S.Amdt. 2890

SA 2890. Mr. CARPER submitted an amendment intended to be proposed to

[[Page S12421]]

amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal
Revenue Code of 1986 to modify the first-time homebuyers credit in the
case of members of the Armed Forces and certain other Federal
employees, and for other purposes; which was ordered to lie on the
table; as follows:

At the appropriate place in title I, insert the following:

SEC. __. ADVANCE CARE PLANNING.

(a) Dissemination of Advance Care Planning Information.--
(1) In general.--A qualified health plan (as defined in
section 1301(a)) shall--
(A) provide for the dissemination of information related to
end-of-life planning to individuals seeking enrollment in
qualified health plans offered through an Exchange;
(B) present such individuals with--
(i) the option to establish advanced directives and
physician's orders for life sustaining treatment according to
the laws of the State in which the individual resides; and
(ii) information related to other planning tools; and
(C) not promote suicide, assisted suicide, euthanasia, or
mercy killing.

The information presented under subparagraph (B) shall not
presume the withdrawal of treatment and shall include end-of-
life planning information that includes options to maintain
all or most medical interventions.
(2) Construction.--Nothing in this subsection shall be
construed--
(A) to require an individual to complete an advanced
directive or a physician's order for life sustaining
treatment or other end-of-life planning document;
(B) to require an individual to consent to restrictions on
the amount, duration, or scope of medical benefits otherwise
covered under a qualified health plan; or
(C) to promote suicide, assisted suicide, euthanasia, or
mercy killing.
(3) Advanced directive defined.--In this subsection, the
term ``advanced directive'' includes a living will, a comfort
care order, or a durable power of attorney for health care.
(4) Prohibition on the promotion of assisted suicide.--
(A) In general.--Subject to subparagraph (C), information
provided to meet the requirements of paragraph (1)(B) shall
not include advanced directives or other planning tools that
list or describe as an option suicide, assisted suicide,
euthanasia, or mercy killing, regardless of legality.
(B) Construction.--Nothing in subparagraph (A) shall be
construed to apply to or affect any option to--
(i) withhold or withdraw of medical treatment or medical
care;
(ii) withhold or withdraw of nutrition or hydration; and
(iii) provide palliative or hospice care or use an item,
good, benefit, or service furnished for the purpose of
alleviating pain or discomfort, even if such use may increase
the risk of death, so long as such item, good, benefit, or
service is not also furnished for the purpose of causing, or
the purpose of assisting in causing, death, for any reason.
(C) No preemption of state law.--Nothing in this subsection
shall be construed to preempt or otherwise have any effect on
State laws regarding advance care planning, palliative care,
or end-of-life decision-making.
(b) Voluntary Advance Care Planning Consultation Under the
Medicare Program.--
(1) In general.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x), as amended by section 4103, is amended--
(A) in subsection (s)(2)--
(i) by striking ``and'' at the end of subparagraph (EE);
(ii) by adding ``and'' at the end of subparagraph (FF); and
(iii) by adding at the end the following new subparagraph:
``(GG) voluntary advance care planning consultation (as
defined in subsection (iii)(1));''; and
(B) by adding at the end the following new subsection:

``Voluntary Advance Care Planning Consultation

``(iii)(1) Subject to paragraphs (3) and (4), the term
`voluntary advance care planning consultation' means an
optional consultation between the individual and a
practitioner described in paragraph (2) regarding advance
care planning. Such consultation may include the following,
as specified by the Secretary:
``(A) An explanation by the practitioner of advance care
planning, including a review of key questions and
considerations, advance directives (including living wills
and durable powers of attorney) and their uses.
``(B) An explanation by the practitioner of the role and
responsibilities of a health care proxy and 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.
``(C) An explanation by the practitioner of physician
orders regarding life sustaining treatment or similar orders,
in States where such orders or similar orders exist.
``(2) A practitioner described in this paragraph is--
``(A) a physician (as defined in subsection (r)(1)); and
``(B) another health care professional (as specified by the
Secretary and who has the authority under State law to sign
orders for life sustaining treatments, such as a nurse
practitioner or physician assistant).
``(3) An individual may receive the voluntary advance care
planning care planning consultation provided for under this
subsection no more than once every 5 years unless there is a
significant change in the health or health-related condition
of the individual.
``(4) 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 effectively communicates
the individual's preferences regarding life sustaining
treatment, is signed and dated by a practitioner, and is in a
form that permits it to be followed by health care
professionals across the continuum of care.''.
(2) Construction.--The voluntary advance care planning
consultation described in section 1861(iii) of the Social
Security Act, as added by paragraph (1), shall be completely
optional. Nothing in this subsection shall--
(A) require an individual to complete an advance directive,
an order for life sustaining treatment, or other advance care
planning document;
(B) require an individual to consent to restrictions on the
amount, duration, or scope of medical benefits an individual
is entitled to receive under this title; or
(C) encourage the promotion of suicide or assisted suicide.
(3) Payment.--Section 1848(j)(3) of the Social Security Act
(42 U.S.C. 1395w-4(j)(3)), as amended by section 4103, is
amended by inserting ``(2)(GG),'' after ``assessment),''.
(4) Frequency limitation.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y(a)), as amended by section
4103, is amended--
(A) in paragraph (1)--
(i) in subparagraph (O), by striking ``and'' at the end;
(ii) in subparagraph (P) by striking the semicolon at the
end and inserting ``, and''; and
(iii) by adding at the end the following new subparagraph:
``(Q) in the case of voluntary advance care planning
consultations (as defined in paragraph (1) of section
1861(iii)), which are performed more frequently than is
covered under such section;''; and
(B) in paragraph (7), by striking ``or (P)'' and inserting
``(P), or (Q)''.
(5) Effective date.--The amendments made by this subsection
shall apply to consultations furnished on or after January 1,
2011.
______