{"ref":"LA-HSP-ELC-03","title":"Revocation, Transfer to Another Hospice and Change of Attending Practitioner","category":"Hospice care","summary":"Protects the patient’s sole right to revoke hospice care, with the Louisiana signed statement giving the reason, no back-dating and no verbal revocations; sets out the transfer statement and once-per-period change of hospice, the change of attending practitioner, and the Medicare and Louisiana Medicaid notices due within five calendar days.","inShort":["Only the patient or representative can revoke hospice care. Never ask for, suggest or arrange a revocation.","The patient signs a revocation statement that says why, with an effective date no earlier than the signing date.","Verbal revocations and blank forms are never accepted.","A patient may change to another hospice once in each election period, with a signed statement to both hospices.","Tell the RN case manager the same day a patient wants to revoke, transfer or change practitioner."],"primaryCitation":"LAC 48:I §8229.C, E","citations":["LAC 48:I §8229.A","LAC 48:I §8229.C","LAC 48:I §8229.D","LAC 48:I §8229.E","LAC 48:I §8217.I.2.a","LAC 48:I §8233.H.6","LAC 48:I §8235.D.1.h","Louisiana Medicaid Services Manual, Chapter 24 (Hospice), §§24.2, 24.7"],"federalCitations":["42 CFR §418.28","42 CFR §418.30","42 CFR §418.24(i)","42 CFR §418.104(e)"],"surveyorAsks":["Show me this patient’s revocation statement. Does it say why the patient revoked?","Who decided this patient would revoke, and what did staff tell the family?"],"forms":[{"ref":"LA-HSP-ELC-03-A","title":"Revocation of Hospice Election"},{"ref":"LA-HSP-ELC-03-B","title":"Change of Designated Hospice"},{"ref":"LA-HSP-ELC-03-C","title":"Change of Attending Practitioner"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (LAC 48:I §8229.C, E)","5. No Pressure to Revoke","6. Revocation","6.1 Notices After Revocation","7. Change of Designated Hospice (Transfer)","7.1 When the Agency Is the Transferring Hospice","7.2 When the Agency Is the Receiving Hospice","8. Change of Attending Practitioner","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":"la-hospice","state":"Louisiana","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}}