Page:United States Statutes at Large Volume 104 Part 2.djvu/524

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104 STAT. 1388-116 PUBLIC LAW 101-508 —NOV. 5, 1990 respecting advance directives at facilities of the provider or organization; and "(E) to provide (individually or with others) for education for staff and the community on issues concerning advance directives. Subparagraph (C) shall not be construed as requiring the provision of care which conflicts with an advance directive. "(2) The written information described in paragraph (1)(A) shall be provided to an adult individual— "(A) in the case of a hospital, at the time of the individual's admission as an inpatient, "(B) in the case of a skilled nursing facility, at the time of the individual's admission as a resident, "(C) in the case of a home health agency, in advance of the individual coming under the care of the agency, "(D) in the case of a hospice program, at the time of initial receipt of hospice care by the individual from the program, and "(E) in the case of an eligible organization (as defined in section 1876(b)) or an organization provided payments under section 1833(a)(1)(A), at the time of enrollment of the individual with the organization. "(3) In this subsection, the term 'advance directive' means a written instruction, such as a living will or durable power of attorney for health care, recognized under State law (whether statutory or as recognized by the courts of the State) and relating to the provision of such care when the individual is incapacitated.", (b) APPLICATION TO PREPAID ORGANIZATIONS. — (1) ELIGIBLE ORGANIZATIONS. —Section 1876(c) of such Act (42 U.S.C. 1395mm(c)) is amended by adding at the end the following new paragraph: "(8) A contract under this section shall provide that the eligible organization shall meet the requirement of section 1866(f) (relating to maintaining written policies and procedures respecting advance directives).". (2) OTHER PREPAID ORGANIZATIONS. —Section 1833 of such Act (42 U.S.C. 13951) is amended by adding at the end the following new subsection: "(r) The Secretary may not provide for payment under subsection (a)(1)(A) with respect to an organization unless the organization provides sissurances satisfactory to the Secretary that the organization meets the requirement of section 1866(f) (relating to maintaining written policies and procedures respecting advance directives).". 42 USC 1395CC (c) EFFECT ON STATE LAW. —Nothing in subsections (a) and (b) shall °°*®- be construed to prohibit the application of a State law which allows for an objection on the basis of conscience for any health care provider or any agent of such provider which, as a matter of conscience, cannot implement an advance directive. (d) CONFORMING AMENDMENTS.— (1) Section 1819(c)(1) of such Act (42 U.S.C. 1395i-3(c)(l)) is amended by adding at the end the following new subparagraph: "(E) INFORMATION RESPECTING ADVANCE DIRECTIVES. —A skilled nursing facility must comply with the requirement of section 1866(f) (relating to maintaining written policies and procedures respecting advance directives).". (2) Section 1891(a) of such Act (42 U.S.C. 1395bbb(a)) is amended by adding at the end the following: