,i #aac? ,,congress #a/ ,session ,h4 ,r4 #aagc ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,m>* #ad1 #bjac ,mr4 ,blum5au] 7= himself1 ,mr4 ,hanna1 ,mr4 ,roe ( ,t5nessee1 ,mr4 ,re$1 ,ms4 ,s*w>tz1 ,mr4 ,k9d1 ,mr4 ,george ,mill] ( ,cali=nia1 ,mr4 ,mc,dermott1 ,mr4 ,b]a ( ,cali=nia1 ,ms4 ,s*ak[sky1 & ,mrs4 ,capps7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d ! ,social ,security ,act to provide = cov]age ( volunt>y advance c>e plann+ consultation "u ,m$ic>e & ,m$icaid1 & = o!r purposes4 #a4 ,%ort title2 f9d+s2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,p]sonalize ,y\r ,c>e ,act ( #bjac4 7b7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,all individuals %\ld be af=d$ ! opportunity to fully p>ticipate 9 decisions relat$ to _! heal? c>e or ! c>e ( a p]son = :om !y are ! proxy or surrogate4 7#b7 ,e individual's values & goals %\ld be id5tifi$1 und]/ood1 & respect$4 ,p>ticul> att5tion %\ld be paid to populations :i* h n regul>ly _h ! opportunity to express _! *oices or pref]5ces4 7#c7 ,advance c>e plann+ plays a valuable role 9 a*iev+ quality c>e by in=m+ physicians & family memb]s ( an individual's treatm5t pref]5ces %\ld he or %e become unable to direct c>e4 7#d7 ,e>ly advance c>e plann+ is ideal because a p]son's ability to make decisions may dim9i% ov] "t & ! p]son may sudd5ly lose ! capability to p>ticipate 9 _! heal? c>e decisions4 7#e7 ,advance directives 7su* z liv+ wills & durable p[]s ( attorney = heal? c>e7 mu/ be prep>$ :ile individuals h ! capacity to complete !m & only apply to future m$ical circum/ances :5 decisionmak+ capacity is lo/4 ,an individual c *ange or revoke an advance directive at any "t4 7#f7 ,physician ord]s = life-su/a9+ treatm5t complem5t advance directives by provid+ a process to focus pati5ts' values1 goals1 & pref]5ces on curr5t m$ical circum/ances & to translate !m into visible & portable m$ical ord]s applicable across c>e sett+s4 ,a pati5t 7or proxy or surrogate7 c *ange or revoke a physician ord] = life-su/a9+ treatm5t at any "t4 7#g7 ,advance c>e plann+ %\ld be r\t9ely conduct$ 9 community & cl9ical practices4 ,c>e plans %\ld be p]iodically revisit$ to reflect a p]son's *anges 9 values & p]ceptions at diff]5t /ages & circum/ances ( life4 ,?is %>$ decisionmak+ & collaborative plann+ betwe5 ! pati5t 7or proxy or surrogate7 & ! cl9ician ( _! *oice w lead to m p]son-c5t]$1 culturally appropriate c>e4 7#h7 ,effective1 respectful1 & culturally compet5t advance c>e plann+ requires recognition t bo? ov]treatm5t & und]treatm5t may be conc]ns ( individuals contemplat+ future c>e4 7#i7 ,m %\ld be done )9 local heal? sy/ems to e/abli% specific policies & programs to assi/ p ) s5sory1 m5tal1 & o!r disabilities 9 ord] to maximize ! degree to :i* !y are active p>ticipants 9 ! decisions relat$ to _! heal? c>e1 includ+ tra9+ heal? c>e provid]s to be aw>e ( augm5tative communication devices & h[ to communicate ) p ) developm5tal1 psy*iatric1 spee*1 & s5sory disabilities4 7#aj7 ,/udies fund$ by ! ,ag5cy = ,heal?c>e ,rese>* & ,quality h %[n t individuals :o talk$ ) _! families or physicians ab\t _! pref]5ces = c>e _h less fe> & anxiety1 felt !y _h m ability to influ5ce & direct _! m$ical c>e1 believ$ t _! physicians _h a bett] und]/&+ ( _! wi%es1 & indicat$ a great] und]/&+ & com=t level ?an !y _h be=e ! discussion4 ,pati5ts :o _h advance plann+ discussions ) _! physicians cont9u$ to discuss & talk ab\t ^! conc]ns ) _! families4 ,su* discussions enabl$ pati5ts & families to reconcile any diff]5ces ab\t c>e & c\ld help ! family & physician come to agreem5t if !y %\ld ne$ to make decisions = ! pati5t4 7#aa7 ,a decade ( rese>* has demon/rat$ t physician ord]s = life-su/a9+ treatm5t effectively convey pati5t pref]5ces & guide m$ical p]sonnel t[>d m$ical treatm5t align$ ) pati5t wi%es4 ,programs = ^! ord]s h develop$ locally on a /atewide or communitywide basis & h diff]5t program names1 =ms1 & policies1 b all foll[ ! pr9ciple ( pati5t-c5t]$ c>e4 7#ab7 ,accord+ to rese>* publi%$ 9 ! ,ar*ives ( ,int]nal ,m$ic9e1 betwe5 #fe & #gf p]c5t ( physicians ^: pati5ts _h an advance directive 7 n aw>e t x exi/$4 7#ac7 ,includ+ complet$ advance c>e plann+ docum5ts )9 a pati5t's electronic heal? record c increase ! likelihood ^! docum5ts are kept up-to-date & available at ! "r place at ! "r "t4 7c7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 f9d+s2 table ( cont5ts4 ,sec4 #b4 ,volunt>y advance c>e plann+ consultation cov]age "u ,m$ic>e & ,m$icaid4 ,sec4 #c4 ,grants = programs = physician ord]s = life-su/a9+ treatm5t4 ,sec4 #d4 ,advance c>e plann+ /&>ds = electronic heal? records4 ,sec4 #e4 ,portability ( advance directives4 #b4 ,volunt>y advance c>e plann+ consultation cov]age "u ,m$ic>e & ,m$icaid 7a7 ,m$ic>e 7#a7 ,9 g5]al ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is am5d$-- 7,a7 9 subsection 7s77#b7-- 7i7 by /rik+ & at ! end ( subp>agraph 7,,ee72 7ii7 by add+ & at ! end ( subp>agraph 7,,ff72 & 7iii7 by add+ at ! end ! foll[+ new subp>agraph3 7,,gg7 volunt>y advance c>e plann+ consultation 7z def9$ 9 subsection 7iii77#a772 2 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7iii7 ,volunt>y advance c>e plann+ consultation 7#a7 ,subject to p>agraphs 7#c7 & 7#d71 ! t]m volunt>y advance c>e plann+ consultation means an optional consultation betwe5 ! individual & a practition] describ$ 9 p>agraph 7#b7 reg>d+ advance c>e plann+4 ,su* consultation may include ! foll[+1 z specifi$ by ! ,secret>y3 7,a7 ,an explanation by ! practition] ( advance c>e plann+ & ! uses ( advance directives4 7,b7 ,an explanation by ! practition] ( ! role & responsibilities ( a proxy or surrogate4 7,c7 ,an explanation by ! practition] ( ! s]vices & supports available "u ?is title dur+ *ronic & s]i\s illness1 includ+ palliative c>e1 home c>e1 long-t]m c>e1 & hospice c>e4 7,d7 ,an explanation by ! practition] ( physician ord]s = life-su/a9+ treatm5t or simil> ord]s 9 ,/ates :]e su* ord]s or simil> ord]s exi/4 7,e7 ,facilitation by ! practition] ( %>$ decisionmak+ ) ! pati5t 7or proxy or surrogate7 :i* may include-- 7i7 use ( decision aids & pati5t support tools2 7ii7 ! provision ( pati5t-c5t]$1 easy-to-und]/& in=mation ab\t advance c>e plann+ or disease-specific c>e plann+2 & 7iii7 ! incorporation ( pati5t pref]5ces & values into ! m$ical plan1 an advance directive1 & a physician ord] = life-su/a9+ treatm5t z appropriate4 7#b7 ,a practition] describ$ 9 ?is p>agraph is a physician 7z def9$ 9 subsection 7r77#a771 nurse practition]1 or physician assi/ant4 7#c7 ,paym5t may n be made "u ?is title = a volunt>y advance c>e plann+ consultation furni%$ m (t5 ?an once e #e ye>s unless !re is a significant *ange 9 ! heal?1 heal?-relat$ condition1 or c>e sett+ ( ! individual4 7#d7 ,= purposes ( ?is section1 ! t]m physician ord] = life-su/a9+ treatm5t means1 ) respect to an individual1 an actionable m$ical ord] relat+ to ! treatm5t ( t individual t effectively communicates ! individual's pref]5ces reg>d+ life-su/a9+ treatm5t1 is 9 a =m t is sanction$ or approv$ "u ,/ate law or regulation or is widely recogniz$ by heal? c>e provid]s 9 ! ,/ate1 & p]mits x to be foll[$ by heal? c>e pr(essionals across ! cont9uum ( c>e4 ,su* an ord] may be *ang$ or revok$ by ! individual 7or proxy or surrogate7 at any "t4 4 7#b7 ,con/ruction ,! volunt>y advance c>e plann+ consultation describ$ 9 section #ahfa7;iii7 ( ! ,social ,security ,act1 z add$ by p>agraph 7#a71 %all be completely optional4 ,no?+ 9 ?is section %all-- 7,a7 require an individual to complete an advance directive or a physician ord] = life-su/a9+ treatm5t2 7,b7 require an individual to cons5t to re/rictions on ! am\nt1 duration1 or scope ( m$ical b5efits an individual is entitl$ to receive "u ?is title2 or 7,c7 violate ! ,assi/$ ,suicide ,fund+ ,re/riction ,act ( #aiig 7,public ,law #aje-ab7 by enc\rag+ ! promotion ( suicide or assi/$ suicide4 7#c7 ,paym5t ,section #ahdh7;j77#c7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is am5d$ by ins]t+ 7#b77;,,gg71 be=e 7#c714 7#d7 ,frequ5cy limitation ,section #ahfb7;a7 ( su* ,act 7#db ,u4,s4,c4 #aciey7a77 is am5d$-- 7,a7 9 p>agraph 7#a7-- 7i7 9 subp>agraph 7,o71 by /rik+ & at ! end2 7ii7 9 subp>agraph 7,p7 by /rik+ ! semicolon at ! end & ins]t+ 1 &2 & 7iii7 by add+ at ! end ! foll[+ new subp>agraph3 7,q7 9 ! case ( volunt>y advance c>e plann+ consultations 7z def9$ 9 p>agraph 7#a7 ( section #ahfa7;iii771 :i* are p]=m$ m frequ5tly ?an is cov]$ "u su* section2 2 & 7,b7 9 p>agraph 7#g71 by /rik+ or 7,p7 & ins]t+ 7,p71 or 7,q74 7#e7 ,effective date ,! am5dm5ts made by ?is subsection %all apply to consultations furni%$ on or aft] ,janu>y #a1 #bjad4 7b7 ,m$icaid 7#a7 ,m&atory b5efit ,section #aijb7;a77#aj77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is am5d$1 9 ! matt] prec$+ clause 7i71 by /rik+ & 7#bh7 & ins]t+ 1 7#bh71 & 7#bi74 7#b7 ,m$ical assi/ance ,section #aije7;a7 ( su* ,act 7#db ,u4,s4,c4 #acif;d7a77 is am5d$-- 7,a7 by /rik+ & at ! end ( p>agraph 7#bh72 7,b7 by r$esignat+ p>agraph 7#bi7 z p>agraph 7#cj72 & 7,c7 by ins]t+ aft] p>agraph 7#bh7 ! foll[+ new p>agraph3 7#bi7 volunt>y advance c>e plann+ consultation 7z def9$ 9 section #ahfa7;iii77#a772 & 4 7c7 ,def9ition ( advance directive "u ,m$ic>e & ,m$icaid 7#a7 ,m$ic>e ,section #ahff7;f77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77#c77 is am5d$ by /rik+ means & all t foll[s & ins]t+ ! foll[+3 means a liv+ w1 m$ical directive1 heal? c>e p[] ( attorney1 durable p[] ( attorney = heal? c>e1 advance heal? c>e directive1 heal? c>e directive1 or o!r /atem5t t is record$ & complet$ 9 a mann] recogniz$ "u ,/ate law by an individual ) capacity to make heal? c>e decisions & t indicates ! individual's wi%es reg>d+ m$ical treatm5t 9 ! ev5t ( future incapacity ( ! individual to make heal? c>e decisions44 7#b7 ,m$icaid ,section #aijb7w77#d7 ( su* ,act 7#db ,u4,s4,c4 #acif;a7w77#d77 is am5d$ by /rik+ means & all t foll[s & ins]t+ ! foll[+3 means a liv+ w1 m$ical directive1 heal? c>e p[] ( attorney1 durable p[] ( attorney = heal? c>e1 advance heal? c>e directive1 heal? c>e directive1 or o!r /atem5t t is record$ & complet$ 9 a mann] recogniz$ "u ,/ate law by an individual ) capacity to make heal? c>e decisions & t indicates ! individual's wi%es reg>d+ m$ical treatm5t 9 ! ev5t ( future incapacity ( ! individual to make heal? c>e decisions44 7d7 ,effective date ,! am5dm5ts made by ?is section take effect on ,janu>y #a1 #bjad4 #c4 ,grants = programs = physician ord]s = life-su/a9+ treatm5t 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all make grants to eligible entities = ! purpose (-- 7#a7 e/abli%+ /atewide programs = physician ord]s = life-su/a9+ treatm5t2 or 7#b7 exp&+ or enhanc+ exi/+ programs = physician ord]s = life-su/a9+ treatm5t4 7b7 ,au?oriz$ activities ,activities fund$ ?r\gh a grant "u ?is section = an area may include-- 7#a7 develop+ su* a program = ! area t includes hospitals1 home c>e1 hospice1 long-t]m c>e1 community & assi/$ liv+ resid5ces1 skill$ nurs+ facilities1 & em]g5cy m$ical s]vices )9 a ,/ate2 & 7#b7 exp&+ an exi/+ program = physician ord]s reg>d+ life-su/a9+ treatm5t to s]ve m pati5ts or enhance ! quality ( s]vices1 includ+ educational s]vices = pati5ts & pati5ts' families1 tra9+ ( heal? c>e pr(essionals1 or e/abli%+ a physician ord]s = life-su/a9+ treatm5t regi/ry4 7c7 ,di/ribution ( funds ,9 fund+ grants "u ?is section1 ! ,secret>y %all ensure t1 ( ! funds appropriat$ to c>ry out ?is section = ea* fiscal ye>-- 7#a7 at lea/ "o-half are us$ = e/abli%+ new programs = physician ord]s reg>d+ life-su/a9+ treatm5t2 & 7#b7 rema9+ funds are to be us$ = exp&+ or enhanc+ exi/+ programs = physician ord]s reg>d+ life-su/a9+ treatm5t4 7d7 ,def9itions ,9 ?is section3 7#a7 ,! t]m eligible entity includes-- 7,a7 an academic m$ical c5t]1 a m$ical s*ool1 a ,/ate heal? dep>tm5t1 a ,/ate m$ical association1 a multi/ate task =ce1 a hospital1 or a heal? sy/em capable ( adm9i/]+ a program = physician ord]s reg>d+ life-su/a9+ treatm5t = a ,/ate2 or 7,b7 any o!r heal? c>e ag5cy or entity z ! ,secret>y det]m9es appropriate4 7#b7 ,! t]m physician ord] = life-su/a9+ treatm5t has ! mean+ giv5 su* t]m 9 section #ahfa7;iii77#d7 ( ! ,social ,security ,act1 z add$ by section #b4 7#c7 ,! t]m program = physician ord]s = life-su/a9+ treatm5t means a program t-- 7,a7 supports ! active use ( physician ord]s = life-su/a9+ treatm5t 9 ! ,/ate2 & 7,b7 is guid$ by a coalition ( /akehold]s t includes pati5t advocacy gr\ps & repres5tatives f across ! cont9uum ( heal? c>e s]vices1 su* z disability rights advocates1 s5ior advocates1 em]g5cy m$ical s]vices1 long-t]m c>e1 m$ical associations1 hospitals1 home heal?1 hospice1 ! ,/ate ag5cy responsible = s5ior & disability s]vices1 & ! ,/ate dep>tm5t ( heal?4 7#d7 ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7e7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = ea* ( ! fiscal ye>s #bjad ?r\gh #bjai4 #d4 ,advance c>e plann+ /&>ds = electronic heal? records ,not)/&+ section #cjjd7;b77#c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#ad7;b77#c771 n lat] ?an ,janu>y #a1 #bjae1 ! ,secret>y ( ,heal? & ,human ,s]vices %all adopt1 by rule1 /&>ds = a qualifi$ electronic heal? record 7z def9$ 9 section #cjjj7ac7 ( su* ,act 7#db ,u4,s4,c4 #cjj;jj7#ac771 ) respect to pati5t communications ) a heal? c>e provid] ab\t values & goals ( c>e1 to adequately display ! foll[+3 7#a7 ,! pati5t's curr5t advance directive 7z def9$ 9 section #ahff7;f77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77#c771 z applicable4 7#b7 ,! pati5t's curr5t physician ord] = life-su/a9+ treatm5t 7z def9$ 9 section #ahfa7;iii77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7iii77#d771 z applicable4 ,a /&>d adopt$ "u ?is section %all be treat$ z a /&>d adopt$ "u section #cjjd ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#ad7 = purposes ( c]tify+ qualifi$ electronic heal? records pursuant to section #cjja7;c77#e7 ( su* ,act 7#db ,u4,s4,c4 #cjj;jj-#aa7;c77#e774 #e4 ,portability ( advance directives 7a7 ,9 g5]al ,section #ahff7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7f77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 7,a7 ,an advance directive validly execut$ outside ! ,/ate 9 :i* su* directive is pres5t$ mu/ be giv5 effect by a provid] ( s]vices or organization to ! same ext5t z an advance directive validly execut$ "u ! law ( ! ,/ate 9 :i* x is pres5t$4 7,b7 ,9 ! abs5ce ( k to ! contr>y1 a physician or o!r heal? c>e provid] or organization may presume t a writt5 advance heal? c>e directive or simil> in/rum5t1 reg>dless ( :]e execut$1 is valid4 7,c7 ,9 ! abs5ce ( a validly execut$ advance directive1 any au!ntic expression ( a p]son's wi%es ) respect to heal? c>e %all be honor$4 7,d7 ,! provisions ( ?is p>agraph %all preempt any ,/ate law on advance directive portability to ! ext5t su* law is inconsi/5t ) su* provisions4 ,no?+ 9 ! p>agraph %all be con/ru$ to au?orize ! adm9i/ration ( heal? c>e treatm5t o!rwise prohibit$ by ! laws ( ! ,/ate 9 :i* ! directive is pres5t$4 4 7b7 ,m$icaid ,section #aijb7w7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7w77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#f7 7,a7 ,an advance directive validly execut$ outside ! ,/ate 9 :i* su* directive is pres5t$ mu/ be giv5 effect by a provid] or organization to ! same ext5t z an advance directive validly execut$ "u ! law ( ! ,/ate 9 :i* x is pres5t$4 7,b7 ,9 ! abs5ce ( k to ! contr>y1 a physician1 o!r heal? c>e provid]1 or organization may presume t a writt5 advance heal? c>e directive or simil> in/rum5t1 reg>dless ( :]e execut$1 is valid4 7,c7 ,9 ! abs5ce ( a validly execut$ advance directive1 any au!ntic expression ( a p]son's wi%es ) respect to heal? c>e %all be honor$4 7,d7 ,! provisions ( ?is p>agraph %all preempt any ,/ate law on advance directive portability to ! ext5t su* law is inconsi/5t ) su* provisions4 ,no?+ 9 ! p>agraph %all be con/ru$ to au?orize ! adm9i/ration ( heal? c>e treatm5t o!rwise prohibit$ by ! laws ( ! ,/ate 9 :i* ! directive is pres5t$4 4