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Is there a difference between the 1990 FEDERAL PATIENT SELF-DETERMINATION ACT and page 425 of the healthcare bill?
Quote:
FEDERAL PATIENT SELF-DETERMINATION ACT
FINAL REGULATIONS
Section 489.100 Definitions
For the purposes of this part “advance directive” means a written instruction, such as a living will or
durable power of attorney for health care, recognized under state law (whether statutory or as recognized
by the courts of the State), relating to the provision of health care when the individual is incapacitated.
Section 489.102 Requirements for providers
(a) Hospitals, rural primary care hospitals, skilled nursing facilities, nursing facilities, home health
agencies, providers of home health-care (and for Medicaid purposes, providers of personal care
services), and hospices must maintain written policies and procedures concerning advance directives
with respect to all adult individuals receiving medical care by or through the provider and are
required to:
(1) Provide written information to such individuals concerning—
(i) An individual’s rights under State law (whether statutory or recognized by courts of the State)
to make decisions concerning such medical cars, including the right to accept or refuse
medical or surgical treatment and the right to formulate, at the individual’s option, advance
directives. Providers are permitted to contract with other entities to furnish this information
but are still legally responsible for ensuring that the requirements of this section are met.
Providers are to update and disseminate amended information as soon as possible, but no
later than 90 days from the effective date of the changes to State law; and
(ii) The written policies of the provider or organization respecting the implementation of such
rights, including a clear and precise statement of limitation if the provider cannot implement
an advance directive on the basis of conscience. At a minimum, a provider’s statement of
limitation should:
(A) Clarify any differences between institution wide conscience objections and those that
may be raised by individual physicians:
(B) Identify the state legal authority permitting such objections.
(C) Describe the range of medical conditions or procedures affected by the conscientious
objection.
(2) Document in the individual’s medical record whether or not-the individual has executed an
advance directive.
(3) Not condition the provision of care or otherwise discriminate against an individual based on
whether or not the individual has executed an advance directive.
(4) Ensure compliance with requirements of State law (whether statutory- or recognized by the
courts of the State) regarding advance directives. The provider must inform individuals that
complaints concerning the advance directive requirements may be filed with the State survey
and certification agency.
(5) Provide education for staff concerning its policies and procedures on advance directive; and,
(6) Provide for community education regarding issues concerning advance directives that may
include material required in paragraph (a)(1) of this section, either directly or in concert with
other providers and organizations. Separate community education materials may be developed
and used, at the discretion of providers. The same written materials do not have to be provided in
all settings, but the material should define what constitutes an advance directive, emphasizing
that an advance directive is designed to enhance an incapacitated individual’s control over
medical treatment, and describe applicable State law concerning advance directives. A provider
must be able to document its community education efforts.
(b) The information specified in paragraph (a) of this section is furnished:
(1) In the case of a hospital, at the time of the individual’s admission as an inpatient.
(2) In the case of a skilled nursing facility at the time of the individual’s admission as a resident.
(3)(i) In the case of a home health agency, in advance of the individual coming under the care of the
agency. HHA may furnish advancer directives information to a patient at the time of the first
home visit, as long as the information is furnished before care is provided.
(ii) In the case of personal care services, in advance of the individual coming under the care of
the personal care services provider. The personal care provider may furnish advance directives
information to a patient at the time of the first home visit, as long as the information is
furnished before care is provided.
(4) In the case of a hospice program, at the time of initial receipt of hospice care by the individual in
the program.
(c) The providers listed in paragraph (a)of this section—
(1) Are not required to provide care that conflicts with an advance directive.
(2) Are not required to implement an advance directive if, as a matter of conscience, the provider
cannot implement an advance directive and State law allows any health care provider or any
agent of such provider to conscientiously object.
(d) Prepaid or eligible organizations (as specified in sections 1883 (a)(1)(A) and 1876 (b) of the Act)
must meet the requirements specified in ‘ 417.436 of this chapter. **
(e) If an adult individual is incapacitated- at the time of admission or at the start of care and is unable to
receive information-(due to the incapacitating conditions or a mental disorder) or articulate whether
or not he or she has executed an advance directive, then the provider may give advance directive
information to the individual’s family or surrogate in the same manner that it issues other material
about policies and procedures to the family of the incapacitated individual or to a surrogate or other
concerned persons in accordance with State law. The provider is not relieved of its obligation to
provide this information to the individual once he or she is no longer incapacitated or unable to
receive such information. Follow up procedures must be in place to provide the information to the
individual directly at the appropriate time.
** The Regulations governing prepaid organizations (HMOs) mirror this part. Information is to be
provided to individuals at the time of enrollment.
Federal Register Citations:
Final Revisions: Vol. 60. No. 123, Tuesday. June 27, 1995, page 33294 forward
Interim Final Rule: Vol. 57 No. 45, Friday March 6, 1992, pages 8194-8204
425
1 ‘‘(FF) advance care planning consultation (as
2 defined in subsection (hhh)(1));’’; and
3 (B) by adding at the end the following new
4 subsection:
5 ‘‘Advance Care Planning Consultation
6 ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the
7 term ‘advance care planning consultation’ means a con8
sultation between the individual and a practitioner de9
scribed in paragraph (2) regarding advance care planning,
10 if, subject to paragraph (3), the individual involved has
11 not had such a consultation within the last 5 years. Such
12 consultation shall include the following:
13 ‘‘(A) An explanation by the practitioner of ad14
vance care planning, including key questions and
15 considerations, important steps, and suggested peo16
ple to talk to.
17 ‘‘(B) An explanation by the practitioner of ad18
vance directives, including living wills and durable
19 powers of attorney, and their uses.
20 ‘‘(C) An explanation by the practitioner of the
21 role and responsibilities of a health care proxy.
22 ‘‘(D) The provision by the practitioner of a list
23 of national and State-specific resources to assist con24
sumers and their families with advance care plan25
ning, including the national toll-free hotline, the ad-
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426
1 vance care planning clearinghouses, and State legal
2 service organizations (including those funded
3 through the Older Americans Act of 1965).
4 ‘‘(E) An explanation by the practitioner of the
5 continuum of end-of-life services and supports avail6
able, including palliative care and hospice, and bene7
fits for such services and supports that are available
8 under this title.
9 ‘‘(F)(i) Subject to clause (ii), an explanation of
10 orders regarding life sustaining treatment or similar
11 orders, which shall include—
12 ‘‘(I) the reasons why the development of
13 such an order is beneficial to the individual and
14 the individual’s family and the reasons why
15 such an order should be updated periodically as
16 the health of the individual changes;
17 ‘‘(II) the information needed for an indi18
vidual or legal surrogate to make informed deci19
sions regarding the completion of such an
20 order; and
21 ‘‘(III) the identification of resources that
22 an individual may use to determine the require23
ments of the State in which such individual re24
sides so that the treatment wishes of that indi25
vidual will be carried out if the individual is un-
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427
1 able to communicate those wishes, including re2
quirements regarding the designation of a sur3
rogate decisionmaker (also known as a health
4 care proxy).
The The Patient Self-Determination Act (PSDA) became a federal law under Pres. Bush. I don't remember the outcry that the government is going to end the lives of senior citizens at that time. What is the difference now?
The The Patient Self-Determination Act (PSDA) became a federal law under Pres. Bush. I don't remember the outcry that the government is going to end the lives of senior citizens at that time. What is the difference now?
President Bush was a Republican. He could do no wrong.
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