Hospice Benefit Periods
Policy Manual (CMS Pub. 100-02) Ch. 9, §10
Operations Manual (CMS Pub. 100-07) Ch. 2 §2080
- The Medicare hospice benefit consists of two 90-day benefit periods and
an unlimited number of sixty-day benefit periods.
- The benefit periods must be used in that order (90-90-60).
- Hospice care is considered continuous from one benefit period to another,
unless the beneficiary revokes the hospice benefit, or the physician discharges
or does not recertify the beneficiary. On rare occasions, the hospice may
discharge the beneficiary from the benefit due to patient or hospice staff
- If a beneficiary revokes or is discharged from hospice care, the remaining
days in the benefit period are lost. If/when the beneficiary meets the hospice
coverage requirements, they can re-elect the hospice benefit, and will begin
with the next benefit period.
NOTE: The two 90-day benefit periods are not renewable – once
they are used, the beneficiary has only 60-day benefit periods remaining. The
eligibility systems, ELGA and ELGH, can be used to identify the benefit periods
already used by the beneficiary. Refer to “ Chapter
Two: Checking Beneficiary Eligibility ” of the Fiscal
Intermediary Standard System (FISS) Guide for more information about
ELGA and ELGH.