A. Certification requirements

In order to be entitled to hospice benefits under Medicare, an individual must be entitled to Part A, be certified as terminally ill, and elect to receive hospice benefits.

An individual is considered terminally ill if the medical prognosis is a life expectancy of six months or less. To be covered, a certification that the individual is terminally ill must have been completed and hospice services must be reasonable and necessary for the palliation or management of the terminal illness and related conditions. A plan of care must be established before services are provided, and services must be consistent with the plan. The Medicare hospice benefit is provided in periods of care. The periods consist of two 90-day periods and an unlimited number of 60-day periods.

The hospice must obtain the certification that an individual is terminally ill in accordance with the following procedures:

1. For the first 90-day period of hospice coverage, the hospice must obtain, no later than two calendar days after hospice care is initiated, written certification statements signed by the medical director of the hospice or the physician member of the hospice interdisciplinary group and the individual's attending physician (if the individual has an attending physician). The attending physician is a physician who is a doctor of medicine or osteopathy and is identified by the individual, at the time they elect to receive hospice care, as having the most significant role in the determination and delivery of the individual's medical care.

2. For the subsequent periods, the hospice must obtain, no later than two calendar days after the beginning of that period, a written certification statement prepared by the medical director of the hospice or the physician member of the hospice's interdisciplinary group. The certification must include the statement that the individual's medical prognosis is that their life expectancy is six months or less and the signature(s) of the physician(s).