Hospice care is a specialized form of medical attention centered on comfort and quality of life for individuals facing a terminal illness, typically defined as a prognosis of six months or less. This type of care focuses on managing pain and other symptoms, rather than pursuing curative treatments. While electing to receive this benefit is a significant decision, it is not a permanent commitment. A patient retains the right to discontinue hospice services at any point, maintaining their autonomy.
The Patient’s Right to Revocation
The right of a patient to change their mind and discontinue hospice care is formally referred to as “revocation.” This freedom is guaranteed by federal regulations, particularly for those utilizing the Medicare Hospice Benefit, and is mandated by the Centers for Medicare & Medicaid Services (CMS). The regulations ensure that the choice to receive comfort care remains voluntary throughout the election period.
A patient does not need permission from their hospice provider or physician to revoke the benefit. This decision is entirely the patient’s or their authorized representative’s to make. Patients may choose to revoke care for several reasons, such as an unexpected improvement in their medical condition that changes their prognosis or a desire to pursue new curative treatments. Dissatisfaction with the current hospice agency is also a common reason.
This patient-initiated action differs from a discharge, which occurs when the hospice provider determines the patient no longer meets the eligibility criteria, such as no longer being considered terminally ill. Revocation is a direct exercise of the patient’s right to choose their care path. The hospice provider is prohibited from requesting or demanding that a patient revoke their election.
The Formal Process of Leaving Hospice
To formally leave hospice care, the patient or their legally authorized representative must provide a clear, written statement of revocation to the hospice provider. This document must be signed and include the specific date on which the revocation is to become effective. A verbal notification is insufficient and will not be accepted.
Once the hospice receives this signed document, they must immediately process the patient’s request. The hospice must accept the revocation without attempting to dissuade the patient beyond providing information about the consequences of the decision. The effective date specified on the written statement is the day the patient officially ends their hospice benefit. Following the revocation, the hospice provider must submit a formal Notice of Termination/Revocation (NOTR) to the Medicare contractor within a short period to update the patient’s coverage status.
Understanding the Financial and Care Implications
Revoking the hospice benefit triggers an immediate and significant shift in the patient’s healthcare coverage and access to services. The comprehensive, interdisciplinary support team, including nurses, social workers, and aides, will cease providing care on the effective date of revocation. Specialized medical equipment and medications provided by the hospice for symptom management will no longer be covered by the hospice benefit and must be returned or covered by other means.
For patients using Medicare, their coverage immediately reverts back to standard Medicare Part A and Part B coverage, which they waived upon electing the hospice benefit. They regain the ability to seek curative treatments for their terminal illness, such as chemotherapy or invasive surgery. However, the patient becomes subject to the standard Medicare cost-sharing rules, including deductibles, co-pays, and coverage limitations.
The coverage is no longer comprehensive and may be fragmented, potentially incurring significant out-of-pocket costs for care, medications, and equipment. It is important to understand that a patient cannot simultaneously receive the Medicare Hospice Benefit and standard Medicare coverage for curative treatments related to the terminal illness. The choice to revoke care shifts the financial and logistical burden of care management back to the patient and their family.
Rejoining Hospice Care
Revocation is not a lifetime ban, and a patient maintains the option to re-elect the hospice benefit in the future. The ability to return to hospice care depends on the patient still meeting the established eligibility criteria. A physician must recertify that the patient has a prognosis of six months or less if the terminal illness follows its expected course.
To re-enroll, the patient must sign a new election statement, formally restarting the process. There is no mandated waiting period after revocation before a patient can re-elect the benefit, but the date of re-admission cannot be the same day as the date of revocation. Each re-election marks the beginning of a new benefit period, and the patient’s previously forfeited days from the prior election period are reinstated. This flexibility allows patients whose medical condition may fluctuate to pursue aggressive treatment and then return to comfort care.