{"ref":"CA-HSP-ELC-03","title":"Revocation, Change of Designated Hospice and Change of Attending Physician","category":"Hospice care","summary":"Sets out how a patient revokes the hospice election, changes to another hospice once in a benefit period, or changes attending physician; what each signed statement must contain; what the Agency sends to the receiving hospice and the attending physician; the notice it files with Medicare; and the rule that the Agency never asks or pressures a patient to revoke.","inShort":["A patient may stop hospice care (revoke) at any time, but only the patient or representative can decide that.","Never ask, suggest or pressure a patient to revoke.","Revocation and changes of hospice or doctor need a signed form. The effective date cannot be earlier than the date signed.","Tell the patient's nurse the same day if a patient says they want to stop hospice or change hospices.","When a patient moves to another hospice, send the consent, certifications and plan of care."],"primaryCitation":"42 CFR §418.28","citations":["22 CCR §74892(w)(1)","22 CCR §74896(m)","22 CCR §74892(a)(16)"],"federalCitations":["42 CFR §418.28","42 CFR §418.30","42 CFR §418.24(h)-(i)","42 CFR §418.104(e)","42 CFR §418.52(c)(4)"],"surveyorAsks":["Show me a revocation statement. Is the effective date on or after the date it was signed?","How do you make sure a revocation was the patient's own decision?"],"forms":[{"ref":"CA-HSP-ELC-03-A","title":"Revocation of Hospice Election"},{"ref":"CA-HSP-ELC-03-B","title":"Change of Designated Hospice"},{"ref":"CA-HSP-ELC-03-C","title":"Change of Attending Physician"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §§418.28, 418.30, 418.24(i))","5. Revocation","6. Re-election","7. Change of Designated Hospice","8. Change of Attending Physician","9. Responsibilities","10. Records and Compliance Monitoring","11. Staff Training","12. References","13. Related Policies and Forms","14. Approval","15. Revision History"],"version":"1.0","sample":false,"pack":"ca-hospice","state":"California","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}