| (a) Filing an election statement. An individual who
meets the eligibility requirements for hospice care may elect hospice
by filing the Individual Election/Cancellation/Update Form with a
particular hospice. If the individual is physically or mentally incapacitated,
the individual's representative may file the form. If the individual
is dually eligible for Medicaid and Medicare, the individual must
elect the Medicaid and Medicare hospice benefit at the same time.
(b) Content of election statement. The election statement
must include the following:
(1) identification of the particular hospice that will
provide care to the individual;
(2) the individual's or representative's acknowledgment
that the individual or representative has been given a full explanation
of the palliative rather than curative nature of hospice care as it
relates to the individual's terminal illness;
(3) acknowledgment that certain Medicaid services,
as set forth in subsection (d) of this section, are waived by the
election;
(4) the effective date of the election, which may be
the first day of hospice care or a later date, but must be no earlier
than the date of the election statement; and
(5) the signature of the individual or representative.
(c) Duration of election. An election to receive hospice
care will continue through the initial election period and the subsequent
election periods without a break in care as long as the individual:
(1) remains in the care of a hospice; and
(2) does not revoke the election under the provisions
of §266.207 of this subchapter (relating to Revoking the Election
of Hospice Care).
(d) Waiver of other benefits. For the duration of an
election of hospice care, an individual 21 years of age or older waives
all rights to the following Medicaid services:
(1) hospice care provided by a hospice other than the
hospice designated by the individual unless the care is provided under
arrangements made by the designated hospice; and
(2) any Medicaid services related to the treatment
of the terminal condition for which hospice care was elected, or a
related condition for which the hospice care was elected, or that
are equivalent to hospice care except for services:
(A) provided by the designated hospice;
(B) provided by another hospice under arrangements
made by the designated hospice; or
(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.
(e) Re-election of hospice benefits. If an election
has been revoked in accordance with §266.207 of this subchapter,
the individual, or the individual's representative, if the individual
is mentally or physically incapacitated, may at any time file an election
in accordance with this section.
(f) Record retention. The hospice must retain copies
of all election forms in the hospice record for the individual and
the individual's nursing facility or ICF/IID record, if applicable.
Providers must meet the record retention requirements specified in
40 TAC Chapter 49 (relating to Contracting for Community Services).
(g) The hospice must submit the Individual Election/Cancellation/Update
Form to the TMHP Long Term Care Online Portal.
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