Determining Hospice Eligibility

Home nursing exam

Hospice referrals should balance a physician's experienced clinical judgement, Medicare regulations, and input from the patient and family. Physicians and admissions coordinators at our local programs are available for consultation.

Medicare eligibility

To elect hospice under Medicare, an individual must be entitled to Medicare Part A and certified as being terminally ill by a physician and have a prognosis of six months or less, if the disease runs its normal course. See the Electronic Code of Federal Regulations, Part 418-22-Hospice care.

Medicare Part A always covers hospice services, even for patients with a Medicare Advantage (Part C) plan. Medicare is testing hospice coverage under Medicare Advantage in a few test markets.

Hospice Pre-election Evaluation (from CMS) - CMS-R386CP.pdf

Medicare allows and reimburses for a one-time visit by a physician who is either the medical director of or employee of a hospice agency. We respect the relationship physicians have with their patients. Our goal is to work together to ensure patients and families receive the right care, at the right time.