Hospice Discharge, Revocation and Transfers

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

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 change hospice agencies once in each benefit period.  Select the topic below for additional information.

• Revocation of the Election
• Transferring to Another Hospice
• Discharge from Hospice

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Revocation of the Election

An individual or representative may revoke the election of hospice care at any time in writing. To revoke the election of hospice care:

• The individual must give a signed statement of revocation to the hospice.  No standardized form for hospice revocation exists.
• The statement must contain the effective date of that 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 an effective date earlier than the date that the revocation is made.
• The day of revocation is a billable day.

Upon revoking the election of Medicare coverage of hospice care for a particular election period, an individual resumes Medicare coverage of the benefits waived when hospice care was elected.  Note: In cases where the individual is a Managed Care enrollee, claims will continue to be paid by fee-for-service contractors as if the beneficiary were a fee-for-service beneficiary until the first day of the month following the month in which hospice was revoked.

An individual may at any time re-elect to receive hospice coverage.  Note: Re-election of the Medicare hospice benefit cannot occur the same day as the revocation.

The election of the hospice benefit is the beneficiary’s choice rather than the hospice’s choice, and the hospice cannot revoke the beneficiary’s election. Neither should the hospice request nor demand that the beneficiary revoke his/her election.

Sample Hospice Medicare Benefit Revocation Form

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Transferring to Another Hospice

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

An individual may change once in each election period, the designation of the particular hospice from which he or she elects to receive hospice care.

• To change the designation of hospice programs, the beneficiary (generally with the assistance of the hospice) must file a signed statement of transfer with both the current hospice provider, and the future hospice provider.
• The transfer must include:
  • the name of the hospice from which the individual has received care;
  • the name of the hospice from which they plan to receive care; and
  • the date the change is to be effective.

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

The change of the designated hospice is not considered a revocation of the election.

The date of transfer is billable by both hospice agencies.

Sample Change of Hospice Form

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Discharge from Hospice

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

A hospice agency can discharge a beneficiary for one of three reasons:

1.  The beneficiary no longer fits the Medicare definition of “terminally ill” with a six-month prognosis; or
2. The beneficiary moves out of the hospice agency’s service area; or
3. The hospice determines, under the agency policy, that the beneficiary’s behavior is disruptive, abusive, or uncooperative to the extent that delivery of care is seriously impaired (Final Rule—11/22/2005, Federal Register).

• Once a hospice chooses to admit a Medicare beneficiary, it may not automatically or routinely discharge the beneficiary at its discretion, even if the care promises to be costly or inconvenient.
• The day of discharge is a billable day.

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Page last updated: May 19, 2010

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