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Hospice Benefit Periods

Medicare Benefit Policy Manual (CMS Pub. 100-02) Ch. 9, §10

Medicare State 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 safety.
  • 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.

Updated: 11.05.12


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