In order to be entitled to hospice benefits under Medicare, an individual must be
entitled to Part A, be certified as terminally ill, and elect to receive hospice benefits.
An individual is considered terminally ill if the medical prognosis is a life expectancy
of six months or less. To be covered, a certification that the individual is terminally
ill must have been completed and hospice services must be reasonable and necessary
for the palliation or management of the terminal illness and related conditions. A
plan of care must be established before services are provided, and services must be
consistent with the plan. The Medicare hospice benefit is provided in periods of care. The
periods consist of two 90-day periods and an unlimited number of 60-day periods.
The hospice must obtain the certification that an individual is terminally ill in
accordance with the following procedures:
For the first 90-day period of hospice coverage, the hospice must obtain, no later
than two calendar days after hospice care is initiated, written certification statements
signed by the medical director of the hospice or the physician member of the hospice
interdisciplinary group and the individual's attending physician (if the individual
has an attending physician). The attending physician is a physician who is a doctor
of medicine or osteopathy and is identified by the individual, at the time he or she
elects to receive hospice care, as having the most significant role in the determination
and delivery of the individual's medical care.
For the subsequent periods, the hospice must obtain, no later than two calendar days
after the beginning of that period, a written certification statement prepared by
the medical director of the hospice or the physician member of the hospice's interdisciplinary
group. The certification must include the statement that the individual's medical
prognosis is that his or her life expectancy is six months or less and the signature(s)
of the physician(s).