Hospice care is specialized support focused on comfort and quality of life for individuals with a terminal illness, prioritizing pain management and emotional well-being rather than curative treatment. The patient or their representative has the right to stop care at any time, a process known as revocation. This decision often arises from changes in the patient’s condition, a desire to pursue new treatments, or a reconsideration of prognosis. Understanding the procedures for ending the benefit is important because it immediately impacts insurance coverage and the structure of ongoing medical care.
The Right to Revoke Hospice Care
The choice to receive hospice services is voluntary, and this autonomy extends to the right to stop receiving care at any point. This is formally called a voluntary revocation, initiated by the patient or their legally authorized representative. The patient’s decision to revoke the hospice benefit is guaranteed, regardless of their medical prognosis or the recommendations of the hospice team or attending physician.
It is important to distinguish between patient-initiated revocation and provider-initiated discharge. A hospice provider may discharge a patient only under specific circumstances, such as when the patient is no longer certified as terminally ill or moves out of the service area. Revocation, in contrast, is solely the patient’s choice and ends their current election period for the Medicare Hospice Benefit. A hospice agency cannot request or demand that a patient revoke their election.
The Formal Process of Stopping Care
The process for formally ending hospice care is governed by regulatory requirements, especially for those utilizing the Medicare Hospice Benefit. To revoke the election, the patient or representative must file a signed, written statement with the hospice agency. This documentation is mandatory; a verbal revocation is not legally acceptable to terminate the election.
The written statement must include the intended effective date of the revocation. The patient cannot designate a date earlier than the actual signing date. Once signed, the revocation is effective immediately, meaning the hospice’s responsibility for care and payment ceases at that moment. The hospice agency must assist with the transition of care back to traditional coverage, even though direct services stop immediately.
The hospice must submit a Notice of Termination/Revocation (NOTR) to the Medicare contractor within five calendar days after the effective date. This administrative step officially informs the payer that the patient is no longer covered under the hospice benefit. Prompt filing helps prevent delays in the patient accessing new, non-hospice services.
Consequences for Coverage and Re-Entry Rules
Revocation has immediate consequences for a patient’s insurance coverage and future eligibility for hospice services. When a patient revokes the benefit, they immediately lose coverage for services related to the terminal illness. Simultaneously, the patient’s standard Medicare Part A and Part B coverage, or regular insurance, is reinstated for all medical services, including curative treatments waived upon electing hospice.
This shift requires the patient to secure new providers and medications for ongoing care, as the hospice agency is no longer responsible for these needs or supplies. If the patient was receiving care through a Medicare Advantage Plan, claims will continue to be processed through the fee-for-service system until the first day of the month following revocation.
A patient may re-elect the hospice benefit at any time after a voluntary revocation, provided they meet the coverage criteria. This requires the patient to be re-certified by a physician as having a terminal illness with a prognosis of six months or less. There is no required waiting period to re-elect, but the patient must restart a new election period with a new certification.