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News - I need some help with this one! It’s been reported that the new health care bill will require seniors to consult every 5 years on matters concerning their future or what is termed "end of life decisions". Some have even stated that the government will require our elders to consider euthanasia or assisted suicide... You know...the shear size of this bill and it's cost is reason alone to ask our representatives to vote no. If there is now a question of how life is honored, then there is no doubt, it is past time to act, call your representatives today and tell them to vote NO! From HR3200 SEC. 1233. ADVANCE CARE PLANNING CONSULTATION. (a) Medicare-
(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
(A) in subsection (s)(2)--
(i) by striking ‘and’ at the end of subparagraph (DD);
(ii) by adding ‘and’ at the end of subparagraph (EE); and
(iii) by adding at the end the following new subparagraph:
‘(FF) advance care planning consultation (as defined in subsection (hhh)(1));’; and
(B) by adding at the end the following new subsection:
‘Advance Care Planning Consultation ‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
‘(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.
‘(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).
‘(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.
‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--
‘(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
‘(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).
‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--
‘(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
‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--
‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;
‘(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;
‘(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
‘(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.
‘(2) A practitioner described in this paragraph is--
‘(A) a physician (as defined in subsection (r)(1)); and
‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.
‘(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).
‘(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
‘(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.
‘(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--
‘(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;
‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.
‘(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items--
‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;
‘(iii) the use of antibiotics; and
‘(iv) the use of artificially administered nutrition and hydration.’.
(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),’.
(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--
(A) in paragraph (1)--
(i) in subparagraph (N), by striking ‘and’ at the end;
(ii) in subparagraph (O) by striking the semicolon at the end and inserting ‘, and’; and
(iii) by adding at the end the following new subparagraph:
‘(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
(B) in paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’.
(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011. From Social Security Act 1861 (s) The term “medical and other health services” means any of the following items or services: (1) physicians' services; (2)(A) services and supplies (including drugs and biologicals which are not usually self-administered by the patient) furnished as an incident to a physician's professional service, of kinds which are commonly furnished in physicians' offices and are commonly either rendered without charge or included in the physicians' bills (or would have been so included but for the application of section 1847B); (B) hospital services (including drugs and biologicals which are not usually self-administered by the patient) incident to physicians' services rendered to outpatients and partial hospitalization services incident to such services; (C) diagnostic services which are— (i) furnished to an individual as an outpatient by a hospital or by others under arrangements with them made by a hospital, and (ii) ordinarily furnished by such hospital (or by others under such arrangements) to its outpatients for the purpose of diagnostic study; (D) outpatient physical therapy services and outpatient occupational therapy services; (E) rural health clinic services and Federally qualified health center services; (F) home dialysis supplies and equipment, self-care home dialysis support services, and institutional dialysis services and supplies, and, for items and services furnished on or after January 1, 2011, renal dialysis services (as defined in section 1881(b)(14)(B))[444]; (G) antigens (subject to quantity limitations prescribed in regulations by the Secretary) prepared by a physician, as defined in section 1861(r)(1), for a particular patient, including antigens so prepared which are forwarded to another qualified person (including a rural health clinic) for administration to such patient, from time to time, by or under the supervision of another such physician; (H)(i) services furnished pursuant to a contract under section 1876 to a member of an eligible organization by a physician assistant or by a nurse practitioner (as defined in subsection (aa)(5)) and such services and supplies furnished as an incident to his service to such a member as would otherwise be covered under this part if furnished by a physician or as an incident to a physician's service; and (ii) services furnished pursuant to a risk-sharing contract under section 1876(g) to a member of an eligible organization by a clinical psychologist (as defined by the Secretary) or by a clinical social worker (as defined in subsection (hh)(2)), and such services and supplies furnished as an incident to such clinical psychologist's services or clinical social worker's services to such a member as would otherwise be covered under this part if furnished by a physician or as an incident to a physician's service; (I) blood clotting factors, for hemophilia patients competent to use such factors to control bleeding without medical or other supervision, and items related to the administration of such factors, subject to utilization controls deemed necessary by the Secretary for the efficient use of such factors; (J) prescription drugs used in immunosuppressive therapy furnished, to an individual who receives an organ transplant for which payment is made under this title; (K)(i) services which would be physicians' services if furnished by a physician (as defined in subsection (r)(1)) and which are performed by a physician assistant (as defined in subsection (aa)(5)) under the supervision of a physician (as so defined) and which the physician assistant is legally authorized to perform by the State in which the services are performed, and such services and supplies furnished as incident to such services as would be covered under subparagraph (A) if furnished incident to a physician's professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services, (ii) services which would be physicians' services if furnished by a physician (as defined in subsection (r)(1)) and which are performed by a nurse practitioner or clinical nurse specialist (as defined in subsection (aa)(5)) working in collaboration (as defined in subsection (aa)(6)) with a physician (as defined in subsection (r)(1)) which the nurse practitioner or clinical nurse specialist is legally authorized to perform by the State in which the services are performed, and such services and supplies furnished as an incident to such services as would be covered under subparagraph (A) if furnished incident to a physician's professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services; (L) certified nurse-midwife services; (M) qualified psychologist services; (N) clinical social worker services (as defined in subsection (hh)(2)); (O) erythropoietin for dialysis patients competent to use such drug without medical or other supervision with respect to the administration of such drug, subject to methods and standards established by the Secretary by regulation for the safe and effective use of such drug, and items related to the administration of such drug; (P) prostate cancer screening tests (as defined in subsection (oo)); (Q) an oral drug (which is approved by the Federal Food and Drug Administration) prescribed for use as an anticancer chemotherapeutic agent for a given indication, and containing an active ingredient (or ingredients), which is the same indication and active ingredient (or ingredients) as a drug which the carrier determines would be covered pursuant to subparagraph (A) or (B) if the drug could not be self-administered; (R) colorectal cancer screening tests (as defined in subsection (pp)); (S) diabetes outpatient self-management training services (as defined in subsection (qq)); (T) an oral drug (which is approved by the Federal Food and Drug Administration) prescribed for use as an acute anti-emetic used as part of an anticancer chemotherapeutic regimen if the drug is administered by a physician (or as prescribed by a physician)— (i) for use immediately before, at, or within 48 hours after the time of the administration of the anticancer chemotherapeutic agent; and (ii) as a full replacement for the anti-emetic therapy which would otherwise be administered intravenously; (U) screening for glaucoma (as defined in subsection (uu)) for individuals determined to be at high risk for glaucoma, individuals with a family history of glaucoma and individuals with diabetes; (V) medical nutrition therapy services (as defined in subsection (vv)(1)) in the case of a beneficiary with diabetes or a renal disease who— (i) has not received diabetes outpatient self-management training services within a time period determined by the Secretary; (ii) is not receiving maintenance dialysis for which payment is made under section 1881; and (iii) meets such other criteria determined by the Secretary after consideration of protocols established by dietitian or nutrition professional organizations; (W) an initial preventive physical examination (as defined in subsection (ww)); (X) cardiovascular screening blood tests (as defined in subsection (xx)(1)); (Y) diabetes screening tests (as defined in subsection (yy)); (Z) intravenous immune globulin for the treatment of primary immune deficiency diseases in the home (as defined in subsection (zz));[445] (AA) ultrasound screening for abdominal aortic aneurysm (as defined in subsection (bbb)) for an individual— (i) who receives a referral for such an ultrasound screening as a result of an initial preventive physical examination (as defined in section 1861(ww)(1)); (ii) who has not been previously furnished such an ultrasound screening under this title; and (iii) who— (I) has a family history of abdominal aortic aneurysm; or (II) manifests risk factors included in a beneficiary category recommended for screening by the United States Preventive Services Task Force regarding abdominal aortic aneurysms; and[446] (BB)[447] additional preventive services (described in subsection (ddd)(1)); (CC)[448] items and services furnished under a cardiac rehabilitation program (as defined in subsection (eee)(1)) or under a pulmonary rehabilitation program (as defined in subsection (fff)(1)); and[449] (DD)[450] items and services furnished under an intensive cardiac rehabilitation program (as defined in subsection (eee)(4));[451] (EE)[452] kidney disease education services (as defined in subsection (ggg)); (3) diagnostic X-ray tests (including tests under the supervision of a physician, furnished in a place of residence used as the patient's home, if the performance of such tests meets such conditions relating to health and safety as the Secretary may find necessary and including diagnostic mammography if conducted by a facility that has a certificate (or provisional certificate) issued under section 354 of the Public Health Service Act[453]), diagnostic laboratory tests, and other diagnostic tests; (4) X-ray, radium, and radioactive isotope therapy, including materials and services of technicians; (5) surgical dressings, and splints, casts, and other devices used for reduction of fractures and dislocations; (6) durable medical equipment; (7) ambulance service where the use of other methods of transportation is contraindicated by the individual's condition, but only to the extent provided in regulations; (8) prosthetic devices (other than dental) which replace all or part of an internal body organ (including colostomy bags and supplies directly related to colostomy care), including replacement of such devices, and including one pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens; (9) leg, arm, back, and neck braces, and artificial legs, arms, and eyes, including replacements if required because of a change in the patient's physical condition; (10)(A) pneumococcal vaccine and its administration and, subject to section 4071(b) of the Omnibus Budget Reconciliation Act of 1987[454], influenza vaccine and its administration; and (B) hepatitis B vaccine and its administration, furnished to an individual who is at high or intermediate risk of contracting hepatitis B (as determined by the Secretary under regulations); (11) services of a certified registered nurse anesthetist (as defined in subsection (bb)); (12) subject to section 4072(e) of the Omnibus Budget Reconciliation Act of 1987[455], extra-depth shoes with inserts or custom molded shoes with inserts for an individual with diabetes, if— (A) the physician who is managing the individual's diabetic condition (i) documents that the individual has peripheral neuropathy with evidence of callus formation, a history of pre-ulcerative calluses, a history of previous ulceration, foot deformity, or previous amputation, or poor circulation, and (ii) certifies that the individual needs such shoes under a comprehensive plan of care related to the individual's diabetic condition; (B) the particular type of shoes are prescribed by a podiatrist or other qualified physician (as established by the Secretary); and (C) the shoes are fitted and furnished by a podiatrist or other qualified individual (such as a pedorthist or orthotist, as established by the Secretary) who is not the physician described in subparagraph (A) (unless the Secretary finds that the physician is the only such qualified individual in the area); (13) screening mammography (as defined in subsection (jj)); (14) screening pap smear and screening pelvic exam; and (15) bone mass measurement (as defined in subsection (rr)). No diagnostic tests performed in any laboratory, including a laboratory that is part of a rural health clinic, or a hospital (which, for purposes of this sentence, means an institution considered a hospital for purposes of section 1814(d)) shall be included within paragraph (3) unless such laboratory— (16) if situated in any State in which State or applicable local law provides for licensing of establishments of this nature, (A) is licensed pursuant to such law, or (B) is approved, by the agency of such State or locality responsible for licensing establishments of this nature, as meeting the standards established for such licensing; and (17)(A) meets the certification requirements under section 353 of the Public Health Service Act;[456] and (B) meets such other conditions relating to the health and safety of individuals with respect to whom such tests are performed as the Secretary may find necessary. There shall be excluded from the diagnostic services specified in paragraph (2)(C) any item or service (except services referred to in paragraph (1)) which would not be included under subsection (b) if it were furnished to an inpatient of a hospital. None of the items and services referred to in the preceding paragraphs (other than paragraphs (1) and (2)(A)) of this subsection which are furnished to a patient of an institution which meets the definition of a hospital for purposes of section 1814(d) shall be included unless such other conditions are met as the Secretary may find necessary relating to health and safety of individuals with respect to whom such items and services are furnished.
Analysis - I have read the portion of the bill in question and yes there is a consultation required every 5 years for discussion about "living wills", "medical directive" and "medical proxy". These are things we should all think about, but especially as we grow older. I do not see euthanasia stated, but I have not studied it in depth and there is language I am unfamiliar with relating to physician orders. I am posting those sections along with section 1861 of the social security act as referenced in the health care bill. Please read them for yourself and see if you find anything about the possibility of euthanasia. If one of you has researched this and would like to weigh in, please feel free to contact me.
The pertinent sections are below. Feel free to go back to the News page, click on the link and read the full bill.
Medical and Other Health Services