,i #aagth ,,congress #ast ,session ,h4 ,r4 #efef ,,in ,,the ,,house ,,of ,,representatives ,october #ba1 #bjba,mr4 ,la,turner 7for himself1 ,mr4 ,smith of ,new ,jersey1 ,mr4 ,banks1 ,mrs4 ,miller-,meeks1 ,mrs4 ,hinson1 ,mr4 ,mann1 ,mr4 ,estes1 ,ms4 ,salazar1 ,mr4 ,moore of ,utah1 ,mrs4 ,bice of ,oklahoma1 ,mr4 ,barr1 ,mr4 ,babin1 ,mr4 ,cawthorn1 ,mrs4 ,lesko1 ,mr4 ,lamborn1 ,mr4 ,latta1 ,ms4 ,van ,duyne1 ,mr4 ,good of ,virginia1 ,ms4 ,letlow1 ,mr4 ,mullin1 ,mr4 ,harris1 ,mr4 ,duncan1 ,mr4 ,rosendale1 ,mr4 ,jackson1 ,mr4 ,c4 ,scott ,franklin of ,florida1 ,mr4 ,williams of ,texas1 ,mr4 ,kustoff1 and ,mrs4 ,miller of ,illinois7 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 titles ,,xviii and ,,xix of the ,social ,security ,act to require providers of services and health maintenance organizations under the ,medicare and ,medicaid programs to provide for certain policies to be in place relating to do-not-resuscitate orders or similar physician's orders for unemancipated minors receiving services4 #a4 ,short title ,this ,act may be cited as the ,simon ,crosier ,act4 #b4 ,medicare and ,medicaid requirements for certain policies relating to do-not-resuscitate orders or similar physician's orders 7a7 ,medicare provider agreement requirement 7#a7 ,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 paragraphs3 7#e7 ,for purposes of subsection 7a77#a77,q7 and sections #ahai7;c77#a77;,e71 #ahcc7s71 #aheb7;i71 #ahgf7;c77#h71 and #ahia7;a77#f71 the requirement of this subsection1 in addition to paragraph 7#a71 is that a provider of services1 ,,ma organization1 or prepaid or eligible organization 7as the case may be7 maintain the following written policies and procedures with respect to all unemancipated minors receiving medical care by or through the provider or organization 7or prospective patient or resident1 with respect to the provider or organization1 who is an unemancipated minor73 7,a7 ,a do-not-resuscitate order or similar physician's order shall not be instituted1 either orally or in writing1 unless at least one parent or legal guardian of such unemancipated minor has first been informed of the physician's intent to institute such an order and a reasonable attempt has been made to inform the other parent if the other parent is reasonably available and has custodial or visitation rights4 ,such information must be provided both orally and in writing unless1 in reasonable medical judgment1 the urgency of the decision requires reliance on only providing the information orally4 ,oral provision of such information shall include speaking to at least one parent or legal guardian in person or on the telephone1 and shall not be limited to recorded voice messages4 ,provision of such information shall include at least #gb hours of diligent efforts made by the physician or provider to contact and notify at least one parent or legal guardian4 ,the provision of such information shall be contemporaneously recorded in the medical record of the unemancipated minor1 specifying by whom and to whom the information was given1 the date and time of its provision1 and whether it was provided in writing4 ,in the case that only one parent has been informed1 the nature of reasonable attempts to inform the other parent or the reason why such attempts were not made shall be contemporaneously recorded in the medical record of the unemancipated minor4 7,b7 ,either parent of the unemancipated minor or the unemancipated minor's guardian may refuse consent for a do-not-resuscitate order or similar physician's order for the unemancipated minor1 either in writing or orally4 ,any such refusal of consent must be contemporaneously recorded in the medical record of the unemancipated minor4 ,no do-not-resuscitate order or similar physician's order shall be instituted either orally or in writing if there has been such a refusal of consent4 7,c7 ,the provider shall not have the authority to require the withholding or withdrawal of life-sustaining procedures from an unemancipated minor over the objection of the parent or legal guardian1 unless electronic brain1 heart1 and respiratory monitoring activity conclusively establishes that the minor has died4 ,there shall be a presumption that the continuation of life is in the minor's best interest4 7,d7 ,within #dh hours of being notified of the intent to institute a do-not-resuscitate order or a similar physician's order according to subparagraph 7,a71 a parent or legal guardian may request a transfer of the unemancipated minor patient or resident to another facility or discharge4 ,if a transfer is requested by a parent or legal guardian1 the hospital or health care facility under whose care the unemancipated minor is admitted must continue provision of artificial life-sustaining procedures and life-sustaining artificial nutrition and hydration for a minimum of #ae days after the transfer request has been made known and make every reasonable effort to assist the requesting parent or legal guardian in the transfer process4 ,the hospital or health care facility's duties and financial obligations regarding transfer shall be governed by existing ,state law1 applicable rules or regulations1 hospital policy1 and relevant third-party payment contracts4 7,e7 ,upon the request of a patient or resident or a prospective patient or resident1 the provider of services or organization shall disclose in writing any policies relating to the patient or resident or the services the patient or resident may receive involving resuscitation or life-sustaining measures1 including any policies related to treatments deemed non-beneficial1 ineffective1 futile or inappropriate1 within the provider of services or organization4 ,nothing in this subparagraph shall require a provider of services or organization to have a written policy relating to or involving resuscitation1 life-sustaining or non-beneficial treatment for unemancipated minor patients or adult patients1 residents or wards4 7#f7 ,in applying paragraph 7#e77;,a71 a determination based on 8reasonable medical judgement0 shall not be solely based on disability alone or the view that the life of a person with a disability is of lower value or of lower quality than that of a person without a disability regardless of whether the person's disability is pre-existing or newly acquired and therefore must not serve as the sole basis for the do-not-resuscitate order or similar physician's order unless treatment is determined to be physiologically futile and supported with objective evidence that is documented in the patient's records in writing4 4 7#b7 ,conforming amendments 7,a7 ,section #ahff7;a77#a77,q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,q77 is amended-- 7i7 by striking requirement and inserting requirements2 and 7ii7 by inserting and certain do-not-resuscitate orders or similar physician's orders after advance directives4 7,b7 ,section #ahai7;c77#a77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7;c77#a77;,e77 is amended-- 7i7 by striking requirement and inserting requirements2 and 7ii7 by inserting and certain do-not-resuscitate orders or similar physician's orders after advance directives4 7,c7 ,section #ahcc7s7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7s77 is amended-- 7i7 by striking requirement and inserting requirements2 and 7ii7 by inserting and certain do-not-resuscitate orders or similar physician's orders after advance directives4 7,d7 ,section #aheb7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;i77 is amended-- 7i7 by striking requirement and inserting requirements2 and 7ii7 by inserting and certain do-not-resuscitate orders or similar physician's orders after advance directives4 7,e7 ,section #ahgf7;c77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciemm7c77#h77 is amended-- 7i7 by striking requirement and inserting requirements2 and 7ii7 by inserting and certain do-not-resuscitate orders or similar physician's orders after advance directives4 7,f7 ,section #ahia7;a77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;bbb7a77#f77 is amended-- 7i7 by striking requirement and inserting requirements2 and 7ii7 by inserting and certain do-not-resuscitate orders or similar physician's orders after advance directives4 7#c7 ,effective date ,the amendments made by this subsection shall apply with respect to items and services furnished on or after the date that is #ij days after the date of the enactment of this ,act4 7b7 ,medicaid ,state plan requirement 7#a7 ,in general ,section #aijb7w7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7w77 is amended by adding at the end the following new paragraphs3 7#f7 ,for purposes of subsection 7a77#eg7 and sections #aijc7m77#a77;,a7 and #aiai7;c77#b77;,e71 the requirement of this subsection1 in addition to paragraph 7#a71 is that a provider or organization 7as the case may be7 maintain the following written policies and procedures with respect to all unemancipated minors receiving medical care by or through the provider or organization 7or prospective patient or resident1 with respect to the provider or organization1 who is an unemancipated minor73 7,a7 ,a do-not-resuscitate order or similar physician's order shall not be instituted1 either orally or in writing1 unless at least one parent or legal guardian of such unemancipated minor has first been informed of the physician's intent to institute such an order and a reasonable attempt has been made to inform the other parent if the other parent is reasonably available and has custodial or visitation rights4 ,such information must be provided both orally and in writing unless1 in reasonable medical judgment1 the urgency of the decision requires reliance on only providing the information orally4 ,oral provision of such information shall include speaking to at least one parent or legal guardian in person or on the telephone1 and shall not be limited to recorded voice messages4 ,provision of such information shall include at least #gb hours of diligent efforts made by the physician or provider to contact and notify at least one parent or legal guardian4 ,the provision of such information shall be contemporaneously recorded in the medical record of the unemancipated minor1 specifying by whom and to whom the information was given1 the date and time of its provision1 and whether it was provided in writing4 ,in the case that only one parent has been informed1 the nature of reasonable attempts to inform the other parent or the reason why such attempts were not made shall be contemporaneously recorded in the medical record of the unemancipated minor4 7,b7 ,either parent of the unemancipated minor or the unemancipated minor's guardian may refuse consent for a do-not-resuscitate order or similar physician's order for the unemancipated minor1 either in writing or orally4 ,any such refusal of consent must be contemporaneously recorded in the medical record of the unemancipated minor4 ,no do-not-resuscitate order or similar physician's order shall be instituted either orally or in writing if there has been such a refusal of consent4 7,c7 ,the provider shall not have the authority to require the withholding or withdrawal of life-sustaining procedures from an unemancipated minor over the objection of the parent or legal guardian1 unless electronic brain1 heart1 and respiratory monitoring activity conclusively establishes that the minor has died4 ,there shall be a presumption that the continuation of life is in the minor's best interest4 7,d7 ,within #dh hours of being notified of the intent to institute a do-not-resuscitate order or a similar physician's order according to subparagraph 7,a71 a parent or legal guardian may request a transfer of the unemancipated minor patient or resident to another facility or discharge4 ,if a transfer is requested by a parent or legal guardian1 the hospital or health care facility under whose care the unemancipated minor is admitted must continue provision of artificial life-sustaining procedures and life-sustaining artificial nutrition and hydration for a minimum of #ae days after the transfer request has been made known and make every reasonable effort to assist the requesting parent or legal guardian in the transfer process4 ,the hospital or health care facility's duties and financial obligations regarding transfer shall be governed by existing ,state law1 applicable rules or regulations1 hospital policy1 and relevant third-party payment contracts4 7,e7 ,upon the request of a patient or resident or a prospective patient or resident1 the provider of services or organization shall disclose in writing any policies relating to the patient or resident or the services the patient or resident may receive involving resuscitation or life-sustaining measures1 including any policies related to treatments deemed non-beneficial1 ineffective1 futile or inappropriate1 within the provider of services or organization4 ,nothing in this subparagraph shall require a provider of services or organization to have a written policy relating to or involving resuscitation1 life-sustaining or non-beneficial treatment for unemancipated minor patients or adult patients1 residents or wards4 7#g7 ,in applying paragraph 7#f77;,a71 a determination based on 8reasonable medical judgement0 shall not be solely based on disability alone or the view that the life of a person with a disability is of lower value or of lower quality than that of a person without a disability regardless of whether the person's disability is pre-existing or newly acquired and therefore must not serve as the sole basis for the do-not-resuscitate order or similar physician's order unless treatment is determined to be physiologically futile and supported with objective evidence that is documented in the patient's records in writing4 4 7#b7 ,conforming amendments 7,a7 ,section #aijc7m77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77#a77;,a77 is amended in the matter preceding clause 7i71 by striking requirement and inserting requirements4 7,b7 ,section #aiai7;c77#b77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7c77#b77;,e77 is amended-- 7i7 by striking requirement and inserting requirements2 and 7ii7 by inserting and certain do-not-resuscitate orders or similar physician's orders after advance directives4 7#c7 ,effective date 7,a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by this subsection shall take effect on the date of the enactment of this ,act and shall apply to services furnished on or after the date that is #ij days after the date of the enactment of this ,act4 7,b7 ,exception if ,state legislation required ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirement imposed by the amendments made by this subsection1 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 this additional requirement 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 the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4