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Social Security Statutes

Congress added a hospice benefit to the Medicare statutes under the Social Security Act in 1982.  The following is a list of relevant statutes and their links.

Medicare Hospice Statutes

  • SSA 1812(a) – Scope of hospice benefits and educational consultation for beneficiaries who are terminally but have not elected the hospice benefit
  • SSA 1812(d) – Scope of hospice benefits and waiver of other services, revocation and transfer
  • SSA 1813(a)(4) – Deductibles and coinsurance applicable to hospice care
  • SSA 1814(a)(7) – Certification of terminal illness, plan of care, face-to-face encounter
  • SSA 1814(i) – Payment for hospice care, including payment reform, hospice cap, aggregate cap, data collection and cost reporting requirements
  • SSA 1861(dd) – Definitions, hospice care, hospice program, attending physician, terminally ill, interdisciplinary group, use of volunteers, traveling patients, multiple locations, and specialized nursing
  • SSA 1862- Exclusions from coverage; in the case of hospice care, excludes from coverage items and services not reasonable and necessary for the palliation or management of terminal illness.

Medicaid Hospice Statutes

  • SSA 1902(a)(10) – For individuals electing to receive hospice care, such assistance may not be made available in an amount, duration or scope less than that provided under Medicare.
  • SSA 1902(a)(13)(B) – Medicaid payment for hospice care must be no less than Medicare mounts, and must use the same methodology, and must pay for nursing home room and board for certain dual eligible patients, at a rate that is 95% of what the State otherwise would have paid for that individual in that facility.
  • SSA 1902(w) – Advance directives; information must be provided to hospice patients at the time of initial receipt of care. (SSA 1905(a) – The term “medical assistance” includes hospice care
  • SSA 1905(o) – Optional hospice benefits; definition of hospice care; coverage of nursing home and ICF/MR room and board, which must be paid to the hospice, for dual eligibles
  • SSA 1916(a) – No deductibles, cost sharing or similar charges for individuals receiving hospice care
  • SSA 1927(k)(3) – The term “covered outpatient drug” doesn’t include any drug provided as part of hospice services.