,i #aacth ,,congress #ast ,session ,h4 ,r4 #aagc ,,in ,,the ,,house ,,of ,,representatives ,march #ad1 #bjac ,mr4 ,blumenauer 7for himself1 ,mr4 ,hanna1 ,mr4 ,roe of ,tennessee1 ,mr4 ,reed1 ,ms4 ,schwartz1 ,mr4 ,kind1 ,mr4 ,george ,miller of ,california1 ,mr4 ,mc,dermott1 ,mr4 ,bera of ,california1 ,ms4 ,schakowsky1 and ,mrs4 ,capps7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend the ,social ,security ,act to provide for coverage of voluntary advance care planning consultation under ,medicare and ,medicaid1 and for other purposes4 #a4 ,short title2 findings2 table of contents 7a7 ,short title ,this ,act may be cited as the ,personalize ,your ,care ,act of #bjac4 7b7 ,findings ,congress finds the following3 7#a7 ,all individuals should be afforded the opportunity to fully participate in decisions related to their health care or the care of a person for whom they are the proxy or surrogate4 7#b7 ,every individual's values and goals should be identified1 understood1 and respected4 ,particular attention should be paid to populations which have not regularly had the opportunity to express their choices or preferences4 7#c7 ,advance care planning plays a valuable role in achieving quality care by informing physicians and family members of an individual's treatment preferences should he or she become unable to direct care4 7#d7 ,early advance care planning is ideal because a person's ability to make decisions may diminish over time and the person may suddenly lose the capability to participate in their health care decisions4 7#e7 ,advance directives 7such as living wills and durable powers of attorney for health care7 must be prepared while individuals have the capacity to complete them and only apply to future medical circumstances when decisionmaking capacity is lost4 ,an individual can change or revoke an advance directive at any time4 7#f7 ,physician orders for life-sustaining treatment complement advance directives by providing a process to focus patients' values1 goals1 and preferences on current medical circumstances and to translate them into visible and portable medical orders applicable across care settings4 ,a patient 7or proxy or surrogate7 can change or revoke a physician order for life-sustaining treatment at any time4 7#g7 ,advance care planning should be routinely conducted in community and clinical practices4 ,care plans should be periodically revisited to reflect a person's changes in values and perceptions at different stages and circumstances of life4 ,this shared decisionmaking and collaborative planning between the patient 7or proxy or surrogate7 and the clinician of their choice will lead to more person-centered1 culturally appropriate care4 7#h7 ,effective1 respectful1 and culturally competent advance care planning requires recognition that both overtreatment and undertreatment may be concerns of individuals contemplating future care4 7#i7 ,more should be done within local health systems to establish specific policies and programs to assist people with sensory1 mental1 and other disabilities in order to maximize the degree to which they are active participants in the decisions related to their health care1 including training health care providers to be aware of augmentative communication devices and how to communicate with people with developmental1 psychiatric1 speech1 and sensory disabilities4 7#aj7 ,studies funded by the ,agency for ,healthcare ,research and ,quality have shown that individuals who talked with their families or physicians about their preferences for care had less fear and anxiety1 felt they had more ability to influence and direct their medical care1 believed that their physicians had a better understanding of their wishes1 and indicated a greater understanding and comfort level than they had before the discussion4 ,patients who had advance planning discussions with their physicians continued to discuss and talk about these concerns with their families4 ,such discussions enabled patients and families to reconcile any differences about care and could help the family and physician come to agreement if they should need to make decisions for the patient4 7#aa7 ,a decade of research has demonstrated that physician orders for life-sustaining treatment effectively convey patient preferences and guide medical personnel toward medical treatment aligned with patient wishes4 ,programs for these orders have developed locally on a statewide or communitywide basis and have different program names1 forms1 and policies1 but all follow the principle of patient-centered care4 7#ab7 ,according to research published in the ,archives of ,internal ,medicine1 between #fe and #gf percent of physicians whose patients had an advance directive were not aware that it existed4 7#ac7 ,including completed advance care planning documents within a patient's electronic health record can increase the likelihood these documents are kept up-to-date and available at the right place at the right time4 7c7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 findings2 table of contents4 ,sec4 #b4 ,voluntary advance care planning consultation coverage under ,medicare and ,medicaid4 ,sec4 #c4 ,grants for programs for physician orders for life-sustaining treatment4 ,sec4 #d4 ,advance care planning standards for electronic health records4 ,sec4 #e4 ,portability of advance directives4 #b4 ,voluntary advance care planning consultation coverage under ,medicare and ,medicaid 7a7 ,medicare 7#a7 ,in general ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7,a7 in subsection 7s77#b7-- 7i7 by striking and at the end of subparagraph 7,,ee72 7ii7 by adding and at the end of subparagraph 7,,ff72 and 7iii7 by adding at the end the following new subparagraph3 7,,gg7 voluntary advance care planning consultation 7as defined in subsection 7iii77#a772 2 and 7,b7 by adding at the end the following new subsection3 7iii7 ,voluntary advance care planning consultation 7#a7 ,subject to paragraphs 7#c7 and 7#d71 the term voluntary advance care planning consultation means an optional consultation between the individual and a practitioner described in paragraph 7#b7 regarding advance care planning4 ,such consultation may include the following1 as specified by the ,secretary3 7,a7 ,an explanation by the practitioner of advance care planning and the uses of advance directives4 7,b7 ,an explanation by the practitioner of the role and responsibilities of a proxy or surrogate4 7,c7 ,an explanation by the practitioner of the services and supports available under this title during chronic and serious illness1 including palliative care1 home care1 long-term care1 and hospice care4 7,d7 ,an explanation by the practitioner of physician orders for life-sustaining treatment or similar orders in ,states where such orders or similar orders exist4 7,e7 ,facilitation by the practitioner of shared decisionmaking with the patient 7or proxy or surrogate7 which may include-- 7i7 use of decision aids and patient support tools2 7ii7 the provision of patient-centered1 easy-to-understand information about advance care planning or disease-specific care planning2 and 7iii7 the incorporation of patient preferences and values into the medical plan1 an advance directive1 and a physician order for life-sustaining treatment as appropriate4 7#b7 ,a practitioner described in this paragraph is a physician 7as defined in subsection 7r77#a771 nurse practitioner1 or physician assistant4 7#c7 ,payment may not be made under this title for a voluntary advance care planning consultation furnished more often than once every #e years unless there is a significant change in the health1 health-related condition1 or care setting of the individual4 7#d7 ,for purposes of this section1 the term physician order for life-sustaining treatment means1 with respect to an individual1 an actionable medical order relating to the treatment of that individual that effectively communicates the individual's preferences regarding life-sustaining treatment1 is in a form that is sanctioned or approved under ,state law or regulation or is widely recognized by health care providers in the ,state1 and permits it to be followed by health care professionals across the continuum of care4 ,such an order may be changed or revoked by the individual 7or proxy or surrogate7 at any time4 4 7#b7 ,construction ,the voluntary advance care planning consultation described in section #ahfa7;iii7 of the ,social ,security ,act1 as added by paragraph 7#a71 shall be completely optional4 ,nothing in this section shall-- 7,a7 require an individual to complete an advance directive or a physician order for life-sustaining treatment2 7,b7 require an individual to consent to restrictions on the amount1 duration1 or scope of medical benefits an individual is entitled to receive under this title2 or 7,c7 violate the ,assisted ,suicide ,funding ,restriction ,act of #aiig 7,public ,law #aje-ab7 by encouraging the promotion of suicide or assisted suicide4 7#c7 ,payment ,section #ahdh7;j77#c7 of such ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is amended by inserting 7#b77;,,gg71 before 7#c714 7#d7 ,frequency limitation ,section #ahfb7;a7 of such ,act 7#db ,u4,s4,c4 #aciey7a77 is amended-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,o71 by striking and at the end2 7ii7 in subparagraph 7,p7 by striking the semicolon at the end and inserting 1 and2 and 7iii7 by adding at the end the following new subparagraph3 7,q7 in the case of voluntary advance care planning consultations 7as defined in paragraph 7#a7 of section #ahfa7;iii771 which are performed more frequently than is covered under such section2 2 and 7,b7 in paragraph 7#g71 by striking or 7,p7 and inserting 7,p71 or 7,q74 7#e7 ,effective date ,the amendments made by this subsection shall apply to consultations furnished on or after ,january #a1 #bjad4 7b7 ,medicaid 7#a7 ,mandatory benefit ,section #aijb7;a77#aj77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is amended1 in the matter preceding clause 7i71 by striking and 7#bh7 and inserting 1 7#bh71 and 7#bi74 7#b7 ,medical assistance ,section #aije7;a7 of such ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended-- 7,a7 by striking and at the end of paragraph 7#bh72 7,b7 by redesignating paragraph 7#bi7 as paragraph 7#cj72 and 7,c7 by inserting after paragraph 7#bh7 the following new paragraph3 7#bi7 voluntary advance care planning consultation 7as defined in section #ahfa7;iii77#a772 and 4 7c7 ,definition of advance directive under ,medicare and ,medicaid 7#a7 ,medicare ,section #ahff7;f77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77#c77 is amended by striking means and all that follows and inserting the following3 means a living will1 medical directive1 health care power of attorney1 durable power of attorney for health care1 advance health care directive1 health care directive1 or other statement that is recorded and completed in a manner recognized under ,state law by an individual with capacity to make health care decisions and that indicates the individual's wishes regarding medical treatment in the event of future incapacity of the individual to make health care decisions44 7#b7 ,medicaid ,section #aijb7w77#d7 of such ,act 7#db ,u4,s4,c4 #acif;a7w77#d77 is amended by striking means and all that follows and inserting the following3 means a living will1 medical directive1 health care power of attorney1 durable power of attorney for health care1 advance health care directive1 health care directive1 or other statement that is recorded and completed in a manner recognized under ,state law by an individual with capacity to make health care decisions and that indicates the individual's wishes regarding medical treatment in the event of future incapacity of the individual to make health care decisions44 7d7 ,effective date ,the amendments made by this section take effect on ,january #a1 #bjad4 #c4 ,grants for programs for physician orders for life-sustaining treatment 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall make grants to eligible entities for the purpose of-- 7#a7 establishing statewide programs for physician orders for life-sustaining treatment2 or 7#b7 expanding or enhancing existing programs for physician orders for life-sustaining treatment4 7b7 ,authorized activities ,activities funded through a grant under this section for an area may include-- 7#a7 developing such a program for the area that includes hospitals1 home care1 hospice1 long-term care1 community and assisted living residences1 skilled nursing facilities1 and emergency medical services within a ,state2 and 7#b7 expanding an existing program for physician orders regarding life-sustaining treatment to serve more patients or enhance the quality of services1 including educational services for patients and patients' families1 training of health care professionals1 or establishing a physician orders for life-sustaining treatment registry4 7c7 ,distribution of funds ,in funding grants under this section1 the ,secretary shall ensure that1 of the funds appropriated to carry out this section for each fiscal year-- 7#a7 at least one-half are used for establishing new programs for physician orders regarding life-sustaining treatment2 and 7#b7 remaining funds are to be used for expanding or enhancing existing programs for physician orders regarding life-sustaining treatment4 7d7 ,definitions ,in this section3 7#a7 ,the term eligible entity includes-- 7,a7 an academic medical center1 a medical school1 a ,state health department1 a ,state medical association1 a multistate task force1 a hospital1 or a health system capable of administering a program for physician orders regarding life-sustaining treatment for a ,state2 or 7,b7 any other health care agency or entity as the ,secretary determines appropriate4 7#b7 ,the term physician order for life-sustaining treatment has the meaning given such term in section #ahfa7;iii77#d7 of the ,social ,security ,act1 as added by section #b4 7#c7 ,the term program for physician orders for life-sustaining treatment means a program that-- 7,a7 supports the active use of physician orders for life-sustaining treatment in the ,state2 and 7,b7 is guided by a coalition of stakeholders that includes patient advocacy groups and representatives from across the continuum of health care services1 such as disability rights advocates1 senior advocates1 emergency medical services1 long-term care1 medical associations1 hospitals1 home health1 hospice1 the ,state agency responsible for senior and disability services1 and the ,state department of health4 7#d7 ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7e7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of the fiscal years #bjad through #bjai4 #d4 ,advance care planning standards for electronic health records ,notwithstanding section #cjjd7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ad7;b77#c771 not later than ,january #a1 #bjae1 the ,secretary of ,health and ,human ,services shall adopt1 by rule1 standards for a qualified electronic health record 7as defined in section #cjjj7ac7 of such ,act 7#db ,u4,s4,c4 #cjj;jj7#ac771 with respect to patient communications with a health care provider about values and goals of care1 to adequately display the following3 7#a7 ,the patient's current advance directive 7as defined in section #ahff7;f77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77#c771 as applicable4 7#b7 ,the patient's current physician order for life-sustaining treatment 7as defined in section #ahfa7;iii77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7iii77#d771 as applicable4 ,a standard adopted under this section shall be treated as a standard adopted under section #cjjd of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ad7 for purposes of certifying qualified electronic health records pursuant to section #cjja7;c77#e7 of such ,act 7#db ,u4,s4,c4 #cjj;jj-#aa7;c77#e774 #e4 ,portability of advance directives 7a7 ,in general ,section #ahff7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77 is amended by adding at the end the following new paragraph3 7#e7 7,a7 ,an advance directive validly executed outside the ,state in which such directive is presented must be given effect by a provider of services or organization to the same extent as an advance directive validly executed under the law of the ,state in which it is presented4 7,b7 ,in the absence of knowledge to the contrary1 a physician or other health care provider or organization may presume that a written advance health care directive or similar instrument1 regardless of where executed1 is valid4 7,c7 ,in the absence of a validly executed advance directive1 any authentic expression of a person's wishes with respect to health care shall be honored4 7,d7 ,the provisions of this paragraph shall preempt any ,state law on advance directive portability to the extent such law is inconsistent with such provisions4 ,nothing in the 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 presented4 4 7b7 ,medicaid ,section #aijb7w7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7w77 is amended by adding at the end the following new paragraph3 7#f7 7,a7 ,an advance directive validly executed outside the ,state in which such directive is presented must be given effect by a provider or organization to the same extent as an advance directive validly executed under the law of the ,state in which it is presented4 7,b7 ,in the absence of knowledge to the contrary1 a physician1 other health care provider1 or organization may presume that a written advance health care directive or similar instrument1 regardless of where executed1 is valid4 7,c7 ,in the absence of a validly executed advance directive1 any authentic expression of a person's wishes with respect to health care shall be honored4 7,d7 ,the provisions of this paragraph shall preempt any ,state law on advance directive portability to the extent such law is inconsistent with such provisions4 ,nothing in the 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 presented4 4