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Public Policy in Palliative and End-of-Life Care 

Public Policy in Palliative and End-of-Life Care
Public Policy in Palliative and End-of-Life Care

Judith R. Peres

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date: 28 June 2022

This textbook on palliative social work is a companion volume to the Oxford Textbook of Palliative Medicine and the Oxford Textbook of Palliative Nursing. To that end, this chapter will accomplish the following:

Advance health care directive or advance directive (AD): A written health care directive and/or appointment of an agent, or a written refusal to appoint an agent or execute a directive.

Life-sustaining treatment: Medical procedures that replace or support an essential bodily function. Life-sustaining treatments include cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition and hydration, dialysis, and certain other treatments.

Medicare: The federal program that provides health care to persons 65 years of age and older and to others entitled to Social Security benefits. Medicare is administered at the federal level, as contrasted with Medicaid, which is administered by the states. Medicare was established in 1965 by amendment to the Social Security Act (Public Law 89-97), the pertinent section of the amendment being “Title XVIII–Health Insurance for the Aged.”

Original Medicare Plan: The term used by the Center for Medicare and Medicaid Services (CMS) (formerly HCFA) to describe the basic “fee-for-service” Medicare plan, offered by the federal government, and available nationwide. Unless the beneficiary chooses an alternate plan such as Medicare managed care plan or a private fee-for-service plan, the original plan will be the one in effect.

Medicaid: The federal program that provides health care to indigent and medically indigent persons. While partially federally funded and managed by CMS, the Medicaid program is administered by the states, in accordance with an approved plan for that state, and each state has considerable flexibility in designing requirements. This is in contrast with Medicare, which is federally funded and administered at the federal level by CMS. The Medicaid program was established in 1965 by amendment to the Social Security Act, under a provision entitled “Title XIX–Medical Assistance.”

MedPAC: The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program. The Commission's statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare.

Patient Self-Determination Act (PSDA): An amendment to the Omnibus Budget Reconciliation Act of 1990, the law became effective December 1991 and requires most U.S. hospitals, nursing homes, hospice programs, home health agencies, and health maintenance organizations to give adult individuals, at the time of inpatient admission or enrollment, information about their rights under state laws governing advance directives. These include the following: (1) the right to participate in and direct their own health care decisions; (2) the right to accept or refuse medical or surgical treatment; (3) the right to prepare an advance directive; and (4) information on the provider's policies governing use of these rights. The act prohibits institutions from discriminating against a patient who does not have an advance directive. The PSDA further requires institutions to document patient information and provide ongoing community education on advance medical care.

Public policy: The body of principles that underpin the operation of legal systems. This addresses the social, moral, and economic values that tie a society together: values that vary in different cultures and change over time. Law regulates behavior either to reinforce existing social expectations or to encourage constructive change, and laws are most likely to be effective when they are consistent with the most generally accepted societal norms and reflect the collective morality of the society.

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