Note: The "following" ("following" being pertinent to what is referenced in title) is shown in Blue, the sections of the bill are shown in Black, the referenced lines in Red; my comments are shown in Green.
Note: I copied and pasted much of this and in some cases (page 430 in particular), I wasn't able to change the font or have the page lines come out right.
All of the excerpts and pages referenced are under
Sec. 1233. ADVANCE CARE PLANNING CONSULTATION
(Meaning that was follows in specified section is what an insurer should cover under "consultation".) Consultation means consultation and these pages should not be taken out of context. In a bill or in law, every line must be very specific and nothing can be taken out of context to mean something else.
PG 425 Lines 4-12 Govt mandates Advance Care Planning Consult. Think Senior Citizens end of life
Pg 425 Lines 17-19 Govt will instruct & consult regarding living wills, durable powers of atty. Mandatory!
PG 425 Lines 22-25, 426 Lines 1-3 Govt provides apprvd list of end of life resources, guiding u in death
All of pages 425 and 426 are shown below with the specified lines shown in
red.
425
•HR 3200 IH
1 not had a consultation within the last 5 years. Such2 consultation shall include the following:
3 ‘‘(A) An explanation by the practitioner of ad
4 vance care planning, including key questions and
5 considerations, important steps, and suggested peo
6 ple to talk to.
7 ‘‘(B) An explanation by the practitioner of ad
8 vance directives, including living wills and durable
9 powers of attorney, and their uses.
10 ‘‘(C) An explanation by the practitioner of the
11 role and responsibilities of a health care proxy.
12 ‘‘(D) The provision by the practitioner of a list
(This is no more than other insurance companies do right now; and it is to insure that an individual who may not be able to decide for themselves (due to being in a coma or whatever) still has their wishes followed. A proxy is the person who speaks for them so assure this. A living will is what many people want because they want to die naturally and not have their life sustained with tubes and machines..... I am thinking of senior citizens and end of life and of people who have said when they are living that they do not want their life to be sustained with machines and because they have not completed a living will or designated a proxy, are put on machines.)
13 of national and State-specific resources to assist con
14
15 ning, including the national toll-free hotline, the ad
16 vance care planning clearinghouses, and State legal
17 service organizations (including those funded
18 through the Older Americans Act of 1965).
19 ‘‘(E) An explanation by the practitioner of the
(Although I can't see where these lines say that the Gov. will instruct & consult regarding living wills, durable powers of atty. Mandatory!; I don't see what could be wrong with it if it did say that. It is important that a person understand their rights with regard to being put on machines and that they are aware that they can have a living will and they can have a proxy to speak for them if they are unable to do so themselves. This way, they can specify what they want and designate someone they trust. If God has chosen to end our life, does anyone else have the right to put us on machines?)
20 continuum of end-of-life services and supports avail
21
22
23 under this title. (Pg 425 only goes to line 23)
426
•HR 3200 IH
1 ‘‘(F)(i) Subject to clause (ii), an explanation of
2 orders regarding life sustaining treatment or similar
3 orders, which shall include—
(Here again, I don't see where this says: Govt provides apprvd list of end of life resources, guiding u in death; what it doesn't say is that what an order regarding life sustaining treatment should include and that is in the following lines not those referenced.) An "order" as explained here is a doctor or provider's order for life sustaining treatment.
4 ‘‘(I) the reasons why the development of
5 such an order is beneficial to the individual and
6 the individual’s family and the reasons why
7 such an order should be updated periodically as
8 the health of the individual changes;
PG 427 Lines 15-24 Govt mandates program 4 orders 4 end of life. The Govt has a say in how ur life ends
12 ‘‘(3)(A) An initial preventive physical examination
13 under subsection (WW), including any related discussion
14 during such examination, shall not be considered an ad
15 vance care planning consultation for purposes of applying
16 the 5-year limitation under paragraph (1).
17 ‘‘(B) An advance care planning consultation with re
18 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.
Here again, I don't see any mandate for orders for end of life or how the gov has a say in how my life ends. The 5-year plan is in reference to a grace period defined on page 17; and "order" mentioned in any portion of the bill is defined right up front and is nothing more than the order doctors already give to have a person put on life sustaining equipment.
Pg 429 Lines 1-9 An "adv. care planning consult" will b used frequently as patients health deteriorates
PG 429 Lines 10-12 "adv. care consultation" may incl an ORDER 4 end of life plans. AN ORDER from GOV
Pg 429 Lines 13-25 - The govt will specify which Doctors can write an end of life order.
-------------------------------
429
•HR 3200 IH
1 ‘‘(4) A consultation under this subsection may in
2 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 de
9 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 au
12
13
14 and is in a form that permits it to stay with the in
15
16 and providers across the continuum of care;
17 ‘‘(ii) effectively communicates the individual’s
18 preferences regarding life sustaining treatment, in
19
20
21 ‘‘(iii) is uniquely identifiable and standardized
22 within a given locality, region, or State (as identified
23 by the Secretary); and (429 only goes to line 23)
PG 430 Lines 11-15 The Govt will decide what level of treatment u will have at end of life
5 graph (A)(ii) may range from an indication for full treat
6 ment to an indication to limit some or all or specified
7 interventions. Such indicated levels of treatment may in
8 clude indications respecting, among other items—
9 ‘‘(i) the intensity of medical intervention if the
10 patient is pulseless, 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 set
14 ting;
15 ‘‘(iii) the use of antibiotics; and
16 ‘‘(iv) the use of artificially administered nutri
17 tion and hydration.’’.
( This is all in reference to medical intervention when someone is dying.... when you are laying in a hospital bed and you are about to die....do you want to die naturally or be put on life sustaining equipment....These are the same decisions that doctors already make and inform family members of; please note what is in bold. I personally want to go when my time comes; I don't want to be hooked up to machines meant to keep me alive....if God has decided it's my time to die, please let me die. Our medical advances are great and when they can make me well, I'm all for them, but when they are just machines meant to keep my body alive when my soul is already departing, I don't want them. ) and I think everyone should have that choice....before man invented these machines, people died when God wanted them to die.
Pg 469 - Community Based Home Medical Services=Non profit orgs. Hello, ACORN Medical Svcs here!!?
HR 3200
2 care or principal care physician or nurse
3 practitioner designated by the beneficiary
4 as his or her community-based medical
5 home provider.
6 ‘‘(iii) The organization employs com
7 munity health workers, including nurses or
8 other non-physician practitioners, lay
9 health workers, or other persons as deter
10 mined appropriate by the Secretary, that
11 assist the primary or principal care physi
12 cian or nurse practitioner in chronic care
13 management activities such as teaching
14 self-care skills for managing chronic ill
15 nesses, transitional care services, care plan
16 setting, medication therapy management
17 services for patients with multiple chronic
18 diseases, or help beneficiaries access the
19 health care and community-based resources
20 in their local geographic area.
21 ‘‘(iv) The organization meets such
22 other requirements as the Secretary may
23 specify.
24 ‘‘(C) HIGH NEED BENEFICIARY.—In this
25 section, the term ‘high need beneficiary’ means
VerDate Nov
& Page 472."
1 sents to receive medical home services through
2 such medical home, as follows:
3 ‘‘(i) PAYMENT TO COMMUNITY-BASED
4 ORGANIZATION.—One monthly payment to
5 a community-based or State-based organi
6 zation.
7 ‘‘(ii) PAYMENT TO PRIMARY OR PRIN
8 CIPAL CARE PRACTICE.—One monthly pay
9 ment to the primary or principal care prac
10 tice for such beneficiary.
11 ‘‘(C) PROSPECTIVE PAYMENT.—The pay
12 ments under subparagraph (B) shall be paid on
13 a prospective basis.
14 ‘‘(D) AMOUNT OF PAYMENT.—In deter
15 mining the amount of such payment, the Sec
16 retary shall consider the following:
17 ‘‘(i) The clinical work and practice ex
18 penses involved in providing the medical
19 home services provided by the community
20 based medical home (such as providing in
21 creased access, care coordination, care plan
22 setting, population disease management,
23 and teaching self-care skills for managing
24 chronic illnesses) for which payment is not
The only place this is mentioned is in regard to payment to a facility...
basically saying that it shall be one monthly payment. This is how a lot of things are handled right now -- in order to help keep costs low .. rather than a payment every time something is done. This is how it was done with my mother-in-law before she died. One monthly payment rather than for each time she had to have medication, etc.
VerDate Nov
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