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Hospice Discharge, Revocation and Transfers

Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch. 9, §20.2External PDF

The Medicare hospice benefit is only available to beneficiaries who are terminally ill. A hospice may discharge a beneficiary in certain situations. A beneficiary or representative may choose to revoke the election of hospice care at any time. In addition, a beneficiary may transfer hospice agencies only once in each benefit period. Select the topic below for additional information.

Discharge from Hospice

Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch. 9, §20.2External PDF

The election of the hospice benefit is the beneficiary’s choice rather than the hospice’s choice, and thus, the hospice cannot revoke the beneficiary’s election. Therefore, when a hospice agency admits a beneficiary to hospice, it may not automatically or routinely discharge the beneficiary at its discretion, even if the care promises to be costly or inconvenient.

Medicare regulations at 42 CFR 418.26 define three reasons for discharge from hospice care:

  • The beneficiary moves out of the hospice’s service area or transfers to another hospice;
  • The hospice determines the beneficiary is no longer terminally ill; or
  • The hospice determines the beneficiary meets their internal policy regarding discharge for cause.

When a patient is discharged from hospice care, the beneficiary:

  • Is no longer covered under the Medicare hospice benefit;
  • Resumes Medicare coverage of the benefits waived by their hospice election; and
  • May at any time, elect to receive hospice care if he/she is again eligible.

Hospices may bill for the day of discharge.

Revocation of the Election

A hospice revocation is a beneficiary’s choice to no longer receive Medicare covered hospice benefits. To revoke the election of hospice care, the beneficiary/representative must give a signed written statement of revocation to the hospice. No standardized hospice revocation form exists.

  • The statement must contain the effective date of the revocation.
  • A verbal revocation of benefits is NOT acceptable.
  • The individual forfeits hospice coverage for any remaining days in that election period.
  • An individual may not designate a revocation effective date earlier than the date the revocation is made.
  • The day of revocation is a billable day.
  • The hospice cannot revoke the beneficiary’s election, nor can the hospice demand the beneficiary revoke his/her election.

Upon revoking the election of Medicare coverage of hospice care for a particular election period, an individual resumes Medicare coverage of the benefits waiver when hospice care was elected. In cases where the individual was enrolled in a Medicare Advantage (MA) Plan at the time they elected hospice, all Medicare claims will continue to be paid by the fee-for-service contractor (A/B MAC) until the first day of the month following the revocation.

An individual may, at any time, re-elect to receive hospice coverage, provided that the beneficiary is otherwise entitled to hospice care benefits.

A revocation is the beneficiary’s choice rather than the hospice’s choice, and the hospice cannot revoke the beneficiary’s election. In addition, the hospice cannot request nor demand the beneficiary revoke his/her election.

Transfer to Another Hospice

Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch. 9, 20.2External PDF

An individual may change the designation of the hospice they receive care from only once in each election period.

  • The change of hospice is not considered a hospice revocation.
  • The beneficiary must file a signed statement with the hospice they have received care from and the newly designated hospice. The statement must include:
    • The name of the hospice the patient was receiving care from;
    • The name of the hospice that patient plans to receive care from; and
    • The date the change is effective.
  • The date of transfer is billable by both the discharging agency and the admitting agency.

A change of ownership is not considered a change in the beneficiary’s designation of a hospice agency, and requires no action by the beneficiary.

Last Updated: 07.20.12


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