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Hospice Benefit Periods

Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 9 §10) Globe to indicate www link.

Medicare State Operations Manual (CMS Pub. 100-07, Ch. 2 §2080) Globe to indicate www link.

Balanced Budget Act of 1997 (P.L. 105-33, §4443)

 

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.
  • 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.
  • When any of these changes takes place, the beneficiary must forfeit any remaining days in that benefit period.  If/When the beneficiary meets the hospice coverage criteria again, they can re-elect the hospice benefit and begin with the next benefit period.

Note: The two 90-day benefit periods are not renewable. Once the two 90-day periods are used, the beneficiary has only 60-day benefit periods remaining.  The eligibility systems, ELGA and ELGH can be used to identify the beneficiary’s available benefit period.  Refer to the Checking Beneciary Eligibility section of the Fiscal Intermediary Standard System (FISS) Reference Guide for information about ELGA and ELGH.  

Page last updated: May 17, 2010

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