Text Size

  • Increase
  • Decrease
  • Normal

Current Size: 100%

CMS - Medicare Hospice Regulations

Additional information can be found in the Operations, Compliance with the Medicare Regulations section.

The Medicare Hospice Conditions of Participation were updated and published in final form on June 5, 2008.  The Federal Register publication can be found at: 

CMS-3844-F:  Hospice Conditions of Participation – Final Rule 06/05/08

Download a copy of the NHPCO Medicare Hospice Regulations in easy to read format… (Clean COPS)

42 CFR 418 – Hospice Care

Subpart A—General Provision and Definitions

  • 418.1        Statutory basis.
  • 418.2        Scope of part.
  • 418.3        Definitions.

http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol3/pdf/CFR-2011-title42-vol3-part418-subpartA.pdf

Subpart B—Eligibility, Election and Duration of Benefits

  • 418.20      Eligibility requirements.
  • 418.21      Duration of hospice care coverage--Election periods.
  • 418.22      Certification of terminal illness.
  • 418.24      Election of hospice care.
  • 418.25      Admission to hospice care.
  • 418.26      Discharge from hospice care.
  • 418.28      Revoking the election of hospice care.
  • 418.30      Change of the designated hospice.

http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol3/pdf/CFR-2011-title42-vol3-part418-subpartB.pdf

Subpart C—Condition of Participation—Patient Care

  • 418.52      Condition of participation: Patient’s rights.
  • 418.54      Condition of participation: Initial and comprehensive assessment of the patient.
  • 418.56      Condition of participation: Interdisciplinary group, care planning, and coordination of services.
  • 418.58      Condition of participation: Quality assessment and performance improvement.
  • 418.60      Condition of participation: Infection control.
  • 418.62      Condition of participation: Licensed professional services.

CORE SERVICES

  • 418.64      Condition of participation: Core services.
  • 418.66      Condition of participation: Nursing services waiver of requirement that substantially all nursing services be routinely provided directly by a hospice.

NON-CORE SERVICES

  • 418.70      Condition of participation: Furnishing of non-core services.
  • 418.72      Condition of participation: Physical therapy, occupational therapy, and speech-language pathology.
  • 418.74      Waiver of requirement—Physical therapy, occupational therapy, speech-language pathology and dietary counseling.
  • 418.76      Condition of participation: Hospice aide and homemaker services.
  • 418.78      Condition of participation: Volunteers.

http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol3/pdf/CFR-2011-title42-vol3-part418-subpartC.pdf

Subpart D—Conditions of Participation: Organizational Environment

  • 418.100    Condition of participation: Organization and administration of services.
  • 418.102    Condition of participation: Medical director.
  • 418.104    Condition of participation: Clinical records.
  • 418.106    Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.
  • 418.108    Condition of participation: Short-term inpatient care.
  • 418.110    Condition of participation: Hospices that provide inpatient care directly.
  • 418.112    Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR.
  • 418.114    Condition of participation: Personnel qualifications.
  • 418.116    Condition of participation: Compliance with Federal, State, and local laws and regulations related to the health and safety of patients.

http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol3/pdf/CFR-2011-title42-vol3-part418-subpartD.pdf

Subpart E—Conditions of Participation: Removed and Reserved Subpart F—Covered Services

  • 418.200    Requirements for coverage.
  • 418.202    Covered services.
  • 418.204    Special coverage requirements.

http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol3/pdf/CFR-2011-title42-vol3-part418-subpartF.pdf   

http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol3/pdf/CFR-2011-title42-vol3-part418-subpartG.pdf

Subpart G—Payment for Hospice Care

  • 418.301    Basic rules.
  • 418.302    Payment procedures for hospice care.
  • 418.304    Payment for physician services.
  • 418.306    Determination of payment rates.
  • 418.307    Periodic interim payments.
  • 418.308    Limitation on the amount of hospice payments.
  • 418.309    Hospice aggregate cap.
  • 418.310    Reporting and record keeping requirements.
  • 418.311     Administrative appeals.

Subpart H—Coinsurance

  • 418.400    Individual liability for coinsurance for hospice care.
  • 418.402    Individual liability for services that are not considered hospice care.
  • 418.405    Effect of coinsurance liability on Medicare payment.

http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol3/pdf/CFR-2011-title42-vol3-part418-subpartH.pdf

CMS Hospice Center

https://www.cms.gov/center/hospice.asp

CMS Transmittals

https://www.cms.gov/Hospice/Transmittals/list.asp

Change Requests for CRs

2001 – list of number, title and link

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

MedLearn Matters

Medicare Learning Network (MLN)

https://www.cms.gov/MLNGenInfo/

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

Center for Medicare & Medicaid Services (CMS) Resources

  • Centers for Medicare & Medicaid Services (CMS) Hospice Center
  • Centers for Medicare & Medicaid Services (CMS) Provider Compliance Group Outreach Call Presentation Slides
  • Hospice Overview Page
  • MLN Educational Web Guides
  • MLN Matter Articles

Archives

CMS-3844-P: Hospice Conditions of Participation – Proposed Rule 05/27/07

1983 COPs

NHPCO comment letter on 2007 proposed rule

1B        Certification and Re-Certification                                     

Additional information can be found in the Operations, Certification and Re-Certification section.

Center for Medicare & Medicaid Services (CMS) Resources

  • Change Request (CR) 6540:  Hospice Reporting Requirements for the Attending Physician and the Hospice Physician Certifying the Terminal Illness 12/23/09
  • Change Request (CR) 6540:  Hospice Reporting Requirements for the Attending Physician and the Hospice Physician Certifying the Terminal Illness 12/11/09
  • Change Request (CR) 6540:  Hospice Reporting Requirements for the Attending Physician and the Hospice Physician Certifying the Terminal Illness 11/27/09     
  • Change Request (CR) 7337:  Medicare Benefit Policy Transmittal 141
  • Medicare General Information, Eligibility and Entitlement Manual – Chapter 4, Section 60:  Physician Certification and Re-Certification of Services