The Medicare Choices Empowerment and Protection Act establishes an online clearinghouse for seniors to register their certified advanced directives. The act also provides a financial incentive for Medicare-eligible seniors who register their directive with the Centers for Medicare & Medicaid Services (CMS).
WHAT: A certified advanced directive, under the act, is any electronically stored statement from an eligible beneficiary who:
- Provides instructions that outline the kind of medical treatment and care, wanted or unwanted under particular conditions, and may also include the identification of a health care representative
- Is executed in accordance with the beneficiary’s state laws
- Is offered by an entity that has received accreditation
WEBSITE: CMS is charged with creating a clearinghouse website that contains links to statutory and alternative advance directives, as well as a state-by-state index of forms for beneficiaries to create, adopt, modify or terminate an advanced directive.
ACCESS: Access to the online advanced directives would be limited to care providers and those who are designated health care representatives of the beneficiary. In the case of disputes over care, additional close family members would be granted access to the directive.
ACCREDITATION: Under the act, accreditation criteria for website vendors would include:
- Adoption—The beneficiary should be able to adopt, create, modify and terminate an advanced directive online.
- Quality review—The Department of Health & Human Services will conduct an annual review of all vendors.
- Forms—The forms for the state the beneficiary indicates are available.
- Access—The vendor limits access to providers and health care representatives.
- Privacy—The database complies with HIPAA standards.
- Security—The system has secure data management and transfer protocols.
- Surveys—The vendor completes annual beneficiary surveys and reports the results to CMS.
INCENTIVE: Beneficiaries who register their directives with the program receive $75, or possibly more, as affected by the Chained Consumer Price Index for All Urban Consumers.
WHY: “You should consider carefully who to choose to speak for you and what directions you want to give to ensure your representative clearly reflects your own values and treatment preferences. You should not feel pressured to violate your own values and preferences, and you are entitled to implement them without discrimination based on age or degree of disability.”—Suggested text for the “Medicare and You” handbook.