1.Short title; table of
contents
(a)This Act may be cited
as the Advance Directive Promotion Act
of 2009
.
(b)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.
2.Improvement of
policies related to the use and portability of advance directives
(a)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)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)
(1)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 amendmentIn 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.
3.Medicare coverage
of an end-of-life planning consultation as part of an initial preventive
physical examination
(a)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)The amendments made by this section shall apply to initial
preventive physical examinations furnished on or after January 1, 2010.
4.National information hotline for
end-of-life decisionmaking and hospice careThe 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.
5.Increasing awareness
of the importance of end-of-life planningTitle 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:
SPrograms to
increase awareness of advance directive planning issues
399FF.Advance
directive education campaigns
(a)Advance
directive education campaignThe 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)
(1)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)Any
grant awarded under paragraph (1) shall be for a period of 3 years.
(c)Authorization of
appropriationsThere are authorized to be appropriated to carry
out this section
$25,000,000.
.