Advance Directives

Living will, living will directive, advance directive, and directive are all terms used to describe a document that provides directions regarding health care to be provided to the person executing the document. In Kentucky, advance directives are governed by the Kentucky Living Will Directive Act codified in KRS 311.621 to 311.643, and as otherwise defined in 42CFR, 489.100.

A member who is 18 years of age or older and who is of sound mind may make a written living directive that does any or all of the following:

  • Directs the withholding or withdrawal of life-prolonging treatment
  • Directs the withholding or withdrawal of artificially provided nutrition or hydration.
  • Designates one or more adults as a surrogate or successor surrogate to make health care decisions on his or her behalf.
  • Directs the giving of all or any part of his or her body upon death for any of the following reasons: medical or dental education, research, advancement of medical or dental science, therapy, or transplantation.

A form of a living will is included in KRS 311.625. The form can be reviewed at www.lrc.state.ky.us/KRS/311-00/625.PDF. Advance directives may be revoked in writing, by an oral statement, or by tearing up the written living will.
The revocation is effective immediately.

In addition to reviewing the Kentucky Living Will Directives Act, providers should:

  • On the first visit, as well as during routine office visits when appropriate, discuss the member’s wishes regarding advance directives for care and treatment;
  • Document in the member’s medical record the discussion and whether the member has executed an advance directive;
  • If asked, provide the member with information about advance directives;
  • Upon receipt of an advance directive from the member, file the advance directive in the member’s record;
  • Not discriminate against a member because he or she has or has not
  • executed an advance directive; and,
  • Communicate to the member if the provider has any conscientious objections to the advance directive as indicated above.

Notice to Providers Regarding the Plan’s Utilization Management (UM) Policies and Procedures

CEU Opportunities

Clinical Criteria Available to Providers

Utilization Management (UM) strives to ensure our members use their benefits as needed and as appropriate. To assist us, we use Milliman Care Guidelines®, InterQual® Criteria, Medicare, and/or Medicaid criteria/guidelines to evaluate the necessity of medical services. These guidelines support the delivery of quality health care and assist us in evidence-based clinical decision making and reviewer consistency.

In addition, we utilize Passport’s medical policy in the decision making process. We involve actively practicing providers with like or similar expertise in the adoption of criteria, the development of policies, and the review of procedures for applying the criteria.

A copy of the Passport medical policy are available to providers upon request by calling (800) 578-0636. They are also available here.

Prior Auth Questions for Therapies, Chiro & Pain Management

Culturally and Linguistically Appropriate Services (CLAS) and Title VI

Title VI

Under Title VI of the 1964 Civil Rights Act, no person in the United States shall be excluded from participation in or discriminated against on the basis of race, color or national origin. All recipients, directly or indirectly, of federal funds (such as, but not limited to, Medicaid, SCHIP and Medicare payments, NIH grants, and CDC monies) are required by Executive Order 13166 to ensure that their own programs provide equal access to persons with Limited English Proficiency (LEP).

Culturally & Linguistically Appropriate Services (CLAS Standards)
U.S. Department of Health and Human Services (HHS) –Office of Minority Health

The CLAS Standards are mandated by HHS to provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages (verbal and written), health literacy, and other communication needs.

CLAS Standards require you to provide qualified interpretive services and professionally translated materials for your non-English speaking patients. Bilingual speakers do not necessarily qualify as medical interpreters, nor do friends, children, or other family members of the patients.

Face to-face interpretation is usually best, but tele-interpreter services are also acceptable and cost-effective. For discounted teleinterpreter services, please call (800) 305-9673, ext. 59105 (client services) or ext. 55316 (new users).

For a language assistance poster,  click here.

Americans with Disabilities Act

Public entities and those receiving HHS funding must:

  • Provide auxiliary aids at no additional cost to individuals with disabilities, where necessary, to ensure effective communication with individuals with hearing, vision or speech impairments.
  • Auxiliary aids include, but are not limited to, services or devices such as: qualified interpreters on-site or through video remote interpreting (VR I) services, note takers, assistive listening devices, television captioning and decoders, telecommunication products and systems, qualified readers, taped texts, Braille materials, and large print materials.

For a language assistance brochure, click here.

For the Culturally Competent Use of Language Services power point, click here.

Helping Members Make the Most of Their Benefits

It is important for all members to know about the Plan’s decision-making policies. Many members have questions about their benefits and how the Plan decides what benefits are authorized for payment.

We hope you will join us in reminding members of the following important points:

  • The purpose of UM is to validate that services are medically necessary and covered by the Plan.
  • Passport Health Plan does not reward anyone, including practitioners, for denying services to members.
  • The Plans do not compensate associates or practitioners to make decisions that keep members from getting the care they need.

Like you, our first concern is that members receive appropriate care in a timely manner. Therefore, if members who visit your office have questions about the UM process or benefit decisions, please refer them to Member Services at 1-800-578-0603 (TDD/TTY 1-800-691-5566). We will be happy to assist them.

Need to Talk About Denials?

Passport providers may speak with Medical Directors regarding Utilization Management (UM) decisions and specific cases or service requests at any time. If you disagree with a UM decision, you can discuss the decision by telephone with the medical director who rendered it.

Whenever a denial is verbally issued, the UM staff provides the name, telephone number, and title of the Medical Director who rendered the decision. The provider may then call the Medical Director directly to discuss the denial. Appeals information is included with each denial letter.

If you have questions about the UM process or a UM issue, please call (800) 578-0636.

Provider Workshops