Advance Directives for Health Care

Congress enacted the Patient Self-Determination Act (PSDA) in 1990, codified at 42 United States Code §§ 1395cc(a)(1) and 1396a(a). This federal law applies to all hospitals, nursing homes, hospices, home health agencies, health maintenance organizations (HMOs), and preferred provider organizations (PPOs) that participate in the Medicare and Medicaid programs. Among other things, the PSDA requires each covered health care provider to adopt a formal policy, consistent with relevant state law, regarding how it will handle advance directives. The provider must make a copy of its policy available to each new patient at or before the time of admission or enrollment. In addition, the PSDA requires the health care provider to ask at admission or enrollment whether the patient has executed an advance directive. If the answer is no, the provider must offer the patient the chance to execute an advance directive then (if the patient is still mentally capable of doing so).