CMS Signals Renewed Focus on Advance Directives

This North Carolina law firm caught my eye with this headline: "CMS Signals Renewed Focus on Advance Directives" in one of its newsletters.  Here is the key language from the newsletter summarizing the impact of this CMS Memo:



On September 27, 2012, CMS issued revised surveyor guidance in Appendix PP to the state operations manual, further interpreting F Tag 155, which is based on 42 Code of Federal Regulations section 483.10(b)(4). The revised guidelines became effective on November 30, 2012.  The regulation itself has not changed, nor has the Federal Patient Self- Determination Act on which the regulation and the surveyor guidance are based. However, in this revised guidance in Appendix PP, CMS reaffirms its commitment to resident choice in end-of-life care and its direction to surveyors to assess providers’ compliance with that right in annual recertification and complaint surveys.



CMS describes four key expectations of SNFs in the revised guidance:

1. To establish and maintain policies and procedures governing the right of choice in end-of-life health care decision-making;


2. To inform and educate residents, or their legal surrogate, about end-of-life choices and the facility’s policies regarding how residents exercise these rights;


3. To help residents exercise these rights by creating advance directives (living wills, health care powers of attorney or other advance directives recognized by state law); and


4. To incorporate residents’ choices into treatment, care and services, specifically including initial, ongoing and revised care planning as a resident’s health care status changes over time.

CMS also (a) spells out the elements that must be addressed in each SNF’s policies and procedures on end-of-life care, (b) defines the normal survey sample for end-of-life issues, and (c) contains examples of deficiency categories applicable to violations of these expectations.