Notices & Disclosures

Questions and Answers about Health Care Directives Provided by MN Department of Health

Minnesota Law
Minnesota Law allows you to inform others of your health care wishes.  You have the right to state your wishes or appoint an agent in writing so that others will know what you want if you can't tell them because of illness or injury.  The information that follows tells about health care directives and how to prepare them.  It does not give every detail of the law.

What is a Health Care Directive?
A health care directive is a written document that informs others of your wishes about your health care.  It allows you to name a person ("agent") to decide for you if you are unable to decide.  It also allows you to name an agent if you want someone else to decide for you.  You must be at least 18 years old to make a health care directive.

Why Have a Health Care Directive?
A health care directive is important if your attending physician determines you can't communicate your health care choices (because of physical or mental incapacity).  It is also important if you wish to have someone else make your health care decisions.  In some circumstances, your directive may state that you want someone other than an attending physician to decide when you cannot make your own decisions.

Must I Have a Health Care Directive?  What Happens if I Don't Have One?
You don't have to have a health care directive.  But, writing one helps to make sure your wishes are followed.

You will still receive medical treatment if you don't have a written directive.  Health care providers will listen to what people close to you say about your treatment preferences, but the best way to be sure your wishes are followed is to have a health care directive.

How Do I Make a Health Care Directive?
There are forms for health care directives.  You don't have to use a form, but your health care directive must meet the following requirements to be legal:

• Be in writing and dated.
• State your name.
• Be signed by you or someone you authorize to sign for you, when you can understand and communicate your health care wishes.
• Have your signature verified by a notary public or two witnesses.
• Include the appointment of an agent to make health care decisions for you and/or instructions about the health care choices you wish to make.

Before you prepare or revise your directive, you should discuss your health care wishes with your doctor or other health care provider.

Information about how to obtain forms for preparation of your health care directives can be found in the Resource Section of this document.

I Prepared My Directive in Another State.  Is it Still Good?
Health care directives prepared in other states are legal if they meet the requirements of the other state's laws or the Minnesota requirements.  But requests for assisted suicide will not be followed.

What Can I Put in a Health Care Directive?
You have many choices of what to put in your health care directive.  For example, you may include:

• The person you trust as your agent to make health care decisions for you.  You can name alternative agents in case the first agent is unavailable, or joint agents.
• Your goals, values and preferences about health care.
• The types of medical treatment you would want (or not want).
• How you want your agent or agents to decide.
• Where you want to receive care.
• Instructions about artificial nutrition and hydration.
• Mental health treatments that use electroshock therapy or neuroleptic medications.
• Instructions if you are pregnant.
• Donation of organs, tissues and eyes.
• Funeral arrangements.
• Who you would like as your guardian or conservator if there is a court action.

You may be as specific or as general as you wish.  You can choose which issues or treatments to deal with in your health care directive.

Are There Any Limits to What I Can Put in My Health Care Directive?
There are some limits about what you can put in your health care directive.  For instance:

• Your agent must be at least 18 years of age.
• Your agent cannot be your health care provider, unless the health care provider is a family member or you give reasons for the naming of the agent in your directive.
• You cannot request health care treatment that is outside of reasonable medical practice.
• You cannot request assisted suicide.

How Long Does a Health Care Directive Last?  Can I Change It?
Your health care directive lasts until you change or cancel it.  As long as the changes meet the health care directive requirements listed above, you may cancel your directive by any of the following:

• A written statement saying you want to cancel it.
• Destroying it.
• Telling at least two other people you want to cancel it.
• Writing a new health care directive.

What If My Health Care Provider Refuses to Follow My Health Care Directive?
Your health care provider generally will follow your health care directive, or any instructions from your agent, as long as the health care follows reasonable medical practice.  But, you or your agent cannot request treatment that will not help you or which the provider cannot provide.  If the provider cannot follow your agent's driections about life-sustaining treatment, the provider must inform the agent.  The provider must also document the notice in your medical record.  The provider must allow the agent to transfer you to another provider who will follow the agent's directions.

What If I've Already Prepared a Health Care Document?  Is it Still Good?
Before August 1, 1998, Minnesota law provided for several other types of directives, including living wills, durable health care powers of attorney and mental health declarations.

The law changed so people can use one form for all their health care instructions.

Forms created before August 1, 1998, are still legal if they followed the law in effect when written.  They are also legal if they meet the requirements of the new law (described above).  You may want to review any existing documents to make sure they say what you want and meet all requirements.

What Should I do With My Health Care Directive After I Have Signed It?
You should inform others of your health care directive and give people copies of it.  You may wish to inform family members, your health care agent or agents, and your health care providers that you have a health care directive.  You should give them a copy.  It's a good idea to review and update your directive as your needs change.  Keep it in a safe place where it is easily found.

What if I Believe a Health Care Provider Has Not Followed Health Care Directive Requirements?
Complaints of this type can be filed with the Office of Health Facility Complaints at 651-201-4200 (Metro Area) or Toll-free at 1-800-369-7994.

What if I Believe a Health Plan Has Not Followed Health Care Directive Requirements?
Complaints of this type can be filed with the Minnesota Health Information Clearinghouse at 651-201-5178 or Toll-free at 1-800-657-3793.

How to Obtain Additional Information
If you want more information about health care directives, please contact your health care provider, your attorney, or:

1. Minnesota Board on Aging's Senior LinkAge Line at 1-800-333-2433.
2. A suggested health care directive form is available on the internet at www.mnaging.org or MN Health Care Directive Legal Form.

As a patient of MNGI Digestive Health, P.A. and Affiliates, MNGI Endoscopy ASC, Inc. or Affiliated Endoscopy Centers, LLC or Minnesota Endoscopy Center, LLC this policy affords you, the patient, the right to:

Minnesota Outpatient Surgical Center Patients’ Bill of Rights

Minnesota Legislature 2004

144.651 Patients and residents of health care facilities; bill of rights.

Subdivision 1. Legislative intent. It is the intent of the legislature and the purpose of this section to promote the interests and well being of the patients and residents of health care facilities. No health care facility may require a patient or resident to waive these rights as a condition of admission to the facility. Any guardian or conservator of a patient or resident or, in the absence of a guardian or conservator, an interested person, may seek enforcement of these rights on behalf of a patient or resident. An interested person may also seek enforcement of these rights on behalf of a patient or resident who has a guardian or conservator through administrative agencies or in district court having jurisdiction over guardianships and conservatorships. Pending the outcome of an enforcement proceeding the health care facility may, in good faith, comply with the instructions of a guardian or conservator. It is the intent of this section that every patient's civil and religious liberties, including the right to independent personal decisions and knowledge of available choices, shall not be infringed and that the facility shall encourage and assist in the fullest possible exercise of these rights.

Definitions

Subd. 2. Definitions. For purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20, "patient" also means a person who receives health care services at an outpatient surgical center.

Subd. 4. Information about rights. Patients shall, at admission, be told that there are legal rights for their protection during their stay at the facility or throughout their course of treatment and maintenance in the community and that these are described in an accompanying written statement of the applicable rights and responsibilities set forth in this section. Reasonable accommodations shall be made for those with communication Impairments and those who speak a language other than English. Current facility policies, inspection findings of state and local health authorities, and further explanation of the written statement of rights shall be available to patients, their guardians or their chosen representatives upon reasonable request to the administrator or other designated staff person, consistent with chapter 13, the Data Practices Act, and section 626.557, relating to vulnerable adults.

Subd. 5. Courteous treatment. Patients have the right to be treated with courtesy and respect for their individuality by employees of or persons providing service in a health care facility.

Subd. 6. Appropriate health care. Patients shall have the right to appropriate medical and personal care based on individual needs.

Subd. 7. Physician's identity. Patients shall have or be given, in writing, the name, business address, telephone number, and specialty, if any, of the physician responsible for coordination of their care. In cases where it is medically inadvisable, as documented by the attending physician in a patient's care record, the information shall be given to the patient's guardian or other person designated by the patient as a representative. Patients shall have the right to change providers if another qualified provider is available.

Subd. 8. Relationship with other health services. Patients who receive services from an outside provider are entitled, upon request, to be told the identity of the provider. Information shall include the name of the outside provider, the address, and a description of the service which may be rendered. In cases where it is medically inadvisable, as documented by the attending physician in a patient's care record, the information shall be given to the patient's guardian or other person designated by the patient as a representative.

Subd. 9. Information about treatment. Patients shall be given by their physicians’ complete and current information concerning their diagnosis, treatment, alternatives, risks, and prognosis as required by the physician's legal duty to disclose. This information shall be in terms and language the patients can reasonably be expected to understand. Patients may be accompanied by a family member or other chosen representative. This information shall include the likely medical or major psychological results of the treatment and its alternatives. In cases where it is medically inadvisable, as documented by the attending physician in a patient's medical record, the information shall be given to the patient's guardian or other person designated by the patient or resident as a representative. Individuals have the right to refuse this information. Every patient suffering from any form of breast cancer shall be fully informed, prior to or at the time of admission and during her stay, of all alternative effective methods of treatment of which the treating physician is knowledgeable, including surgical, radiological, or chemotherapeutic treatments or combinations of treatments and the risks associated with each of those methods.

Subd. 12. Right to refuse care. Competent patients shall have the right to refuse treatment based on the information required in subdivision 9. In cases where a patient is incapable of understanding the circumstances but has not been adjudicated incompetent, or when legal requirements limit the right to refuse treatment, the conditions and circumstances shall be fully documented by the attending physician in the patient's medical record.

Subd. 13. Experimental research. Written, informed consent must be obtained prior to a patient's participation in experimental research. Patients have the right to refuse participation. Both consent and refusal shall be documented in the individual care record.

Subd. 15. Treatment privacy. Patients shall have the right to respectfulness and privacy as it relates to their medical and personal care program. Case discussion, consultation, examination, and treatment are confidential and shall be conducted discreetly. Privacy shall be respected during toileting, bathing, and other activities of personal hygiene, except as needed for patient safety or assistance.

Subd. 16. Confidentiality of records. Patients shall be assured confidential treatment of their personal and medical records, and may approve or refuse their release to any individual outside the facility. Copies of records and written information from the records shall be made available in accordance with this subdivision and section 144.293. This right does not apply to complaint investigations and inspections by the Department of Health, where required by third party payment contracts, or where otherwise provided by law

Subd. 18. Responsive service. Patients shall have the right to a prompt and reasonable response to their questions and requests.

Subd. 19. Personal privacy. Patients shall have the right to every consideration of their privacy, individuality, and cultural identity as related to their social, religious, and psychological well-being. Facility staff shall respect the privacy of a resident's room by knocking on the door and seeking consent before entering, except in an emergency or where clearly inadvisable.

Subd. 20. Grievances. Patients shall be encouraged and assisted, throughout their stay in a facility or their course of treatment, to understand and exercise their rights as patients and citizens. Patients may voice grievances and recommend changes in policies and services to facility staff and others of their choice, free from restraint, interference, coercion, discrimination, or reprisal, including threat of discharge. Notice of the grievance procedure of the facility or program, as well as addresses and telephone numbers for the Office of Health Facility Complaints and the area nursing home ombudsman pursuant to the Older Americans Act, section 307(a)(12) shall be posted in a conspicuous place.

Compliance by outpatient surgery centers with section 144.691 and compliance by health maintenance organizations with section 62D.11 is deemed to be compliance with the requirement for a written internal grievance procedure.

MNGI Endoscopy ASC, Inc. and Affiliated Endoscopy Centers, LLC and Minnesota Endoscopy Center, LLC is certified by the Centers for Medicare and Medicaid Services. Additional Ambulatory Surgery Center patient rights are listed below.

§ 416.50 Condition for Coverage – Patient Rights

The ASC must inform the patient or the patient’s representative of the patient’s rights, and must protect and promote the exercise of such rights.

Interpretive Guidelines §416.50

§ 416.50(a)(1) Standard: Notice of Rights

(1) The ASC must provide the patient or the patient’s representative with verbal notice of the patient’s rights in advance of the date of the procedure, in a language and manner that the patient or the patient’s representative understands.

§ 416.50(a) Standard: Notice of Rights

(1)[…] In addition, the ASC must –

(i) Post written notice of patient rights in a place or places within the ASC likely to be noticed by patients (or their representatives, if applicable) waiting for treatment. The ASC’s notice of right must include the name, address and telephone number of the representative in the State agency to whom patients can report complaints, as well as the Web site for the Office of the Medicare Beneficiary Ombudsman.

§ 416.50(a)(3) Standard: Submission and investigation of grievances

(ii) All alleged violations/grievances relating, but not limited to, mistreatment, neglect, verbal, mental, sexual, or physical abuse must be fully documented.

(iii) All allegations must be immediately reported to a person in authority in the ASC.

(iv) Only substantiated allegations must be reported to the State authority or the local authority, or both.

§ 416.50(b) Standard: Exercise of rights and respect for property and person

(4) If a patient is adjudges incompetent under applicable State health and safety laws by a court of jurisdiction, the rights of the patients are exercised by the person appointed under State law to act on the patient’s behalf.

(5) If a State court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with State law may exercise the patient’s rights to the extent allowed by State law.

§ 416.50(c) Standard: Privacy and Safety.

The patient has the right to –

(2) Receive care in a safe setting.

§ 416.50(c) Standard: Privacy and Safety.

The patient has the right to –

(3) Be free from all forms of abuse or harassment.

IF YOU HAVE A COMPLAINT ABOUT THE AGENCY OR PERSON PROVIDING YOU OUTPATIENT SURGICAL SERVICES, YOU MAY CALL, WRITE, OR VISIT THE OFFICE OF HEALTH FACILITY COMPLAINTS, MINNESOTA DEPARTMENT OF HEALTH. YOU MAY ALSO CONTACT THE OMBUDSMAN FOR LONG-TERM CARE.

Minnesota Department of Health, Office of the Ombudsman for Long-Term Care

Office of Health Facility Complaints (651) 431-2555

(651) 201-4201 1-800-657-3591

1-800-369-7994 Fax: (651) 431-7452

Fax: (651) 281-9796

www.mnaging.org

Mailing Address: Mailing Address:

Ombudsman for Long-Term Care Minnesota Department of Health,

PO Box 64971 Office of Health Facility Complaints

St. Paul, MN 55164-0971 85 East Seventh Place, Suite 300

P.O. Box 64970

St. Paul, Minnesota 55164-0970

Medicare Beneficiary Ombudsman

1-800-MEDICARE (1-800-633-4227)

https://www.cms.gov/center/special-topic/ombudsman/medicare-beneficiary-ombudsman-home

Translated: Patient Bill of Rights

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out of network provider or facility, the most the provider or facility may bill you is your plans in network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
  • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
  • Cover emergency services by out-of-network providers. o Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact the Department of Health &Human Services, 1-877-696-6775. Visit www.hhs.gov for more information about your rights under federal law.