Page:United States Statutes at Large Volume 104 Part 2.djvu/523

 note. PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-115 (B) EFFECTIVE DATE. — The amendments made by subpara- 42 USC 1320c-3 graph (A) shall take effect as if included in the enactment °°*®- of the Omnibus Budget Reconiliation 22 Act of 1989. (2) CLARIFICATION OF APPLICATION OF CRITERIA FOR DENIAL OF PAYMENT.— (A) IN GENERAL.— Section 1154(a)(2) (42 U.S.C. 1320c- 3(a)(2)) is amended by striking the third sentence and inserting the following: "The organization shall identify cases for which payment should not be made by reason of paragraph (1)(B) only through the use of criteria developed pursuant to guidelines established by the Secretary.". (B) EFFECTIVE DATE. —The amendment made by subpara- f^ ^SC 1320c-3 graph (A) shall take effect as if included in the enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985. SEC. 4206. MEDICARE PROVIDER AGREEMENTS ASSURING THE IM- PLEMENTATION OF A PATIENT'S RIGHT TO PARTICIPATE IN AND DIRECT HEALTH CARE DECISIONS AFFECTING THE PATIENT. (a) IN GENERAL.— Section 1866(a)(1) (42 U.S.C. 1395cc(a)(l)) is amended— (1) in subsection (a)(l)— (A) by striking "and" at the end of subparagraph (O), (B) by striking the period at the end of subparagraph (P) and inserting ", and", and (C) by inserting after subparagraph (P) the following new sulsparagraph: "(Q) in the case of hospitals, skilled nursing facilities, home health agencies, and hospice programs, to comply with the requirement of subsection (f) (relating to maintaining written policies and procedures respecting advance directives)."; and (2) by inserting after subsection (e) the following new subsection: "(f)(1) For purposes of subsection (a)(l)(Q) and sections 1819(c)(2)(E), 1833(r), 1876(c)(8), and 1891(a)(6), the requirement of this subsection is that a provider of services or prepaid or eligible organization (as the case may be) maintain written policies and procedures with respect to all adult individuals receiving medical care by or through the provider or organization— "(A) to provide written information to each such individual concerning— "(i) an individual's rights under State law (whether statutory or as recognized by the courts of the State) to make decisions concerning such medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives (as defined in paragraph (3)), and "(ii) the written policies of the provider or organization respecting the implementation of such rights; "(B) to document in the individual's medical record whether or not the individual has executed an advance directive; "(C) not to condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive; "(D) to ensure compliance with requirements of State law (whether statutory or as recognized by the courts of the State)
 * So in original. Probably should be "Reconciliation".

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