DAR File No. 37442

Health, Family Health and Preparedness, Licensing

Rule R432-31

Life with Dignity Order

Notice of Proposed Rule

(Amendment)

DAR File No.: 37442
Filed: 03/25/2013 08:21:28 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The previous version of the rule was separated into sections for different provider types and had different requirements for each section, resulting in some confusion for health care providers. The Governor's Commission on Aging recommended some changes to clarify the rule and to update requirements to current national standards of practice. This rule amendment was reviewed and approved on 02/13/2013 by the Health Facility Committee which has representation of the type of providers this rule would apply to.

Summary of the rule or change:

The amendments streamline the rule by creating the same requirements for all provider types. The amendments define policy and procedures that are required to be implemented in all licensed health care facilities in regards to the use of the Life with Dignity Form. One major change is that health facilities no longer need to offer Life With Dignity Forms to every patient or resident; only those that have conditions outlined in the rule that may lead to the use of the form.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 21

Anticipated cost or savings to:

the state budget:

This rule amendment will have no effect on state budgets since there will be no change in current practice.

local governments:

This rule amendment will have no effect on local government budgets since there will be no change in current practice.

small businesses:

This rule amendment will have no effect on small businesses since there will be no change in current practice.

persons other than small businesses, businesses, or local governmental entities:

This rule amendment will have no effect on persons since there will be no change in current practice.

Compliance costs for affected persons:

This rule amendment will have no effect on persons since there will be no change in current practice.

Comments by the department head on the fiscal impact the rule may have on businesses:

This amendment will have little or no impact on affected business because it simplifies statutorily required procedures currently in place.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Licensing
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Joel Hoffman at the above address, by phone at 801-538-6279, by FAX at 801-538-6024, or by Internet E-mail at jhoffman@utah.gov
• Carmen Richins at the above address, by phone at 801-538-9087, by FAX at 801-538-6024, or by Internet E-mail at carmenrichins@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

05/15/2013

This rule may become effective on:

05/22/2013

Authorized by:

David Patton, Executive Director

R432. Health, Family Health and Preparedness, Licensing.

R432-31. Life with Dignity Order.

R432-31-1. Authority and Purpose.

(1) This rule is adopted pursuant to Utah Code Title 26, Chapter 21, and Section 75-2a-106.

(2) This rule establishes the forms and systems for Life with Dignity Orders.

 

R432-31-2. Definitions.

The definitions found in Sections UCA 26-21-2 and 75-2a apply to this rule. In addition, "licensed health care facility" means a facility or entity licensed pursuant to Title 26, Chapter 21, Health Care Facility Licensing and Inspection Act.

 

R432-31-3. Life with Dignity Order Forms.

(1) An individual who desires to execute a Life with Dignity Order must use a form or electronic format approved[created] by the Department. The form may not be altered in layout or style, including font style and size, without the express written permission of the Department.

(2) Any person, health care provider or health care facility may obtain a form from the Department and, if made available by the Department, from a website established for that purpose.

(3) A health care provider, licensed health care facility, or EMS provider may act upon a copy of a Life with Dignity Order as if it were the original.

 

R432-31-4. Facility Policies and Procedures.[Facilities That Must Offer Life with Dignity Orders-Policies and Procedures.]

(1) [The following] H[h]ealth care facilities must[ comply with Subsection (2):

(a) a general acute hospital licensed under R432-100;

(b) a long-term acute care hospital licensed under R432-104;

(c) a nursing care facility licensed under R432-150;

(d) a mental disease facility licensed under R432-151;

(e) a mental retardation facility licensed under R432-152;

(f) a small health care facility (four to sixteen beds) licensed under R432-200;

(g) an assisted living facility licensed under R432-270;

(h) a small health care facility - type N licensed under R432-300;

(i) a hospice agency licensed under R432-750, whether inpatient or home-based;

(j) a critical access hospital licensed under R432-106;

(k) a home health agency licensed under R432-700; and

(l) a personal care agency licensed under R432-725.

(2) Each facility described in Subsection (1) shall] establish and implement[follow] policies and procedures that conform to Section 75-2a-106[ and that assure that:].

(2) Health care facilities policies and procedures must assure that:

(a) the facility determines upon admission whether each individual has a Life with Dignity Order;

(b) the facility is not required to offer all individuals the opportunity to complete a Life With Dignity Order;

(c) the facility determines which [of those] individuals[who do not have a Life With Dignity Order should]may be offered the opportunity to complete a Life with Dignity Order , which may include individuals who;

(i) have a serious illness and are likely to face a life-threatening health crisis;

(ii) have specific preferences for end of life treatments; or

(iii) have declining cognitive abilities and lack a surrogate to make decisions for them;

( d[c]) the facility identifies circumstances under which an individual with a Life with Dignity Order shall be offered the opportunity to modify the order[the facility shall review for changes or amendments the Life with Dignity Order for each individual who has one];

( e[d]) the facility maintains the Life with Dignity Order[ in a prominent location] in the individual's medical record[for each individual who has a Life with Dignity Order; and];

( f[e]) the facility identifies circumstances under which it would not follow a Life With Dignity Order;[.]

(g) only qualified providers, as per Utah Code 75-2a-106(2) assist with the completion of a Life With Dignity Order. Qualified providers include;

(i) the physician, advanced practice registered nurse, or physician assistant of the person to whom the life with dignity order relates; or

(ii) a health care provider who is acting under the supervision of a person described in Subsection (2)(g)(i)and is a licensed nurse, physician assistant, or mental health professional.

(h) a Life With Dignity order shall be signed personally by the physician or APRN, or, subject to 75-2a-106(11), physician assistant of the person to whom the life with dignity order relates;

(i) if the licensed health care facility's services do not include the supervision of a physician, physician assistant or advanced practice registered nurse, the facility shall make a referral to the primary care provider to create, replace or modify a Life With Dignity Order.

 

[R432-31-5. Facilities Not Required to Offer Life with Dignity Orders-Policies and Procedures.

(1) The following health care facilities must comply with Subsection (2):

(a) a specialty hospital - psychiatric licensed under R432-101;

(b) a specialty hospital - chemical dependency/substance abuse licensed under R432-102;

(c) a freestanding ambulatory surgical center licensed under R432-500;

(d) a specialty hospital - rehabilitation licensed under R432-103;

(e) an orthopedic hospital licensed under R432-105;

(f) a birthing center licensed under R432-550;

(g) an abortion clinic licensed under R432-600; and

(h) an end stage renal disease facility licensed under R432-650.

(2) Each facility described in Subsection (1) shall establish and follow policies and procedures that conform to Section 75-2a-106 and that assure that:

(a) the facility determines upon admission whether each individual has a Life with Dignity Order;

(b) the facility maintains the Life with Dignity Order in a prominent location in the individual's medical record for each individual who has a Life with Dignity Order.

 

]R432-31-5[6]. Training.

Each licensed health care facility shall appropriately train relevant health care, quality improvement, and record keeping staff on the requirements of Title 75, Chapter 2a, the Advance Health Care Directive Act; this rule; and the facility's policies and procedures established pursuant to this rule.

 

R432-31-6[7]. Transferability of Life with Dignity Orders.

(1)(a) A Life with Dignity Order is fully transferable between all licensed health care facilities.

(b) The health care providers assuming the individual's care at the receiving licensed health care facility shall read the Life with Dignity Order.

(c) The receiving provider must have policies and procedures to address the circumstances under which the provider will not follow the instructions contained in the Life With Dignity Order.

(2)(a) A licensed health care facility that discharges, but does not transfer to another licensed health care facility, an individual who has a Life with Dignity Order, shall provide a copy of the individual's Life with Dignity Order to the individual or, if the individual lacks the capacity to make a health care decision, as defined in section 75-2a-104, to the individual's surrogate.

(b) A licensed health care facility that transfers an individual with a Life with Dignity Order to another licensed health care facility shall provide a copy of the Life with Dignity Order to the receiving licensed health care facility.

(3) A licensed health care facility shall allow an individual to complete, amend, or revoke a Life with Dignity Order at any time upon request.

 

R432-31-7[8]. Presentation of Life with Dignity Orders to EMS Personnel.

(1) Except for home health agencies, personal care agencies and home-based hospice, a licensed health care facility in possession of a Life with Dignity Order must present the individual's Life with Dignity Order to EMS personnel upon the arrival of EMS personnel who are present to treat or transport the individual; and

(2) For an individual who resides at home, if home health agency, personal care agency or home-based hospice personnel are present when EMS personnel arrive at the home, the personnel must present the individual's Life with Dignity Order, upon the arrival of the EMS personnel who are present to treat or transport the individual.

 

R432-31-8[9]. Home Placement of Life with Dignity Orders.

(1) If an individual under the care of a home health agency, personal care agency or a hospice agency possesses a Life with Dignity Order, the agency must ensure that a copy of the Life with Dignity Order is left at the individual's place of residence.

(2) For an individual adult who resides at home, including an emancipated minor, it is recommended that a copy of the Life with Dignity Order be posted on the front of the refrigerator or over the individual's bed.

(3) For a minor who resides at home, it is recommended that a copy of the Life with Dignity Order be placed in a tube and placed on the top shelf of the door of the refrigerator.

 

R432-31-9[10]. Life with Dignity Bracelets and Necklaces.

(1) The Department may contract with a vendor or vendors to provide an approved Life with Dignity bracelet or necklace.

(2) An individual with a Life with Dignity Order may obtain an approved Life with Dignity bracelet or necklace from a vendor approved by the Department. The approved Life with Dignity bracelet or necklace identifies the individual to EMS or other health care providers as possessing a Life with Dignity Order.

 

R432-31-10[1]. Prior Orders and Out of State Orders.

(1) EMS and other health care providers may recognize as valid all POLST, Life With Dignity and EMS/DNR orders, including bracelets and necklaces, unless superseded by a subsequent Life with Dignity Order or POLST.

(2) Licensed health care facilities must ensure that all individuals receiving services who have current POLST/Life With Dignity Orders, receive assistance to complete new orders to comply with current rule requirements by January 31, 2011.

(3) Physicians may complete and sign new Life With Dignity Orders for individuals with prior forms who no longer have capacity to complete new orders, and who do not have a surrogate/guardian to authorize the new order. The physician must indicate on the new order that the individual's preferences from the prior order are still applicable.

(4) A form that an individual executed while in another state may be honored as if it were executed in compliance with this rule and Section 75-2a-106 if it:

(a) is substantially similar to a Life with Dignity Order or a Physician's Order for Life Sustaining Treatment; and

(b) was executed according to the laws of that state.

 

KEY: POLST, do not resuscitate, Life with Dignity Order

Date of Enactment or Last Substantive Amendment: [October 1, 2011]2013

Notice of Continuation: March 28, 2012

Authorizing, and Implemented or Interpreted Law: 26-21; 75-2a-106