Federal advance-directive and patient self-determination authority

What changed

42 U.S.C. 1395cc(f) requires covered providers and organizations to maintain written policies and procedures for adult individuals, provide written information about state-law rights to accept or refuse medical or surgical treatment and formulate advance directives, document whether an advance directive exists, avoid discrimination based on advance-directive status, and educate staff and the community. Current 42 CFR Part 489 Subpart I implements those duties for hospitals, SNFs, home health agencies, hospices, and related provider types.

Why it matters

Advance directives and health-care agents are core legal-authority pathways for family caregivers, but the federal row must stay clear that state law controls the actual directive and representative authority.

Who it touches

Family caregivers, Care providers and plans, People receiving care, Businesses and agencies that must complyadult patients, family caregivers, health care agents, patient representatives, Medicare beneficiaries, hospitals, skilled nursing facilities, home health agencies, hospices

What it does

Limits or bans a practice, or narrows eligibility

• 42 U.S.C. 1395cc(f)
• eCFR 42 CFR Part 489 Subpart I
• eCFR API Title 42 Part 489 issue text

Last reviewed Jul 4, 2026. This is information, not legal advice; check the source for the current text.