CMS - Medicare Hospice Regulations
CMS - Medicare Hospice Regulations |
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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)
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
