The Medicare Regulations for Hospice Care, Including the ...

The Medicare Regulations for Hospice Care, Including the Conditions of Participation for

Hospice Care 42 CFR418

Current as of July 29, 2011

Hospice Provisions from:

Balanced Budget Act of 1997 Balanced Budget Refinement Act of 1999 Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule for Calendar Year 2005 ? Nov. 15, 2004 FY2006 Hospice Wage Index Final Rule ? August 4, 2005 Medicare Hospice Regulations - Subparts B, F, G - November 22, 2005 FY2008 Hospice Wage Index Final Rule ? August 31, 2007 Medicare Hospice Conditions of Participation - Subparts C and D - June 5, 2008 FY2010 Hospice Wage Index Final Rule - August 6, 2009 Medicare Program: Home Health Prospective Payment System Rate Update

for Calendar Year 2011; Changes in Certification Requirements for Home Health Agencies and Hospices - November 17, 2010 Medicare Program; Hospice Wage Index for Fiscal Year 2012 ? July 29, 2011

July 29, 2011

Prepared by National Hospice and Palliative Care Organization

1731 King Street Alexandria, VA 22315

(703) 837-1500

INTRODUCTION

Medicare regulations for hospices, including the Medicare Hospice Conditions of

Participation (CoPs) for Hospice Care (Subparts C and D) have been in existence since

1983. Since these are the rules that govern all Medicare-certified hospices, they are a

must read for hospice staff.

These Medicare Hospice regulations include all changes since 1983, including

changes due to the Balanced Budget Act of 1997 (BBA), the Balanced Budget

Refinement Act of 1999 (BBRA), the Medicare, Medicaid, and SCHIP Benefits

Improvement and Protection Act of 2000 (BIPA), the Medicare Modernization Act of 2003

(MMA), revisions to the Physician Fee Schedule for Calendar Year 2005, and three final

rules issued as regulations specifically for hospices. Revisions to Subparts B, F, and G

were published in the Federal Register on November 22, 2005 and took effect on

January 23, 2006. Revisions to Subparts C and D were published in the Federal

Register on June 5, 2008 and take effect on December 2, 2008. Revisions to 418.2,

Scope of part, Subpart B ? Eligibility, Election and Duration of Benefits, corrections to

Subparts C and D ? Conditions of Participation, revisions to Subpart F ? Covered

Services, and Subpart G ? Payment for Hospice Care, were published in the Federal

Register as part of the FY2010 Final Wage Index rule on August 6, 2009. Revisions to

Subpart B, ?418.22, Certification of terminal illness which added the face-to-face

encounter requirement for hospice were published by the Federal Register on November

17, 2010 as a part of the Home Health Prospective Payment System Rate Update for

Calendar Year 2011; Changes in Certification Requirements for Home Health Agencies

National Hospice and Palliative Care Organization, 2011

2|Page

and Hospices. The latest revisions to the Medicare Hospice Regulations were posted on July 29, 2011 in the final rule for the Hospice Wage Index for Fiscal Year 2012, published in the Federal Register on August 4, 2011. The revisions include changes to Subpart B, ?418.22, Certification of terminal illness, which clarified the provisions of the hospice face-to-face encounter requirement; changes to Subpart F, Covered Services, which changes ?418.202(g), to correct regulatory text where the word "homemaker" was inadvertently replaced with "aide" and updates the regulatory citation; and changes to Subpart G, Payment for Hospice Care, which amends the title of ?418.309 to "Hospice aggregate cap" and finalizes two methodologies for determining the number of Medicare beneficiaries for a given cap year.

NHPCO thanks Heather Wilson and Weatherbee Resources for the initial formatting of this easy-to-read version of the Medicare Hospice Regulations, including the Hospice Conditions of Participation.

National Hospice and Palliative Care Organization, 2011

3|Page

Code of Federal Regulations - Title 42, Volume 2, Parts 400 to 429

Revised as of July 29, 2011 From the U.S. Government Printing Office via GPO Access cfr/ CITE: 42CFR418

TITLE 42--PUBLIC HEALTH

CHAPTER IV--CENTERS FOR MEDICARE AND MEDICAID SERVICES DEPARTMENT OF HEALTH AND HUMAN SERVICES

PART 418--HOSPICE CARE

Sec. 418.1 418.2 418.3

Subpart A--General Provision and Definitions

Statutory basis. Scope of part. Definitions.

Subpart B--Eligibility, Election and Duration of Benefits

418.20 418.21 418.22 418.24 418.25 418.26 418.28 418.30

Eligibility requirements. Duration of hospice care coverage--Election periods. Certification of terminal illness. Election of hospice care. Admission to hospice care. Discharge from hospice care. Revoking the election of hospice care. Change of the designated hospice.

Subpart C--Condition of Participation--Patient Care

418.52 418.54

418.56

418.58

418.60 418.62

Condition of participation: Patient's rights. Condition of participation: Initial and comprehensive assessment of the patient. Condition of participation: Interdisciplinary group, care planning, and coordination of services. Condition of participation: Quality assessment and performance improvement. Condition of participation: Infection control. Condition of participation: Licensed professional services.

CORE SERVICES

418.64 418.66

Condition of participation: Core services. Condition of participation: Nursing services waiver of requirement that

National Hospice and Palliative Care Organization, 2011

4|Page

substantially all nursing services be routinely provided directly by a hospice.

NON-CORE SERVICES

418.70 418.72

418.74

418.76 418.78

Condition of participation: Furnishing of non-core services. Condition of participation: Physical therapy, occupational therapy, and speech-language pathology. Waiver of requirement--Physical therapy, occupational therapy, speechlanguage pathology and dietary counseling. Condition of participation: Hospice aide and homemaker services. Condition of participation: Volunteers.

Subpart D--Conditions of Participation: Organizational Environment

418.100 418.102 418.104 418.106

418.108 418.110 418.112

418.114 418.116

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

Subpart E--Conditions of Participation: Removed and Reserved

Subpart F--Covered Services

418.200 418.202 418.204

Requirements for coverage. Covered services. Special coverage requirements.

Subpart G--Payment for Hospice Care

418.301 418.302 418.304 418.306 418.307 418.308 418.309 418.310 418.311

Basic rules. Payment procedures for hospice care. Payment for physician services. Determination of payment rates. Periodic interim payments. Limitation on the amount of hospice payments. Hospice aggregate cap. Reporting and record keeping requirements. Administrative appeals.

National Hospice and Palliative Care Organization, 2011

5|Page

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download