Advance Directives & Declaration for Mental Health Treatment

DEFINITIONS:

Adult: A Member who is 18 years of age or older, who has been adjudicated an emancipated minor or who is married.

Advance Directive: A written instruction, such as a living will or durable power of attorney for health care, recognized under State law relating to the provision of health care when an individual is incapacitated pursuant to 42 CFR 438.3(j), 42 CFR 422.128, and 42 CFR 489.100.

Declaration for Mental Health Treatment: mental health treatment made when the individual is able to understand and make decisions related to treatment that are honored when they are unable to make such decisions.

Health Care: Diagnosis, treatment or care of disease, injury and congenital or degenerative conditions, including the use, maintenance, withdrawal or withholding of life-sustaining procedures and the use, maintenance, withdrawal or withholding of artificially administered nutrition and hydration.

Health Care Decision: Consent, refusal of consent or withholding or withdrawal of consent to health care, including decisions regarding admission to or discharge from a health care facility.

Health Care Representative: An adult given medical power of attorney to make health care decisions on behalf.

Incapacitation: Inability of an individual, in the opinion of the court in a proceeding to appoint or confirm authority of a Health Care Representative, or in the opinion of the individual physician, to make and communicate health care decisions to health care providers.

Member: An Oregon Health Plan client enrolled with Health Share of Oregon.

Subcontractor: A entity that has entered into a contract with Health Share of Oregon to perform designated work under the Health Plan Services Contract.

PURPOSE:

Health Share of Oregon (Health Share) recognizes the right of Members to be informed about medical care and to consent to, or refuse, treatment. Health Share also recognizes M rights to make health care decisions in advance, thus ensuring their treatment wishes will be carried out whether or not they are capable of speaking for themselves.

POLICY:

1. Health Share complies with, and ensures Subcontractors comply with, federal and state regulations regarding Advance Directives and Declarations for Mental Health Treatment.
2. Subcontractors are required to assist Members or their assigned Health Care Representative in completing advance planning documents including an Advanced Directive or Declaration for Mental Health Treatment.
3. Information is provided by Health Share and Subcontractors to Members regarding advanced planning, including:
   • The rights under Oregon Law including their right to accept or refuse mental, dental, medical or surgical treatment and the right to formulate, at the Member s option, an Advance Healthcare Directive or Declaration for Mental Health Treatment;
   • Notification that whether or not the Member executes an Advance Healthcare Directive or a Declaration for Mental Health Treatment will have no effect on the provision of health care services, and they will not be discriminated against in any way;
   • The process for a Member to request a copy of the Advance Healthcare Directive or Declaration for Mental Health Treatment;
   • Notification that should the Member be incapacitated at the time of initial Health Share enrollment and not able to receive information (due to the incapacitating condition or mental disorder) or articulate whether or not he or she has executed an Advance Directive or Declaration for Mental Health Treatment, the Delegated Entity may give information to the Member s family in accordance with State law; and
   • Existing Advance Directives or Declarations for Mental Health Treatment may be reviewed and amended at the request.
4. Subcontractors are required to inform providers of their responsibilities regarding Advance Directives and Declarations for Mental Health Treatment.
   1. Physician offices should ask adult Members if they have completed an Advance Directive and mental health providers should ask adult Members if they have completed a Declaration for Mental Health Treatment.
   2. Documentation of the existence of advanced planning documents should be prominently displayed in the clinical record.
   3. Providers are prohibited from conditioning the provision of care or otherwise discriminating against a Member based on whether or not the individual has executed an Advance Directive or Declaration for Mental Health Treatment.
5. Subcontractors are required an Advance Directive or Declaration for Mental Health Treatment.
6. Subcontractors are required to provide for community education regarding issues concerning Advance Directives that may include material as referenced in section II above. The Subcontractor must be able to document its community education efforts.
7. If a Subcontractor has made a decision that they would be unable to implement certain provisions of an Advance Directive or Declaration for Mental Health Treatment as a matter of conscience (conscientious objection), the Subcontractor must produce a clear statement of limitation that includes a description of the range of medical conditions or procedures affected by the conscientious objection, identification of the state legal authority permitting such objection, and explain the difference between institution-wide conscientious objections and those raised by individual physicians. This statement must be made available to Health Share and to Members enrolled with the objecting Subcontractor.

PROCEDURE:

1. Health Share Members receive information on how to obtain an Advance Directive in the Health Share of Oregon Member handbook. Members receive a handbook upon initial enrollment or at their request. The handbook is also available on the Health Share website. The handbook describes the rights of the Member, including information about how to obtain an Advance Directive or Declaration for Mental Health Treatment and how to file a complaint with the Oregon Board of Medical Examiners if the advance directive has not been followed.
2. Members are informed of changes in federal or state laws no later than ninety (90) days following the changes through updated information on the Health Share website. Such changes will also be incorporated in later editions of the Member handbook.
3. Information regarding Advance Directives and Declaration for Mental Health Treatment may also be provided to Members through Subcontractor websites and newsletters, provider offices, hospitals, or case managers.
4. If a Member is unable to receive advance planning information due to Incapacitation or has executed an Advance Directive or Declaration for Mental Health Treatment naming a Health Care Representative, information regarding advanced planning may be provided to the Health Care Representative in the same manner in which a Member would receive the information. If the Member, the information will be provided directly to the Member at that time.
5. Members and authorized Health Care Representatives may file a complaint if a health care provider has not followed an Advance Directive or Declaration for Mental Health Treatment. Information on how to file Advance Directive complaints with the State Survey and Certification office can be obtained from:
   Health Care Regulation and Quality Improvement Office of Community Health and Health Planning Oregon Health Authority
   800 NE Oregon Street, Suite 465
   Portland, OR 97232
   971-673-0540; fax 971-673-0556
6. Health Share monitors the performance of Subcontractors on an ongoing basis and performs, at least once a year, a formal review of compliance with all delegated functions, obligations and other responsibilities, performance deficiencies, and areas for improvement, including those related to ensuring compliance with federal and state regulations related to Advance Directives and Declarations for Mental Health Treatment. If deficiencies are found in Subcontractor performance for any delegated function, whether identified by Health Share or the Oregon Health Authority, Health Share will require the Subcontractor to respond and remedy those deficiencies within the timeframes determined by the Oregon Health Authority.

REFERENCES:
Health Plan Services Contract
Oregon Revised Statute 127.649
42 CFR 422.128
42 CFR 489, Subpart