{"ref":"TX-HSP-ELC-03","title":"Revocation, Change of Designated Hospice and Change of Attending Physician","category":"Hospice care","summary":"Explains how a patient revokes the hospice election, changes to another hospice or changes attending physician, what each statement must contain, what the Agency must send to the attending physician or the new hospice, and the 5-calendar-day notice the Agency files with its Medicare contractor after a revocation.","inShort":["Only the patient or their legal representative can revoke hospice. It must be signed, and the date cannot be earlier than the day they sign.","Never suggest that a patient revoke, especially to avoid the cost of care.","If a patient talks about leaving hospice, tell the RN coordinator the same day.","A patient can change to another hospice once in each benefit period, and can change their attending doctor with a signed statement.","After a revocation, send the discharge summary to the patient’s doctor. The office files the Medicare notice within 5 calendar days."],"primaryCitation":"42 CFR §418.28","citations":["26 TAC §558.859(a)-(c)","26 TAC §558.295(e)(1)","26 TAC ch. 266"],"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. Who signed it, and what is the effective date?","Did anyone from the Agency suggest or arrange this revocation? How do you prevent that?"],"forms":[{"ref":"TX-HSP-ELC-03-A","title":"Revocation of Hospice Election"},{"ref":"TX-HSP-ELC-03-B","title":"Change of Designated Hospice"},{"ref":"TX-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. If the Patient Cannot or Will Not Sign","7. Change of Designated Hospice","8. Change of Attending Physician","9. Discharge Summary and Records After Revocation or Transfer","10. Texas Medicaid","11. Learning From Revocations","12. Responsibilities","13. Records and Compliance Monitoring","14. Staff Training","15. References","16. Related Policies and Forms","17. Approval","18. Revision History"],"version":"1.0","sample":false,"pack":"tx-hospice","state":"Texas","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 Hospice","legalName":"Sample Hospice, LLC","logo":null}}