{"ref":"OH-HSP-ELC-03","title":"Withdrawal of Consent, Revocation, Change of Designated Hospice and Change of Attending Physician","category":"Hospice care","summary":"Sets out how the Agency honors a patient's withdrawal of consent and revocation of the hospice election, a change of designated hospice once in each benefit period and a change of attending physician, with the signed statements, notices, Ohio Medicaid portal entries and hearing rights each requires, and the rule that staff never pressure a patient to revoke.","inShort":["A patient may stop hospice care at any time. Never suggest or push a patient to revoke.","If a patient says they want to stop, tell the RN coordinator the same day.","A revocation must be signed and dated. Do not accept a spoken revocation.","A patient may change hospice once in each benefit period, with a signed statement filed with both hospices.","To change attending physician, the patient signs a statement naming the new physician and the effective date."],"primaryCitation":"42 CFR §418.28","citations":["OAC 3701-19-20(D)","OAC 5160-56-03(A)(2)-(3)","OAC 5160-56-03(B)-(G)","OAC 5160-56-02(C), (K)","OAC 5160-56-03.3","OAC Chapters 5101:6-1 to 5101:6-9"],"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)(3)-(4)"],"surveyorAsks":["Show me the signed revocation statement for this patient. What effective date does it give, and when was it signed?","Did anyone at the Agency suggest that this patient revoke? How do you prevent that?"],"forms":[{"ref":"OH-HSP-ELC-03-A","title":"Statement of Revocation of Hospice Election"},{"ref":"OH-HSP-ELC-03-B","title":"Change of Designated Hospice"},{"ref":"OH-HSP-ELC-03-C","title":"Change of Attending Physician"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (OAC 3701-19-20(D); 42 CFR §418.28)","5. No Pressure to Revoke","6. Revocation","7. Change of Designated Hospice","8. Change of Attending Physician","9. Ohio Medicaid Hearing Rights","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":"oh-hospice","state":"Ohio","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}}