Search This Blog

Tuesday, August 11, 2009

Decisions By The Stakeholders?
16 (a) MEDICARE.— 17 (1) IN GENERAL.—Section 1861 of the Social 18 Security Act (42 U.S.C. 1 395x) is amended—
4 “(E) An explanation by the practitioner of the 5 continuum of end-of-life services and supports avail- 6 able, including palliative care and hospice, and bene 7 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 indi 18 vidual or legal surrogate to make informed deci 19 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 require- 23 ments of the State in which such individual re- 24 sides so that the treatment wishes of that indi 25 vidual will be carried out if the individual is un 1 able to communicate those wishes, including re- 2 quirements regarding the designation of a sur 3 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 or- 13 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 profes 22 sionals that (acting within the scope of the pro- 23 fessional’s authority under State law) may sign 24 orders for life sustaining treatment; 1 “(III) provides training for health care 2 professionals across the continuum of care 3 about the goals and use of orders for life sus- 4 taining treatment; and 5 “(IV) is guided by a coalition of stake- 6 holders includes representatives from emergency 7 medical services, emergency department physi 8 cians or nurses, state long-term care associa 9 tion, state medical association, state surveyors, 10 agency responsible for senior services, state de- 11 partment of health, state hospital association, 12 home health association, state bar association, 13 and state hospice association. 1 “(B) An advance care planning consultation with re- 2 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 in- 11 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 de- 18 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 au- 21 thority under State law in signing such an order, in- 22 cluding a nurse practitioner or physician assistant) 23 and is in a form that permits it to stay with the in- 24 dividual and be followed by health care professionals 25 and providers across the continuum of care;
1 “(ii) effectively communicates the individual’s 2 preferences regarding life sustaining treatment, in- 3 cluding an indication of the treatment and care de- 4 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 in- 10 dividual. 11 “(B) The level of treatment indicated under subpara 12 graph (A)(ii) may range from an indication for full treat- 13 ment to an indication to limit some or all or specified 14 interventions. Such indicated levels of treatment may in- 15 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 set- 21 ting; 22 “(iii) the use of antibiotics; and 23 “(iv) the use of artificially administered nutri 24 tion and hydration.”.
Note that the ‘stakeholders’ will be the deciders here.