[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 2556 Introduced in Senate (IS)]

103d CONGRESS
  2d Session
                                S. 2556

To provide for the portability of validly executed advance directives, 
 to provide patients with a better understanding of their health care 
choices and to promote study of the quality of care for the gravely or 
           terminally ill or injured, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

            October 8 (legislative day, September 12), 1994

 Mr. Danforth introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To provide for the portability of validly executed advance directives, 
 to provide patients with a better understanding of their health care 
choices and to promote study of the quality of care for the gravely or 
           terminally ill or injured, 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. PORTABILITY OF ADVANCE DIRECTIVES.

    (a) In General.--An advance directive validly executed outside the 
State in which such directive is presented must be given effect to the 
same extent as an advance directive validly executed under the law of 
the State in which presented.
    (b) No Inference.--Nothing in this section may be construed to 
authorize the administration, withholding, or withdrawal of health care 
otherwise prohibited by the laws of the State.
    (c) Preemption.--The provisions of this section shall preempt any 
State law to the extent such law is inconsistent with such provisions. 
The provisions of this section 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.
    (d) Effective Date.--This section shall take effect on the date 
that is 6 months after the date of enactment of this Act.

SEC. 2. AMENDMENTS TO RULES UNDER MEDICARE AND MEDICAID.

    (a) Medicare.--Section 1866(f)(1) of the Social Security Act (42 
U.S.C. 1395cc(f)(1)) is amended--
            (1) in subparagraph (A), by striking ``and'' at the end of 
        clause (i), by redesignating clause (ii) as clause (iii), and 
        by inserting after clause (i) the following new clause:
                    ``(ii) the result under such State law if the 
                individual is incapacitated in the absence of an 
                advance directive, and'';
            (2) in subparagraph (B), by inserting ``and to include the 
        content of such directive if the individual so desires'' before 
        the semicolon;
            (3) in subparagraph (D), by striking ``and'' at the end;
            (4) in subparagraph (E), by striking the period at the end 
        and inserting ``; and''; and
            (5) by inserting after subparagraph (E) the following new 
        subparagraph:
            ``(F) to provide for effective communication between the 
        individual (or surrogate decision maker when appropriate) and 
        the appropriate provider regarding all relevant aspects of 
        health care decisions affecting the individual, including 
        obtaining informed consent, individual prognosis and treatment 
        decisions, and the formulation of advance directives.''.
    (b) Medicaid.--Section 1902(a) (42 U.S.C. 1396a(a)) is amended by 
inserting in paragraph 58, ``and what occurs in the absence of an 
advance directive'' after ``subsection (w) of this section.'' Section 
1902(w)(1) of the Social Security Act (42 U.S.C. 1396a(w)(1)) is 
amended--
            (1) in subparagraph (A), by striking ``and'' at the end of 
        clause (i), by redesignating clause (ii) as clause (iii), and 
        by inserting after clause (i) the following new clause:
                    ``(ii) the result under such State law if the 
                individual is incapacitated in the absence of an 
                advance directive, and'';
            (2) in subparagraph (B), by inserting ``and to include the 
        content of such directive if the individual so desires'' before 
        the semicolon;
            (3) in subparagraph (D), by striking ``and'' at the end;
            (4) in subparagraph (E), by striking the period at the end 
        and inserting ``; and''; and
            (5) by inserting after subparagraph (E) the following new 
        subparagraph:
            ``(F) to provide for effective communication between the 
        individual (or surrogate decision maker when appropriate) and 
        the appropriate provider regarding all relevant aspects of 
        health care decisions affecting the individual, including 
        obtaining informed consent, individual prognosis and treatment 
        decisions, and the formulation of advance directives.''.
    (c) Application to Kidney Dialysis Centers of Provisions Relating 
to Advance Directives.--
            (1) Medicare.--Section 1866(a)(1)(Q) of the Social Security 
        Act (42 U.S.C. 1395cc(a)(1)(Q)) is amended by striking ``and 
        hospice programs'' and inserting ``hospice programs, and kidney 
        dialysis centers''.
            (2) Medicaid.--Section 1902(a)(57) of such Act (42 U.S.C. 
        1396(a)(57)) is amended by striking ``hospice program'' and 
        inserting ``hospice program, kidney dialysis center''.
    (d) Effective Date.--The amendments made by this section shall take 
effect on and after the date which is 1 year after the date of the 
enactment of this Act.

SEC. 3. STUDY OF ISSUES RELATED TO END OF LIFE CARE.

    (a) Study.--
            (1) In general.--Within 6 months after the date of the 
        enactment of this Act, the Secretary shall enter into an 
        agreement with the Institute of Medicine of the National 
        Academy of Sciences (or with another nonprofit, nongovernmental 
        organization or consortium of institutions if the Institute 
        declines to perform the study) to investigate and report on 
        issues relating to care at the end of life, including how to 
        determine the application of medically necessary or appropriate 
        care for gravely or terminally ill or injured persons of all 
        ages.
            (2) Specific issues.--The study described in paragraph (1) 
        shall specifically include an examination of the following 
        issues:
                    (A) The epidemiology of dying.
                    (B) Conditions that promote or impede appropriate 
                care (such as professional training and beliefs, 
                financing and organization of services, patient and 
                public knowledge and attitudes).
                    (C) Concerns of health care practitioners and 
                providers, medical educators, the religious and medical 
                ethics communities, the general public, and others 
                responsible for public and private decisions about the 
                organization, financing, and quality of health care in 
                the United States.
                    (D) Measures to evaluate systems of care on the 
                quality of care they provide for gravely or terminally 
                ill or injured patients.
                    (E) Methods of communication and health care 
                decisionmaking among providers, patients, and 
                surrogates.
                    (F) Priorities for research on the issues described 
                in the preceding subparagraphs.
    (b) Report.--The Institute of Medicine (or the organization 
conducting the study under this section) shall submit to the Secretary 
and the Congress a report on the study described in subsection (a) 
within 27 months after the date of the enactment of this Act.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out the purposes of 
this section.
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