Replies

Some ‘end of life’ language”

‘‘(B) An advance care planning consultation with re18
spect to an individual may be conducted more frequently
19 than provided under paragraph (1) if there is a significant
20 change in the health condition of the individual, including
21 diagnosis of a chronic, progressive, life-limiting disease, a
22 life-threatening or terminal diagnosis or life-threatening
23 injury, or upon admission to a skilled nursing facility, a
24 long-term care facility (as defined by the Secretary), or
25 a hospice program.
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1 ‘‘(4) A consultation under this subsection may in2
clude the formulation of an order regarding life sustaining
3 treatment or a similar order.
4 ‘‘(5)(A) For purposes of this section, the term ‘order
5 regarding life sustaining treatment’ means, with respect
6 to an individual, an actionable medical order relating to
7 the treatment of that individual that—
8 ‘‘(i) is signed and dated by a physician (as de9
fined in subsection (r)(1)) or another health care
10 professional (as specified by the Secretary and who
11 is acting within the scope of the professional’s au12
thority under State law in signing such an order, in13
cluding a nurse practitioner or physician assistant)
14 and is in a form that permits it to stay with the in15
dividual and be followed by health care professionals
16 and providers across the continuum of care;
17 ‘‘(ii) effectively communicates the individual’s
18 preferences regarding life sustaining treatment, in19
cluding an indication of the treatment and care de20
sired by the individual;
21 ‘‘(iii) is uniquely identifiable and standardized
22 within a given locality, region, or State (as identified
23 by the Secretary); and
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1 ‘‘(iv) may incorporate any advance directive (as
2 defined in section 1866(f)(3)) if executed by the in3
dividual.
4 ‘‘(B) The level of treatment indicated under subpara5
graph (A)(ii) may range from an indication for full treat6
ment to an indication to limit some or all or specified
7 interventions. Such indicated levels of treatment may in8
clude indications respecting, among other items—
9 ‘‘(i) the intensity of medical intervention if the
10 patient is pulse less, apneic, or has serious cardiac
11 or pulmonary problems;
12 ‘‘(ii) the individual’s desire regarding transfer
13 to a hospital or remaining at the current care set14
ting;
15 ‘‘(iii) the use of antibiotics; and
16 ‘‘(iv) the use of artificially administered nutri17
tion and hydration.’’.
18 (2) PAYMENT.—Section 1848(j)(3) of such Act
19 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting
20 ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’.
21 (3) FREQUENCY LIMITATION.—Section 1862(a)
22 of such Act (42 U.S.C. 1395y(a)) is amended—
23 (A) in paragraph (1)—
24 (i) in subparagraph (N), by striking
25 ‘‘and’’ at the end;
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1 (ii) in subparagraph (O) by striking
2 the semicolon at the end and inserting ‘‘,
3 and’’; and
4 (iii) by adding at the end the fol5
lowing new subparagraph:
6 ‘‘(P) in the case of advance care planning
7 consultations (as defined in section
8 1861(hhh)(1)), which are performed more fre9
quently than is covered under such section;’’;
10 and
11 (B) in paragraph (7), by striking ‘‘or (K)’’
12 and inserting ‘‘(K), or (P)’’.
13 (4) EFFECTIVE DATE.—The amendments made
14 by this subsection shall apply to consultations fur15
nished on or after January 1, 2011.
16 (b) EXPANSION OF PHYSICIAN QUALITY REPORTING
17 INITIATIVE FOR END OF LIFE CARE.—

TRI-CARE

10 SEC. 1234. PART B SPECIAL ENROLLMENT PERIOD AND
11 WAIVER OF LIMITED ENROLLMENT PENALTY
12 FOR TRICARE BENEFICIARIES.
13 (a) PART B SPECIAL ENROLLMENT PERIOD.—
14 (1) IN GENERAL.—Section 1837 of the Social
15 Security Act (42 U.S.C. 1395p) is amended by add16
ing at the end the following new subsection:
17 ‘‘(l)(1) In the case of any individual who is a covered
18 beneficiary (as defined in section 1072(5) of title 10,
19 United States Code) at the time the individual is entitled
20 to hospital insurance benefits under part A under section
21 226(b) or section 226A and who is eligible to enroll but
22 who has elected not to enroll (or to be deemed enrolled)
23 during the individual’s initial enrollment period, there
24 shall be a special enrollment period described in paragraph
25 (2).
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1 ‘‘(2) The special enrollment period described in this
2 paragraph, with respect to an individual, is the 12-month
3 period beginning on the day after the last day of the initial
4 enrollment period of the individual or, if later, the 12-
5 month period beginning with the month the individual is
6 notified of enrollment under this section.
7 ‘‘(3) In the case of an individual who enrolls during
8 the special enrollment period provided under paragraph
9 (1), the coverage period under this part shall begin on the
10 first day of the month in which the individual enrolls or,
11 at the option of the individual, on the first day of the sec12
ond month following the last month of the individual’s ini13
tial enrollment period.
14 ‘‘(4) The Secretary of Defense shall establish a meth15
od for identifying individuals described in paragraph (1)
16 and providing notice to them of their eligibility for enroll17
ment during the special enrollment period described in
18 paragraph (2).’’.
19 (2) EFFECTIVE DATE.—The amendment made
20 by paragraph (1) shall apply to elections made on or
21 after the date of the enactment of this Act.
22 (b) WAIVER OF INCREASE OF PREMIUM.—
23 (1) IN GENERAL.—Section 1839(b) of the So24
cial Security Act (42 U.S.C. 1395r(b)) is amended
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1 by striking ‘‘section 1837(i)(4)’’ and inserting ‘‘sub2
section (i)(4) or (l) of section 1837’’.
3 (2) EFFECTIVE DATE.—
4 (A) IN GENERAL.—The amendment made
5 by paragraph (1) shall apply with respect to
6 elections made on or after the date of the en7
actment of this Act.
8 (B) REBATES FOR CERTAIN DISABLED
9 AND ESRD BENEFICIARIES.—
10 (i) IN GENERAL.—With respect to
11 premiums for months on or after January
12 2005 and before the month of the enact13
ment of this Act, no increase in the pre14
mium shall be effected for a month in the
15 case of any individual who is a covered
16 beneficiary (as defined in section 1072(5)
17 of title 10, United States Code) at the time
18 the individual is entitled to hospital insur19
ance benefits under part A of title XVIII
20 of the Social Security Act under section
21 226(b) or 226A of such Act, and who is el22
igible to enroll, but who has elected not to
23 enroll (or to be deemed enrolled), during
24 the individual’s initial enrollment period,
25 and who enrolls under this part within the
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1 12-month period that begins on the first
2 day of the month after the month of notifi3
cation of entitlement under this part.
4 (ii) CONSULTATION WITH DEPART5
MENT OF DEFENSE.—The Secretary of
6 Health and Human Services shall consult
7 with the Secretary of Defense in identi8
fying individuals described in this para9
graph.
10 (iii) REBATES.—The Secretary of
11 Health and Human Services shall establish
12 a method for providing rebates of premium
13 increases paid for months on or after Jan14
uary 1, 2005, and before the month of the
15 enactment of this Act for which a penalty
16 was applied and collected.
17 SEC. 1235. EXCEPTION FOR USE OF MORE RECENT TAX
18 YEAR IN CASE OF GAINS FROM SALE OF PRI19
MARY RESIDENCE IN COMPUTING PART B IN20
COME-RELATED PREMIUM.
21 (a) IN GENERAL.—Section 1839(i)(4)(C)(ii)(II) of
22 the Social Security Act (42 U.S.C. 1395r(i)(4)(C)(ii)(II))
23 is amended by inserting ‘‘sale of primary residence,’’ after
24 ‘‘divorce of such individual,’’.
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1 (b) EFFECTIVE DATE.—The amendment made by
2 subsection (a) shall apply to premiums and payments for
3 years beginning with 2011.
4 SEC. 1236. DEMONSTRATION PROGRAM ON USE OF PA5
TIENT DECISIONS AIDS.
6 (a) IN GENERAL.—The Secretary of Health and
7 Human Services shall establish a shared decision making
8 demonstration program (in this subsection referred to as
9 the ‘‘program’’) under the Medicare program using pa10
tient decision aids to meet the objective of improving the
11 understanding by Medicare beneficiaries of their medical
12 treatment options, as compared to comparable Medicare
13 beneficiaries who do not participate in a shared decision
14 making process using patient decision aids.

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