QUEST Integration – Advance Directives

Original Effective Date:

04/01/2008

Current Effective Date:

01/01/2015

I. Policy

Hawaii Medical Service Association (HMSA) complies with the Hawaii law regarding Advance Directives.

II. Definitions

1. Advance Directive – written instruction, such as a living will or durable power of attorney for health care, recognized under Hawaii state law, relating to the provision of health care when the individual is incapacitated.
2. Uniform Health – Care Decisions Act (Modified) ? HRS (Hawaii Revised Statutes) Chapter 327E
3. HMSA – Hawaii Medical Service Association
4. PCP – Primary Care Physician
5. HMSA QUEST Integration – HMSA’s Medicaid Managed Care Plan approved by CMS (Center for Medicare and Medicaid Services) for QUEST Integration Members
6. DHS – State of Hawaii Department of Human Services

III. Procedures

1. Information regarding Advance Directives is available in the Member Handbook for QUEST Integration and includes:
   • Members’ rights under State law, the Uniform Health-Care Decisions Act (Modified). If there are changes to the law which affect members’ rights, HMSA will notify members of such changes within 90 days of any changes.
   • The right to accept or refuse medical or surgical treatment.
   • The right to execute an Advance Directives.
   • A statement that HMSA does not limit as a matter of conscience the member’s right to execute or implement an Advance Directive.
   • An educational overview of how members may direct their care using the Advance Directive mechanism and contact information on individual staff members (HMSA QUEST Integration Administration department) who may provide additional education
2. The Member Handbook for QUEST Integration Members also includes information on how to file complaints with HMSA and DHS if a Member is dissatisfied with HMSA’s or a provider’s operations, activities or behavior. This complaint procedure includes information on how members can file complaints regarding noncompliance with Advance Directives with the state Office of Health Care Assurance, and provides an address for members to send complaints to DHS.
3. If the member is incapacitated at the time of enrollment, HMSA will work with the family members, authorized representative or surrogate to ensure that the member’s Advance Directive is followed. This will ensure appropriate follow up with the member when the member is no longer incapacitated.
4. HMSA does not condition the provision of treatment or discriminate on the basis of whether an individual has executed an Advance Directive. HMSA does not limit as a matter of conscience the member’s right to execute or implement an Advance Directive.
5. HMSA employee’s in public contact areas including, but not limited to, Customer Service Representatives, Managers and Service Coordinators, are educated through various internal training sessions about HMSA’s policies and procedures on Advance Directives and will educate members about situations in which Advance Directives may be of benefit and the ability to direct care using this mechanism. If specific questions regarding Advance Directives arise, the member will be forwarded to or may contact the HMSA QUEST Integration Administration department.
6. HMSA will educate its agents and providers regarding HMSA’s policies and procedures on Advance Directives via written communications, including the Provider Handbook and Provider Updates.
7. Members or their representative are encouraged to inform their PCP and other participating providers that they have executed an Advance Directive and provide a copy of the Advance Directive to them.
8. PCP’s and other providers who have undertaken primary responsibility for the member’s health care who know of the existence of an Advance Directive are required to document the existence of the Advance Directive in the member’s health care record, in accordance with the Uniform Health-Care Decisions Act. If the member, or the members authorized representative, changes or revokes the Advance Directive, the member’s PCP shall promptly document and implement those changes.
9. QUEST Integration providers with 50 or more members are required to have a medical record review every three years. Others are subject to review periodically on a less frequent basis. They will be monitored for compliance in documentation of the existence of an Advance Directive, and changes or revocation of an existing Advance Directive, using the medical record review tool for QUEST Integration members 18 years of age and older.
10. The provisions of 42 CFR § 422.128 and the Hawaii Uniform Health-Care Decisions Act (Hawaii Rev. Stat. Chapter 327E) are binding on HMSA, its employees, agents and providers. If a member’s provider raises a conscientious objection or other limitation to the implementation of a member’s Advance Directive, the provider has the responsibility to inform the member, the member’s authorized representative or surrogate of the objection and to arrange for transfer to another provider or facility where the members’ wishes will be carried out. If HMSA becomes aware of a situation where a provider raises a conscientious objection to the implementation of a member’s Advance Directive, HMSA will inform the member, the member’s authorized representative or surrogate of the objection and assist the member in arranging for transfer to another provider or facility as needed.
11. If there are any changes to state or federal law, HMSA shall update its policies and procedures within 90 days of any changes.
12. Information on Advance Directives as well as compliance in documentation is provided to PCP’s through provider updates and other written communication.

Revision History