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View Diary: Far-right religious group behind outrageous health care lies (40 comments)

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  •  Here's the text of sec. 1233, so people can check (3+ / 0-)
    Recommended by:
    xaxado, allep10, sullivanst

    the text for themselves:

    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.

         (b) Expansion of Physician Quality Reporting Initiative for End of Life Care-

               (1) Physician'S QUALITY REPORTING INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:

               `(3) Physician'S QUALITY REPORTING INITIATIVE-

                     `(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.

                     `(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.'.

         (c) Inclusion of Information in Medicare & You Handbook-

               (1) MEDICARE & YOU HANDBOOK-

                     (A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:

                           (i) An explanation of advance care planning and advance directives, including--

                                 (I) living wills;

                                 (II) durable power of attorney;

                                 (III) orders of life-sustaining treatment; and

                                 (IV) health care proxies.

                           (ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including--

                                 (I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);

                                 (II) website links or addresses for State-specific advance directive forms; and

                                 (III) any additional information, as determined by the Secretary.

                     (B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.

    The influence of the [executive] has increased, is increasing, and ought to be diminished.

    by lysias on Tue Aug 11, 2009 at 11:58:08 AM PDT

    [ Parent ]

    •  And here's the text of sec. 122 of the (3+ / 0-)
      Recommended by:
      xaxado, allep10, sullivanst

      bill:

      SEC. 122. ESSENTIAL BENEFITS PACKAGE DEFINED.

           (a) In General- In this division, the term `essential benefits package' means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security, that--

                 (1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;

                 (2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);

                 (3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;

                 (4) complies with section 115(a) (relating to network adequacy); and

                 (5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage.

           (b) Minimum Services To Be Covered- The items and services described in this subsection are the following:

                 (1) Hospitalization.

                 (2) Outpatient hospital and outpatient clinic services, including emergency department services.

                 (3) Professional services of physicians and other health professionals.

                 (4) Such services, equipment, and supplies incident to the services of a physician's or a health professional's delivery of care in institutional settings, physician offices, patients' homes or place of residence, or other settings, as appropriate.

                 (5) Prescription drugs.

                 (6) Rehabilitative and habilitative services.

                 (7) Mental health and substance use disorder services.

                 (8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.

                 (9) Maternity care.

                 (10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.

           (c) Requirements Relating to Cost-sharing and Minimum Actuarial Value-

                 (1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.

                 (2) ANNUAL LIMITATION-

                       (A) ANNUAL LIMITATION- The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).

                       (B) APPLICABLE LEVEL- The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.

                       (C) USE OF COPAYMENTS- In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.

                 (3) MINIMUM ACTUARIAL VALUE-

                       (A) IN GENERAL- The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).

                       (B) REFERENCE BENEFITS PACKAGE DESCRIBED- The reference benefits package described in this subparagraph is the essential benefits package if there were no cost-sharing imposed.

      The influence of the [executive] has increased, is increasing, and ought to be diminished.

      by lysias on Tue Aug 11, 2009 at 12:01:23 PM PDT

      [ Parent ]

      •  And here is sec. 1177 of the (2+ / 0-)
        Recommended by:
        xaxado, sullivanst

        bill:

        SEC. 1177. EXTENSION OF AUTHORITY OF SPECIAL NEEDS PLANS TO RESTRICT ENROLLMENT.

             (a) In General- Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w-28(f)(1)) is amended by striking `January 1, 2011' and inserting `January 1, 2013 (or January 1, 2016, in the case of a plan described in section 1177(b)(1) of the America's Affordable Health Choices Act of 2009)'.

             (b) Grandfathering of Certain Plans-

                   (1) PLANS DESCRIBED- For purposes of section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w-28(f)(1)), a plan described in this paragraph is a plan that had a contract with a State that had a State program to operate an integrated Medicaid-Medicare program that had been approved by the Centers for Medicare & Medicaid Services as of January 1, 2004.

                   (2) ANALYSIS; REPORT- The Secretary of Health and Human Services shall provide, through a contract with an independent health services evaluation organization, for an analysis of the plans described in paragraph (1) with regard to the impact of such plans on cost, quality of care, patient satisfaction, and other subjects as specified by the Secretary. Not later than December 31, 2011, the Secretary shall submit to Congress a report on such analysis and shall include in such report such recommendations with regard to the treatment of such plans as the Secretary deems appropriate.

        The influence of the [executive] has increased, is increasing, and ought to be diminished.

        by lysias on Tue Aug 11, 2009 at 12:04:07 PM PDT

        [ Parent ]

        •  And here is sec. 1308 of the (2+ / 0-)
          Recommended by:
          xaxado, allep10

          bill:

          SEC. 1308. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES AND MENTAL HEALTH COUNSELOR SERVICES.

               (a) Coverage of Marriage and Family Therapist Services-

                     (1) COVERAGE OF SERVICES- Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 1235, is amended--

                           (A) in subparagraph (EE), by striking `and' at the end;

                           (B) in subparagraph (FF), by adding `and' at the end; and

                           (C) by adding at the end the following new subparagraph:

                           `(GG) marriage and family therapist services (as defined in subsection (jjj));'.

                     (2) DEFINITION- Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by sections 1235 and 1305, is amended by adding at the end the following new subsection:

          `Marriage and Family Therapist Services

               `(jjj)(1) The term `marriage and family therapist services' means services performed by a marriage and family therapist (as defined in paragraph (2)) for the diagnosis and treatment of mental illnesses, which the marriage and family therapist is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as 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.

               `(2) The term `marriage and family therapist' means an individual who--

                     `(A) possesses a master's or doctoral degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law;

                     `(B) after obtaining such degree has performed at least 2 years of clinical supervised experience in marriage and family therapy; and

                     `(C) is licensed or certified as a marriage and family therapist in the State in which marriage and family therapist services are performed.'.

                     (3) PROVISION FOR PAYMENT UNDER PART B- Section 1832(a)(2)(B) of the Social Security Act (42 U.S.C. 1395k(a)(2)(B)) is amended by adding at the end the following new clause:

                                 `(v) marriage and family therapist services;'.

                     (4) AMOUNT OF PAYMENT-

                           (A) IN GENERAL- Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended--

                                 (i) by striking `and' before `(W)'; and

                                 (ii) by inserting before the semicolon at the end the following: `, and (X) with respect to marriage and family therapist services under section 1861(s)(2)(GG), the amounts paid shall be 80 percent of the lesser of the actual charge for the services or 75 percent of the amount determined for payment of a psychologist under clause (L)'.

                           (B) DEVELOPMENT OF CRITERIA WITH RESPECT TO CONSULTATION WITH A HEALTH CARE PROFESSIONAL- The Secretary of Health and Human Services shall, taking into consideration concerns for patient confidentiality, develop criteria with respect to payment for marriage and family therapist services for which payment may be made directly to the marriage and family therapist under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) under which such a therapist must agree to consult with a patient's attending or primary care physician or nurse practitioner in accordance with such criteria.

                     (5) EXCLUSION OF MARRIAGE AND FAMILY THERAPIST SERVICES FROM SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM- Section 1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)), as amended by section 1307(a), is amended by inserting `marriage and family therapist services (as defined in subsection (jjj)(1)),' after `clinical social worker services,'.

                     (6) COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS- Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking `or by a clinical social worker (as defined in subsection (hh)(1)),' and inserting `, by a clinical social worker (as defined in subsection (hh)(1)), or by a marriage and family therapist (as defined in subsection (jjj)(2)),'.

                     (7) INCLUSION OF MARRIAGE AND FAMILY THERAPISTS AS PRACTITIONERS FOR ASSIGNMENT OF CLAIMS- Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clause:

                     `(vii) A marriage and family therapist (as defined in section 1861(jjj)(2)).'.

               (b) Coverage of Mental Health Counselor Services-

                     (1) COVERAGE OF SERVICES- Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as previously amended, is further amended--

                           (A) in subparagraph (FF), by striking `and' at the end;

                           (B) in subparagraph (GG), by inserting `and' at the end; and

                           (C) by adding at the end the following new subparagraph:

                     `(HH) mental health counselor services (as defined in subsection (kkk)(1));'.

                     (2) DEFINITION- Section 1861 of the Social Security Act (42 U.S.C. 1395x), as previously amended, is amended by adding at the end the following new subsection:

          `Mental Health Counselor Services

               `(kkk)(1) The term `mental health counselor services' means services performed by a mental health counselor (as defined in paragraph (2)) for the diagnosis and treatment of mental illnesses which the mental health counselor is legally authorized to perform under State law (or the State regulatory mechanism provided by the State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as 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.

               `(2) The term `mental health counselor' means an individual who--

                     `(A) possesses a master's or doctor's degree which qualifies the individual for licensure or certification for the practice of mental health counseling in the State in which the services are performed;

                     `(B) after obtaining such a degree has performed at least 2 years of supervised mental health counselor practice; and

                     `(C) is licensed or certified as a mental health counselor or professional counselor by the State in which the services are performed.'.

                     (3) PROVISION FOR PAYMENT UNDER PART B- Section 1832(a)(2)(B) of the Social Security Act (42 U.S.C. 1395k(a)(2)(B)), as amended by subsection (a)(3), is further amended--

                           (A) by striking `and' at the end of clause (iv);

                           (B) by adding `and' at the end of clause (v); and

                           (C) by adding at the end the following new clause:

                                 `(vi) mental health counselor services;'.

                     (4) AMOUNT OF PAYMENT-

                           (A) IN GENERAL- Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by subsection (a), is further amended--

                                 (i) by striking `and'before `(X)'; and

                                 (ii) by inserting before the semicolon at the end the following: `, and (Y), with respect to mental health counselor services under section 1861(s)(2)(HH), the amounts paid shall be 80 percent of the lesser of the actual charge for the services or 75 percent of the amount determined for payment of a psychologist under clause (L)'.

                           (B) DEVELOPMENT OF CRITERIA WITH RESPECT TO CONSULTATION WITH A PHYSICIAN- The Secretary of Health and Human Services shall, taking into consideration concerns for patient confidentiality, develop criteria with respect to payment for mental health counselor services for which payment may be made directly to the mental health counselor under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) under which such a counselor must agree to consult with a patient's attending or primary care physician in accordance with such criteria.

                     (5) EXCLUSION OF MENTAL HEALTH COUNSELOR SERVICES FROM SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM- Section 1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)), as amended by section 1307(a) and subsection (a), is amended by inserting `mental health counselor services (as defined in section 1861(kkk)(1)),' after `marriage and family therapist services (as defined in subsection (jjj)(1)),'.

                     (6) COVERAGE OF MENTAL HEALTH COUNSELOR SERVICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS- Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)), as amended by subsection (a), is amended by striking `or by a marriage and family therapist (as defined in subsection (jjj)(2)),' and inserting `by a marriage and family therapist (as defined in subsection (jjj)(2)), or a mental health counselor (as defined in subsection (kkk)(2)),'.

                     (7) INCLUSION OF MENTAL HEALTH COUNSELORS AS PRACTITIONERS FOR ASSIGNMENT OF CLAIMS- Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)), as amended by subsection (a)(7), is amended by adding at the end the following new clause:

                     `(viii) A mental health counselor (as defined in section 1861(kkk)(2)).'.

               (c) Effective Date- The amendments made by this section shall apply to items and services furnished on or after January 1, 2011.

          The influence of the [executive] has increased, is increasing, and ought to be diminished.

          by lysias on Tue Aug 11, 2009 at 12:06:31 PM PDT

          [ Parent ]

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