15 SEC. 1233. ADVANCE CARE PLANNING CONSULTATION. 16 (a) MEDICARE.— 17 (1) IN GENERAL.—Section 1861 of the Social 18 Security Act (42 U.S.C. 1395x) is amended— 19 (A) in subsection (s)(2)— 20 (i) by striking ‘‘and’’ at the end of 21 subparagraph (DD); 22 (ii) by adding ‘‘and’’ at the end of 23 subparagraph (EE); and 24 (iii) by adding at the end the fol25 lowing new subparagraph: VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC 425 1 ‘‘(FF) advance care planning consultation (as 2 defined in subsection (hhh)(1));’’; and 3 (B) by adding at the end the following new 4 subsection: 5 ‘‘Advance Care Planning Consultation 6 ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the 7 term ‘advance care planning consultation’ means a con8 sultation between the individual and a practitioner de9 scribed in paragraph (2) regarding advance care planning, 10 if, subject to paragraph (3), the individual involved has 11 not had such a consultation within the last 5 years. Such 12 consultation shall include the following: 13 ‘‘(A) An explanation by the practitioner of ad14 vance care planning, including key questions and 15 considerations, important steps, and suggested peo16 ple to talk to. 17 ‘‘(B) An explanation by the practitioner of ad18 vance directives, including living wills and durable 19 powers of attorney, and their uses. 20 ‘‘(C) An explanation by the practitioner of the 21 role and responsibilities of a health care proxy. 22 ‘‘(D) The provision by the practitioner of a list 23 of national and State-specific resources to assist con24 sumers and their families with advance care plan25 ning, including the national toll-free hotline, the ad- VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00425 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC 426 1 vance care planning clearinghouses, and State legal 2 service organizations (including those funded 3 through the Older Americans Act of 1965). 4 ‘‘(E) An explanation by the practitioner of the 5 continuum of end-of-life services and supports avail6 able, including palliative care and hospice, and bene7 fits for such services and supports that are available 8 under this title. 9 ‘‘(F)(i) Subject to clause (ii), an explanation of 10 orders regarding life sustaining treatment or similar 11 orders, which shall include— 12 ‘‘(I) the reasons why the development of 13 such an order is beneficial to the individual and 14 the individual’s family and the reasons why 15 such an order should be updated periodically as 16 the health of the individual changes; 17 ‘‘(II) the information needed for an indi18 vidual or legal surrogate to make informed deci19 sions regarding the completion of such an 20 order; and 21 ‘‘(III) the identification of resources that 22 an individual may use to determine the require23 ments of the State in which such individual re24 sides so that the treatment wishes of that indi25 vidual will be carried out if the individual is un- VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC 427 1 able to communicate those wishes, including re2 quirements regarding the designation of a sur3 rogate decisionmaker (also known as a health 4 care proxy). 5 ‘‘(ii) The Secretary shall limit the requirement 6 for explanations under clause (i) to consultations 7 furnished in a State— 8 ‘‘(I) in which all legal barriers have been 9 addressed for enabling orders for life sustaining 10 treatment to constitute a set of medical orders 11 respected across all care settings; and 12 ‘‘(II) that has in effect a program for or13 ders for life sustaining treatment described in 14 clause (iii). 15 ‘‘(iii) A program for orders for life sustaining 16 treatment for a States described in this clause is a 17 program that— 18 ‘‘(I) ensures such orders are standardized 19 and uniquely identifiable throughout the State; 20 ‘‘(II) distributes or makes accessible such 21 orders to physicians and other health profes22 sionals that (acting within the scope of the pro23 fessional’s authority under State law) may sign 24 orders for life sustaining treatment; VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC 428 1 ‘‘(III) provides training for health care 2 professionals across the continuum of care 3 about the goals and use of orders for life sus4 taining treatment; and 5 ‘‘(IV) is guided by a coalition of stake6 holders includes representatives from emergency 7 medical services, emergency department physi8 cians or nurses, state long-term care associa9 tion, state medical association, state surveyors, 10 agency responsible for senior services, state de11 partment of health, state hospital association, 12 home health association, state bar association, 13 and state hospice association. 14 ‘‘(2) A practitioner described in this paragraph is—15 ‘‘(A) a physician (as defined in subsection 16 (r)(1)); and 17 ‘‘(B) a nurse practitioner or physician’s assist18 ant who has the authority under State law to sign 19 orders for life sustaining treatments. 20 ‘‘(3)(A) An initial preventive physical examination 21 under subsection (WW), including any related discussion 22 during such examination, shall not be considered an ad23 vance care planning consultation for purposes of applying 24 the 5-year limitation under paragraph (1). VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC 429 1 ‘‘(B) An advance care planning consultation with re2 spect to an individual may be conducted more frequently 3 than provided under paragraph (1) if there is a significant 4 change in the health condition of the individual, including 5 diagnosis of a chronic, progressive, life-limiting disease, a 6 life-threatening or terminal diagnosis or life-threatening 7 injury, or upon admission to a skilled nursing facility, a 8 long-term care facility (as defined by the Secretary), or 9 a hospice program. 10 ‘‘(4) A consultation under this subsection may in11 clude the formulation of an order regarding life sustaining 12 treatment or a similar order. 13 ‘‘(5)(A) For purposes of this section, the term ‘order 14 regarding life sustaining treatment’ means, with respect 15 to an individual, an actionable medical order relating to 16 the treatment of that individual that— 17 ‘‘(i) is signed and dated by a physician (as de18 fined in subsection (r)(1)) or another health care 19 professional (as specified by the Secretary and who 20 is acting within the scope of the professional’s au21 thority under State law in signing such an order, in22 cluding a nurse practitioner or physician assistant) 23 and is in a form that permits it to stay with the in24 dividual and be followed by health care professionals 25 and providers across the continuum of care; VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC 430 1 ‘‘(ii) effectively communicates the individual’s 2 preferences regarding life sustaining treatment, in3 cluding an indication of the treatment and care de4 sired by the individual; 5 ‘‘(iii) is uniquely identifiable and standardized 6 within a given locality, region, or State (as identified 7 by the Secretary); and 8 ‘‘(iv) may incorporate any advance directive (as 9 defined in section 1866(f)(3)) if executed by the in10 dividual. 11 ‘‘(B) The level of treatment indicated under subpara12 graph (A)(ii) may range from an indication for full treat13 ment to an indication to limit some or all or specified 14 interventions. Such indicated levels of treatment may in15 clude indications respecting, among other items— 16 ‘‘(i) the intensity of medical intervention if the 17 patient is pulse less, apneic, or has serious cardiac 18 or pulmonary problems; 19 ‘‘(ii) the individual’s desire regarding transfer 20 to a hospital or remaining at the current care set21 ting; 22 ‘‘(iii) the use of antibiotics; and 23 ‘‘(iv) the use of artificially administered nutri24 tion and hydration.’’. VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC 431 1 (2) PAYMENT.—Section 1848(j)(3) of such Act 2 (42 U.S.C. 1395w-4(j)(3)) is amended by inserting 3 ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’. 4 (3) FREQUENCY LIMITATION.—Section 1862(a) 5 of such Act (42 U.S.C. 1395y(a)) is amended— 6 (A) in paragraph (1)— 7 (i) in subparagraph (N), by striking 8 ‘‘and’’ at the end; 9 (ii) in subparagraph (O) by striking 10 the semicolon at the end and inserting ‘‘, 11 and’’; and 12 (iii) by adding at the end the fol13 lowing new subparagraph: 14 ‘‘(P) in the case of advance care planning 15 consultations (as defined in section 16 1861(hhh)(1)), which are performed more fre17 quently than is covered under such section;’’; 18 and 19 (B) in paragraph (7), by striking ‘‘or (K)’’ 20 and inserting ‘‘(K), or (P)’’. 21 (4) EFFECTIVE DATE.—The amendments made 22 by this subsection shall apply to consultations fur23 nished on or after January 1, 2011. 24 (b) EXPANSION OF PHYSICIAN QUALITY REPORTING 25 INITIATIVE FOR END OF LIFE CARE.— VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00431 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC 432 1 (1) PHYSICIAN’S QUALITY REPORTING INITIA2 TIVE.—Section 1848(k)(2) of the Social Security Act 3 (42 U.S.C. 1395w–4(k)(2)) is amended by adding at 4 the end the following new paragraphs: 5 ‘‘(3) PHYSICIAN’S QUALITY REPORTING INITIA6 TIVE.— 7 ‘‘(A) IN GENERAL.—For purposes of re8 porting data on quality measures for covered 9 professional services furnished during 2011 and 10 any subsequent year, to the extent that meas11 ures are available, the Secretary shall include 12 quality measures on end of life care and ad13 vanced care planning that have been adopted or 14 endorsed by a consensus-based organization, if 15 appropriate. Such measures shall measure both 16 the creation of and adherence to orders for life17 sustaining treatment. 18 ‘‘(B) PROPOSED SET OF MEASURES.— The 19 Secretary shall publish in the Federal Register 20 proposed quality measures on end of life care 21 and advanced care planning that the Secretary 22 determines are described in subparagraph (A) 23 and would be appropriate for eligible profes24 sionals to use to submit data to the Secretary. 25 The Secretary shall provide for a period of pub- VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC 433 1 lic comment on such set of measures before fi2 nalizing such proposed measures.’’. 3 (c) INCLUSION OF INFORMATION IN MEDICARE & 4 YOU HANDBOOK.— 5 (1) MEDICARE & YOU HANDBOOK.— 6 (A) IN GENERAL.—Not later than 1 year 7 after the date of the enactment of this Act, the 8 Secretary of Health and Human Services shall 9 update the online version of the Medicare & 10 You Handbook to include the following: 11 (i) An explanation of advance care 12 planning and advance directives, includ13 ing— 14 (I) living wills; 15 (II) durable power of attorney; 16 (III) orders of life-sustaining 17 treatment; and 18 (IV) health care proxies. 19 (ii) A description of Federal and State 20 resources available to assist individuals 21 and their families with advance care plan22 ning and advance directives, including— 23 (I) available State legal service 24 organizations to assist individuals 25 with advance care planning, including VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC 434 1 those organizations that receive fund2 ing pursuant to the Older Americans 3 Act of 1965 (42 U.S.C. 93001 et 4 seq.); 5 (II) website links or addresses for 6 State-specific advance directive forms; 7 and 8 (III) any additional information, 9 as determined by the Secretary. 10 (B) UPDATE OF PAPER AND SUBSEQUENT 11 VERSIONS.—The Secretary shall include the in12 formation described in subparagraph (A) in all 13 paper and electronic versions of the Medicare & 14 You Handbook that are published on or after 15 the date that is 1 year after the date of the en16 actment of this Act. | 
