Md. Code Regs. 10.01.21.04 - Use of the MOLST Form

A. Definitions.

(1) In this regulation, the following terms have the meanings indicated.

(2) Defined Terms.

(a) "Completing a MOLST form" means:

(i) Certifying, when applicable, the bases for the orders contained therein;

(ii) Completing section one for all patients and only those sections two through nine of the form that are related to the patient's current medical condition and wishes for care; and

(iii) Signing and dating the MOLST form.

(b) "Updating a MOLST form" means to revise an existing MOLST form by voiding the existing form and completing a new MOLST form in accordance with the form's instructions.

B. Beginning July 1, 2013, the following health care facilities are required to accept, update if appropriate, and complete the MOLST form for each patient during the admission process in accordance with the form's instructions:

(1) An assisted living program;

(2) A home health agency;

(3) A hospice;

(4) A kidney dialysis center; and

(5) A nursing home.

C. An assisted living program or a nursing home shall also complete the MOLST form for a patient:

(1) Admitted before January 1, 2013; and

(2) Who continues to reside in the assisted living program or nursing home after July 1, 2013.

D. Beginning July 1, 2013, a hospital shall:

(1) Accept and update if appropriate, a completed MOLST form in accordance with the form's instructions; or

(2) Complete a MOLST form for a patient during the patient's inpatient stay if the patient is to be discharged or transferred to another health care facility.

E. When initially completing a MOLST form or updating an existing MOLST form, a health care facility shall:

(1) Offer the patient or authorized decision maker the opportunity to participate in completing or updating the MOLST form, and on request of the patient, offer any physician [or], nurse practitioner, or physician assistant selected by the patient the opportunity to participate in updating or completing the MOLST form;

(2) Note in the medical record when a patient or an authorized decision maker declines to participate in completing or updating the MOLST form, indicating the date and time of discussion, with whom the form was discussed, and a summary of the discussion;

(3) Inform the competent patient or authorized decision maker that the MOLST form will become part of the medical record and can be accessed through the procedures used to access a medical record; and

(4) Give the patient or authorized decision maker a copy of the completed form within 48 hours or sooner if the patient is discharged or transferred.

F. A practitioner who completes or updates a MOLST form shall do so in accordance with the form's instructions.

G. Except as otherwise provided in the Health Care Decisions Act, a practitioner shall complete, or update a MOLST form in a manner that is consistent with:

(1) The known decisions of:

(a) A competent patient; or

(b) An authorized decision maker; and

(2) Any known advance directive if the patient is incapable of making an informed decision.

H. Any individual may request that a health care facility complete a MOLST form on his or her behalf, even if completion of a MOLST form is not required under these regulations or otherwise required by law. A health care facility that completes a MOLST form under these circumstances shall provide a copy of the completed form within 48 hours to the individual requesting completion of the form.

Notes

Md. Code Regs. 10.01.21.04

Regulation .04E amended effective 41:3 Md. R. 201, eff.2/17/2014