I 

118TH CONGRESS 

1ST SESSION H. R. 6344 

To amend titles XVIII and XIX of the Social Security Act to require providers 

of services and health maintenance organizations under the Medicare 

and Medicaid programs to provide for certain policies to be in place 

relating to do-not-resuscitate orders or similar physician’s orders for 

unemancipated minors receiving services. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 9, 2023 

Mr. LATURNER (for himself, Ms. STEFANIK, Mr. ADERHOLT, Mr. BANKS, Mr. 

SMITH of New Jersey, Mrs. MILLER-MEEKS, Ms. LETLOW, Mr. MOORE

of Utah, Mr. ROUZER, Mr. MANN, Mrs. MILLER of Illinois, Mr. SESSIONS, Mr. ROSENDALE, Mr. BABIN, Mr. FULCHER, Mr. DUNCAN, Mr. 

ESTES, Mr. LAMBORN, Ms. VAN DUYNE, Mrs. BICE, Mr. VALADAO, and 

Mr. BOST) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to require providers of services and health maintenance 

organizations under the Medicare and Medicaid programs 

to provide for certain policies to be in place relating 

to do-not-resuscitate orders or similar physician’s orders 

for unemancipated minors receiving services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Simon Crosier Act’’. 

3 SEC. 2. MEDICARE AND MEDICAID REQUIREMENTS FOR 

4 CERTAIN POLICIES RELATING TO DO-NOT-RE5 SUSCITATE ORDERS OR SIMILAR PHYSI6 CIAN’S ORDERS. 

7 (a) MEDICARE PROVIDER AGREEMENT REQUIRE8 MENT.— 

9 (1) IN GENERAL.—Section 1866(f) of the Social 

10 Security Act (42 U.S.C. 1395cc(f)) is amended by 

11 adding at the end the following new paragraphs: 

12 ‘‘(5) For purposes of subsection (a)(1)(Q) and 

13 sections 1819(c)(1)(E), 1833(s), 1852(i), 

14 1876(c)(8), and 1891(a)(6), the requirement of this 

15 subsection, in addition to paragraph (1), is that a 

16 provider of services, MA organization, or prepaid or 

17 eligible organization (as the case may be) maintain 

18 the following written policies and procedures with re19 spect to all unemancipated minors receiving medical 

20 care by or through the provider or organization (or 

21 prospective patient or resident, with respect to the 

22 provider or organization, who is an unemancipated 

23 minor): 

24 ‘‘(A) A do-not-resuscitate order or similar 

25 physician’s order shall not be instituted, either 

26 orally or in writing, unless at least one parent 


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1 or legal guardian of such unemancipated minor 

2 has first been informed of the physician’s intent 

3 to institute such an order and a reasonable at4 tempt has been made to inform the other par5 ent if the other parent is reasonably available 

6 and has custodial or visitation rights. Such in7 formation must be provided both orally and in 

8 writing unless, in reasonable medical judgment, 

9 the urgency of the decision requires reliance on 

10 only providing the information orally. Oral pro11 vision of such information shall include speak12 ing to at least one parent or legal guardian in 

13 person or on the telephone, and shall not be 

14 limited to recorded voice messages. Provision of 

15 such information shall include at least 72 hours 

16 of diligent efforts made by the physician or pro17 vider to contact and notify at least one parent 

18 or legal guardian. The provision of such infor19 mation shall be contemporaneously recorded in 

20 the medical record of the unemancipated minor, 

21 specifying by whom and to whom the informa22 tion was given, the date and time of its provi23 sion, and whether it was provided in writing. In 

24 the case that only one parent has been in25 formed, the nature of reasonable attempts to 


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1 inform the other parent or the reason why such 

2 attempts were not made shall be contempora3 neously recorded in the medical record of the 

4 unemancipated minor. 

5 ‘‘(B) Either parent of the unemancipated 

6 minor or the unemancipated minor’s guardian 

7 may refuse consent for a do-not-resuscitate 

8 order or similar physician’s order for the 

9 unemancipated minor, either in writing or oral10 ly. Any such refusal of consent must be contem11 poraneously recorded in the medical record of 

12 the unemancipated minor. No do-not-resuscitate 

13 order or similar physician’s order shall be insti14 tuted either orally or in writing if there has 

15 been such a refusal of consent. 

16 ‘‘(C) The provider shall not have the au17 thority to require the withholding or withdrawal 

18 of life-sustaining procedures from an 

19 unemancipated minor over the objection of the 

20 parent or legal guardian, unless electronic 

21 brain, heart, and respiratory monitoring activity 

22 conclusively establishes that the minor has died. 

23 There shall be a presumption that the continu24 ation of life is in the minor’s best interest. 


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1 ‘‘(D) Within 48 hours of being notified of 

2 the intent to institute a do-not-resuscitate order 

3 or a similar physician’s order according to sub4 paragraph (A), a parent or legal guardian may 

5 request a transfer of the unemancipated minor 

6 patient or resident to another facility or dis7 charge. If a transfer is requested by a parent 

8 or legal guardian, the hospital or health care fa9 cility under whose care the unemancipated 

10 minor is admitted must continue provision of 

11 artificial life-sustaining procedures and life-sus12 taining artificial nutrition and hydration for a 

13 minimum of 15 days after the transfer request 

14 has been made known and make every reason15 able effort to assist the requesting parent or 

16 legal guardian in the transfer process. The hos17 pital or health care facility’s duties and finan18 cial obligations regarding transfer shall be gov19 erned by existing state law, applicable rules or 

20 regulations, hospital policy, and relevant third21 party payment contracts. 

22 ‘‘(E) Upon the request of a patient or resi23 dent or a prospective patient or resident, the 

24 provider of services or organization shall dis25 close in writing any policies relating to the paVerDate Sep 11 2014 03:58 Nov 21, 2023 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6344.IH H6344

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1 tient or resident or the services the patient or 

2 resident may receive involving resuscitation or 

3 life-sustaining measures, including any policies 

4 related to treatments deemed non-beneficial, in5 effective, futile or inappropriate, within the pro6 vider of services or organization. Nothing in 

7 this subparagraph shall require a provider of 

8 services or organization to have a written policy 

9 relating to or involving resuscitation, life-sus10 taining or non-beneficial treatment for 

11 unemancipated minor patients or adult patients, 

12 residents or wards. 

13 ‘‘(6) In applying paragraph (5)(A), a deter14 mination based on ‘‘reasonable medical judgement’’ 

15 shall not be solely based on disability alone or the 

16 view that the life of a person with a disability is of 

17 lower value or of lower quality than that of a person 

18 without a disability regardless of whether the per19 son’s disability is pre-existing or newly acquired and 

20 therefore must not serve as the sole basis for the do21 not-resuscitate order or similar physician’s order un22 less treatment is determined to be physiologically fu23 tile and supported with objective evidence that is 

24 documented in the patient’s records in writing.’’. 

25 (2) CONFORMING AMENDMENTS.— 


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1 (A) Section 1866(a)(1)(Q) of the Social 

2 Security Act (42 U.S.C. 1395cc(a)(1)(Q)) is 

3 amended— 

4 (i) by striking ‘‘requirement’’ and in5 serting ‘‘requirements’’; and 

6 (ii) by inserting ‘‘and certain do-not7 resuscitate orders or similar physician’s or8 ders’’ after ‘‘advance directives’’. 

9 (B) Section 1819(c)(1)(E) of the Social 

10 Security Act (42 U.S.C. 1395i–3(c)(1)(E)) is 

11 amended— 

12 (i) by striking ‘‘requirement’’ and in13 serting ‘‘requirements’’; and 

14 (ii) by inserting ‘‘and certain do-not15 resuscitate orders or similar physician’s or16 ders’’ after ‘‘advance directives’’. 

17 (C) Section 1833(s) of the Social Security 

18 Act (42 U.S.C. 1395l(s)) is amended— 

19 (i) by striking ‘‘requirement’’ and in20 serting ‘‘requirements’’; and 

21 (ii) by inserting ‘‘and certain do-not22 resuscitate orders or similar physician’s or23 ders’’ after ‘‘advance directives’’. 

24 (D) Section 1852(i) of the Social Security 

25 Act (42 U.S.C. 1395w–22(i)) is amended— 


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1 (i) by striking ‘‘requirement’’ and in2 serting ‘‘requirements’’; and 

3 (ii) by inserting ‘‘and certain do-not4 resuscitate orders or similar physician’s or5 ders’’ after ‘‘advance directives’’. 

6 (E) Section 1876(c)(8) of the Social Secu7 rity Act (42 U.S.C. 1395mm(c)(8)) is amend8 ed— 

9 (i) by striking ‘‘requirement’’ and in10 serting ‘‘requirements’’; and 

11 (ii) by inserting ‘‘and certain do-not12 resuscitate orders or similar physician’s or13 ders’’ after ‘‘advance directives’’. 

14 (F) Section 1891(a)(6) of the Social Secu15 rity Act (42 U.S.C. 1395bbb(a)(6)) is amend16 ed— 

17 (i) by striking ‘‘requirement’’ and in18 serting ‘‘requirements’’; and 

19 (ii) by inserting ‘‘and certain do-not20 resuscitate orders or similar physician’s or21 ders’’ after ‘‘advance directives’’. 

22 (3) EFFECTIVE DATE.—The amendments made 

23 by this subsection shall apply with respect to items 

24 and services furnished on or after the date that is 

25 90 days after the date of the enactment of this Act. 


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1 (b) MEDICAID STATE PLAN REQUIREMENT.— 

2 (1) IN GENERAL.—Section 1902(w) of the So3 cial Security Act (42 U.S.C. 1396a(w)) is amended 

4 by adding at the end the following new paragraphs: 

5 ‘‘(6) For purposes of subsection (a)(57) and 

6 sections 1903(m)(1)(A) and 1919(c)(2)(E), the re7 quirement of this subsection, in addition to para8 graph (1), is that a provider or organization (as the 

9 case may be) maintain the following written policies 

10 and procedures with respect to all unemancipated 

11 minors receiving medical care by or through the pro12 vider or organization (or prospective patient or resi13 dent, with respect to the provider or organization, 

14 who is an unemancipated minor): 

15 ‘‘(A) A do-not-resuscitate order or similar 

16 physician’s order shall not be instituted, either 

17 orally or in writing, unless at least one parent 

18 or legal guardian of such unemancipated minor 

19 has first been informed of the physician’s intent 

20 to institute such an order and a reasonable at21 tempt has been made to inform the other par22 ent if the other parent is reasonably available 

23 and has custodial or visitation rights. Such in24 formation must be provided both orally and in 

25 writing unless, in reasonable medical judgment, 


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1 the urgency of the decision requires reliance on 

2 only providing the information orally. Oral pro3 vision of such information shall include speak4 ing to at least one parent or legal guardian in 

5 person or on the telephone, and shall not be 

6 limited to recorded voice messages. Provision of 

7 such information shall include at least 72 hours 

8 of diligent efforts made by the physician or pro9 vider to contact and notify at least one parent 

10 or legal guardian. The provision of such infor11 mation shall be contemporaneously recorded in 

12 the medical record of the unemancipated minor, 

13 specifying by whom and to whom the informa14 tion was given, the date and time of its provi15 sion, and whether it was provided in writing. In 

16 the case that only one parent has been in17 formed, the nature of reasonable attempts to 

18 inform the other parent or the reason why such 

19 attempts were not made shall be contempora20 neously recorded in the medical record of the 

21 unemancipated minor. 

22 ‘‘(B) Either parent of the unemancipated 

23 minor or the unemancipated minor’s guardian 

24 may refuse consent for a do-not-resuscitate 

25 order or similar physician’s order for the 


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1 unemancipated minor, either in writing or oral2 ly. Any such refusal of consent must be contem3 poraneously recorded in the medical record of 

4 the unemancipated minor. No do-not-resuscitate 

5 order or similar physician’s order shall be insti6 tuted either orally or in writing if there has 

7 been such a refusal of consent. 

8 ‘‘(C) The provider shall not have the au9 thority to require the withholding or withdrawal 

10 of life-sustaining procedures from an 

11 unemancipated minor over the objection of the 

12 parent or legal guardian, unless electronic 

13 brain, heart, and respiratory monitoring activity 

14 conclusively establishes that the minor has died. 

15 There shall be a presumption that the continu16 ation of life is in the minor’s best interest. 

17 ‘‘(D) Within 48 hours of being notified of 

18 the intent to institute a do-not-resuscitate order 

19 or a similar physician’s order according to sub20 paragraph (A), a parent or legal guardian may 

21 request a transfer of the unemancipated minor 

22 patient or resident to another facility or dis23 charge. If a transfer is requested by a parent 

24 or legal guardian, the hospital or health care fa25 cility under whose care the unemancipated 


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1 minor is admitted must continue provision of 

2 artificial life-sustaining procedures and life-sus3 taining artificial nutrition and hydration for a 

4 minimum of 15 days after the transfer request 

5 has been made known and make every reason6 able effort to assist the requesting parent or 

7 legal guardian in the transfer process. The hos8 pital or health care facility’s duties and finan9 cial obligations regarding transfer shall be gov10 erned by existing state law, applicable rules or 

11 regulations, hospital policy, and relevant third12 party payment contracts. 

13 ‘‘(E) Upon the request of a patient or resi14 dent or a prospective patient or resident, the 

15 provider of services or organization shall dis16 close in writing any policies relating to the pa17 tient or resident or the services the patient or 

18 resident may receive involving resuscitation or 

19 life-sustaining measures, including any policies 

20 related to treatments deemed non-beneficial, in21 effective, futile or inappropriate, within the pro22 vider of services or organization. Nothing in 

23 this subparagraph shall require a provider of 

24 services or organization to have a written policy 

25 relating to or involving resuscitation, life-susVerDate Sep 11 2014 03:58 Nov 21, 2023 Jkt 049200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H6344.IH H6344

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1 taining or non-beneficial treatment for 

2 unemancipated minor patients or adult patients, 

3 residents or wards. 

4 ‘‘(7) In applying paragraph (6)(A), a deter5 mination based on ‘‘reasonable medical judgement’’ 

6 shall not be solely based on disability alone or the 

7 view that the life of a person with a disability is of 

8 lower value or of lower quality than that of a person 

9 without a disability regardless of whether the per10 son’s disability is pre-existing or newly acquired and 

11 therefore must not serve as the sole basis for the do12 not-resuscitate order or similar physician’s order un13 less treatment is determined to be physiologically fu14 tile and supported with objective evidence that is 

15 documented in the patient’s records in writing.’’. 

16 (2) CONFORMING AMENDMENTS.— 

17 (A) Section 1903(m)(1)(A) of the Social 

18 Security Act (42 U.S.C. 1396b(m)(1)(A)) is 

19 amended in the matter preceding clause (i), by 

20 striking ‘‘requirement’’ and inserting ‘‘require21 ments’’. 

22 (B) Section 1919(c)(2)(E) of the Social 

23 Security Act (42 U.S.C. 1396r(c)(2)(E)) is 

24 amended— 


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1 (i) by striking ‘‘requirement’’ and in2 serting ‘‘requirements’’; and 

3 (ii) by inserting ‘‘and certain do-not4 resuscitate orders or similar physician’s or5 ders’’ after ‘‘advance directives’’. 

6 (3) EFFECTIVE DATE.— 

7 (A) IN GENERAL.—Except as provided in 

8 paragraph (2), the amendments made by this 

9 subsection shall take effect on the date of the 

10 enactment of this Act and shall apply to serv11 ices furnished on or after the date that is 90 

12 days after the date of the enactment of this 

13 Act. 

14 (B) EXCEPTION IF STATE LEGISLATION

15 REQUIRED.—In the case of a State plan for 

16 medical assistance under title XIX of the Social 

17 Security Act which the Secretary of Health and 

18 Human Services determines requires State leg19 islation (other than legislation appropriating 

20 funds) in order for the plan to meet the addi21 tional requirement imposed by the amendments 

22 made by this subsection, the State plan shall 

23 not be regarded as failing to comply with the 

24 requirements of such title solely on the basis of 

25 its failure to meet this additional requirement 


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1 before the first day of the first calendar quarter 

2 beginning after the close of the first regular 

3 session of the State legislature that begins after 

4 the date of the enactment of this Act. For pur5 poses of the previous sentence, in the case of a 

6 State that has a 2-year legislative session, each 

7 year of such session shall be deemed to be a 

8 separate regular session of the State legislature. 

Æ 


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