Section
3.12 Advance Directives
3.12.1
Introduction
3.12.2 References
3.12.3 Scope
3.12.4 Did you know?
3.12.5 Definitions
3.12.6 Objective
3.12.7 Procedures
3.12.7-A: What does a mental health care power
of attorney do?
3.12.7-B: What are some of the powers and duties
of the designee(s)?
3.12.7-C: What must be provided to an adult
person at the time of enrollment?
3.12.7-D: How do I help an adult person develop
an advance directive?
3.12.7-E: What else must health care providers do
regarding advance directives?
3.12.1
Introduction
An advance directive is a written set of instructions developed
by an adult person in the event the person becomes incapable of
making decisions regarding his or her behavioral health treatment.
An advance directive instructs others regarding the person’s
wishes if he/she becomes incapacitated and can include the appointment
of a friend or relative to make behavioral health care decisions
for the person. A person prepares an advance directive when
capable and the directive is followed when the person is incapable
of making treatment decisions. This section outlines the requirements
of behavioral health care providers with regard to advance directives.
3.12.2
References
The following citations can serve as additional resources for this
content area:
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3.12.3
Scope
All adult persons enrolled in the behavioral health system.
3.12.4
Did you know?
Advance directives not only identify services a person
would desire if he or she becomes unable to make a decision,
advance directives also:
- Promote
individual treatment planning;
- Provide opportunities
to create a team approach to treatment; and
- Foster recovery
approaches.
The Arizona Secretary of State (www.azsos.gov) maintains a free registry called the “Arizona Advance Directive” where individuals can send advance directives for secure storage and can be accessible to individuals, loved ones and health care providers. This webpage also has other resources available on advanced directives.
If changes
occur in State law regarding advance directives, adult persons
receiving behavioral health services must be notified by their
provider regarding
the changes as soon as possible, but no later than 90 days after
the effective date of the change.
3.12.5
Definitions
Advance
Directive
Health
Care Power of Attorney
Mental
Health Care Power of Attorney
3.12.6
Objective
To ensure behavioral health care providers comply with Federal and
State laws regarding advance directives for adult persons.
3.12.7
Procedures
3.12.7-A.
What does a mental health care power of attorney do?
A mental health care power of attorney gives an adult person
the right to designate another adult person to make behavioral health
care treatment decisions on his or her behalf. The designee may make
decisions on behalf of the adult person if/when she or he is found incapable
of making these types of decisions. The designee, however, must
not be a provider directly involved with the behavioral health treatment
of the adult person at the time the mental health care power of
attorney is executed.
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3.12.7-B.
What are some of the powers and duties of the designee(s)?
The designee:
- May act
in this capacity until his or her authority is revoked by the adult
person or by court order;
- Has the
same right as the adult person to receive information and to review
the adult person’s medical records regarding proposed behavioral
health treatment and to receive, review and consent to the disclosure
of medical records relating to the adult person’s treatment;
- Must act
consistently with the wishes of the adult person as expressed
in the mental health care power of attorney. If, however, the
adult person’s wishes are not expressed in a mental health
care power of attorney and are not otherwise known by the designee,
the designee must act in good faith and consent to treatment that
she or he believes to be in the adult person’s best interest;
and
- May consent
to admitting the adult person to a level 1 behavioral health facility
licensed by the Arizona Department of Health Services if this authority
is expressly stated in the mental health care power of attorney
or health care power of attorney.
See
A.R.S. §36-3283
for a complete list of the powers and duties of an agent designated
under a mental health care power of attorney.
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3.12.7-C.
What must be provided to an adult person at the time of enrollment?
At the time of enrollment, all adult persons and when the
individual is incapacitated or unable to receive information, the
enrollee’s family or surrogate, must receive
information regarding (see
42 C.F.R.
§
422.128):
- The person’s
rights, in writing, regarding advance directives under Arizona State law;
- A
description of the applicable State law (summarized in 3.12.7-A
and 3.12.7-B above); and information regarding the
implementation of these rights;
- The
behavioral health recipient's right to file complaints directly
with AHCCCS; and
- Written
policies including a clear and precise statement of limitations
if the provider cannot implement an advance directive as a matter
of conscience. This statement, at a minimum should:
- Clarify
institution-wide conscience objections and those of individual
physicians;
- Identify
state legal authority permitting such objections; and
- Describe
the range of medical conditions or procedures affected by
the conscience objection.
If an enrollee is incapacitated at the time
of enrollment, behavioral health providers may give advance directive information to the enrollee’s
family or surrogate in accordance with state law.
Behavioral health providers must also follow up when the person is no longer incapacitated and
ensure that the information is given to the person directly.
3.12.7-D.
How do I help an adult person develop an advance directive?
Behavioral health providers must assist adult persons who
are interested in developing and executing an advance directive.
The T/RBHA can offer the following resources: The Gila River RBHA
provides information regarding advance directives to all enrolled
adults and is available to assist individuals in executing an advance
directive upon request. Adult persons are encouraged to speak with
their Gila River RBHA Clinician or physician for additional information.
3.12.7-E:
What else must health care providers do regarding advance directives?
The Gila River T/RBHA must:
- Document
in the adult person’s clinical record whether or not the
adult person was provided the information and whether an advance
directive was executed;
- Not
condition provision of care or discriminate against an adult
person because of his or her decision to execute or not to
execute an advance directive;
- Provide a
copy of a person’s executed advanced directive, or documentation
of refusal, to the acute care primary care provider (PCP) for
inclusion in the person’s medical record; and
- Provide
education to staff on issues concerning advance directive
including notification of direct care providers of services,
such as home health care and personal care, of any advance
directives executed by behavioral health recipients to whom they
are assigned to provide services.
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3.12
Advance Directive
Last Revised: 10/20/2011
Effective Date: 12/01/2011 |
