(1) A client or a client's authorized representative may choose to stop hospice care at any time by signing a revocation statement.
(2) The revocation statement documents the client's choice to stop medicaid hospice care. The revocation statement must include all of the following:
(a) Client's signature (or the client's authorized representative's signature if the client is unable to sign);
(b) Date the revocation was signed; and
(c) Actual date that the client chose to stop receiving hospice care.
(3) The hospice agency must keep any explanation supporting any difference in the signature and revocation dates in the client's hospice records.
(4) When a client revokes hospice care, the hospice agency must:
(a) Inform and notify in writing the medicaid agency's hospice program manager, within five working days of becoming aware of the client's decision (see WAC 182-551-1400
for additional requirements);
(b) Notify the appropriate department of social and health services (DSHS) home and community services (HCS) office or community services office (CSO) of the revocation by completing and forwarding a copy of the medicaid hospice notification form (HCA 13-746) to the appropriate DSHS home and community services (HCS) office or community services office (CSO);
(c) Keep the revocation statement in the client's hospice record;
(d) Provide the client with a copy of the revocation statement; and
(e) Inform the client that the revocation statement must be:
(i) Presented with the client's current services card when obtaining medicaid covered health care services or supplies, or both; and
(ii) Used until the medicaid agency issues a new services card that identifies that the client is no longer a hospice client.
(5) After a client revokes hospice care, the remaining days within the current election period are forfeited. The client may immediately enter the next consecutive election period. The client does not have to wait for the forfeited days to pass before entering the next consecutive election period.
[Statutory Authority: RCW 41.05.021
, Section 2302 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), and Section 1814 (a)(7) of the Social Security Act. WSR 12-09-079, § 182-551-1360, filed 4/17/12, effective 5/18/12. WSR 11-14-075, recodified as § 182-551-1360, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090
. WSR 05-18-033, § 388-551-1360, filed 8/30/05, effective 10/1/05. Statutory Authority: RCW 74.09.520
, 42 C.F.R. 418.22 and 418.24. WSR 99-09-007, § 388-551-1360, filed 4/9/99, effective 5/10/99.]