Healthcare directives form widened eligibility

Summary#

The Health-Care Decisions Amendment Act of 2026 would amend Chapter 22 of Title 21 of the District of Columbia Official Code, which governs Medical Orders for Scope of Treatment (MOST) forms. Its stated goal is to make it easier to document patients’ treatment preferences and help providers honor them; the bill is introduced and is not law.

  • It broadens who may qualify as a patient: a person may be medically fragile, or the patient and an authorized health professional may agree that a MOST form is appropriate, with that decision documented in the medical record. The fiscal note says the bill removes the current 12-month life-expectancy limit.
  • It expands who may assist with MOST forms, including naturopathic physicians and physician assistants acting under a valid delegation agreement. The fiscal note says physicians and advanced practice registered nurses already participate.
  • A valid form must be signed by the patient or authorized representative and an authorized health professional. Patients and representatives must be offered the opportunity to make a form, but are not required to do so.
  • Health-care institutions and private practices must upload an executed form to the patient’s electronic medical record and submit it to the District’s health information exchange. They must also keep a prominent paper copy and transfer a copy when the patient moves to another care setting or home.
  • DC Health may establish a MOST Advisory Committee. The Director would choose its members, and the committee could review forms, promote public awareness, recommend training, and do other assigned work.

What it means for you#

  • Patients and authorized representatives: The wider patient definition may make a MOST form available to people who do not meet the current 12-month life-expectancy limit. A form is still voluntary, and the bill does not change the requirement for signatures from both the patient or representative and an authorized health professional.
  • Health professionals: More types of professionals may assist with forms, including naturopathic physicians and physician assistants under valid delegation agreements. The form still needs an authorized health professional’s signature.
  • Health-care institutions and private practices: They would have to send completed forms to the electronic medical record and the District’s health information exchange, keep a prominent paper copy, and transfer a copy with the patient.
  • Other residents: The bill does not directly change taxes, health-care benefits, or the treatment choices listed on a MOST form.

Money#

The fiscal impact statement says funds are sufficient through the proposed fiscal year 2030 budget period, and DC Health can implement the bill with existing resources.

  • The Chief Financial Officer says the expanded participation, committee changes, and electronic-record requirement have no cost.
  • The materials give no separate estimate for costs that health-care institutions or private practices might face.

What is unclear#

  • The full current law is not supplied, so the exact existing rules—and the full effect of all amendments—cannot be independently checked against it.
  • The bill leaves “medically fragile” to an authorized health professional’s clinical judgment and lists several conditions, but does not set a more detailed decision process.
  • The bill does not specify how DC Health would choose committee members or how often the committee would meet. Establishing the committee is optional.
  • The supplied text changes “shall” to “may” in another provision and repeals a section, but does not include enough of those provisions to explain the practical effects.
  • The bill does not describe how the health information exchange will handle access to or protection of MOST forms.

Case for#

  • A possible argument for the bill is that patients with serious or complex conditions may want to document treatment preferences even if their life expectancy is not 12 months or less.
  • Allowing more types of professionals to assist may make it easier for patients to complete a form.
  • Requiring forms to be included in electronic and paper records, and transferred with the patient, could help make those preferences available across care settings.
  • A committee could provide advice on forms, public awareness, and professional training.

Case against#

  • The broader eligibility test relies partly on clinical judgment and agreement between a professional and the patient or representative. The bill does not spell out how disagreements would be handled.
  • Sending forms to the District’s health information exchange would make them available through that system, but the supplied text does not explain access or privacy safeguards.
  • DC Health may establish the advisory committee, but is not required to do so. The bill does not guarantee that the committee’s review or training recommendations will happen.
  • The fiscal note says existing resources are sufficient, but provides no separate estimate of costs to care institutions or practices that must handle, store, and transfer forms.