3.12 Advance Directives
3.12.3-A: What does a health care power of attorney do?
3.12.3-B: What does a mental health care power of attorney do?
3.12.3-C: What are some of the powers and duties
of the designee(s)?
3.12.3-D: What must be provided to an adult
person at the time of enrollment?
3.12.3-E: How do I help an adult person develop
an advance directive?
3.12.3-F: What else must health care providers do
regarding advance directives?
An advance directive is a written set of instructions developed
by an adult person in the event the person becomes incapable of
making decisions regarding his or her health care.
An advance directive instructs others regarding the person’s
wishes if he/she becomes incapacitated and can include the appointment
of a friend or relative to make behavioral health care decisions
for the person. A person prepares an advance directive when
competent and capable of making decisions, and the directive is followed when the person is incapable
of making treatment decisions. This section outlines the requirements
of behavioral health care providers with regard to advance directives.
Definitions for terms are located online at
http://www.azdhs.gov/bhs/definitions/index.php. The following terms are referenced in this section:
Care Power of Attorney
Health Care Power of Attorney
What does a health care power of attorney do?
A health care power of attorney gives an adult person,
not under legal guardianship, the right to designate another adult person to make health care treatment decisions on his or her behalf. The designee may make
health care decisions on behalf of the adult person if/when she or he is found incapable of making
health care decisions. The designee, however, must not be a provider directly involved with the health treatment of the adult person at the time the health care power of attorney is executed (see A.R.S. § 36-3283 for additional information regarding a mental health power of attorney and a person who is “found incapable” of making his/her own health care decisions).
What does a mental health care power of attorney do?
A mental health care power of attorney gives an adult person
the right to designate another adult person to make mental health
care treatment decisions on his or her behalf. The designee may make
decisions on behalf of the adult person if/when she or he is found incapable
of making these types of decisions. The designee, however, must
not be a mental health care provider directly involved with the behavioral health treatment
of the adult person at the time the mental health care power of
attorney is executed.
What are some of the powers and duties of the designee(s)?
- May act
in this capacity until his or her authority is revoked by the adult
person, a legal guardian, or by court order;
- Has the
same right as the adult person to receive information and to review
the adult person’s medical records regarding proposed behavioral
health treatment and to receive, review and consent to the disclosure
of medical records relating to the adult person’s treatment;
- Must act
consistently with the wishes of the adult person or legal
guardian as expressed
in the mental health care power of attorney or health care power
of attorney. If, however, the
adult person’s wishes are not expressed in a mental health
care power of attorney or health care power of attorney and are not otherwise known by the designee,
the designee must act in good faith and consent to treatment that
she or he believes to be in the adult person’s best interest;
- May consent
to admitting the adult person to a Behavioral Health Inpatient Facility
licensed by the Arizona Department of Health Services if this authority
is expressly stated in the mental health care power of attorney
or health care power of attorney.
for a complete list of the powers and duties of an agent designated
under a mental health care power of attorney.
What must be provided to an adult person at the time of enrollment?
At the time of enrollment, all adult persons and when the
individual is incapacitated or unable to receive information, the
enrollee’s family or surrogate, must receive
information regarding (see
- The person’s
rights, in writing, regarding advance directives under Arizona State law;
description of the applicable State law (summarized in 3.12.7-A
and 3.12.7-B above); and information regarding the
implementation of these rights;
behavioral health recipient's right to file complaints directly
with AHCCCS; and
policies including a clear and precise statement of limitations
if the provider cannot implement an advance directive as a matter
of conscience. This statement, at a minimum should:
institution-wide conscientious objections and those of individual
state legal authority permitting such objections; and
the range of medical conditions or procedures affected by
the conscience objection.
If an enrollee is incapacitated at the time
of enrollment, behavioral health providers may give advance directive information to the enrollee’s
family or surrogate in accordance with state law.
Behavioral health providers must also follow up when the person is no longer incapacitated and
ensure that the information is given to the person directly.
How do I help an adult person develop an advance directive?
Providers must assist adult persons or their legal
are interested in developing and executing an advance directive.
They must also maintain written policies that address the rights of adult members to make decisions about medical care, including the right to accept or refuse medical care, and the right to execute an advance directive. The T/RBHA can offer the following resources: The Gila River RBHA
provides information regarding advance directives to all enrolled
adults and is available to assist individuals in executing an advance
directive upon request. Adult persons are encouraged to speak with
their Gila River RBHA Clinician or physician for additional information. Members must be provided information about formulating Advance Directives (see AHCCCS Medical Policy Manual, Policy 930).
What else must health care providers do regarding advance directives?
in the adult person’s medical record whether or not the
adult person was provided the information and whether an advance
directive was executed;
condition provision of care or discriminate against an adult
person because of his or her decision to execute or not to
execute an advance directive;
- Provide a
copy of a person’s executed advanced directive, or documentation
of refusal, to the acute care primary care provider (PCP) for
inclusion in the person’s medical record; and
education to staff on issues concerning advance directive
including notification of direct care providers of services,
such as home health care and personal care, of any advance
directives executed by behavioral health recipients to whom they
are assigned to provide services.
The following citations can serve as additional resources for this
Last Revised: 7/31/2015
Effective Date: 7/31/2015