Section 471-1-006 - ADVANCE DIRECTIVES An advance directive is a written instruction, such as a living will or durable power of attorney for health care, recognized under applicable law that relates to the provision of medical care if the client becomes incapacitated. Medicaid-participating hospitals, nursing facilities, providers of home health care or personal care services, hospice programs, and Managed Care Organizations (MCOs) must.
(A) Maintain written policies, procedures, and materials concerning advance directives;(B) Provide written information to all adult clients receiving medical care by or through the provider or organization concerning their rights under applicable law to: (1) Make decisions concerning their medical care;(2) Accept or refuse medical or surgical treatment; and(3) Formulate advance directives, such as living wills or durable power of attorney for health care; and(C) Provide written information to all adult clients on the provider's policies concerning implementation of these rights;(D) Document in the client's medical record whether the client has executed an advance directive;(E) Not condition the provision of care or otherwise discriminate against a client based on whether that client has executed an advance directive;(F) Ensure compliance with requirements of applicable law concerning advance directives; and(G) Provide for educating staff and the community on advance directives.006.01WHEN PROVIDERS GIVE INFORMATION CONCERING ADVANCE DIRECTIVES. Providers must give information concerning advance directives to each adult client as follows. (A) A hospital must give information at the time of the client's admission as an inpatient;(B) A nursing facility must give information at the time of the client's admission as a resident;(C) A provider of home health care or personal care services must give information to the client in advance of the client's coming under the care of the provider;(D) A hospice program must give information at the time of initial receipt of hospice care by the client; and(E) A Managed Care Organization (MCO) must give information at the time of enrollment. If a managed care plan has more than one medical record for its members, it must document in all medical records.006.02INFORMATION CONCERING ADVANCE DIRECTIVES AT THE TIME AN INCAPACITATED CLIENT IS ADMITTED. A client could be admitted to a facility in a comatose or otherwise incapacitated state and be unable to receive information or articulate whether the client has executed an advance directive. In this case, to the extent that a facility issues materials about policies and procedures to the families or to the surrogates or other concerned persons of the incapacitated client in accordance with applicable law, it must also include the information concerning advance directives. This does not relieve the facility from its obligation to provide this information to the patient once the client is no longer incapacitated.006.03PREVIOUSLY EXECUTED ADVANCE DIRECTIVES. When the client or a relative, surrogate, or other concerned or related client presents the facility with a copy of the client's advance directive, the facility must comply with the advance directive to the extent allowed under applicable law. This does not preclude a facility from objecting as a matter of conscience, if it is permitted to do so under applicable law.006.04INFORMATION CONCERNING ADVANCE DIRECTIVES ABSENT CONTRARY LAW. Absent contrary applicable law, if no one comes forward with a previously executed advance directive and the client is incapacitated or otherwise unable to receive information or articulate whether the client has executed an advance directive, the facility will note that the client was not able to receive information and was unable to communicate whether an advance direct.471 Neb. Admin. Code, ch. 1, § 006
Amended effective 9/21/2020