Hospice Proposed Rule Includes Important changes to Hospice Certification Requirements

The Medicare hospice benefit is a fully reimbursable Medicare Part A benefit option, which covers the multidisciplinary services addressing the physical and emotional pain associated with terminal illness through palliative treatment. To be eligible to elect hospice care under Medicare, an individual must be entitled to Part A of Medicare, and be certified as being terminally ill (i.e., the individual must be certified as having a limited life expectancy of six months or less if the terminal illness were to take its normal course).

Significantly, CMS recognizes that terminal illnesses do not have entirely predictable courses, and despite the best clinical judgment of the certifying physician, some individuals receiving hospice care survive longer than six months. The Medicare hospice benefit is not a six month benefit. The Medicare hospice benefit is provided for specified amounts of time known as “election periods.” Pursuant to Section 1812 (a) (4) of the Social Security Act and 42 C.F.R § 418.21 of the federal regulations, a physician may certify a patient for hospice care coverage for two initial 90-day election periods, followed by an unlimited number of 60-day election periods. Each election period requires that the physician certify a terminal illness.

The Patient Protection and Affordable Care Act of 2010 (“PPACA”) included important changes to the hospice certification requirements. Pursuant to Section 3132 of PPACA, Section 1814 (a) (7) of the Social Security Act will be amended to require that on and after January 1, 2011, a hospice physician or nurse practitioner must have a face-to-face encounter with every hospice patient to determine continued eligibility of the patient prior to the 180-day recertification and prior to each subsequent certification. PPACA also requires that the hospice physician or NP attest that such visit took place. A Proposed Rule that would serve to implement provisions of PPACA was published on July 23, 2010.

For more information regarding this topic or hospice issues generally, please visit the Hospice page of The HLP’s website, or call Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510.