{"ref":"MI-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 the designated hospice once in a benefit period, or changes the attending physician; the written statements each requires; the notice of termination or revocation filed within 5 calendar days; the Michigan Medicaid steps in CHAMPS, including transfers to another hospice with no lapse in services; offering controlled substance disposal help to a patient who revokes; and the rule that staff never encourage a revocation.","inShort":["A patient may stop hospice, change hospice once per benefit period, or change physicians. It is always the patient's choice.","Never suggest stopping hospice so the patient can go to the hospital or get costly care. Offer other options first.","Get the right signed form: ELC-03-A to revoke, ELC-03-B to change hospice, ELC-03-C to change physician. The date can never be before the signature.","When a home patient revokes, offer to help dispose of controlled drugs and write down the answer.","Tell billing the same day. The notice must be filed within 5 calendar days."],"primaryCitation":"42 CFR §418.28","citations":["Michigan Medicaid Provider Manual, Hospice, Sections 4, 4.2, 4.3, 4.6, 5.4 and 7.1","MCL 333.21418(1)(c)","Mich. Admin. Code R 325.45129(3)","Mich. Admin. Code R 325.45169(5)","Mich. Admin. Code R 325.45131(2)"],"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 the revocation statement for this patient. What is the effective date, and when was it signed?","Did anyone at the Agency suggest that this patient revoke before going to the hospital?"],"forms":[{"ref":"MI-HSP-ELC-03-A","title":"Statement of Revocation of Hospice Election"},{"ref":"MI-HSP-ELC-03-B","title":"Change of Designated Hospice Statement"},{"ref":"MI-HSP-ELC-03-C","title":"Change of Attending Physician Statement"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.28)","5. No Pressure to Revoke","6. Revocation","7. Change of Designated Hospice","8. Change of Attending Physician","9. Re-election After Revocation","10. Responsibilities","11. Records and Compliance Monitoring","12. Staff Training","13. References","14. Related Policies and Forms","15. Approval","16. Revision History"],"version":"1.0","sample":false,"pack":"mi-hospice","state":"Michigan","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}}