110 HR 7181 IH: Life Sustaining Treatment Preferences Act of U.S. House of Representatives 2008-09-27 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.

I 110th CONGRESS 2d Session H. R. 7181 IN THE HOUSE OF REPRESENTATIVES September 27, 2008 Mr. Blumenauer (for himself, Mr. Kind, Mr. McDermott, Mr. Fattah, Ms. Hooley, and Mr. Wu) 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 title XVIII of the Social Security Act to provide for coverage under the Medicare Program for consultations regarding orders for life sustaining treatment and to provide grants for the development and expansion of programs for such orders.

1.

Short title

This Act may be cited as the Life Sustaining Treatment Preferences Act of 2008.

2.

Findings

Congress finds as follows: (1)Serious illness, death, and dying are often difficult subjects to talk about for individuals, their families, and health care professionals. (2)Poor communication about preferences for care at the end of life can cause distress for both patients and their families. (3)As individuals approach the last chapter of their life, more can be done to educate them about treatment choices and help individuals communicate to health providers what care they want or do not want to receive. (4)A decade of research has demonstrated that orders for life sustaining treatment effectively convey treatment preferences, guiding medical personnel in providing or withholding interventions. (5)Orders for life sustaining treatment differ from advance directives. Advance directives (including living wills and durable powers of attorney for health care) must be completed while individuals have the capacity to complete them and generally apply to future, hypothetical medical circumstances when decisionmaking capacity is lost. Patients’ values, goals, and preferences, as expressed in advance directives, require a thoughtful interpretive process to apply to specific medical circumstances in real time. Yet, patients and proxy decisionmakers are often uncertain how to apply and implement patients’ values and goals in unfamiliar health care settings when real treatment plans and complicated decisions need to be made. (6)Orders for life sustaining treatment complement advances 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, including home, long-term care, emergency medical services, and hospitals. Without such medical orders emergency medical personnel may be required to provide treatments that may not be consistent with the individual’s preferences. Completion of such an order is equally valuable to patients who have not executed advance directives. (7)The following States have implemented or are developing statewide programs for orders for life sustaining treatment: California, Colorado, Georgia, Florida, Hawaii, Idaho, Louisiana, Michigan, Missouri, Nebraska, New Hampshire, New York, North Carolina, Ohio, Oregon, Tennessee, Texas, Utah, Washington, and West Virginia. Localities within Maine, Minnesota, Nevada, North Dakota, Pennsylvania, and Wisconsin have implemented or are developing programs for orders for life sustaining treatment. (8)Programs for orders for life sustaining treatment provide valuable services to individuals, their families, and health care providers through educational materials, professional training on advance care planning, coordinating and collaborating with hospitals, skilled nursing facilities, hospice programs, home health agencies, and emergency medical services to implement such orders across the continuum of care, and monitoring the success of the program. (9)Medicare pays for acute care services provided to beneficiaries, but does not pay for informed discussions between beneficiaries and health providers to allow beneficiaries the opportunity to determine if they desire such acute care in the last months and years of life.

3.

Medicare coverage of consultation regarding orders for life sustaining treatment

(a)

In general

Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by sections 101(a), 144(a), and 152(b) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275), is amended— (1)in subsection (s)(2)— (A)by striking and at the end of subparagraph (DD); (B)by adding and at the end of subparagraph (EE); and (C)by adding at the end the following new subparagraph: (FF)consultations regarding an order for life sustaining treatment (as defined in subsection (hhh)(1)) for qualified individuals (as defined in subsection (hhh)(3)); ; and (2)by adding at the end the following new subsection: (hhh)

Consultation regarding an order for life sustaining treatment

(1)The term consultation regarding an order for life sustaining treatment means, with respect to a qualified individual, consultations between the individual and the individual’s physician (as defined in subsection (r)(1)) (or other health care professional described in paragraph (2)(A)) and, to the extent applicable, registered nurses, nurse practitioners, physicians’ assistants, and social workers, regarding the establishment, implementation, and changes in an order regarding life sustaining treatment (as defined in paragraph (2)) for that individual. Such a consultation may include a consultation regarding— (A)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; (B)the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and (C)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). The Secretary may limit consultations regarding an order regarding life sustaining treatment to consultations furnished in States, localities, or other geographic areas in which such orders have been widely adopted.(2)The terms order regarding life sustaining treatment means, with respect to an individual, an actionable medical order relating to the treatment of that individual that— (A)is signed 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) and is in a form that permits it to be followed by health care professionals and providers across the continuum of care, including hospitals, nursing facilities, and emergency medical technicians; (B)effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual; (C)is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); (D)is portable across care settings; and (E)may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual. (3)The term qualified individual means an individual who a physician (as defined in subsection (r)(1)) (or other health care professional described in paragraph (2)(A)) determines has a chronic, progressive illness and, as a consequence of such illness, is as likely as not to die within 1 year. (4)The level of treatment indicated under paragraph (2)(B) 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— (A)the intensity of medical intervention if the patient is pulseless, apneic, or, has serious cardiac or pulmonary problems; (B)the individual’s desire regarding transfer to a hospital or remaining at the current care setting; (C)the use of antibiotics; and (D)the use of artificially administered nutrition. . (b)

Payment

(1)

In general

Section 1848(j)(3) of such Act (42 U.S.C. 1395w–4(j)(3)), as amended by sections 144(a)(2) and 152(b)(1)(C) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275), by inserting (2)(FF), after (2)(EE),. (2)

Construction

Nothing in this section shall be construed as preventing the payment for a consultation regarding an order regarding life sustaining treatment to be made to multiple health care providers if they are providing such consultation as a team, so long as the total amount of payment is not increased by reason of the payment to multiple providers. (c)

Effective Date

The amendments made by this section shall apply to consultations furnished on or after January 1, 2010.

4.

Grants for programs for orders regarding life sustaining treatment

(a)

In general

The Secretary of Health and Human Services shall make grants to eligible entities for the purpose of— (1)establishing new programs for orders regarding life sustaining treatment in a States or localities; (2)expanding or enhancing an existing program for orders regarding life sustaining treatment in States or localities; or (3)providing a clearinghouse of information on programs for orders for life sustaining treatment and consultative services for the development or enhancement of such programs. (b)

Authorized activities

Activities funded through a grant under this section for an area may include— (1)developing such a program for the area that includes hospitals, skilled nursing facilities, hospice programs, home health agencies, and emergency medical technicians within the area; (2)securing consultative services and advice from institutions with experience in developing and managing such programs; and (3)expanding an existing program for orders regarding life sustaining treatment to serve more patients or enhance the quality of services, including educational services for patients and patients' families or training of health care professionals. (c)

Distribution of funds

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 two-thirds are used for establishing or developing new programs for orders regarding life sustaining treatment; and (2)one-third is used for expanding or enhancing existing programs for orders regarding life sustaining treatment. (d)

Definitions

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 multi-State taskforce, a hospital, or a health system capable of administering a program for orders regarding life sustaining treatment for a State or locality; or (B)any other health care agency or entity as the Secretary determines appropriate. (2)The term order regarding life sustaining treatment has the meaning given such term in section 1861(hhh)(2) of the Social Security Act, as added by section 3. (3)The term program for orders regarding life sustaining treatment means, with respect to an area, a program that supports the active use of orders regarding life sustaining treatment in the area. (4)The term Secretary means the Secretary of Health and Human Services. (e)

Authorization of appropriations

To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2009 through 2014.