|(a) An individual or representative may revoke the individual's election of hospice care at any time during an election period. If the recipient is dually eligible, the individual must revoke the Medicaid and Medicare hospice benefit at the same time. (b) To revoke the election of hospice care, the individual or representative must file a statement with the hospice that includes the following information: (1) a signed statement that the individual or representative revokes the individual's election for Medicaid coverage of hospice care for the remainder of that election period; and (2) the date that the revocation is to be effective. An individual or representative may not designate an effective date earlier than the date that the revocation is made. (c) An individual, upon revocation of the election of Medicaid coverage of hospice care for a particular election period: (1) is no longer covered under Medicaid for hospice care; (2) resumes Medicaid coverage of the benefits waived under §30.16(d)(2) of this title (relating to Election of Hospice Care); and (3) may at any time elect to receive hospice coverage as long as he meets eligibility requirements. (d) The provider must submit the Medicaid Hospice Recipient Election/Cancellation/Discharge Notice to Provider Claims Services.