Wash. HCA Hospice Services Billing Guide, May a client choose to end (revoke) hospice care?

A client or authorized health care representative may decide to stop hospice care

at any time by signing a revocation statement.

The revocation statement documents the client’s choice to stop Medicaid hospice

care. The revocation statement must include all the following:

• The client’s (or authorized health care representative’s) signature

• The date the revocation was signed

• The actual date that the client decided to stop receiving hospice care

The hospice agency must keep an explanation supporting any difference in the

signature and revocation dates in the client’s hospice records.

When a client revokes hospice care, the hospice agency must do all the following:

• Inform and notify HCA’s hospice program within five business days of

becoming aware of the client’s decision.

• Fax a completed copy of HCA’s HCA/Medicaid Hospice Notification form, HCA

13-746, to HCA hospice/PPC notification number at 360-725-1965. See Where

can I download HCA forms?

• Do not bill HCA for the client’s last day of hospice services.

• Keep the revocation statement in the client’s hospice record.

• Provide the client with a copy of the revocation statement as described in

WAC 182-551-1360.

After a client revokes hospice care, the remaining days within the current election

period are forfeited. The client may immediately enter the next consecutive

election period. The client does not have to wait for the forfeited days to pass

before entering the next consecutive election period.