Text: H.R.4449 — 101st Congress (1989-1990)All Information (Except Text)

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HR 4449 IH
101st CONGRESS
2d Session
 H. R. 4449
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 assure that individuals receiving services will be
given an opportunity to participate in and direct health care decisions
affecting themselves.
IN THE HOUSE OF REPRESENTATIVES
April 3, 1990
Mr. LEVIN of Michigan (for himself, Mr. SWIFT, Mr. MOODY, Mr. MCDERMOTT,
and Mr. FAUNTROY) introduced the following bill; which was referred jointly
to the Committees on Ways and Means and Energy and Commerce
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 assure that individuals receiving services will be
given an opportunity to participate in and direct health care decisions
affecting themselves.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
SECTION 1. SHORT TITLE.
  This Act may be cited as the `Patient Self Determination Act of 1990'.
SEC. 2. MEDICARE PROVIDER AGREEMENTS ASSURING THE IMPLEMENTATION OF A PATIENT'S
RIGHT TO PARTICIPATE IN AND DIRECT HEALTH CARE DECISIONS AFFECTING THE PATIENT.
  (a) IN GENERAL- Section 1866(a)(1) of the Social Security Act (42
  U.S.C. 1395cc(a)(1)), as amended by section 6112 of the Omnibus Budget
  Reconciliation Act of 1989, is amended--
  (1) by striking `and' at the end of subparagraph (O),
  (2) by striking the period at the end of subparagraph (P) and inserting
  `, and', and
  (3) by inserting after subparagraph (P) the following new subparagraph:
  `(Q) in the case of hospitals, skilled nursing facilities, home health
  agencies, and hospice programs, to maintain written policies and procedures
  with respect to all individuals receiving medical care by or through
  the provider--
  `(i) to inform such individuals of an individual's rights under State law
  (whether statutory or as recognized by the courts of the State) to make
  decisions concerning such medical care, including the right to accept or
  refuse medical or surgical treatment and the right to formulate advanced
  directives recognized under State law relating to the provision of care when
  such individuals are incapacitated (such a directive in this subparagraph
  referred to as an `advanced directive'), such as through--
  `(I) the appointment of an agent or surrogate to make health care decisions
  on behalf of such an individual, and
  `(II) the provision of written instructions concerning the individual's
  health care (including instructions for the disposition of organs);
  `(ii) to inquire periodically (and to document in the individual's medical
  record) whether or not the individual has executed an advanced directive
  and to document in such record the individual's wishes (if any) with
  respect to such medical care;
  `(iii) not to deny the initial provision of care or otherwise discriminate
  against an individual based on whether or not the individual has executed
  an advanced directive;
  `(iv) to ensure that legally valid advanced directives and wishes otherwise
  documented under clause (ii) are implemented to the extent permissible
  under State law, including such provisions of State law as relate to the
  transfer of an individual in the case of a provider which, as a matter of
  conscience, cannot implement the wishes of the individual; and
  `(v) to provide (individually or with others) for educational programs
  for staff, individuals receiving medical care by or through the provider,
  and the community on ethical issues concerning patient self determination
  and concerning advance directives respecting such care.'.
  (b) APPLICATION TO HEALTH MAINTENANCE ORGANIZATIONS- Section 1876(c)
  of such Act (42 U.S.C. 1395mm(c)) is amended by adding at the end the
  following new paragraph:
  `(8) A contract under this section shall provide that the eligible
  organization shall meet the requirements of section 1866(a)(1)(Q) in the
  same manner as they apply to hospitals.'.
  (c) Effective Dates-
  (1) The amendments made by subsection (a) shall apply with respect to
  services furnished on or after the first day of the first month beginning
  more than 180 days after the date of the enactment of this Act.
  (2) The amendment made by subsection (b) shall apply to contracts under
  section 1876 of the Social Security Act as of the first day of the first
  month beginning more than 180 days after the date of the enactment of
  this Act.
SEC. 3. MEDICAID STATE PLANS ASSURING THE IMPLEMENTATION OF A PATIENT'S
RIGHT TO PARTICIPATE IN AND DIRECT HEALTH CARE DECISIONS AFFECTING THE PATIENT.
  (a) IN GENERAL- Section 1902(a) of the Social Security Act (42
  U.S.C. 1396a(a)), as amended by section 6406(a) of the Omnibus Budget
  Reconciliation Act of 1989, is amended--
  (1) by striking `and' at the end of paragraph (52),
  (2) by striking the period at the end of paragraph (53) and inserting `;
  and', and
  (3) by inserting after paragraph (53) the following new paragraph:
  `(54) provide that each hospital, nursing facility, home health agency,
  hospice program, or health maintenance organization receiving funds under
  the plan shall maintain written policies and procedures with respect
  to all individuals receiving medical care by or through the provider or
  organization--
  `(A) to inform such individuals of an individual's rights under State law
  (whether statutory or as recognized by the courts of the State) to make
  decisions concerning such medical care, including the right to accept or
  refuse medical or surgical treatment and the right to formulate advanced
  directives recognized under State law relating to the provision of care
  when such individuals are incapacitated (such a directive in this paragraph
  referred to as an `advanced directive'), such as through--
  `(i) the appointment of an agent or surrogate to make health care decisions
  on behalf of such an individual, and
  `(ii) the provision of written instructions concerning the individual's
  health care (including instructions for the disposition of organs);
  `(B) to inquire periodically (and to document in the individual's medical
  record) whether or not the individual has executed an advanced directive
  and to document in such record the individual's wishes (if any) with
  respect to such medical care;
  `(C) not to deny the initial provision of care or otherwise discriminate
  against an individual based on whether or not the individual has executed
  an advanced directive;
  `(D) to ensure that legally valid advanced directives and wishes otherwise
  documented under subparagraph (B) are implemented to the extent permissible
  under State law, including such provisions of State law as relate to the
  transfer of an individual in the case of a provider or organization which,
  as a matter of conscience, cannot implement the wishes of the individual; and
  `(E) to provide (individually or with others) for educational programs
  for staff, individuals receiving medical care by or through the provider
  or organization, and the community on ethical issues concerning patient
  self determination and concerning advance directives respecting such care.'.
  (b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply with
  respect to services furnished on or after the first day of the first month
  beginning more than 180 days after the date of the enactment of this Act.
SEC. 4. STUDY TO ASSESS IMPLEMENTATION OF A PATIENT'S RIGHT TO PARTICIPATE
IN AND DIRECT HEALTH CARE DECISIONS AFFECTING THE PATIENT.
  (a) IN GENERAL- The Secretary of Health and Human Services shall (subject
  to subsection (b)) enter into an agreement with the Institute of Medicine
  of the National Academy of Sciences to conduct a study with respect to
  the implementation of directed health care decisions. Such study shall--
  (1) evaluate the experience of practitioners, providers, and government
  regulators experienced in complying with the requirement imposed by the
  amendments made by sections 2(a) and 3(a); and
  (2) investigate methods of making decisions reached by a patient or
  nursing home resident transferrable, so that the wishes of the patient
  or resident can be known and respected in other health care settings to
  which the patient or resident may be transferred or discharged.
  (b) ARRANGEMENTS FOR STUDY- The Secretary shall request the Institute of
  Medicine of the National Academy of Sciences to submit an application to
  conduct the study described in subsection (a). If the Institute submits
  an acceptable application, the Secretary shall enter into an appropriate
  arrangement with the Academy for the conduct of the study within 28 days of
  the date the application is received. If the Institute does not submit an
  acceptable application to conduct the study, the Secretary may request one
  or more appropriate nonprofit private entities to submit an application
  to conduct the study and may enter into an appropriate arrangement for
  the conduct of the study by the entity which submits the best acceptable
  application.
  (c) REPORT- The results of the study shall be reported to Congress and
  the Secretary by not later than 4 years after the date of the enactment of
  this Act. Such report shall include such recommendations for legislation
  as may be appropriate to carry out further the purpose of this Act.
SEC. 5. PUBLIC EDUCATION DEMONSTRATION PROJECT.
  The Secretary of Health and Human Services, no later than 6 months after
  the date of the enactment of this Act, shall develop and implement a
  demonstration project in selected States to inform the public of the option
  to execute advance directives and of a patient's right to participate in
  and direct health care decisions. The Secretary shall report to Congress on
  the results of the project and on whether such project should be expanded
  to cover all the States.

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