Election, Revocation, and Change of Hospice

Each hospice designs and prints its election statement. The election statement must include the following items of information:
* Identification of the particular hospice that will provide care to the individual;

* The individual’s or representative’s (as applicable) acknowledgment that the individual has been given a full understanding of hospice care;

* The individual’s or representative’s (as applicable) acknowledgment that the individual understands that certain Medicare services are waived by the election;

* The effective date of the election; and

* The signature of the individual or representative.

An individual or representative may revoke the election of hospice care at any time in writing. To revoke the election of hospice care, the individual must file a document with the hospice that includes a signed statement that the individual revokes the election for Medicare coverage of hospice care for the remainder of that election period and the effective date of that revocation. Note that a verbal revocation of benefits is NOT acceptable. The individual forfeits hospice coverage for any remaining days in that election period. An individual may not designate an effective date earlier than the date that the revocation is made.
Upon revoking the election of Medicare coverage of hospice care for a particular election period, an individual resumes Medicare coverage of the benefits waived when hospice care was elected. An individual may at any time elect to receive hospice coverage.
An individual may change, once in each election period, the designation of the particular hospice from which he or she elects to receive hospice care. The change of the designated hospice is not considered a revocation of the election. To change the designation of hospice programs, the individual must file, with the hospice from which he or she has received care and with the newly designated hospice, a signed statement that includes the following information: the name of the hospice from which the individual has received care, the name of the hospice from which they plan to receive care and the date the change is to be effective. (A change of ownership of a hospice is not considered a change in the patient’s designation of a hospice and requires no action on the patient’s part.)
Medicare beneficiaries enrolled in managed care plans may elect hospice benefits. Federal regulations require that the regional home health intermediaries (RHHIs) maintain payment responsibility for hospice services and for other claims the RHHI may pay as a regular servicing fiscal intermediary (FI) for managed care enrollees who elect hospice; specifically regulations at 42 CFR 417, Subpart P, 42 CFR 417.585 Special Rules: Hospice Care (b), and 42 CFR 417.531 Hospice Care Services (b). FI claims for services not related to the terminal illness would otherwise be the responsibility of another FI.
Managed care enrollees that have elected hospice may revoke hospice election at any time, but claims will continue to be paid by fee-for-service contractors as if the beneficiary were a fee-for-service beneficiary until the first day of the month following the month in which hospice was revoked. As specified above, by regulation, the duration of payment responsibility by fee-for-service contractors extends through the remainder of the month in which hospice is revoked by hospice beneficiaries.
See the Medicare Claims Processing Manual, Chapter 2, “Admission and Registration” and Chapter 11, “Hospice,” for requirements for hospice reporting to the intermediary and carrier.

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