What The House Health Bill Says About End-Of-Life Care
The furious controversy over Medicare payments for聽end-of-life care counseling stems from Section 1233 in the health bill passed by three House committees.
That language would amend the Social Security Act, which also governs Medicare, the federal program for the elderly and disabled. In 1990, when George H. W. Bush was president, new language was inserted in the Act (Title 18, Section 1866) which defined an “advance directive” to be “a written instruction, such as a living will or durable power of attorney for health care, recognized under State law and relating to the provision of such care when the individual is incapacitated.”
The 1990 language required that health care providers and organizations “maintain written policies and procedures with respect to all adult individuals receiving medical care by or through the provider or organization.” That included things like documenting an advance directive “in a prominent part of the individual’s current medical record” and providing “education for staff and the community on issues concerning advance directives.”
But no provision was made to have Medicare explicitly reimburse doctors for advance planning consultations. The new House bill changes that, requiring Medicare reimburse doctors and other practitioners for consultations covering a range of information, including information about living wills and power of attorney. Here is an excerpt of the relevant bill language:
Advance Care Planning Consultation
Section 1233 goes on to describe how to apply these regulations based on state laws, what the bill means when referring to “practitioners”, how often Medicare will reimburse for a consultation, the effective date of the provisions (Jan. 1, 2011),聽items on a physician quality reporting initiative and inclusion of language in聽the “Medicare & You Handbook.”
