CurrentAdvanced HealthPolicy N/A

Advance Directives Policy and Procedures

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This policy governs how Advanced Health and its Network Providers inform and support adult Members regarding Advance Directives, treatment decisions, and Member Representatives. It establishes nondiscrimination, documentation, complaint, oversight, training, and accountability requirements.

Policy Summary

PayerAdvanced Health

PolicyAdvance Directives Policy and Procedures

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Last ReviewOct 27, 2026

Next Review DateN/A

Key ActionMaintain documentation of each adult Member’s Advance Directive status in a prominent part of the current medical record.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Adult MembersPopulation covered by the policy

90 daysMaximum update period after a State law change

0Conscientious objections maintained

5Required enrollment communication elements

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CurrentAdvanced HealthPolicy N/A

Advance Directives Policy and Procedures

Customize your policy alerts

Sign up for all advancedhealth policy alerts

Know when advancedhealth releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerAdvanced Health

PolicyAdvance Directives Policy and Procedures

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Last ReviewOct 27, 2026

Next Review DateN/A

Key ActionMaintain documentation of each adult Member’s Advance Directive status in a prominent part of the current medical record.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Adult MembersPopulation covered by the policy

90 daysMaximum update period after a State law change

0Conscientious objections maintained

5Required enrollment communication elements

Advance Directive Requirements

Advance Directive operational requirements

Advanced Health and Network Providers must meet the following Advance Directive requirements for adult Members.

ALL of the following

Provide written information to adult Members receiving medical care about their rights to accept or refuse medical or surgical treatment, formulate Advance Directives, and understand how Advance Directives are implemented.
Do not condition authorization or provision of a Member's care on whether the Member has executed an Advance Directive.
Do not discriminate against a Member based on whether the Member has executed an Advance Directive.
Maintain documentation of the Member's executed Advance Directive, or documentation of whether the Member has executed one, in a prominent part of the Member's current medical record.
Provide Advance Directive information in the Member's preferred language or alternate format through enrollment communications, including information about the right to accept or refuse treatment, applicable implementation policies, conscientious-objection limitations, differences between institution-wide and Network Provider objections, and complaint procedures.
When a Member reports Provider noncompliance with an Advance Directive, inform the Member that a complaint may be filed with the Oregon Health Authority.

When applicable

If a Member is incapacitated at enrollment or when medical care is initiated and cannot receive information or articulate whether an Advance Directive exists, provide Advance Directive information to the Member's family or Member's Representative in accordance with State law. If the incapacity is temporary, communicate directly with the Member once the Member is no longer incapacitated.

When applicable

If Advanced Health adopts a conscientious objection in the future, revise these policies and procedures, inform the Oregon Health Authority, describe the affected medical conditions, procedures, and limitations, and comply with applicable CMS or Oregon Health Authority legal rulings.

Provider Responsibilities and Member Support

Documentation Required

Inform adult Members of Advance Directive rights

Provide written information to all adult Members receiving medical care about their rights under State law, including the right to accept or refuse medical or surgical treatment, formulate Advance Directives, and understand how an Advance Directive is implemented.

Denial Risk

Do not condition care on an Advance Directive

Do not condition authorization or provision of care on whether a Member has executed an Advance Directive. Do not otherwise discriminate against a Member based on whether or not the Member has executed one.

Documentation Required

Document Advance Directive status

Maintain documentation of the Member’s executed Advance Directive in a prominent part of the Member’s current medical record. The medical record must also document whether or not the Member has executed an Advance Directive.

Documentation Required

Escalate provider noncompliance

Providers identified as noncompliant with a Member’s Advance Directive or treatment decision are referred by the Chief Medical Officer and the Credentialing and Access Committee for review.

Documentation Required

Update Advance Directive information

Keep information provided to Members and Providers current and reflective of changes in State law as soon as possible after the changes become effective, and no later than 90 calendar days after the effective date.

Documentation Required

Provide complaint pathway

If a Member reports Provider noncompliance with an Advance Directive, inform the Member that they may file a complaint with the Oregon Health Authority.