1. (1) An individual who meets the eligibility requirements of OAR 410-142-0040 may file an election statement with a particular hospice. If the individual is physically or mentally incapacitated, his or her representative may file the election statement.

2. (2) The election statement must include the following:

   1. (a) Identification of the particular hospice that will provide care to the individual;
   2. (b) The individual's or representative's acknowledgment that he or she has been given a full understanding of the palliative rather than curative nature of hospice care, as related to the individual's terminal illness;
   3. (c) Except for children (see 410-124-0110), acknowledgment that certain otherwise covered services are waived by the election. Election of a hospice benefit means that the Division of Medical Assistance Programs (Division) will only reimburse the hospice for those services included in the hospice benefit;
   4. (d) The effective date of the election, which may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement;
   5. (e) The signature of the individual or representative.
3. (3) Re-election of hospice benefits. If an election has been revoked in accordance with OAR 410-142-0160, the individual (or his or her representative if the individual is mentally or physically incapacitated) may at any time file an election, in accordance with this section, for any other election period that is still available to the individual.
4. (4) File the election statement in the medical record.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.065

History

DMAP 36-2010, f. 12-15-10, cert. ef. 1-1-11
OMAP 1-2003, f. 1-31-03, cert. ef. 2-1-03
HR 28-1997, f. 12-31-97, cert. ef. 1-1-98
HR 9-1994, f. & cert. ef. 2-1-94