113 HR 1173 IH: Personalize Your Care Act of 2013
U.S. House of Representatives
2013-03-14
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; findings; table
of contents
(a)This Act may be cited
as the Personalize Your Care Act of
2013
.
(b)Congress
finds the following:
(1)All individuals should be afforded the
opportunity to fully participate in decisions related to their health care or
the care of a person for whom they are the proxy or surrogate.
(2)Every individual's values and goals should
be identified, understood, and respected. Particular attention should be paid
to populations which have not regularly had the opportunity to express their
choices or preferences.
(3)Advance care
planning plays a valuable role in achieving quality care by informing
physicians and family members of an individual’s treatment preferences should
he or she become unable to direct care.
(4)Early advance care
planning is ideal because a person’s ability to make decisions may diminish
over time and the person may suddenly lose the capability to participate in
their health care decisions.
(5)Advance directives (such as living wills
and durable powers of attorney for health care) must be prepared while
individuals have the capacity to complete them and only apply to future medical
circumstances when decisionmaking capacity is lost. An individual can change or
revoke an advance directive at any time.
(6)Physician orders
for life-sustaining treatment complement advance directives by providing a
process to focus patients’ values, goals, and preferences on current medical
circumstances and to translate them into visible and portable medical orders
applicable across care settings. A patient (or proxy or surrogate) can change
or revoke a physician order for life-sustaining treatment at any time.
(7)Advance care
planning should be routinely conducted in community and clinical practices.
Care plans should be periodically revisited to reflect a person’s changes in
values and perceptions at different stages and circumstances of life. This
shared decisionmaking and collaborative planning between the patient (or proxy
or surrogate) and the clinician of their choice will lead to more
person-centered, culturally appropriate care.
(8)Effective,
respectful, and culturally competent advance care planning requires recognition
that both overtreatment and undertreatment may be concerns of individuals
contemplating future care.
(9)More should be
done within local health systems to establish specific policies and programs to
assist people with sensory, mental, and other disabilities in order to maximize
the degree to which they are active participants in the decisions related to
their health care, including training health care providers to be aware of
augmentative communication devices and how to communicate with people with
developmental, psychiatric, speech, and sensory disabilities.
(10)Studies funded by
the Agency for Healthcare Research and Quality have shown that individuals who
talked with their families or physicians about their preferences for care had
less fear and anxiety, felt they had more ability to influence and direct their
medical care, believed that their physicians had a better understanding of
their wishes, and indicated a greater understanding and comfort level than they
had before the discussion. Patients who had advance planning discussions with
their physicians continued to discuss and talk about these concerns with their
families. Such discussions enabled patients and families to reconcile any
differences about care and could help the family and physician come to
agreement if they should need to make decisions for the patient.
(11)A decade of research has demonstrated that
physician orders for life-sustaining treatment effectively convey patient
preferences and guide medical personnel toward medical treatment aligned with
patient wishes. Programs for these orders have developed locally on a statewide
or communitywide basis and have different program names, forms, and policies,
but all follow the principle of patient-centered care.
(12)According to
research published in the Archives of Internal Medicine, between 65 and 76
percent of physicians whose patients had an advance directive were not aware
that it existed.
(13)Including
completed advance care planning documents within a patient’s electronic health
record can increase the likelihood these documents are kept up-to-date and
available at the right place at the right time.
(c)The table of contents of this Act is as follows:
Sec. 1. Short title; findings; table of contents.
Sec. 2. Voluntary advance care planning consultation coverage
under Medicare and Medicaid.
Sec. 3. Grants for programs for physician orders for
life-sustaining treatment.
Sec. 4. Advance care planning standards for electronic health
records.
Sec. 5. Portability of advance directives.
2.Voluntary advance
care planning consultation coverage under Medicare and Medicaid
(a)
(1)Section 1861 of the
Social Security Act (42 U.S.C. 1395x) is amended—
(A)in subsection (s)(2)—
(i)by
striking and
at the end of subparagraph (EE);
(ii)by
adding and
at the end of subparagraph (FF); and
(iii)by
adding at the end the following new subparagraph:
(GG)voluntary advance
care planning consultation (as defined in subsection
(iii)(1));
;
and
(B)by adding at the
end the following new subsection:
(iii)Voluntary advance care planning
consultation(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 and the uses of
advance directives.
(B)An explanation by the practitioner of
the role and responsibilities of a proxy or surrogate.
(C)An
explanation by the practitioner of the services and supports available under
this title during chronic and serious illness, including palliative care, home
care, long-term care, and hospice care.
(D)An explanation by the practitioner of
physician orders for life-sustaining treatment or similar orders in States
where such orders or similar orders exist.
(E)Facilitation by the practitioner of shared
decisionmaking with the patient (or proxy or surrogate) which may
include—
(i)use of decision aids and patient
support tools;
(ii)the provision of patient-centered,
easy-to-understand information about advance care planning or disease-specific
care planning; and
(iii)the incorporation of patient
preferences and values into the medical plan, an advance directive, and a
physician order for life-sustaining treatment as appropriate.
(2)A
practitioner described in this paragraph is a physician (as defined in
subsection (r)(1)), nurse practitioner, or physician assistant.
(3)Payment may not be made under this title
for a voluntary advance care planning consultation furnished more often than
once every 5 years unless there is a significant change in the health,
health-related condition, or care setting of the individual.
(4)For purposes of this section, the term
physician order for 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 in a form that is sanctioned or approved under
State law or regulation or is widely recognized by health care providers in the
State, and permits it to be followed by health care professionals across the
continuum of care. Such an order may be changed or revoked by the individual
(or proxy or surrogate) at any
time.
.
(2)The
voluntary advance care planning consultation described in section 1861(iii) of
the Social Security Act, as added by paragraph (1), shall be completely
optional. Nothing in this section shall—
(A)require an
individual to complete an advance directive or a physician order for
life-sustaining treatment;
(B)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
(C)violate the
Assisted Suicide Funding Restriction Act of 1997 (Public Law 105–12) by
encouraging the promotion of suicide or assisted suicide.
(3)Section
1848(j)(3) of such Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting
(2)(GG),
before (3),
.
(4)Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is
amended—
(A)in paragraph
(1)—
(i)in
subparagraph (O), by striking and
at the end;
(ii)in
subparagraph (P) by striking the semicolon at the end and inserting ,
and
; and
(iii)by
adding at the end the following new subparagraph:
(Q)in the case of voluntary advance care
planning consultations (as defined in paragraph (1) of section 1861(iii)),
which are performed more frequently than is covered under such
section;
;
and
(B)in paragraph (7),
by striking or (P)
and inserting (P), or
(Q)
.
(5)The amendments made by this subsection shall apply to
consultations furnished on or after January 1, 2014.
(b)
(1)Section
1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is
amended, in the matter preceding clause (i), by striking and
(28)
and inserting , (28), and (29)
.
(2)Section 1905(a) of such Act (42 U.S.C. 1396d(a)) is
amended—
(A)by striking
and
at the end of paragraph (28);
(B)by redesignating
paragraph (29) as paragraph (30); and
(C)by inserting after
paragraph (28) the following new paragraph:
(29)voluntary advance
care planning consultation (as defined in section 1861(iii)(1));
and
.
(c)Definition of
advance directive under Medicare and Medicaid
(1)Section 1866(f)(3) of the Social Security
Act (42 U.S.C. 1395cc(f)(3)) is amended by striking means
and
all that follows and inserting the following: means a living will,
medical directive, health care power of attorney, durable power of attorney for
health care, advance health care directive, health care directive, or other
statement that is recorded and completed in a manner recognized under State law
by an individual with capacity to make health care decisions and that indicates
the individual’s wishes regarding medical treatment in the event of future
incapacity of the individual to make health care decisions.
.
(2)Section
1902(w)(4) of such Act (42 U.S.C. 1396a(w)(4)) is amended by striking
means
and all that follows and inserting the following:
means a living will, medical directive, health care power of attorney,
durable power of attorney for health care, advance health care directive,
health care directive, or other statement that is recorded and completed in a
manner recognized under State law by an individual with capacity to make health
care decisions and that indicates the individual’s wishes regarding medical
treatment in the event of future incapacity of the individual to make health
care decisions.
.
(d)The amendments made by this section take effect on January
1, 2014.
3.Grants for
programs for physician orders for life-sustaining treatment
(a)The Secretary of Health and Human Services shall make
grants to eligible entities for the purpose of—
(1)establishing
statewide programs for physician orders for life-sustaining treatment;
or
(2)expanding or
enhancing existing programs for physician orders for life-sustaining
treatment.
(b)Activities funded through a grant under this section
for an area may include—
(1)developing such a
program for the area that includes hospitals, home care, hospice, long-term
care, community and assisted living residences, skilled nursing facilities, and
emergency medical services within a State; and
(2)expanding an
existing program for physician orders regarding life-sustaining treatment to
serve more patients or enhance the quality of services, including educational
services for patients and patients’ families, training of health care
professionals, or establishing a physician orders for life-sustaining treatment
registry.
(c)In funding grants under this section, the Secretary shall
ensure that, of the funds appropriated to carry out this section for each
fiscal year—
(1)at least one-half
are used for establishing new programs for physician orders regarding
life-sustaining treatment; and
(2)remaining funds
are to be used for expanding or enhancing existing programs for physician
orders regarding life-sustaining treatment.
(d)In
this section:
(1)The term
eligible entity includes—
(A)an academic
medical center, a medical school, a State health department, a State medical
association, a multistate task force, a hospital, or a health system capable of
administering a program for physician orders regarding life-sustaining
treatment for a State; or
(B)any other health
care agency or entity as the Secretary determines appropriate.
(2)The term
physician order for life-sustaining treatment has the meaning
given such term in section 1861(iii)(4) of the Social Security Act, as added by
section 2.
(3)The term
program for physician orders for life-sustaining treatment means a
program that—
(A)supports the
active use of physician orders for life-sustaining treatment in the State;
and
(B)is guided by a coalition of stakeholders
that includes patient advocacy groups and representatives from across the
continuum of health care services, such as disability rights advocates, senior
advocates, emergency medical services, long-term care, medical associations,
hospitals, home health, hospice, the State agency responsible for senior and
disability services, and the State department of health.
(4)The term
Secretary means the Secretary of Health and Human Services.
(e)Authorization of
appropriationsTo carry out this section, there are authorized to
be appropriated such sums as may be necessary for each of the fiscal years 2014
through 2019.
4.Advance care
planning standards for electronic health recordsNotwithstanding section 3004(b)(3) of the
Public Health Service Act (42 U.S.C. 300jj–14(b)(3)), not later than January 1,
2015, the Secretary of Health and Human Services shall adopt, by rule,
standards for a qualified electronic health record (as defined in section
3000(13) of such Act (42 U.S.C. 300jj(13)), with respect to patient
communications with a health care provider about values and goals of care, to
adequately display the following:
(1)The patient’s
current advance directive (as defined in section 1866(f)(3) of the Social
Security Act (42 U.S.C. 1395cc(f)(3)), as applicable.
(2)The patient's current physician order for
life-sustaining treatment (as defined in section 1861(iii)(4) of the Social
Security Act (42 U.S.C. 1395x(iii)(4)), as applicable.
A standard
adopted under this section shall be treated as a standard adopted under section
3004 of the Public Health Service Act (42 U.S.C. 300jj–14) for purposes of
certifying qualified electronic health records pursuant to section 3001(c)(5)
of such Act (42 U.S.C. 300jj–11(c)(5)).5.Portability of
advance directives
(a)Section 1866(f) of
the Social Security Act (42 U.S.C. 1395cc(f)) is amended by adding at the end
the following new paragraph:
(5)(A)An advance directive
validly executed outside the State in which such directive is presented must be
given effect by a provider of services or organization to the same extent as an
advance directive validly executed under the law of the State in which it is
presented.
(B)In the absence of knowledge to the
contrary, a physician or other health care provider or organization may presume
that a written advance health care directive or similar instrument, regardless
of where executed, is valid.
(C)In the absence of a validly executed
advance directive, any authentic expression of a person’s wishes with respect
to health care shall be honored.
(D)The provisions of this paragraph shall
preempt any State law on advance directive portability to the extent such law
is inconsistent with such provisions. Nothing in the 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)Section 1902(w) of the Social Security Act
(42 U.S.C. 1396a(w)) is amended by adding at the end the following new
paragraph:
(6)(A)An advance directive
validly executed outside the State in which such directive is presented must be
given effect by a provider or organization to the same extent as an advance
directive validly executed under the law of the State in which it is
presented.
(B)In the absence of knowledge to the
contrary, a physician, other health care provider, or organization may presume
that a written advance health care directive or similar instrument, regardless
of where executed, is valid.
(C)In the absence of a validly executed
advance directive, any authentic expression of a person’s wishes with respect
to health care shall be honored.
(D)The provisions of this paragraph shall
preempt any State law on advance directive portability to the extent such law
is inconsistent with such provisions. Nothing in the 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.
.