The Catechism states that only mortal sins would exclude one from receiving Communion. If one is aware of mortal sin(s), one should refrain from going forward to receive if they have not first gone to sacramental confession.
 
As the Catechism notes, there are rare exceptions to this rule. Canonists define "grave reason to receive communion" in different ways, but most all concur that the reason must be more serious than ordinary embarrassment at not going forward. Most restrict it to danger of death. Even in such cases the communicant is required to make an act of contrition that includes the intent to confess the sin later, if a priest can reasonably be found.
 
There are some who struggle with habitual mortal sin, e.g. masturbation, and in such cases they should work closely with a confessor so as to be able to stay faithful to communion.

The catechism, while less than exact in the quote you supply does footnote Canon 989 for greater precision, which says: All the faithful who have reached the age of discretion are bound faithfully to confess their grave sins at least once a year.
 
The Catechism states elsewhere: According to the Church's command, "after having attained the age of discretion, each of the faithful is bound by an obligation faithfully to confess serious sins at least once a year." Anyone who is aware of having committed a mortal sin must not receive Holy Communion, even if he experiences deep contrition, without having first received sacramental absolution, unless he has a grave reason for receiving Communion and there is no possibility of going to confession. (#1457).
 
Thus, there is no change in the precept, though one may admit the catechism could have been more precise in the text you cite.
 
That said, it may be of some pastoral advantage to remember that there is a tendency today to minimize the possibility and frequency of mortal sin. It is not hard to understand that most of the adult faithful ought to be getting to confession more than once a year anyway. It is quite likely that most adults, even if not guilty of sins against life and sexual purity, are often guilty of rather serious sins against charity. It is quite possible to cause serious harm, and emotional or spiritual distress to people by harsh things we say. Further, lies can cause more than minimal harm, reputations can be tainted, people misled, and error flourish. Sins of omission through greed, neglect or laziness can also cause grave harm. Missing Mass is a mortal sin, and being significantly neglectful in handing on or defending the faith can also become quite serious.
 
More could be said here, but one ought not to causally dismiss that they should likely get to confession even more than once a year. Further, the Church also encourages the faithful to confess frequently even if they are not aware of mortal sin since the Sacrament of Confession not only confers the grace of absolution, but also the grace to avoid sin in the future.

St. Augustine states this in The City of God, XV, 22. Essentially what Augustine is teaching is that we can become too focused on lesser goods and, thereby, neglect higher goods.
 
Physical beauty, though somewhat differently defined, does exist, and is a pleasant gift of God to behold. But we can esteem it too much, failing to realize that spiritual beauty; truth, goodness, holiness and God Himself, are far greater gifts. Hence, God signals the limits of physical beauty by often bestowing it on those who may seem undeserving of it, to teach us that physical beauty is a limited good.
 
St. Augustine continues, “And thus beauty, which is indeed God’s handiwork, but only a temporal, carnal, and lower kind of good, is not fitly loved in preference to God…” The problem is not with beauty, but with us. So Augustine adds, “When the miser prefers gold to justice, it is through no fault of the gold, but of the man; and so with every created thing.”

Church teaching on this matter is clear. Nutrition and hydration, even by artificial means (e.g. a feeding tube), cannot simply be terminated because doctors have determined that a person will never recover consciousness. A statement from the Congregation for the Doctrine of the Faith emphasized that administering food and water to a patient in a persistently unconscious state is morally obligatory "to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient." "In this way suffering and death by starvation and dehydration are prevented."

Exceptions may occur when patients are unable to assimilate food and water or in the "rare" cases when nutrition and hydration become excessively burdensome for the patient because the fluids swamp the body.

Nutrition and hydration are not extraordinary care since they are not excessively expensive and do not necessarily require hospitalization. Giving them is not a treatment that cures the patient, but is ordinary care aimed at the preservation of life.

A priest should certainly handle these sorts of cases. The priest for his part, in encountering cases like this should ascertain the facts and be sure it is not a rare case where the food or fluids, because they cannot be digested offer no help, and only intensify suffering. Precluding such rare cases, he should then instruct and admonish the family to see that caretakers provide food and water (usually via a tube).

Unfortunately, if the family or caretaker with medical power of attorney refuses, there are very few legal remedies in most jurisdictions. Judges have usually ruled that food and water through a tube is not required care for those who are unconscious.

Many do die prematurely on account of this flawed understanding of ordinary and necessary medical care. It is another tragic example of the world’s rejection of Church’s teachings on life.

The first destination is the judgment seat of Christ: It is appointed unto men once to die, and after this the judgment (Heb 9:27). And again, For we must all appear before the judgment seat of Christ, that each one may receive what is due him for the things done while in the body, whether good or bad. (2 Cor 5:10)

From here are three possible destinations. Many do go to Heaven, the ultimate destination of all who believe in the Lord and, by his grace, die in love, and friendship with him, and are perfected.

But most of the heaven-bound likely first experience Purgatory where those who die in friendship with God, but are not yet fully perfected in His love, are purified and then drawn to heaven (cf 1 Cor 3:12-15).

Finally, some go from judgment to Hell, for by their own choice they rejected God and the values of the Kingdom. It is wrong, as some do, to dismiss Hell as an unlikely possibility since the Lord Jesus taught frequently of it, and warned that many were on the wide road that led there.