Advance Care Planning Provision Still Alive in Reform

In the House version of the Health Care Reform Bill submitted last week, the provision for physician reimbursement once every 5 years for Advance Care Planning (also erroneously known as Death Panels) was kept in.  Apparently the sound and the fury of this summer did not deter the Democrats from including it and may have even helped keep it in once all the fire died down.  The provision is supported by numerous medical groups including the AAHPM, AMA and even AARP.

I am including the text as copied from HR 3200 here for posterity.  (obtained from Opencongress.org) (Sorry for the long post but hey this is history here.)

‘Advance Care Planning Consultation

‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to. CommentsClose CommentsPermalink


‘(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. CommentsClose CommentsPermalink


‘(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). CommentsClose CommentsPermalink


‘(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. CommentsClose CommentsPermalink


‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include-- CommentsClose CommentsPermalink


‘(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the individual’s family and thereasons why such an order should be updated periodically as the health of the individual changes; CommentsClose CommentsPermalink


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


‘(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 decisionmaker (also known as a health care proxy). CommentsClose CommentsPermalink


‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State-- CommentsClose CommentsPermalink


‘(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 CommentsClose CommentsPermalink


‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii). CommentsClose CommentsPermalink


‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that-- CommentsClose CommentsPermalink


‘(I) ensures such orders are standardized and uniquely identifiable throughout the State; CommentsClose CommentsPermalink


‘(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; CommentsClose CommentsPermalink


‘(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and CommentsClose CommentsPermalink


‘(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. CommentsClose CommentsPermalink

‘(A) a physician (as defined in subsection (r)(1)); and CommentsClose CommentsPermalink


‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments. CommentsClose CommentsPermalink

‘(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; CommentsClose CommentsPermalink


‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual; CommentsClose CommentsPermalink


‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and CommentsClose CommentsPermalink


‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual. CommentsClose CommentsPermalink

‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems; CommentsClose CommentsPermalink


‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting; CommentsClose CommentsPermalink


‘(iii) the use of antibiotics; and CommentsClose CommentsPermalink


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


(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),’. CommentsClose CommentsPermalink


(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended-- CommentsClose CommentsPermalink


(A) in paragraph (1)-- CommentsClose CommentsPermalink


(i) in subparagraph (N), by striking ‘and’ at the end; CommentsClose CommentsPermalink


(ii) in subparagraph (O) by striking the semicolon at the end and inserting ‘, and’; and CommentsClose CommentsPermalink


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


‘(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 CommentsClose CommentsPermalink


(B) in paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’. CommentsClose CommentsPermalink


(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011. CommentsClose CommentsPermalink

(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:‘(3subparagraph: CommentsClose CommentsPermalink


‘(E) Physician’S QUALITY REPORTING INITIATIVE- CommentsClose CommentsPermalink


‘(Ai) 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. CommentsClose CommentsPermalink


‘(Bii) 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.’. CommentsClose CommentsPermalink

(i) An explanation of advance care planning and advance directives, including-- CommentsClose CommentsPermalink


(I) living wills; CommentsClose CommentsPermalink


(II) durable power of attorney; CommentsClose CommentsPermalink


(III) orders of life-sustaining treatment; and CommentsClose CommentsPermalink


(IV) health care proxies. CommentsClose CommentsPermalink


(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including-- CommentsClose CommentsPermalink


(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.); CommentsClose CommentsPermalink


(II) website links or addresses for State-specific advance directive forms; and CommentsClose CommentsPermalink


(III) any additional information, as determined by the Secretary. CommentsClose CommentsPermalink

(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.