104 STAT. 1388-204 PUBLIC LAW 101-508—NOV. 5, 1990 Subpart E—Miscellaneous SEC. 4751. REQUIREMENTS FOR ADVANCED DIRECTIVES UNDER STATE PLANS FOR MEDICAL ASSISTANCE. (a) IN GENERAL.— Section 1902 (42 U.S.C. 1396a(a)), as amended by sections 4401(a)(2), 4601(d), 4701(a), 4711(a), and 4722 of this title, is amended— (1) in subsection (a)— (A) by striking "and" at the end of paragraph (55), (B) by striking the period at the end of paragraph (56) and inserting "; and", and (C) by inserting after paragraph (56) the following new paragraphs: "(57) provide that each hospital, nursing facility, provider of home health care or personal care services, hospice program, or health maintenance organization (as defined in section 1903(m)(l)(A)) receiving funds under the plan shall comply with the requirements of subsection (w); "(58) provide that the State, acting through a State agency, association, or other private nonprofit entity, develop a written description of the law of the State (whether statutory or as recognized by the courts of the State) concerning advance directives that would be distributed by providers or organizations under the requirements of subsection (w)."; and (2) by adding at the end the following new subsection: "(w)(l) For purposes of subsection (a)(57) and sections 1903(m)(l)(A) and 1919(c)(2)(E), the requirement of this subsection is that a provider or organization (as the case may be) maintain written policies and procedures with respect to all adult individuals receiving medical care by or through the provider or organization— "(A) to provide written information to each such individual concerning— "(i) an individual's rights under State law (whether statutory or as recognized by the courts of the State) to make decisions concerning such medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives (as defined in paragraph (3)), and "(ii) the provider's or organization's written policies respecting the implementation of such rights; "(B) to document in the individual's medical record whether or not the individual has executed an advance directive; "(C) not to condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive; "(D) to ensure compliance with requirements of State law (whether statutory or as recognized by the courts of the State) respecting advance directives; and "(E) to provide (individually or with others) for education for staff and the community on issues concerning advance directives. Subparagraph (C) shall not be construed as requiring the provision of care which conflicts with an advance directive. "(2) The written information described in paragraph (I)(A) shall be provided to an adult individual—
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