Simon Crosier Act
Bill: H.R.5656 | Sponsor: Rep. LaTurner, Jake (R-KS)
Policy area: Health

Summary:
Simon Crosier Act
This bill requires hospitals and other health care providers, as a condition of Medicare and Medicaid participation, to have certain written policies and procedures in place that limit the implementation of do-not-resuscitate (DNR) orders for unemancipated minors in accordance with specified criteria.
Among other provisions, such policies and procedures must (1) require the informed consent of at least one parent and a reasonable attempt to contact the other parent before instituting a DNR order, (2) allow either parent to refuse to consent to a DNR order, and (3) allow a parent to transfer a minor to another facility after being informed of an intent to institute a DNR order.

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Simon Crosier Act''.

SEC. 2. MEDICARE AND MEDICAID REQUIREMENTS FOR CERTAIN POLICIES 
              RELATING TO DO-NOT-RESUSCITATE ORDERS OR SIMILAR 
              PHYSICIAN'S ORDERS.

    (a) Medicare Provider Agreement Requirement.--
            (1) In general.--Section 1866(f) of the Social Security Act 
        (42 U.S.C. 1395cc(f)) is amended by adding at the end the 
        following new paragraphs:
            ``(5) For purposes of subsection (a)(1)(Q) and sections 
        1819(c)(1)(E), 1833(s), 1852(i), 1876(c)(8), and 1891(a)(6), 
        the requirement of this subsection, in addition to paragraph 
        (1), is that a provider of services, MA organization, or 
        prepaid or eligible organization (as the case may be) maintain 
        the following written policies and procedures with respect to 
        all unemancipated minors receiving medical care by or through 
        the provider or organization (or prospective patient or 
        resident, with respect to the provider or organization, who is 
        an unemancipated minor):
                    ``(A) A do-not-resuscitate order or similar 
                physician's order shall not be instituted, either 
                orally or in writing, unless at least one parent or 
                legal guardian of such unemancipated minor has first 
                been informed of the physician's intent to institute 
                such an order and a reasonable attempt has been made to 
                inform the other parent if the other parent is 
                reasonably available and has custodial or visitation 
                rights. Such information must be provided both orally 
                and in writing unless, in reasonable medical judgment, 
                the urgency of the decision requires reliance on only 
                providing the information orally. Oral provision of 
                such information shall include speaking to at least one 
                parent or legal guardian in person or on the telephone, 
                and shall not be limited to recorded voice messages. 
                Provision of such information shall include at least 72 
                hours of diligent efforts made by the physician or 
                provider to contact and notify at least one parent or 
                legal guardian. The provision of such information shall 
                be contemporaneously recorded in the medical record of 
                the unemancipated minor, specifying by whom and to whom 
                the information was given, the date and time of its 
                provision, and whether it was provided in writing. In 
                the case that only one parent has been informed, the 
                nature of reasonable attempts to inform the other 
                parent or the reason why such attempts were not made 
                shall be contemporaneously recorded in the medical 
                record of the unemancipated minor.
                    ``(B) Either parent of the unemancipated minor or 
                the unemancipated minor's guardian may refuse consent 
                for a do-not-resuscitate order or similar physician's 
                order for the unemancipated minor, either in writing or 
                orally. Any such refusal of consent must be 
                contemporaneously recorded in the medical record of the 
                unemancipated minor. No do-not-resuscitate order or 
                similar physician's order shall be instituted either 
                orally or in writing if there has been such a refusal 
                of consent.
                    ``(C) The provider shall not have the authority to 
                require the withholding or withdrawal of life-
                sustaining procedures from an unemancipated minor over 
                the objection of the parent or legal guardian, unless 
                electronic brain, heart, and respiratory monitoring 
                activity conclusively establishes that the minor has 
                died. There shall be a presumption that the 
                continuation of life is in the minor's best interest.
                    ``(D) Within 48 hours of being notified of the 
                intent to institute a do-not-resuscitate order or a 
                similar physician's order according to subparagraph 
                (A), a parent or legal guardian may request a transfer 
                of the unemancipated minor patient or resident to 
                another facility or discharge. If a transfer is 
                requested by a parent or legal guardian, the hospital 
                or health care facility under whose care the 
                unemancipated minor is admitted must continue provision 
                of artificial life-sustaining procedures and life-
                sustaining artificial nutrition and hydration for a 
                minimum of 15 days after the transfer request has been 
                made known and make every reasonable effort to assist 
                the requesting parent or legal guardian in the transfer 
                process. The hospital or health care facility's duties 
                and financial obligations regarding transfer shall be 
                governed by existing State law, applicable rules or 
                regulations, hospital policy, and relevant third-party 
                payment contracts.
                    ``(E) Upon the request of a patient or resident or 
                a prospective patient or resident, the provider of 
                services or organization shall disclose in writing any 
                policies relating to the patient or resident or the 
                services the patient or resident may receive involving 
                resuscitation or life-sustaining measures, including 
                any policies related to treatments deemed non-
                beneficial, ineffective, futile or inappropriate, 
                within the provider of services or organization. 
                Nothing in this subparagraph shall require a provider 
                of services or organization to have a written policy 
                relating to or involving resuscitation, life-sustaining 
                or non-beneficial treatment for unemancipated minor 
                patients or adult patients, residents or wards.
            ``(6) In applying paragraph (5)(A), a determination based 
        on ``reasonable medical judgement'' shall not be solely based 
        on disability alone or the view that the life of a person with 
        a disability is of lower value or of lower quality than that of 
        a person without a disability regardless of whether the 
        person's disability is pre-existing or newly acquired and 
        therefore must not serve as the sole basis for the do-not-
        resuscitate order or similar physician's order unless treatment 
        is determined to be physiologically futile and supported with 
        objective evidence that is documented in the patient's records 
        in writing.''.
            (2) Conforming amendments.--
                    (A) Section 1866(a)(1)(Q) of the Social Security 
                Act (42 U.S.C. 1395cc(a)(1)(Q)) is amended--
                            (i) by striking ``requirement'' and 
                        inserting ``requirements''; and
                            (ii) by inserting ``and certain do-not-
                        resuscitate orders or similar physician's 
                        orders'' after ``advance directives''.
                    (B) Section 1819(c)(1)(E) of the Social Security 
                Act (42 U.S.C. 1395i-3(c)(1)(E)) is amended--
                            (i) by striking ``requirement'' and 
                        inserting ``requirements''; and
                            (ii) by inserting ``and certain do-not-
                        resuscitate orders or similar physician's 
                        orders'' after ``advance directives''.
                    (C) Section 1833(s) of the Social Security Act (42 
                U.S.C. 1395l(s)) is amended--
                            (i) by striking ``requirement'' and 
                        inserting ``requirements''; and
                            (ii) by inserting ``and certain do-not-
                        resuscitate orders or similar physician's 
                        orders'' after ``advance directives''.
                    (D) Section 1852(i) of the Social Security Act (42 
                U.S.C. 1395w-22(i)) is amended--
                            (i) by striking ``requirement'' and 
                        inserting ``requirements''; and
                            (ii) by inserting ``and certain do-not-
                        resuscitate orders or similar physician's 
                        orders'' after ``advance directives''.
                    (E) Section 1876(c)(8) of the Social Security Act 
                (42 U.S.C. 1395mm(c)(8)) is amended--
                            (i) by striking ``requirement'' and 
                        inserting ``requirements''; and
                            (ii) by inserting ``and certain do-not-
                        resuscitate orders or similar physician's 
                        orders'' after ``advance directives''.
                    (F) Section 1891(a)(6) of the Social Security Act 
                (42 U.S.C. 1395bbb(a)(6)) is amended--
                            (i) by striking ``requirement'' and 
                        inserting ``requirements''; and
                            (ii) by inserting ``and certain do-not-
                        resuscitate orders or similar physician's 
                        orders'' after ``advance directives''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply with respect to items and services furnished on or 
        after the date that is 90 days after the date of the enactment 
        of this Act.
    (b) Medicaid State Plan Requirement.--
            (1) In general.--Section 1902(w) of the Social Security Act 
        (42 U.S.C. 1396a(w)) is amended by adding at the end the 
        following new paragraphs:
            ``(6) For purposes of subsection (a)(57) and sections 
        1903(m)(1)(A) and 1919(c)(2)(E), the requirement of this 
        subsection, in addition to paragraph (1), is that a provider or 
        organization (as the case may be) maintain the following 
        written policies and procedures with respect to all 
        unemancipated minors receiving medical care by or through the 
        provider or organization (or prospective patient or resident, 
        with respect to the provider or organization, who is an 
        unemancipated minor):
                    ``(A) A do-not-resuscitate order or similar 
                physician's order shall not be instituted, either 
                orally or in writing, unless at least one parent or 
                legal guardian of such unemancipated minor has first 
                been informed of the physician's intent to institute 
                such an order and a reasonable attempt has been made to 
                inform the other parent if the other parent is 
                reasonably available and has custodial or visitation 
                rights. Such information must be provided both orally 
                and in writing unless, in reasonable medical judgment, 
                the urgency of the decision requires reliance on only 
                providing the information orally. Oral provision of 
                such information shall include speaking to at least one 
                parent or legal guardian in person or on the telephone, 
                and shall not be limited to recorded voice messages. 
                Provision of such information shall include at least 72 
                hours of diligent efforts made by the physician or 
                provider to contact and notify at least one parent or 
                legal guardian. The provision of such information shall 
                be contemporaneously recorded in the medical record of 
                the unemancipated minor, specifying by whom and to whom 
                the information was given, the date and time of its 
                provision, and whether it was provided in writing. In 
                the case that only one parent has been informed, the 
                nature of reasonable attempts to inform the other 
                parent or the reason why such attempts were not made 
                shall be contemporaneously recorded in the medical 
                record of the unemancipated minor.
                    ``(B) Either parent of the unemancipated minor or 
                the unemancipated minor's guardian may refuse consent 
                for a do-not-resuscitate order or similar physician's 
                order for the unemancipated minor, either in writing or 
                orally. Any such refusal of consent must be 
                contemporaneously recorded in the medical record of the 
                unemancipated minor. No do-not-resuscitate order or 
                similar physician's order shall be instituted either 
                orally or in writing if there has been such a refusal 
                of consent.
                    ``(C) The provider shall not have the authority to 
                require the withholding or withdrawal of life-
                sustaining procedures from an unemancipated minor over 
                the objection of the parent or legal guardian, unless 
                electronic brain, heart, and respiratory monitoring 
                activity conclusively establishes that the minor has 
                died. There shall be a presumption that the 
                continuation of life is in the minor's best interest.
                    ``(D) Within 48 hours of being notified of the 
                intent to institute a do-not-resuscitate order or a 
                similar physician's order according to subparagraph 
                (A), a parent or legal guardian may request a transfer 
                of the unemancipated minor patient or resident to 
                another facility or discharge. If a transfer is 
                requested by a parent or legal guardian, the hospital 
                or health care facility under whose care the 
                unemancipated minor is admitted must continue provision 
                of artificial life-sustaining procedures and life-
                sustaining artificial nutrition and hydration for a 
                minimum of 15 days after the transfer request has been 
                made known and make every reasonable effort to assist 
                the requesting parent or legal guardian in the transfer 
                process. The hospital or health care facility's duties 
                and financial obligations regarding transfer shall be 
                governed by existing State law, applicable rules or 
                regulations, hospital policy, and relevant third-party 
                payment contracts.
                    ``(E) Upon the request of a patient or resident or 
                a prospective patient or resident, the provider of 
                services or organization shall disclose in writing any 
                policies relating to the patient or resident or the 
                services the patient or resident may receive involving 
                resuscitation or life-sustaining measures, including 
                any policies related to treatments deemed non-
                beneficial, ineffective, futile or inappropriate, 
                within the provider of services or organization. 
                Nothing in this subparagraph shall require a provider 
                of services or organization to have a written policy 
                relating to or involving resuscitation, life-sustaining 
                or non-beneficial treatment for unemancipated minor 
                patients or adult patients, residents or wards.
            ``(7) In applying paragraph (6)(A), a determination based 
        on ``reasonable medical judgement'' shall not be solely based 
        on disability alone or the view that the life of a person with 
        a disability is of lower value or of lower quality than that of 
        a person without a disability regardless of whether the 
        person's disability is pre-existing or newly acquired and 
        therefore must not serve as the sole basis for the do-not-
        resuscitate order or similar physician's order unless treatment 
        is determined to be physiologically futile and supported with 
        objective evidence that is documented in the patient's records 
        in writing.''.
            (2) Conforming amendments.--
                    (A) Section 1903(m)(1)(A) of the Social Security 
                Act (42 U.S.C. 1396b(m)(1)(A)) is amended in the matter 
                preceding clause (i), by striking ``requirement'' and 
                inserting ``requirements''.
                    (B) Section 1919(c)(2)(E) of the Social Security 
                Act (42 U.S.C. 1396r(c)(2)(E)) is amended--
                            (i) by striking ``requirement'' and 
                        inserting ``requirements''; and
                            (ii) by inserting ``and certain do-not-
                        resuscitate orders or similar physician's 
                        orders'' after ``advance directives''.
            (3) Effective date.--
                    (A) In general.--Except as provided in paragraph 
                (2), the amendments made by this subsection shall take 
                effect on the date of the enactment of this Act and 
                shall apply to services furnished on or after the date 
                that is 90 days after the date of the enactment of this 
                Act.
                    (B) Exception if state legislation required.--In 
                the case of a State plan for medical assistance under 
                title XIX of the Social Security Act which the 
                Secretary of Health and Human Services determines 
                requires State legislation (other than legislation 
                appropriating funds) in order for the plan to meet the 
                additional requirement imposed by the amendments made 
                by this subsection, 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 
                this additional requirement 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 enactment 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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