B. Election requirements

If an individual elects to receive hospice care, they must file an election statement with a particular hospice. An election may also be filed by a representative acting pursuant to State law. With respect to an individual granted the power of attorney for the patient, State law determines the extent to which the individual may act on the patient's behalf.

The two 90-day election periods must be used before the 60-day periods. An election to receive hospice care will be considered to continue through the initial election period and through the subsequent election periods without a break in care as long as the individual remains in the care of the hospice and does not revoke the election. An individual may designate an effective date for the election period that begins with the first day of hospice care or any subsequent day of hospice care, but not earlier than the date the election is made.

An individual must waive all rights to Medicare payments for the duration of the election of hospice care for the following services:

1. Hospice care provided by a hospice other than the hospice designated by the individual (unless provided under arrangements made by the designated hospice).

2. Any Medicare services that are related to the treatment of the terminal condition for which hospice care was elected or a related condition or that are equivalent to hospice care except for services— a. provided (either directly or under arrangement) by the designated hospice; b. provided by another hospice under arrangements made by the designated hospice; and c. provided by the individual's attending physician if that physician is not an employee of the designated hospice or receiving compensation from the hospice for those services. An individual or representative may revoke the election of hospice care at any time. To revoke the election of hospice care, the individual must file a signed statement with the hospice that revokes the election for Medicare coverage of hospice care for the remainder of that election period and the date that the revocation is to be effective. The effective date cannot be earlier than the date that the revocation is made. The individual forfeits coverage for any remaining days in that election period. Upon revoking the election of Medicare coverage of hospice care for a particular election period, an individual resumes Medicare coverage of the benefits waived when hospice care was elected. An individual may at any time elect to receive hospice coverage for any other hospice election periods for which they are eligible. An individual may change, once in each election period, the designation of the particular hospice from which they elect to receive hospice care. The change of the designated hospice is not considered a revocation of the election. To change the designation of hospice programs, the individual must file, with the hospice from which they have received care and with the newly designated hospice, a signed statement that includes the following information: the name of the hospice from which the individual has received care, the name of the hospice from which they plan to receive care and the date the change is to be effective. A change of ownership of a hospice is not considered a change in the patient's designation of a hospice and requires no action on the patient's part.