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
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.
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.
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.