Obama’s “End of Life” 

SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

(a) MEDICARE.—

(1) IN GENERAL.—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 (DD);

 (ii) by adding ‘‘and’’ at the end of

 subparagraph (EE); and

 (iii) by adding at the end the following new subparagraph:

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 ‘‘(FF) advance care planning consultation (as

 defined in subsection (hhh)(1));’’; and

 (B) by adding at the end the following new

 subsection:

 ‘‘Advance Care Planning Consultation

 ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the

 term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning,

 if, subject to paragraph (3), the individual involved has

 not had such a consultation within the last 5 years. Such

 consultation shall include the following:

 ‘‘(A) An explanation by the practitioner of advance care planning, including key questions and

 considerations, important steps, and suggested people to talk to.
‘‘(B) An explanation by the practitioner of advance directives, including living wills and durable

 powers of attorney, and their uses.

‘‘(C) An explanation by the practitioner of the

 role and responsibilities of a health care proxy.

 ‘‘(D) The provision by the practitioner of a list

 of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal

 service organizations (including those funded

 through the Older Americans Act of 1965).

 ‘‘(E) An explanation by the practitioner of the

 continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available

 under this title.

‘‘(F)(i) Subject to clause (ii), an explanation of

 orders regarding life sustaining treatment or similar

 orders, which shall include—

 ‘‘(I) 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;

 ‘‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

 ‘‘(III) 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).

‘‘(ii) The Secretary shall limit the requirement

for explanations under clause (i) to consultations

furnished in a State—

‘‘(I) in which all legal barriers have been

addressed for enabling orders for life sustaining

 treatment to constitute a set of medical orders

 respected across all care settings; and

 ‘‘(II) that has in effect a program for orders for life sustaining treatment described in

 clause (iii).

 ‘‘(iii) A program for orders for life sustaining

 treatment for a States described in this clause is a

 program that—

 ‘‘(I) ensures such orders are standardized

 and uniquely identifiable throughout the State;

 ‘‘(II) distributes or makes accessible such

 orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign

 orders for life sustaining treatment;

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‘‘(III) provides training for health care

 professionals across the continuum of care

 about the goals and use of orders for life sustaining treatment; and

 ‘‘(IV) is guided by a coalition of stakeholders includes representatives from emergency

 medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors,

 agency responsible for senior services, state department of health, state hospital association,

 home health association, state bar association,

 and state hospice association.

 ‘‘(2) A practitioner described in this paragraph is—

 ‘‘(A) a physician (as defined in subsection

 (r)(1)); and

 ‘‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign

 orders for life sustaining treatments.

 ‘‘(3)(A) An initial preventive physical examination

 under subsection (WW), including any related discussion

 during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).

 ‘‘(B) An advance care planning consultation with respect to an individual may be conducted more frequently

 than provided under paragraph (1) if there is a significant

 change in the health condition of the individual, including

 diagnosis of a chronic, progressive, life-limiting disease, a

 life-threatening or terminal diagnosis or life-threatening

 injury, or upon admission to a skilled nursing facility, a

 long-term care facility (as defined by the Secretary), or

 a hospice program.

 ‘‘(4) A consultation under this subsection may include the formulation of an order regarding life sustaining

 treatment or a similar order.

 ‘‘(5)(A) For purposes of this section, the term ‘order

 regarding life sustaining treatment’ means, with respect

 to an individual, an actionable medical order relating to

 the treatment of that individual that—

 ‘‘(i) is signed and dated 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, including a nurse practitioner or physician assistant)

 and is in a form that permits it to stay with the individual and be followed by health care professionals

 and providers across the continuum of care;

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‘‘(ii) effectively communicates the individual’s

 preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

 ‘‘(iii) is uniquely identifiable and standardized

 within a given locality, region, or State (as identified

 by the Secretary); and

 ‘‘(iv) may incorporate any advance directive (as

 defined in section 1866(f)(3)) if executed by the individual.

 ‘‘(B) The level of treatment indicated under subparagraph (A)(ii) 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—

 ‘‘(i) the intensity of medical intervention if the

 patient is pulse less, apneic, or has serious cardiac

 or pulmonary problems;

 ‘‘(ii) the individual’s desire regarding transfer

 to a hospital or remaining at the current care setting;

 ‘‘(iii) the use of antibiotics; and

 ‘‘(iv) the use of artificially administered nutrition and hydration.’’.

 (2) PAYMENT.—Section 1848(j)(3) of such Act

 (42 U.S.C. 1395w-4(j)(3)) is amended by inserting

 ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’.

 (3) FREQUENCY LIMITATION.—Section 1862(a)

 of such Act (42 U.S.C. 1395y(a)) is amended—

 (A) in paragraph (1)—

 (i) in subparagraph (N), by striking

 ‘‘and’’ at the end;

 (ii) in subparagraph (O) by striking

 the semicolon at the end and inserting ‘‘,

 and’’; and

 (iii) by adding at the end the following new subparagraph:

 ‘‘(P) in the case of advance care planning

 consultations (as defined in section

 1861(hhh)(1)), which are performed more frequently than is covered under such section;’’;

 and

 (B) in paragraph (7), by striking ‘‘or (K)’’

 and inserting ‘‘(K), or (P)’’.

 (4) EFFECTIVE DATE.—The amendments made

 by this subsection shall apply to consultations furnished on or after January 1, 2011.

 (b) EXPANSION OF PHYSICIAN QUALITY REPORTING

 INITIATIVE FOR END OF LIFE CARE.—

 (1) PHYSICIAN’S QUALITY REPORTING INITIATIVE.—Section 1848(k)(2) of the Social Security Act

(42 U.S.C. 1395w–4(k)(2)) is amended by adding at

the end the following new paragraphs:

 ‘‘(3) PHYSICIAN’S QUALITY REPORTING INITIATIVE.—

‘‘(A) IN GENERAL.—For purposes of reporting data on quality measures for covered

professional services furnished during 2011 and

any subsequent year, to the extent that measures are available, the Secretary shall include

 quality measures on end of life care and advanced care planning that have been adopted or

endorsed by a consensus-based organization, if

 appropriate. Such measures shall measure both

 the creation of and adherence to orders for life sustaining treatment.

 ‘‘(B) PROPOSED SET OF MEASURES.— The

 Secretary shall publish in the Federal Register

 proposed quality measures on end of life care

 and advanced care planning that the Secretary

 determines are described in subparagraph (A)

 and would be appropriate for eligible professionals to use to submit data to the Secretary.

 The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.’’.

 (c) INCLUSION OF INFORMATION IN MEDICARE &

 YOU HANDBOOK.—

 (1) MEDICARE & YOU HANDBOOK.—

 (A) IN GENERAL.—Not later than 1 year

 after the date of the enactment of this Act, the

 Secretary of Health and Human Services shall

 update the online version of the Medicare &

 You Handbook to include the following:

 (i) An explanation of advance care

 planning and advance directives, including—

 (I) living wills;

 (II) durable power of attorney;

 (III) orders of life-sustaining

 treatment; and

 (IV) health care proxies.

 (ii) A description of Federal and State

 resources available to assist individuals

 and their families with advance care planning and advance directives, including—

 (I) available State legal service

 organizations to assist individuals

 with advance care planning, including

 those organizations that receive funding pursuant to the Older Americans

 Act of 1965 (42 U.S.C. 93001 et

 seq.);

 (II) website links or addresses for

 State-specific advance directive forms;

 and

 (III) any additional information,

 as determined by the Secretary.

 (B) UPDATE OF PAPER AND SUBSEQUENT

 VERSIONS.—The Secretary shall include the information described in subparagraph (A) in all

 paper and electronic versions of the Medicare &

 You Handbook that are published on or after

 the date that is 1 year after the date of the enactment of this Act.