Family Health Care Decisions Act and MOLST Form Procedures

April 7, 2014

Effective on March 26, 2014 the State finalized regulatory changes now integrating the Family Health Care Decisions Act and the MOLST form procedures with medical facility obligations regarding advance directives. In response to comments from the MOLST - Statewide Implementation Team, that (1) the MOLST as an actionable Medical Order, not just an advance directive, (2) the MOLST will be viewed as both a “form and process”, and recognize the eMOLST application, and (3) health care facilities will be required to include the MOLST form and process within their existing policies and procedures on Do Not Resuscitate (DNR) Orders and/or Palliative Care, DOH responded that it will be issuing a “Notice of Adoption” letter to providers educating them on, and clarifying this new rule.

DOH’s MOLST web site on patient rights contains extensive tools for implementation and is found at: 
http://www.health.ny.gov/professionals/patients/patient_rights/molst/

The actual revised regulation is, in substantive part, as follows:

10 NYCRR 400.21(a) **** In the absence of a health care proxy, the Family Health Care Decisions Act allows a surrogate (a family member or close friend) to make treatment decisions on behalf of a patient, in accordance with the patient’s wishes, if known, or if the patient’s wishes are not known, in accordance with the patient’s best interests. Facilities must ensure that all adult patients/residents are informed of their rights and are supported and protected as they exercise their right to formulate written or oral instructions regarding their health care in the event such adults become incapacitated and are unable to direct their own health care. *** (e) - To implement a patient’s wishes regarding cardiopulmonary resuscitation (CPR) and other life-sustaining treatment, facilities may, if appropriate, utilize the department approved MOLST form for patients with serious health conditions who: (1) want to avoid or receive any or all life-sustaining treatment; or (2) can reasonably be expected to die within one year.