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RULE §30.16Election of Hospice Care

(a) Filing an election statement. An individual who meets the eligibility requirement of §30.10 of this title (relating to Eligibility Requirements) may file an election statement with a particular hospice. If the individual is physically or mentally incapacitated, the individual's representative may file the election statement. If the recipient 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 he 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 through 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 §30.18 of this title (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 Medicaid payments 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); 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; 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.

(e) Re-election of hospice benefits. If an election has been revoked in accordance with §30.18 of this title (relating to Revoking the Election of Hospice Care), 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 maintenance. The hospice provider must retain copies of all election forms in the hospice records for the recipient and the recipient's nursing facility clinical record, or the intermediate care facility for persons with mental retardation or related conditions (ICF/MR-RC), if applicable.

Source Note: The provisions of this §30.16 adopted to be effective March 1, 2001, 26 TexReg 1549; amended to be effective May 1, 2002, 27 TexReg 3585; amended to be effective March 1, 2003, 28 TexReg 1396; amended to be effective October 30, 2011, 36 TexReg 7176

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