Maryland's Medical Orders for Life-Sustaining Treatment Form Delayed

2011: Issue 6 – Focus on Long Term Care

As a result of legislation enacted by the 2011 Maryland General Assembly, Maryland health care providers will soon be required to accept a Medical Orders for Life-Sustaining Treatment (MOLST) Form for patients. The MOLST form is a portable medical order that that contains a physician’s or nurse practitioner’s written medical orders relating to a patient’s medical condition, including a patient’s instructions relating to cardiopulmonary resuscitation (CPR) and the use of other life-sustaining treatments. Similar to the current Maryland Institute for Emergency Medical Services System (MIEMSS) Do Not Resuscitate (DNR) form, Maryland emergency medical system (EMS) personnel and first responders will be required to comply with a patient’s instructions regarding CPR contained in the MOLST form. While the Maryland Department of Health and Mental Hygiene (DHMH) had initially planned to require implementation of the MOLST form effective October 1, 2011, DHMH recently announced that it would delay the implementation until after public comment to proposed regulations [PDF]. A sample of the MOLST form [PDF] was also published as part of the regulations. Comments regarding the proposed regulations are due by October 24, 2011.

Once implemented, Maryland hospitals, nursing facilities, assisted living programs, home health agencies, hospices, and kidney dialysis centers will be required to accept and update as necessary, the orders set forth in a completed MOLST form that is presented for a patient admitted into the facility. To the extent that a patient does not have a current MOLST form, each of these facilities, with the exception of hospitals, must offer to complete a MOLST form for all patients during the admissions process. Hospitals are required to complete a MOLST form during a patient’s inpatient stay if the patient will be discharged to another health care facility. The patient, health care agent or surrogate decision-maker must be offered the opportunity to participate in the update or completion of the form and to request that any physician or nurse practitioner of the patient’s choice also participate. If the patient, patient’s agent or surrogate declines to use the MOLST form, the health care facility should document such declination in the patient’s medical record. If completed, the facility will keep a copy of the MOLST form in the patient’s medical record and a copy must accompany the patient if he or she is transferred to another facility.

While the MOLST form is not an advance directive, the medical orders set forth in the MOLST form should be consistent with the patient’s known decisions if the patient is competent, or the known decisions of a health care agent or surrogate and any known advance directive of the patient, if the patient is incapable of making a medical decision. The MOLST form must be signed by the patient’s physician or nurse practitioner in order to validate the order.

Ober|Kaler’s Comments

The implementation of the MOLST form is inevitably right around the corner. Maryland nursing facilities, assisted living programs and other affected providers should be ensuring that they have policies and procedures in place to ensure that the MOLST form is accepted, completed and updated as necessary during the admissions process. Health care facilities should be training their staffs regarding the requirements to avoid any penalties for failing to comply with the MOLST process once it is implemented. For additional information on health care decision-making in Maryland, please visit http://www.marylandadvancedirectives.com. In addition, stay tuned for future training sessions offered by Ober|Kaler regarding the MOLST implementation. If you would like to receive information about our upcoming trainings as it becomes available, please email us at info@marylandadvancedirectives.com.