Section 1233 HR 3200

The events of the past week in town halls across the country have me almost giddy with thoughts of the Obama machine coming apart at the seams. ALMOST! I still can’t quite believe he has blundered this badly. It is like playing chess with a grand master, and winning his queen in the opening. It just makes me wonder what he’s up to. After all, this guy is brilliant, right? An Ivy leaguer, constitutional law professor, seasoned community organizer, and startlingly successful Chicago politician, how then can he screw up this badly?

He has been unable to explain the health care reform plan with anything approaching clarity. He has given Nancy Pelosi, the antithesis of everything American, free rein to implement the furthest left of all possible legislation, and has supported everything she has done, except that I’m not sure he even understands what is in the bills making the rounds in House committees right now. His rhetoric certainly does not match the facts easily found, particularly in Section 1233 of HR 3200. There really is a section dealing with end of life decisions with regard to health care. I read the bill, and it is there. He puts together a town hall of his supporters to make himself look good, while Congressional members are being bombarded all over the country. What’s up with that?

It is true, there are no specific requirements as to what decisions have to be made, and no chart defining age VS disease VS cost. However, the fact that the bill even goes into the end of life requirements for planning is sufficient to convince me the government bureaucracy will indeed play a very large role in helping me make those decisions when the time comes. He who has the money, has the power, and wins. That is the way life works. If the government controls what procedures are paid for based on economics, or economics VS age, VS history, or any combination of facts that can be plugged into spreadsheet logic, then make no mistake, that is exactly what they will do.

That is the way it works in England, Canada, Israel, and all other countries with nationalized health care. There is always a finite number of doctors, hospital beds, and money. There is never a finite number of medical problems, disease, or injuries requiring procedures or pain medication. What then, logically, are we left to believe? Are we to believe Obama when he says, no, we would never make those decisions for you. You can keep you doctor if you like him. You can keep your insurance if you want to. How is it then that one of the House bills says: “Private insurers can't sign new insurees after 1/1/2013”? Does Obama know what is in the bills currently making the rounds?

Do members of Congress know what is in the bills? What is the Senate doing in committee? Why are they keeping it so secretive? I think it is pretty obvious why so many Americans are worried, and why the numbers are going in reverse every single day. I don’t think we can write Obama off yet though. He is certainly capable of turning this thing around. The Cap and Tax bill was in serious trouble of passing the House right up until the day it was passed. He had a luncheon at the White House, and voila, he got all the votes he needed, plus Pelosi had plenty of breathing room to allow certain democrats to vote against the bill, knowing they would be in serious trouble with their constituents if they voted for the largest tax increase in American history. The Senate still hasn’t passed a version yet, and it hasn’t come up for a vote, only because Obama doesn’t have the required number of votes to pass it quite yet.

I fear the same thing may happen with health care. The majority has shown they do not care what the people want. They are going to vote the way Pelosi, and the rest of the majority leadership tell them to vote. I don’t understand how she could have that much power, but it certainly appears that she does. Hopefully, the massive show of force from opponents of health care reform will give them pause, but I am not going to hold my breath. The President of the United States, the Speaker of the House, and many other legislators are demonizing regular American citizens who are voicing their dissent publicly, sometimes loudly, but always plainly, and with more understanding of the issues than any of the lawmakers have demonstrated to this point.

I remain hopeful that the events of the past couple of weeks are turning the tide of the government’s total disregard for the American people, but I am wary that Obama has something else up his sleeve. I am troubled that he has looked so inept of late. This is out of character for him, and I find it hard to believe he didn’t see this coming. Am I over estimating him?

In any event, here is section 1233 of HR 3200. Enjoy!

5 SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
6 (a) MEDICARE.—
7 (1) IN GENERAL.—Section 1861 of the Social
8 Security Act (42 U.S.C. 1395x) is amended—
9 (A) in subsection (s)(2)—
10 (i) by striking ‘‘and’’ at the end of
11 subparagraph (DD);
12 (ii) by adding ‘‘and’’ at the end of
13 subparagraph (EE); and
14 (iii) by adding at the end the fol15
lowing new subparagraph:
16 ‘‘(FF) advance care planning consultation (as
17 defined in subsection (hhh)(1));’’; and
18 (B) by adding at the end the following new
19 subsection:
20 ‘‘Advance Care Planning Consultation
21 ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the
22 term ‘advance care planning consultation’ means a con23
sultation between the individual and a practitioner de24
scribed in paragraph (2) regarding advance care planning,
25 if, subject to paragraph (3), the individual involved has
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1 not had such a consultation within the last 5 years. Such
2 consultation shall include the following:
3 ‘‘(A) An explanation by the practitioner of ad4
vance care planning, including key questions and
5 considerations, important steps, and suggested peo6
ple to talk to.
7 ‘‘(B) An explanation by the practitioner of ad8
vance directives, including living wills and durable
9 powers of attorney, and their uses.
10 ‘‘(C) An explanation by the practitioner of the
11 role and responsibilities of a health care proxy.
12 ‘‘(D) The provision by the practitioner of a list
13 of national and State-specific resources to assist con14
sumers and their families with advance care plan15
ning, including the national toll-free hotline, the ad16
vance care planning clearinghouses, and State legal
17 service organizations (including those funded
18 through the Older Americans Act of 1965).
19 ‘‘(E) An explanation by the practitioner of the
20 continuum of end-of-life services and supports avail21
able, including palliative care and hospice, and bene22
fits for such services and supports that are available
23 under this title.
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1 ‘‘(F)(i) Subject to clause (ii), an explanation of
2 orders regarding life sustaining treatment or similar
3 orders, which shall include—
4 ‘‘(I) the reasons why the development of
5 such an order is beneficial to the individual and
6 the individual’s family and the reasons why
7 such an order should be updated periodically as
8 the health of the individual changes;
9 ‘‘(II) the information needed for an indi10
vidual or legal surrogate to make informed deci11
sions regarding the completion of such an
12 order; and
13 ‘‘(III) the identification of resources that
14 an individual may use to determine the require15
ments of the State in which such individual re16
sides so that the treatment wishes of that indi17
vidual will be carried out if the individual is un18
able to communicate those wishes, including re19
quirements regarding the designation of a sur20
rogate decisionmaker (also known as a health
21 care proxy).
22 ‘‘(ii) The Secretary shall limit the requirement
23 for explanations under clause (i) to consultations
24 furnished in a State—
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1 ‘‘(I) in which all legal barriers have been
2 addressed for enabling orders for life sustaining
3 treatment to constitute a set of medical orders
4 respected across all care settings; and
5 ‘‘(II) that has in effect a program for or6
ders for life sustaining treatment described in
7 clause (iii).
8 ‘‘(iii) A program for orders for life sustaining
9 treatment for a States described in this clause is a
10 program that—
11 ‘‘(I) ensures such orders are standardized
12 and uniquely identifiable throughout the State;
13 ‘‘(II) distributes or makes accessible such
14 orders to physicians and other health profes15
sionals that (acting within the scope of the pro16
fessional’s authority under State law) may sign
17 orders for life sustaining treatment;
18 ‘‘(III) provides training for health care
19 professionals across the continuum of care
20 about the goals and use of orders for life sus21
taining treatment; and
22 ‘‘(IV) is guided by a coalition of stake23
holders includes representatives from emergency
24 medical services, emergency department physi25
cians or nurses, state long-term care associa-
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1 tion, state medical association, state surveyors,
2 agency responsible for senior services, state de3
partment of health, state hospital association,
4 home health association, state bar association,
5 and state hospice association.
6 ‘‘(2) A practitioner described in this paragraph is—
7 ‘‘(A) a physician (as defined in subsection
8 (r)(1)); and
9 ‘‘(B) a nurse practitioner or physician’s assist10
ant who has the authority under State law to sign
11 orders for life sustaining treatments.
12 ‘‘(3)(A) An initial preventive physical examination
13 under subsection (WW), including any related discussion
14 during such examination, shall not be considered an ad15
vance care planning consultation for purposes of applying
16 the 5-year limitation under paragraph (1).
17 ‘‘(B) An advance care planning consultation with re18
spect to an individual may be conducted more frequently
19 than provided under paragraph (1) if there is a significant
20 change in the health condition of the individual, including
21 diagnosis of a chronic, progressive, life-limiting disease, a
22 life-threatening or terminal diagnosis or life-threatening
23 injury, or upon admission to a skilled nursing facility, a
24 long-term care facility (as defined by the Secretary), or
25 a hospice program.
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1 ‘‘(4) A consultation under this subsection may in2
clude the formulation of an order regarding life sustaining
3 treatment or a similar order.
4 ‘‘(5)(A) For purposes of this section, the term ‘order
5 regarding life sustaining treatment’ means, with respect
6 to an individual, an actionable medical order relating to
7 the treatment of that individual that—
8 ‘‘(i) is signed and dated by a physician (as de9
fined in subsection (r)(1)) or another health care
10 professional (as specified by the Secretary and who
11 is acting within the scope of the professional’s au12
thority under State law in signing such an order, in13
cluding a nurse practitioner or physician assistant)
14 and is in a form that permits it to stay with the in15
dividual and be followed by health care professionals
16 and providers across the continuum of care;
17 ‘‘(ii) effectively communicates the individual’s
18 preferences regarding life sustaining treatment, in19
cluding an indication of the treatment and care de20
sired by the individual;
21 ‘‘(iii) is uniquely identifiable and standardized
22 within a given locality, region, or State (as identified
23 by the Secretary); and
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1 ‘‘(iv) may incorporate any advance directive (as
2 defined in section 1866(f)(3)) if executed by the in3
dividual.
4 ‘‘(B) The level of treatment indicated under subpara5
graph (A)(ii) may range from an indication for full treat6
ment to an indication to limit some or all or specified
7 interventions. Such indicated levels of treatment may in8
clude indications respecting, among other items—
9 ‘‘(i) the intensity of medical intervention if the
10 patient is pulse less, apneic, or has serious cardiac
11 or pulmonary problems;
12 ‘‘(ii) the individual’s desire regarding transfer
13 to a hospital or remaining at the current care set14
ting;
15 ‘‘(iii) the use of antibiotics; and
16 ‘‘(iv) the use of artificially administered nutri17
tion and hydration.’’.
18 (2) PAYMENT.—Section 1848(j)(3) of such Act
19 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting
20 ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’.
21 (3) FREQUENCY LIMITATION.—Section 1862(a)
22 of such Act (42 U.S.C. 1395y(a)) is amended—
23 (A) in paragraph (1)—
24 (i) in subparagraph (N), by striking
25 ‘‘and’’ at the end;
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1 (ii) in subparagraph (O) by striking
2 the semicolon at the end and inserting ‘‘,
3 and’’; and
4 (iii) by adding at the end the fol5
lowing new subparagraph:
6 ‘‘(P) in the case of advance care planning
7 consultations (as defined in section
8 1861(hhh)(1)), which are performed more fre9
quently than is covered under such section;’’;
10 and
11 (B) in paragraph (7), by striking ‘‘or (K)’’
12 and inserting ‘‘(K), or (P)’’.
13 (4) EFFECTIVE DATE.—The amendments made
14 by this subsection shall apply to consultations fur15
nished on or after January 1, 2011.
16 (b) EXPANSION OF PHYSICIAN QUALITY REPORTING
17 INITIATIVE FOR END OF LIFE CARE.—
18 (1) PHYSICIAN’S QUALITY REPORTING INITIA19
TIVE.—Section 1848(k)(2) of the Social Security Act
20 (42 U.S.C. 1395w–4(k)(2)) is amended by adding at
21 the end the following new paragraphs:
22 ‘‘(3) PHYSICIAN’S QUALITY REPORTING INITIA23
TIVE.—
24 ‘‘(A) IN GENERAL.—For purposes of re25
porting data on quality measures for covered
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1 professional services furnished during 2011 and
2 any subsequent year, to the extent that meas3
ures are available, the Secretary shall include
4 quality measures on end of life care and ad5
vanced care planning that have been adopted or
6 endorsed by a consensus-based organization, if
7 appropriate. Such measures shall measure both
8 the creation of and adherence to orders for life9
sustaining treatment.
10 ‘‘(B) PROPOSED SET OF MEASURES.—The
11 Secretary shall publish in the Federal Register
12 proposed quality measures on end of life care
13 and advanced care planning that the Secretary
14 determines are described in subparagraph (A)
15 and would be appropriate for eligible profes16
sionals to use to submit data to the Secretary.
17 The Secretary shall provide for a period of pub18
lic comment on such set of measures before fi19
nalizing such proposed measures.’’.
20 (c) INCLUSION OF INFORMATION IN MEDICARE &
21 YOU HANDBOOK.—
22 (1) MEDICARE & YOU HANDBOOK.—
23 (A) IN GENERAL.—Not later than 1 year
24 after the date of the enactment of this Act, the
25 Secretary of Health and Human Services shall
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1 update the online version of the Medicare &
2 You Handbook to include the following:
3 (i) An explanation of advance care
4 planning and advance directives, includ5
ing—
6 (I) living wills;
7 (II) durable power of attorney;
8 (III) orders of life-sustaining
9 treatment; and
10 (IV) health care proxies.
11 (ii) A description of Federal and State
12 resources available to assist individuals
13 and their families with advance care plan14
ning and advance directives, including—
15 (I) available State legal service
16 organizations to assist individuals
17 with advance care planning, including
18 those organizations that receive fund19
ing pursuant to the Older Americans
20 Act of 1965 (42 U.S.C. 93001 et
21 seq.);
22 (II) website links or addresses for
23 State-specific advance directive forms;
24 and
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1 (III) any additional information,
2 as determined by the Secretary.
3 (B) UPDATE OF PAPER AND SUBSEQUENT
4 VERSIONS.—The Secretary shall include the in5
formation described in subparagraph (A) in all
6 paper and electronic versions of the Medicare &
7 You Handbook that are published on or after
8 the date that is 1 year after the date of the en9
actment of this Act.