Section 1233, HR 3200 "End of Life Council/Euthenasia talk origins"

[PLYMCO_PILGRIM]

Read for yourself and decide. Taken from http://www.opencongress.org/bill/111-h3200/text?version=ih&nid=t0:ih:2834

‘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:CommentsClose CommentsPermalink

‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.CommentsClose CommentsPermalink

‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.CommentsClose CommentsPermalink

‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.CommentsClose CommentsPermalink

‘(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).CommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink

‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--CommentsClose CommentsPermalink

‘(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;CommentsClose CommentsPermalink

‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; andCommentsClose CommentsPermalink

‘(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).CommentsClose CommentsPermalink

‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--CommentsClose CommentsPermalink

‘(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; andCommentsClose CommentsPermalink

‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).CommentsClose CommentsPermalink

‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--CommentsClose CommentsPermalink

‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;CommentsClose CommentsPermalink

‘(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;CommentsClose CommentsPermalink

‘(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; andCommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink

‘(2) A practitioner described in this paragraph is--CommentsClose CommentsPermalink

‘(A) a physician (as defined in subsection (r)(1)); andCommentsClose CommentsPermalink

‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.CommentsClose CommentsPermalink

‘(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).CommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink

‘(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.CommentsClose CommentsPermalink

‘(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--CommentsClose CommentsPermalink

‘(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;CommentsClose CommentsPermalink

‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;CommentsClose CommentsPermalink

‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); andCommentsClose CommentsPermalink

‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.CommentsClose CommentsPermalink

‘(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--CommentsClose CommentsPermalink

‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;CommentsClose CommentsPermalink

‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;CommentsClose CommentsPermalink

‘(iii) the use of antibiotics; andCommentsClose CommentsPermalink

‘(iv) the use of artificially administered nutrition and hydration.’.CommentsClose CommentsPermalink

(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),’.CommentsClose CommentsPermalink

(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--CommentsClose CommentsPermalink

(A) in paragraph (1)--CommentsClose CommentsPermalink

(i) in subparagraph (N), by striking ‘and’ at the end;CommentsClose CommentsPermalink

(ii) in subparagraph (O) by striking the semicolon at the end and inserting ‘, and’; andCommentsClose CommentsPermalink

(iii) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink

‘(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;’; andCommentsClose CommentsPermalink

(B) in paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’.CommentsClose CommentsPermalink

(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.CommentsClose CommentsPermalink

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

(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:CommentsClose CommentsPermalink

‘(3) Physician’S QUALITY REPORTING INITIATIVE-CommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink

‘(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.’.CommentsClose CommentsPermalink

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

(1) MEDICARE & YOU HANDBOOK-CommentsClose CommentsPermalink

(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:CommentsClose CommentsPermalink

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

(I) living wills;CommentsClose CommentsPermalink

(II) durable power of attorney;CommentsClose CommentsPermalink

(III) orders of life-sustaining treatment; andCommentsClose CommentsPermalink

(IV) health care proxies.CommentsClose CommentsPermalink

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

(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.);CommentsClose CommentsPermalink

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

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

(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

 

[jillian]

if you think that's about euthenasia, you're an idiot.

and you loons need to stop spewing that garbage....

 

[PLYMCO_PILGRIM]

I already wrote up my interpretation but want to see what the pro-govt health care and the anti-govt health care people in here think first.


This is one section of the bill where people get the "this bill will deny care to seniors" from

 

[PLYMCO_PILGRIM]

So can anyone tell me where it shows the claims some people say are in the bill?

Or how about show where it disproves the claims of end of life counciling?

Anyone?

Someone in here must have actually read the stuff you're all debating in a few other threads.

 

[deaddude]

If you are referring to the death panel nonsense, then of course I can't show you where it is because it isn't there. The entire thing was made up to scare the elderly.

 

[veritas]

If you are referring to the death panel nonsense, then of course I can't show you where it is because it isn't there. The entire thing was made up to scare the elderly.

IOW it's a wacko lie talking point that's to be repeated by republidrones.

 

[PLYMCO_PILGRIM]

If you are referring to the death panel nonsense, then of course I can't show you where it is because it isn't there. The entire thing was made up to scare the elderly.

I am referring to the actual term "death panel" and its lack of being in the language of the bill.

I in no way support the bill as currently written but I also don't support bogus claims being used to make the bill less popular...when the truth comes out it hurts my chances of them changing the bill drastically so I can find it acceptable.


However, there are some points in the language above that make it sound as if the govt will make a cutoff point for coverage based on "value"


I'm still waiting for someone to find it on their own...i put the language up now people be good political activists and find it on their own .

 

[Emma]

It's not about 'death panels' or offing grandma. It's amending current law so that Medicare will reimburse for advance care planning. Which, by the way, can mean go all out as well as comfort measures only ... and everything in between.

 

[Zoom-boing]

‘(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.CommentsClose CommentsPermalink

‘(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.’.CommentsClose CommentsPermalink

Who makes up this 'consensus-based organization'?

 

[PLYMCO_PILGRIM]

‘(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.CommentsClose CommentsPermalink

‘(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.’.CommentsClose CommentsPermalink

Who makes up this 'consensus-based organization'?

thats answered in section 122

“Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.” This will be chaired by the Surgeon General and will have “9 members who are not Federal employees or officers and who are appointed by the President”, “9 members who are not Federal employees or officers and who are appointed by the Comptroller General”, and an “even number of members (not to exceed 8 ) who are Federal employees and officers, as the President may appoint.” A committe with up to 27 members, 18 of whom are picked by the President. The bill says these people will “reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies, and at least one practicing physician or other health professional and an expert on children’s health”. But with no checks and balances on the selection of this group, you can only hope that absolute power does not corrupt absolutely.

 

[AllieBaba]

if you think that's about euthenasia, you're an idiot.

and you loons need to stop spewing that garbage....

You have to have an order for enabling life supporting treatment, Jillie.

Do you read at all?

The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--CommentsClose CommentsPermalink

‘(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; andCommentsClose CommentsPermalink

‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).CommentsClose CommentsPermalink

‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--CommentsClose CommentsPermalink

‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;CommentsClose CommentsPermalink

‘(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;CommentsClose CommentsPermalink

‘(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; andCommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink


You know what that says, Jillian? A group of people including ATTORNEYS will determine how LIFE SUPPORTING ORDERS are defined, and when to put them in place.

You're the lawyer. Do we currently have to have ORDERS defining whether or not we can opt for life saving treatments?

 

[AllieBaba]

Crickets. Imagine.

 

[AllieBaba]

"Federal employees and officers, as the President may appoint."

Gosh, abortion is between a woman and her dr...but apparently if you want to live, you'll have to be approved by a bunch of beaurocrats picked by the pres.

Imagine THAT line.

 

[Emma]

You're the lawyer. Do we currently have to have ORDERS defining whether or not we can opt for life saving treatments?

All "life sustaining treatment" requires a physician order.

Do you have a link to the section you quoted? So I can read it all in context. Thanks.

 

[Sinatra]

if you think that's about euthenasia, you're an idiot.

and you loons need to stop spewing that garbage....

You have to have an order for enabling life supporting treatment, Jillie.

Do you read at all?

The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--CommentsClose CommentsPermalink

‘(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; andCommentsClose CommentsPermalink

‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).CommentsClose CommentsPermalink

‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--CommentsClose CommentsPermalink

‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;CommentsClose CommentsPermalink

‘(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;CommentsClose CommentsPermalink

‘(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; andCommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink


You know what that says, Jillian? A group of people including ATTORNEYS will determine how LIFE SUPPORTING ORDERS are defined, and when to put them in place.

You're the lawyer. Do we currently have to have ORDERS defining whether or not we can opt for life saving treatments?

You beat me to it.

It is so laughable when a few drones go around stating the term 'Death Panel" is not in the bill. Of course not! I don't know of anyone who stated it is! The term death panel is descriptive, not actual, and as such, if anyone actually takes the time to read the material, could be quite applicable.

This Democrat House bill is rampant with broad stroke powers legislated to the federal government, and when combined with the stimulus bill additions regarding cost control measures in health care, paints a most ominous potential that some appear unwilling to consider.

How is that these same individuals who were for so long so suspicious of their government, are now willing to concede to it some of the most intimate and far-reaching powers possible simply because the individual residing at 1600 Pennsylvania Ave has a (D) after his name?

Don't simply consider yourself a Republican or a Democrat - consider yourself an American - and as such, educate yourself.

Read the bill - it is frightening the attempted scope of authorities being granted the federal government...

 

[AllieBaba]

You're the lawyer. Do we currently have to have ORDERS defining whether or not we can opt for life saving treatments?

All "life sustaining treatment" requires a physician order.

Do you have a link to the section you quoted? So I can read it all in context. Thanks.

However, there's never been a "panel" picked by the president to approve what procedures are paid for. Nor has there ever been a requirement that if older ppl want any of their medical care paid for, they have to sit through end of life counseling every 5 years.

 

[Emma]

You're the lawyer. Do we currently have to have ORDERS defining whether or not we can opt for life saving treatments?

All "life sustaining treatment" requires a physician order.

Do you have a link to the section you quoted? So I can read it all in context. Thanks.

However, there's never been a "panel" picked by the president to approve what procedures are paid for. Nor has there ever been a requirement that if older ppl want any of their medical care paid for, they have to sit through end of life counseling every 5 years.

There's no requirement in this bill that older people have to sit through end of life counseling every 5 years, either. The only requirement is that Medicare reimburses IF the counseling occurs, but their limit on how often it will be reimbursed is every 5 years.

Link to "'panel' picked by the president to approve what procedures are paid for" ?

 

[jillian]

Crickets. Imagine.

that's cause some of us are working, living life, going to broadway shows with family and friends, yadda, yadda, yadda.... i don't sit at the computer all day

and the purpose of the section has already been explained to you by someone in the health field.

i can't help it if you can't read with comprehension.

oh...and i'm going back to work now... so i may or may not think about this thread again.... and may or may not bother answering you if i do think about it, depending on how ignorant and nasty your answer is. Farshtey?

and perhaps this, from another thread on this board, which you've clearly ignored, will be in simple enough english for you to follow:

http://news.yahoo.com/s/ap/20090811...uYXRlX3N1bW1hcnlfbGlzdARzbGsDZmFjdGNoZWNrbm9k

 

[Navy1960]

When this bill was first introduced it was my impression that the section in question while not mandatory had the implied message to Seniors that it was more cost effective for them to consider methods of ending life rather than seeking any and all means available to them that might extend their lives. After much consideration on this matter, and reading the section over and over I have come to two conclusions , first that to make a blanket statement that there is a requirement in the bill as written that Seniors are required to appear before a panel i.e. "death panel" is a little bit of a stretch and can be considered somewhat more of a political intrepretation more so than an actual one. The second thing however is the implied meaning of the section, while perhaps not intentional does send the message as it applies to cost factors to providers and to Seniors by encouraging end of life counsel every 5 years. The message it sends is one that on a cost savings basis it would be easier to counsel Seniors on dignified ways to end their lives rather than seek out perhaps expensive medical care that would perhaps cost the taxpayers more than they had planned on.

One more thing to consider here too is that end of life counsel and living wills, etc. are very private family matters and should NEVER be legislated in any manner by any branch of any Govt. other than the legal aspects that apply to the estates themselves. What people need to consider here, that like it or not, in our society there is a rather large segment that values life in all it forms and see's any encouragement to end it as repulsive. While there are still other segments of our society that see this issue as one of more to do with dignity and respect and wish to encourage it as much as possible and IMO that was the prupose of this section. While, again I think it a little bit of a stretch to just up claim this is a so called section that requires "death panels" I do think that we as a nation must in the end see this matter as a very private family matter that can be done respectfully and without the need for legislation that applies to a healthcare bill.

 

[Emma]

You're the lawyer. Do we currently have to have ORDERS defining whether or not we can opt for life saving treatments?

All "life sustaining treatment" requires a physician order.

Do you have a link to the section you quoted? So I can read it all in context. Thanks.

However, there's never been a "panel" picked by the president to approve what procedures are paid for. Nor has there ever been a requirement that if older ppl want any of their medical care paid for, they have to sit through end of life counseling every 5 years.

And there's no requirement for that in this bill, either.

Are you arguing just to argue, being intentionally obtuse?