[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 2556 Introduced in Senate (IS)]
103d CONGRESS
2d Session
S. 2556
To provide for the portability of validly executed advance directives,
to provide patients with a better understanding of their health care
choices and to promote study of the quality of care for the gravely or
terminally ill or injured, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 8 (legislative day, September 12), 1994
Mr. Danforth introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To provide for the portability of validly executed advance directives,
to provide patients with a better understanding of their health care
choices and to promote study of the quality of care for the gravely or
terminally ill or injured, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. PORTABILITY OF ADVANCE DIRECTIVES.
(a) In General.--An advance directive validly executed outside the
State in which such directive is presented must be given effect to the
same extent as an advance directive validly executed under the law of
the State in which presented.
(b) No Inference.--Nothing in this section may be construed to
authorize the administration, withholding, or withdrawal of health care
otherwise prohibited by the laws of the State.
(c) Preemption.--The provisions of this section shall preempt any
State law to the extent such law is inconsistent with such provisions.
The provisions of this section shall not preempt any State law that
provides for greater portability, more deference to a patient's wishes,
or more latitude in determining a patient's wishes.
(d) Effective Date.--This section shall take effect on the date
that is 6 months after the date of enactment of this Act.
SEC. 2. AMENDMENTS TO RULES UNDER MEDICARE AND MEDICAID.
(a) Medicare.--Section 1866(f)(1) of the Social Security Act (42
U.S.C. 1395cc(f)(1)) is amended--
(1) in subparagraph (A), by striking ``and'' at the end of
clause (i), by redesignating clause (ii) as clause (iii), and
by inserting after clause (i) the following new clause:
``(ii) the result under such State law if the
individual is incapacitated in the absence of an
advance directive, and'';
(2) in subparagraph (B), by inserting ``and to include the
content of such directive if the individual so desires'' before
the semicolon;
(3) in subparagraph (D), by striking ``and'' at the end;
(4) in subparagraph (E), by striking the period at the end
and inserting ``; and''; and
(5) by inserting after subparagraph (E) the following new
subparagraph:
``(F) to provide for effective communication between the
individual (or surrogate decision maker when appropriate) and
the appropriate provider regarding all relevant aspects of
health care decisions affecting the individual, including
obtaining informed consent, individual prognosis and treatment
decisions, and the formulation of advance directives.''.
(b) Medicaid.--Section 1902(a) (42 U.S.C. 1396a(a)) is amended by
inserting in paragraph 58, ``and what occurs in the absence of an
advance directive'' after ``subsection (w) of this section.'' Section
1902(w)(1) of the Social Security Act (42 U.S.C. 1396a(w)(1)) is
amended--
(1) in subparagraph (A), by striking ``and'' at the end of
clause (i), by redesignating clause (ii) as clause (iii), and
by inserting after clause (i) the following new clause:
``(ii) the result under such State law if the
individual is incapacitated in the absence of an
advance directive, and'';
(2) in subparagraph (B), by inserting ``and to include the
content of such directive if the individual so desires'' before
the semicolon;
(3) in subparagraph (D), by striking ``and'' at the end;
(4) in subparagraph (E), by striking the period at the end
and inserting ``; and''; and
(5) by inserting after subparagraph (E) the following new
subparagraph:
``(F) to provide for effective communication between the
individual (or surrogate decision maker when appropriate) and
the appropriate provider regarding all relevant aspects of
health care decisions affecting the individual, including
obtaining informed consent, individual prognosis and treatment
decisions, and the formulation of advance directives.''.
(c) Application to Kidney Dialysis Centers of Provisions Relating
to Advance Directives.--
(1) Medicare.--Section 1866(a)(1)(Q) of the Social Security
Act (42 U.S.C. 1395cc(a)(1)(Q)) is amended by striking ``and
hospice programs'' and inserting ``hospice programs, and kidney
dialysis centers''.
(2) Medicaid.--Section 1902(a)(57) of such Act (42 U.S.C.
1396(a)(57)) is amended by striking ``hospice program'' and
inserting ``hospice program, kidney dialysis center''.
(d) Effective Date.--The amendments made by this section shall take
effect on and after the date which is 1 year after the date of the
enactment of this Act.
SEC. 3. STUDY OF ISSUES RELATED TO END OF LIFE CARE.
(a) Study.--
(1) In general.--Within 6 months after the date of the
enactment of this Act, the Secretary shall enter into an
agreement with the Institute of Medicine of the National
Academy of Sciences (or with another nonprofit, nongovernmental
organization or consortium of institutions if the Institute
declines to perform the study) to investigate and report on
issues relating to care at the end of life, including how to
determine the application of medically necessary or appropriate
care for gravely or terminally ill or injured persons of all
ages.
(2) Specific issues.--The study described in paragraph (1)
shall specifically include an examination of the following
issues:
(A) The epidemiology of dying.
(B) Conditions that promote or impede appropriate
care (such as professional training and beliefs,
financing and organization of services, patient and
public knowledge and attitudes).
(C) Concerns of health care practitioners and
providers, medical educators, the religious and medical
ethics communities, the general public, and others
responsible for public and private decisions about the
organization, financing, and quality of health care in
the United States.
(D) Measures to evaluate systems of care on the
quality of care they provide for gravely or terminally
ill or injured patients.
(E) Methods of communication and health care
decisionmaking among providers, patients, and
surrogates.
(F) Priorities for research on the issues described
in the preceding subparagraphs.
(b) Report.--The Institute of Medicine (or the organization
conducting the study under this section) shall submit to the Secretary
and the Congress a report on the study described in subsection (a)
within 27 months after the date of the enactment of this Act.
(c) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out the purposes of
this section.
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