Hospice care offers palliative support, focusing on comfort and quality of life for individuals with a terminal diagnosis rather than providing curative treatments. When a patient chooses hospice, they are making an “election” to receive this benefit, which is typically covered by Medicare or other insurers. The decision to revoke hospice care is an important patient right that allows them to pursue curative treatments if their condition improves or their priorities change. Understanding the rules for leaving and re-entering this care requires navigating the administrative structure that governs these benefits.
Understanding the Hospice Benefit Periods
The structure of hospice coverage is defined by specific time frames known as benefit periods, which are set by the Centers for Medicare and Medicaid Services (CMS). A patient must meet eligibility criteria, primarily a prognosis of six months or less if the illness runs its normal course, to begin the benefit. The initial enrollment consists of two separate 90-day benefit periods, which together cover the first six months of care.
Following these first two periods, the coverage transitions to subsequent periods that are each 60 days long. There is no predetermined limit to how many 60-day periods a patient can receive, provided they continue to meet the medical requirements.
Recertification of the terminal illness is required at the start of each new benefit period. The hospice medical director or physician must sign a document stating the patient’s continued eligibility before the new period begins. Starting with the third benefit period—the first 60-day period—a face-to-face encounter with the patient by a physician or nurse practitioner is also mandated to confirm eligibility.
The Rules Governing Revocation Frequency
There is no administrative limit on the number of times a patient can revoke and subsequently re-elect the hospice benefit. The freedom to revoke the benefit is protected as a patient right, allowing them to make choices about their medical care at any time. This flexibility is important because a patient’s medical condition or personal goals can change unexpectedly.
Each time a patient revokes the benefit, they immediately forfeit the remaining days in that current election period. However, they retain the ability to re-elect the benefit at a later date, provided they still meet the necessary eligibility criteria for any available benefit periods.
A revocation must be a formal action initiated by the patient or their authorized representative. The hospice provider cannot unilaterally request or demand that a patient revoke the benefit, ensuring the patient’s choice to pursue curative measures or other options is respected without pressure.
Administrative Procedures Following Revocation
Revoking hospice care requires a formal, written statement from the patient or their representative submitted to the hospice provider. This document must state the patient’s intent to revoke the election and specify the date the revocation is to become effective. A verbal statement alone is not sufficient to terminate the benefit administratively.
Upon revocation, the patient returns to standard Medicare coverage, including full coverage for curative treatments for the terminal illness that were previously waived. The hospice is required to file a Notice of Termination/Revocation (NOTR) with the Medicare contractor, typically within five calendar days of the effective date. This signals the end of the hospice’s responsibility for the patient’s care under the benefit.
To re-elect the hospice benefit after a revocation, the patient must meet the eligibility criteria, including physician certification of a terminal illness. Re-election starts a new benefit period (90-day or 60-day), depending on how many the patient has previously used. The patient must sign a new election statement and can choose to return to their previous hospice provider or select a different one.