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Get Masshealth Hospice Election Form

H member elects, revokes, or disenrolls from hospice services, or changes his or her hospice provider. MassHealth does not pay for hospice services unless a completed MassHealth Hospice Election Form has been submitted, and will not pay for hospice services provided before the effective date entered on the form. The effective date for hospice services may not be earlier than the date the member or the member s representative signs the form. Attention MassHealth Managed Care Organization Member.

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