Kentucky 2024 Regular Session Status: Passed House 1 R cosponsors

HB 645 — AN ACT relating to medical orders for scope of treatment.

Last action — to Committee on Committees (S)

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2024 Regular Session. It reached “Passed House” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Summary

Amend KRS 311.6225 to make changes to the medical order for scope of treatment form.

Bill Text

What changed in the latest version

109 added · 90 removed

109 line(s) added, 90 removed.

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UNOFFICIAL COPY 24 RS BR 1710 AN ACT relating to medical orders for scope of treatment.
UNOFFICIAL COPY 24 RS HB 645/GA AN ACT relating to medical orders for scope of treatment.
and Page 1 of 12 XXXX 2/22/2024 11:46 AM Jacketed UNOFFICIAL COPY 24 RS BR 1710 include the statement "When not in cardiopulmonary arrest, follow orders in B, C, and D.";
and Page 1 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA include the statement "When not in cardiopulmonary arrest, follow orders in B, C, and D.";
Page 2 of 12 XXXX 2/22/2024 11:46 AM Jacketed UNOFFICIAL COPY 24 RS BR 1710 Treatment Plan:
Page 2 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA Treatment Plan:
hip fracture)].".
hip fracture)]."[.
[These options shall be followed by a space for other instructions;] (c) Section C of the form shall direct the use of artificially administered fluids and nutrition, including always offering food and fluids by mouth as tolerated, and shall include a statement that medically assisted nutrition and hydration when it cannot reasonably be expected to prolong life, would be more burdensome than beneficial, or would cause significant physical discomfort.
These options shall be followed by a space for other instructions];
(c) Section C of the form shall direct the use of artificially administered fluids and nutrition, including always offering food and fluids by mouth as tolerated, and shall include a statement that medically assisted nutrition and hydration when it cannot reasonably be expected to prolong life, would be more burdensome than beneficial, or would cause significant physical discomfort.
Page 3 of 12 XXXX 2/22/2024 11:46 AM Jacketed UNOFFICIAL COPY 24 RS BR 1710 3.
Page 3 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA 3.
or Page 4 of 12 XXXX 2/22/2024 11:46 AM Jacketed UNOFFICIAL COPY 24 RS BR 1710 c.
or Page 4 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA c.
The provision of nutrition and fluids, even if medically administered, is a basic human right and authorization to deny or withdraw shall be limited to the patient, the surrogate in accordance with KRS 311.629, or the responsible Page 5 of 12 XXXX 2/22/2024 11:46 AM Jacketed UNOFFICIAL COPY 24 RS BR 1710 party in accordance with KRS 311.631.";
The provision of nutrition and fluids, even if medically administered, is a basic human right and authorization to deny or withdraw shall be limited to the patient, the surrogate in accordance with KRS 311.629, or the responsible Page 5 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA party in accordance with KRS 311.631.";
Indicate whether oral or written directions were given and, if so, by which one Page 6 of 12 XXXX 2/22/2024 11:46 AM Jacketed UNOFFICIAL COPY 24 RS BR 1710 (1) or more of the following:
Indicate whether oral or written directions were given and, if so, by which one Page 6 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA (1) or more of the following:
The provision of nutrition and fluids, even if Page 7 of 12 XXXX 2/22/2024 11:46 AM Jacketed UNOFFICIAL COPY 24 RS BR 1710 medically administered, is a basic human right and authorization to deny or withdraw shall be limited to the patient, the surrogate in accordance with KRS 311.629, or the responsible party in accordance with KRS 311.631.";
The provision of nutrition and fluids, even if Page 7 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA medically administered, is a basic human right and authorization to deny or withdraw shall be limited to the patient, the surrogate in accordance with KRS 311.629, or the responsible party in accordance with KRS 311.631.";
Page 8 of 12 XXXX 2/22/2024 11:46 AM Jacketed UNOFFICIAL COPY 24 RS BR 1710 1.
Page 8 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA 1.
Page 9 of 12 XXXX 2/22/2024 11:46 AM Jacketed UNOFFICIAL COPY 24 RS BR 1710 "This MOST must be reviewed at least annually, at any time the patient or patient's representative requests and when[ or earlier if]:
Page 9 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA "This MOST must be reviewed at least annually, at any time the patient or patient's representative requests and when[ or earlier if]:
(3)[(2)] The Kentucky Board of Medical Licensure shall promulgate administrative regulations in accordance with KRS Chapter 13A to develop the format for a standardized medical order for scope of treatment form to be approved by the board, including spacing, size, borders, fill and location of boxes, type of fonts used Page 10 of 12 XXXX 2/22/2024 11:46 AM Jacketed UNOFFICIAL COPY 24 RS BR 1710 and their size, and placement of boxes on the front or back of the form so as to fit on a single sheet.
(3)[(2)] The Kentucky Board of Medical Licensure shall promulgate administrative regulations in accordance with KRS Chapter 13A to develop:
(a) The format for a standardized medical order for scope of treatment form to be approved by the board, including spacing, size, borders, fill and location of Page 10 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA boxes, type of fonts used and their size, and placement of boxes on the front or back of the form so as to fit on a single sheet.
The board may not alter the wording or order of wording provided in subsection (1) or (2)[subsection (1)] of this section, except to provide translated versions of the MOST form or add identifying data such as form number and date of promulgation or revision and instructions for completing, reviewing, and revoking the election of the form.
The board may not alter the wording or order of wording provided in subsection (1) or (2)[subsection (1)] of this section, except to provide translated versions of the MOST form or add identifying data such as form number and date of promulgation or revision and instructions for completing, reviewing, and revoking the election of the form;
The board shall provide a translation of the MOST form in print and in an electronically fillable version into Spanish, and other languages as needed.
and (b) A guide to advance care planning that describes the following three (3) options for advance care planning:
The board shall consult with appropriate professional organizations to develop the format for the medical order for scope of treatment form, including:
1.
An advance directive as defined in KRS 311.621;
2.
A power of attorney including advance health care instructions;
and 3.
A medical order for scope of treatment.
(4) The board shall:
(a) Provide a translation of the MOST form in print and in an electronically fillable version into Spanish, and other languages as needed;
(b) Provide a translation of the guide to advance care planning into Spanish, and other languages as needed;
and (c) Make the MOST form and the guide to advance care planning accessible on its website.
(5) The board shall consult with appropriate professional organizations to develop the format for the medical order for scope of treatment form and the guide to advance care planning, including:
(d) The Kentucky Association of Health Care Facilities;
Page 11 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA (d) The Kentucky Association of Health Care Facilities;
Page 11 of 12 XXXX 2/22/2024 11:46 AM Jacketed UNOFFICIAL COPY 24 RS BR 1710 (e) The expiration or review date of the form, which shall be no more than one (1) calendar year from the effective date of the form;
(e) The expiration or review date of the form, which shall be no more than one (1) calendar year from the effective date of the form;
however, if it is not practicable for the patient's surrogate or a responsible party to sign the original form, the surrogate or a responsible party shall sign a copy of the completed form and return it to the health care provider completing the form.
however, if it is not practicable for the patient's surrogate or a responsible party to sign the original form, the surrogate or a responsible party Page 12 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA UNOFFICIAL COPY 24 RS HB 645/GA shall sign a copy of the completed form and return it to the health care provider completing the form.
When the signature of the surrogate or a responsible party is on a separate copy of the form, the original form shall indicate in the appropriate signature field that the signature is attached.] (4)[(6)] The MOST form may be electronic or printed on any color of paper and the form shall be honored on any color of paper.
When the signature of the surrogate or a responsible party is on a separate copy of the form, the original form shall indicate in the appropriate signature field that the signature is attached.] (6) The MOST form may be electronic or printed on any color of paper and the form shall be honored on any color of paper.
Page 12 of 12 XXXX 2/22/2024 11:46 AM Jacketed
(7) Health care professionals are encouraged to provide a copy of the guide to advance care planning to the patient, surrogate, or responsible party at the time a MOST form is being completed.
Page 13 of 13 HB064510.100 - 1710 - XXXX 3/12/2024 3:20 PM GA
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How this bill changes current law

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Compared against the Kentucky Revised Statutes as published AI-generated reading aid — verify against the official bill.

The bill amends the Kentucky medical order for scope of treatment (MOST) form to include new requirements and options for content, as well as additional instructions for completion and review.

  • KRS 311.6225

    the effective date of the form, including the statement "Form must be reviewed at least annually"

    Removes the requirement for stating the effective date and annual review of the MOST form.

  • KRS 311.6225

    other → health care professionals

    Specifies that only health care professionals are permitted to access the MOST form as necessary for treatment.

  • KRS 311.6225

    This document is based on this person's medical condition and wishes.

    Removes a statement concerning the basis of the document being the patient's condition and wishes.

  • KRS 311.6225

    scope of treatment → medical interventions

    Changes the terminology from 'scope of treatment' to 'medical interventions' in Section B of the form.

  • KRS 311.6225

    the use of intubation, advanced airway interventions, mechanical ventilation, defibrillation or cardioversion as indicated, medical treatment, intravenous fluids, and comfort measures. This option shall include the statement "Transfer to a hospital if indicated. Includes intensive care. Treatment Plan: Full treatment, including life support measures". → including intensive care.

    Streamlines the language related to full treatment options while preserving the intent.

  • KRS 311.6225

    including the use of medical treatment, oral and intravenous medications, intravenous fluids, cardiac monitoring as indicated, noninvasive bi-level positive airway pressure, a bag valve mask, and comfort measures. This option excludes the use of intubation or mechanical ventilation. This option shall include the statement "Transfer to a hospital if indicated. Avoid intensive care. Treatment Plan: Provide basic medical treatments". → requires avoidance of intensive care and transfer to a hospital if treatment needs cannot be met in the current location.

    Clarifies limitations on medical interventions for limited additional intervention as described.

  • KRS 311.6225

    keeping the patient clean, warm, and dry; use of medication by any route; positioning, wound care, and other measures to relieve pain and suffering; and the use of oxygen, suction, and manual treatment of airway obstruction as needed for comfort. This option shall include the statement "Do not transfer to a hospital unless comfort needs cannot be met in the patient's current location (e.g. hip fracture)".

    Removes specific language on maintaining patient comfort while streamlining the comfort measures.

  • KRS 311.6225

    oral and intravenous antibiotics by selection of one (1) of the following: 1. Antibiotics if indicated for the purpose of maintaining life; 2. Determine use or limitation of antibiotics when infection occurs; 3. Use of antibiotics to relieve pain and discomfort; or 4. No antibiotics, use other measures to relieve symptoms.

    Removes the specific options regarding antibiotic use from Section C, focusing instead on artificial nutrition.

  • KRS 311.6225

    The provision of nutrition and fluids, even if medically administered, is a basic human right and authorization to deny or withdraw shall be limited to the patient, the surrogate in accordance with KRS 311.629, or the responsible party in accordance with KRS 311.631.

    Removes the statement regarding nutrition and fluids as a basic human right from the MOST form.

  • KRS 311.6225

    Indicate whether oral or written directions were given and, if so, by which one (1) or more of the following: a. Patient; b. Parent or guardian if patient is a minor; c. Surrogate appointed by the patient's advance directive; d. The judicially appointed guardian of the patient, if the guardian has been appointed and if medical decisions are within the scope of the guardianship; e. The attorney-in-fact named in a durable power of attorney, if the durable power of attorney specifically includes authority for health care decisions; f. The spouse of the patient; g. An adult child of the patient or, if the patient has more than one (1) child, the majority of the adult children who are reasonably available for consultation; h. The parents of the patient; and i. The nearest living relative of the patient or, if more than one (1) relative of the same relation is reasonably available for consultation, a majority of the nearest living relatives.

    Removes the detailed list of individuals who may provide directions in the MOST form.

Action History

  1. to Committee on Committees (S)

  2. received in Senate

  3. 3rd reading, passed 95-0 with Committee Substitute (1)

  4. posted for passage in the Regular Orders of the Day for Monday, March 11, 2024

  5. 2nd reading, to Rules

  6. reported favorably, 1st reading, to Calendar with Committee Substitute (1)

  7. to Health Services (H)

  8. to Committee on Committees (H)

  9. introduced in House

Sponsors

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 137 not signed on

Sponsors (1)

Co-sponsors (0)

None.

Not signed on (137)

137 members have not signed on to this bill.

Show all 137 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Pass

Passed 95 Yea · 0 Nay · 3 Other
Party YeaNayPresentNot Voting
Democrat 15000
Republican 70002
Unaffiliated 10001
Total 95003
% of votes cast 97%0%0%3%
How each member voted (98)
Member Party Vote
Heath — Yea
Dixon — Yea
Bentley — Yea
Palumbo — Yea
Timoney — Yea
Pratt — Yea
Raymond — Yea
Graham — Yea
Justice — Not Voting
Bratcher K. — Yea
Stevenson C — Yea
Adrielle Camuel Democrat Yea
Al Gentry Democrat Yea
Ashley Tackett Laferty Democrat Yea
Beverly Chester-Burton Democrat Yea
Chad Aull Democrat Yea
Daniel Grossberg Democrat Yea
George Brown Jr. Democrat Yea
Keturah J. Herron Democrat Yea
Lindsey Burke Democrat Yea
Lisa Willner Democrat Yea
Nima Kulkarni Democrat Yea
Pamela Stevenson Democrat Yea
Rachel Roarx Democrat Yea
Sarah Stalker Democrat Yea
Tina Bojanowski Democrat Yea
Adam Bowling Republican Yea
Amy Neighbors Republican Yea
Bill Wesley Republican Yea
Bobby McCool Republican Not Voting
Candy Massaroni Republican Yea
Chris Freeland Republican Yea
Chris Fugate Republican Yea
DJ Johnson Republican Yea
Daniel Elliott Republican Yea
Daniel Fister Republican Yea
David Hale Republican Yea
David Meade Republican Yea
David W. Osborne Republican Yea
Deanna Gordon Republican Yea
Derek Lewis Republican Yea
Emily Callaway Republican Yea
Felicia Rabourn Republican Yea
James Tipton Republican Yea
Jared Bauman Republican Yea
Jason Nemes Republican Yea
Jason Petrie Republican Yea
Jennifer Decker Republican Yea
Jim Gooch Jr. Republican Yea
John Blanton Republican Not Voting
John Hodgson Republican Yea
Josh Branscum Republican Yea
Josh Bray Republican Yea
Josh Calloway Republican Yea
Ken Fleming Republican Yea
Ken Upchurch Republican Yea
Kevin Jackson Republican Yea
Kim Banta Republican Yea
Kim King Republican Yea
Kimberly Poore Moser Republican Yea
Marianne Proctor Republican Yea
Mark Hart Republican Yea
Mary Beth Imes Republican Yea
Matt Lockett Republican Yea
Matthew Koch Republican Yea
Michael Meredith Republican Yea
Michael Sarge Pollock Republican Yea
Mike Clines Republican Yea
Myron Dossett Republican Yea
Nancy Tate Republican Yea
Nick Wilson Republican Yea
Patrick Flannery Republican Yea
Randy Bridges Republican Yea
Rebecca Raymer Republican Yea
Richard White Republican Yea
Robert Duvall Republican Yea
Ryan Dotson Republican Yea
Samara Heavrin Republican Yea
Savannah Maddox Republican Yea
Scott Lewis Republican Yea
Scott Sharp Republican Yea
Shane Baker Republican Yea
Shawn McPherson Republican Yea
Stephanie Dietz Republican Yea
Steve Bratcher Republican Yea
Steve Rawlings Republican Yea
Steve Riley Republican Yea
Steven Doan Republican Yea
Steven Rudy Republican Yea
Susan Witten Republican Yea
Suzanne Miles Republican Yea
T.J. Roberts Republican Yea
Thomas Huff Republican Yea
Timmy Truett Republican Yea
Tom Smith Republican Yea
Wade Williams Republican Yea
Walker Thomas Republican Yea
William Lawrence Republican Yea

Official roll call →

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does HB 645 do?
Amend KRS 311.6225 to make changes to the medical order for scope of treatment form.
Who sponsors HB 645?
HB 645 is sponsored by Rebecca Raymer (Republican).
What is the current status of HB 645?
This bill died with 2024 Regular Session. It reached “Passed House” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track HB 645?
Track HB 645 free on One Click Politics — get push/email alerts when it moves.

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