Connecticut Governor Ned Lamont recently signed Public Act No. 26-68 (the Act), which includes changes to the state’s medical orders for life-sustaining treatment (MOLST) program. Shortly after the Act was signed into law, the Connecticut Department of Public Health (DPH) issued policies and procedures regarding the MOLST program, which will operate as regulations in the interim until DPH promulgates final regulations. The statutory changes to the MOLST program became effective May 26, 2026, and the DPH policies and procedures became effective June 8, 2026.
Background
MOLST is Connecticut’s framework for documenting medical orders concerning life-sustaining treatment for individuals who are approaching the end stage of a serious, life-limiting illness or who are in a condition of advanced chronic progressive frailty. The purpose of the program is to support patients’ preferences regarding treatment at such point in their disease progression. MOLST is implemented through medical orders that can guide treatment decisions across care settings.
Statutory Changes to the MOLST Program
The Act redefines a “medical order for life-sustaining treatment” to now mean a set of orders established by DPH and specific to the MOLST program. Previously, a MOLST was an order made by a physician, advanced practice registered nurse (APRN) or physician assistant. The Act further specifies that a MOLST will be valid only if it is completed on a form prescribed by DPH. Pursuant to this change, DPH published a form which providers must now use to effectuate patients’ wishes for life-sustaining treatment.
The Act also allows physician assistants, in addition to APRNs and physicians, to determine that a patient’s condition has progressed to the point appropriate for a MOLST.
MOLST Policies and Procedures
DPH’s policies and procedures operationalize the MOLST changes made by the Act. The policies include training-related requirements for providers who are authorized to execute a MOLST form. Each eligible provider must complete DPH-approved MOLST training, which will focus on conditions that qualify a patient for participation in the MOLST program. No provider may sign a MOLST form without first completing the required DPH-approved training.
The new DPH policies require that a provider conduct a MOLST discussion with the patient or the patient’s legally authorized representative before executing a MOLST form. During this discussion, the provider must discuss the patient’s goals for care and treatment and the benefits and risks of various methods for documenting the patient’s wishes for end-of-life treatment. The MOLST discussion must be completed again as clinically appropriate to review goals of care and treatment preferences according to disease progression, when the patient is transferred to a different care setting or level of care, or if the patient’s preferences change. The provider must document these discussions in the patient’s medical record. Once the MOLST form is executed, it must be made available for the patient to review.
The policies also address revocation, amendment and treatment requests that differ from a valid MOLST form. A patient or their legally authorized representative may request and receive treatment that differs from the patient’s valid MOLST form at any time, without revoking the MOLST form. A patient or legally authorized representative may revoke or amend a valid MOLST form at any time.
Each health care provider must follow the orders on a valid MOLST form, unless instructed otherwise by the patient or legally authorized representative. The policies also provide that valid MOLST forms must be recognized by any receiving health care provider or institution.
Key Takeaways
The Act and related DPH policies result in a more detailed and standardized operational framework for the MOLST program, and place new training requirements on providers. Health care providers involved in end-of-life care should be aware of these new changes to the MOLST program and may need to update their processes and forms to comply with the new state-mandated MOLST program requirements.