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comply with those directives, in accordance with part 489, Subpart I of this chapter.

For purposes of conforming with the requirement in §489.102 that there be

documentation in the patient's care records concerning advance directives, the

patient care records of a beneficiary in an RNHCI are equivalent to medical records

held by other providers.

Interpretive Guidelines: §403.730(b)(3)

Advance directives are particularly important for a patient choosing to rely solely upon

religious nonmedical methods of healing, as it makes his or her wishes known in the

event he or she becomes incapacitated and unable to make health care choices. An

advance directive could lead to the provision of nonexcepted medical care, and thus

effectively revoke an Election, or support the choice made in that Election, and must be

honored by the facility. The RNHCI must discuss this with the patient and/or

representative to ensure the patient and/or representative are aware of this. The Election

would not be revoked on the signing of an advanced directive, but on the initiation of

medical care based on the advance directive. The RNHCI should document this process

and their policy on providing this information to the patient in writing.

Survey Procedures:

• Ensure that an Election form that complies with §403.724(a) is on file for each

patient. Revocations of elections must also be on file.

• Ensure that there is evidence that the patient has had the opportunity to formulate

his or her advance directive.

• Corroborate through patient interviews that the patient has or does not have an

advanced directive.