Admission, Certification and Recertification

TITLE 42--Public Health, PART 418--HOSPICE CARE

Admission - The hospice admits a patient only on the recommendation of the medical director in consultation with, or with input from, the patient’s attending physician (if any). In reaching a decision to certify that the patient is terminally ill, the hospice medical director must consider at least the following information:
Diagnosis of the terminal condition of the patient.
Other health conditions, whether related or unrelated to the terminal condition.
Current clinically relevant information supporting all diagnoses.

Regulations: §418.25 Admission to hospice care.

Certification – a physician must certify certified a patient as being terminally ill and having a prognosis of 6 months or less if the disease runs its normal course. For the first 90-day period, the attending physician (if any) AND the hospice medical director/ hospice physician are required to certify terminal illness. For subsequent certification periods, only the hospice medical director/ hospice physician is required to certify terminal illness, unless otherwise specified by state hospice regulations.
- Regulations related certification and recertification:
- §418.22 Certification of terminal illness.
- [CMS–1420–F] – Physician Narrative requirement (Hospice Wage Index for Fiscal Year 2010) (AUG 6, 2009)
- Change Request (CR) 6540: Hospice Reporting Requirements for the Attending Physician and the Hospice Physician Certifying the Terminal Illness 12/23/09
Face-to-face encounter requirements:

Medicare Eligibility and Entitlement Manual – Physician Certification and Re-certification of Services

Medicare General Information, Eligibility, and Entitlement Manual – Chapter 4, Section 60: Physician Certification and Re-Certification of Services

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