and supported with
objective evidence that is documented in the patient's records
in writing.''.
(2) Conforming amendments.--
(A) Section 1903(m)(1)(A) of the Social Security
Act (42 U.S.C. 1396b(m)(1)(A)) is amended in the matter
preceding clause (i), by striking ``requirement'' and
inserting ``requirements''.
(B) Section 1919(c)(2)(E) of the Social Security
Act (42 U.S.C. 1396r(c)(2)(E)) is amended--
(i) by striking ``requirement'' and
inserting ``requirements''; and
(ii) by inserting ``and certain do-not-
resuscitate orders or similar physician's
orders'' after ``advance directives''.
(3) Effective date.--
(A) In general.--Except as provided in paragraph
(2), the amendments made by this subsection shall take
effect on the date of the enactment of this Act and
shall apply to services furnished on or after the date
that is 90 days after the date of the enactment of this
Act.
(B) Exception if state legislation required.--In
the case of a State plan for medical assistance under
title XIX of the Social Security Act which the
Secretary of Health and Human Services determines
requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the
additional requirement imposed by the amendments made
by this subsection, 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
this additional requirement 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 the 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 such session shall be deemed to be a separate
regular session of the State legislature.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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