[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.''.
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