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103D CONGRESS
1ST SESSION
H. R. 1580
To amend titles XVIII and XIX of the Social Security Act to require that
individuals entitled to medicare benefits or enrolled in a State medicaid
plan be provided with notice of their rights to accept or refuse medical
care and the right to formulate advance directives.
IN THE HOUSE OF REPRESENTATIVES
APRIL 1, 1993
Mr. DOOLEY (for himself, Mr. HOYER, and Mr. BARRETT of Wisconsin) intro-
duced the following bill; which was referred jointly to the Committees on
Ways and Energy and Commerce
A BILL
To amend titles XVIII and XIX of the Social Security Act
to require that individuals entitled to medicare benefits
or enrolled in a State medicaid plan be provided with
notice of their rights to accept or refuse medical care
and the right to formulate advance directives.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Advance Directive Ex-
pansion Act of 1993’’.
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SEC. 2. PROVIDING NOTICE OF RIGHTS REGARDING MEDI-
CAL CARE TO INDIVIDUALS ENTERING MEDI-
CARE OR MEDICAID.
(a) NOTICE TO MEDICARE BENEFICIARIES.—
(1) IN GENERAL.—Section 1804 of the Social
Security Act (42 U.S.C. 1395b–2) is amended—
(A) in paragraph (2), by striking ‘‘and’’ at
the end;
(B) in paragraph (3), by striking the pe-
riod at the end and inserting ‘‘, and’’; and
(C) by inserting after paragraph (3) the
following new paragraph:
‘‘(4) a description of an individual’s rights
under State law to make decisions concerning medi-
cal care, including the right to accept or refuse med-
ical or surgical treatment and the right to formulate
advance 
directives 
(as 
defined 
in 
section
1866(f)(3)).’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to notices provided
under section 1804 of the Social Security Act on or
after January 1, 1994.
(b) NOTICE TO INDIVIDUALS ENROLLED IN STATE
MEDICAID PLANS.—
(1) IN GENERAL.—Section 1902(a) of the So-
cial Security Act (42 U.S.C. 1396a(a)) is amended
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in 
the 
paragraph 
(58) 
added 
by 
section
4751(a)(1)(C) of the Omnibus Budget Reconciliation
Act of 1990 by striking the period at the end and
inserting the following: ‘‘, and that would be pro-
vided by the State to each individual enrolled in the
State plan.’’.
(2) EFFECTIVE DATE.—(A) Except as provided
in subparagraph (B), the amendment made by para-
graph (1) shall apply to calendar quarters beginning
on or after January 1, 1994, without regard to
whether or not final regulations to carry out such
amendments have been promulgated by such date.
(B) In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act
which the Secretary of Health and Human Services
determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to
meet the additional requirements imposed by the
amendments made by paragraph (1), the State plan
shall not be regarded as failing to comply with the
requirements of such title solely on the basis of its
failure to meet these additional requirements before
the first day of the first calendar quarter beginning
after the close of the first regular session of the
State legislature that begins after the date of the en-
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actment of this Act. For purposes of the previous
sentence, in the case of a State that has a 2-year
legislative session, each year of such session shall be
deemed to be a separate regular session of the State
legislature.
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