END OF LIFE CARE AND IN-FACILITY CARE
Assisted Suicide (Pages 129-131) (Section 240) While page 129,
lines 21-26 state, “(b) Construction – Nothing in this section shall be construed – (1) to require an individual to complete and advance directive or a physician’s order for life sustaining treatment or other end of life planning document”, this section DOES require insurance companies to provide information related to "end-of-life planning" to individuals seeking enrollment in insurance offered on the health insurance exchange. Additionally, there is concern that because key terminology is not provided and because broader protective language adopted earlier in the Energy and Commerce Committee version no longer exists in this version of legislation, that awareness of current law in the states of Oregon and Washington regarding assisted suicide may
become cause for information purposes for patients.
*Government Panel for Senior Care Decisions (Pages 649-661): The Secretary has the right to waive requirements of the Social Security Act Titles XI & XVIII. These providers will put together patient decisions aids and share in seniors’ decisions regarding their health care. Seniors will attend counseling provided by said panel.
Compensation will be granted to providers who generate less cost for care with regards to Parts A and B of Medicare.
Government Regulation of Staffing in Nursing Facilities (Pages
822-826): In a specific motion to alter state authority of nursing
facilities and to provide the Secretary and consumer advocacy groups with overreaching authority, this section of the bill calls for an amendment to the Social Security Act "(C) Submission of Staffing Information Based on Payroll Data in a Uniform Format." The Secretary of Health and Human Services shall require a skilled nursing facility to electronically submit to the Secretary direct care staffing
information including agency and contract staff, based on payroll and other verifiable and auditable data in a uniform format as established by the Secretary in consultation with among others, consumer advocacy groups.
Government Authority in Determining Medical Home Models (Pages
680-690): Secretary is provided wide latitude to fund and create both independent and community-based medical home models in order to reward physicians and others to coordinate treatment for chronically ill patients in underserved (rural) areas. Patient need not designate a doctor as their caregiver.
Regulation of Services (Page 383) Lines 11-16 allot for using
appropriate indicators for non-therapy ancillary services
classification, which may include age, physical and mental status, ability to perform activities of daily living, etc. The concern is over the method of deciding care delivery, placing key decision-making elements in the hands of politicians and other non-medical staff as opposed to the hands of patients’ doctors and families.
Regulation on Patient Stay (Page 385) Establishes payment based on total costs during stay in a skilled nursing facility as opposed to the number of days in such stay.
“CLASS” Program for Assisted Living – National Voluntary Insurance Program
SEC. 3204 . Enrollment and Disenrollment Requirements
Automatic Enrollment (Page 1575) Line 3 – Individuals are automatically enrolled by their employer if they meet the following description in subsection (c) (Page 156- unable to perform 2-3 daily living activities, pose a threat due to cognitive impairment, or have a functional limitation “as determined under regulations prescribed by the Secretary”.
Opt-Out Option (Page 1576) – Individuals may waive enrollment “in such form and manger as the Secretary shall prescribe”.
Inability to Disenroll (Page 1579) Line 16 –Individuals may only be permitted to disenroll during an annual disenrollment period
established by the Secretary.
Life Independence Account (Page 1583) Line 20 – Account established by Secretary on behalf of each eligible beneficiary for nonmedical services and supports. (Page 1584) Line 9 – “Nothing in the preceding sentence shall prevent an eligible beneficiary from using cash benefits from the (LIA) for obtaining assistance with decision-making concerning
medical care, including the right to accept or refuse medical or
surgical treatment and the right to formulate advance
directives….living will”.
Access to Cash Benefits (Page 1589) Lines 15-19 – Secretary will allow authorized persons to receive the beneficiary’s cash benefits if the individual is considered an “institutionalized beneficiary under clause
(i)”.
SEC. 3207. “CLASS Indpendence Advisory Council – Council established to advise the Secretary.
