CMS published changes to hospital Conditions of Participation regarding advance directives. The changes expanded patient rights related to advance directives and focused on incapacitated patients designating a representative for healthcare decisions. Hospitals must now provide written notice of advance directive policies to inpatients, emergency patients, and those in observation or having outpatient surgery. The notice must include any limitations where advance directives cannot be followed due to conscience objections, clarifying these objections and citing the relevant state legal authority. Hospitals must also review policies where advance directives are not honored to ensure any limitations are due to legally permitted conscience objections.