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1992.03.06 :  Medicare/Medicaid Advance Directives

Contact: Bob Hardy 202-245-6145
March 6, 1992
 
        Hospitals, nursing homes and other providers of health care
must provide written information to adult patients on advance
directives, such as a living will or durable power of attorney for
health care, under regulations published today.
        The requirement to provide information on advance
directives as a condition of Medicare and Medicaid participation
was enacted in the Omnibus Budget Reconciliation Act of 1990.  It
became effective Dec. 1.  Under the interim final rule published
today in the Federal Register, providers and organizations must
provide patients with a description of state law regarding advance
directive requirements and the provider's or organization's
policies on advance directives.  Providers must give this
information to all adult individuals receiving medical care at
admission or before receiving services.
        The types of providers subject to this ruling include
hospitals, nursing facilities, hospice programs, health maintenance
organizations, providers of home health care and providers of
personal care services.
        The regulation requires the provider or organization to
inquire of the patient whether he or she has executed an advance
directive and to note the patient's response in his or her medical
record.  
        "The new law in no way requires individuals to execute
advance directives," said Gail R. Wilensky, Ph.D., who heads the
Health Care Financing Administration.  "What it does require is
that adult patients be informed upon admission to a health care
facility, of their right to make such directives under state laws. 
Those who desire to execute advance directives will be able to
spell out their instructions for certain types of treatment or
care."
        The rule prohibits a provider from denying care to an
individual based on whether or not the individual has executed an
advance directive, Dr. Wilensky added.  If allowed under state law,
providers are not required to implement these provisions if they
object as a matter of conscience.  
        The Department of Health and Human Services is conducting
a public education campaign to inform the public about advance
directives, as required by the law.  Providers will also be
required to educate their staffs and the community concerning
advance directives. 
        Comments on the interim final rule will be considered if
submitted within 60 days of publication in the Federal Register. 
Mail comments to the Health Care Financing Administration,
Attention: BPD-718-IFC, P.O. Box 26676, Baltimore, Md.  21207. 

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