---
kind: "section"
citation: "42 C.F.R. § 403.724"
title: "42"
number: "403.724"
heading: "Valid election requirements."
url: "https://uscodex.org/cfr/42/403.724"
---

# §403.724. Valid election requirements.

- (a) **General requirements.** An election statement must be made by the Medicare beneficiary or his or her legal representative.
  - (1) The election must be a written statement that must include the following statements:
    - (i) **The beneficiary is conscientiously opposed to acceptance of nonexcepted medical treatment.**
    - (ii) The beneficiary acknowledges that the acceptance of nonexcepted medical treatment is inconsistent with his or her sincere religious beliefs.
    - (iii) The beneficiary acknowledges that the receipt of nonexcepted medical treatment constitutes a revocation of the election and may limit further receipt of services in an RNHCI.
    - (iv) The beneficiary acknowledges that the election may be revoked by submitting a written statement to CMS.
    - (v) The beneficiary acknowledges that revocation of the election will not prevent or delay access to medical services available under Medicare Part A in facilities other than RNHCIs.
  - (2) The election must be signed and dated by the beneficiary or his or her legal representative.
  - (3) The election must be notarized.
  - (4) The RNHCI must keep a copy of the election statement on file and submit the original to CMS with any information obtained regarding prior elections or revocations.
  - (5) **The election becomes effective on the date it is signed.**
  - (6) **The election remains in effect until revoked.**
- (b) **Revocation of election.**
  - (1) **A beneficiary's election is revoked by one of the following—**
    - (i) **The beneficiary receives nonexcepted medical treatment for which Medicare payment is requested.**
    - (ii) **The beneficiary voluntarily revokes the election and notifies CMS in writing.**
  - (2) The receipt of excepted medical treatment as defined in [§ 403.702](/cfr/42/403.702.md) does not revoke the election made by a beneficiary.
- (c) **Limitation on subsequent elections.**
  - (1) If a beneficiary's election has been made and revoked twice, the following limitations on subsequent elections apply:
    - (i) **The third election is not effective until 1 year after the date of the most recent revocation.**
    - (ii) **Any succeeding elections are not effective until 5 years after the date of the most recent revocation.**
  - (2) CMS will not accept as the basis for payment of any claim any elections executed on or after January 1 of the calendar year in which the sunset provision described in [§ 403.756](/cfr/42/403.756.md) becomes effective.

## Notes

### Source

Source: 64 FR 67047, Nov. 30, 1999, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.