Electing the Medicare Hospice Benefit

To be eligible for Medicare hospice care, a beneficiary must be entitled to Part A of Medicare and be certified as having a terminal illness with a life expectancy of six months or less if the disease runs its normal course. Two key requirements of the Medicare hospice benefit are for the beneficiary to elect hospice care and for a physician to certify that the beneficiary is terminally ill. When electing hospice care, the beneficiary signs an election statement that is written by the hospice. The election statement is intended to ensure that the beneficiary understands the hospice benefit-particularly that hospice care is palliative, not curative-and that the beneficiary waives the right to Medicare payment for treatment of the terminal illness except for services provided by the hospice. Since there are other payers that have a hospice benefit, the Medicare provider should document that beneficiary understands he/she is electing the Medicare Hospice Benefit as opposed to Medicaid or some other payer. When providers are using a single election form for multiple payer sources, Medicare needs to specifically be designated.

Resources:

• Social Security Act, §§ 1814(a)(7)(A) and 1861(dd)(3)(A), 42 U.S.C. §§ 1395f(a)(7)(A) and 1395x(dd)(3)(A); 42 CFR §§ 418.20 and 418.22
• 42 CFR § 418.24