Utah Medicaid Provider Manual, Hospice Care Services § 8-9.6

The member (or legal representative) may revoke the election of hospice care at

any time. To revoke the election of hospice care, the member or representative

must give the hospice a signed statement revoking the election of hospice care

for the remainder of that election period with the date revocation is to be

effective. The individual forfeits the remainder of the election period. Signed

statements must include the following information:

• A signed statement that the member or representative revokes the

member's election for Medicaid coverage of hospice care,

• The date that the revocation is to be effective, which may not be earlier

than the date that the revocation is made, and

• An acknowledgment signed by the patient or the patient's representative

that the patient will forfeit Medicaid hospice coverage for any remaining

days in that election period.

Upon revocation of the election of Medicaid coverage of hospice care for a

particular election period, a member:

• Is no longer covered under Medicaid for hospice care,

• Resumes Medicaid coverage for the benefits waived (for adult members),

and

• May at any time elect to receive hospice coverage for any other hospice

election periods that they are eligible to receive.

Hospice agencies may not encourage adult members to temporarily revoke

hospice care services solely for the purpose of avoiding financial responsibility

for Medicaid services that have been waived at the time of hospice election.