This regulation establishes the federal coverage requirements for hospice services under Medicare, specifying that services must be reasonable and necessary for palliation of a terminal illness, the patient must formally elect hospice care, a plan of care must be established by the attending physician, medical director, and interdisciplinary group prior to service delivery, and a terminal illness certification must be completed. These requirements govern hospice programs, not behavioral health, IDD, ABA, or foster care facilities.
View official source§ 418.200 Requirements for coverage. To be covered, hospice services must meet the following requirements. They must be reasonable and necessary for the palliation and management of the terminal illness as well as related conditions. The individual must elect hospice care in accordance with § 418.24. A plan of care must be established and periodically reviewed by the attending physician, the medical director, and the interdisciplinary group of the hospice program as set forth in § 418.56. That plan of care must be established before hospice care is provided. The services provided must be consistent with the plan of care. A certification that the individual is terminally ill must be completed as set forth in section § 418.22. [74 FR 39413, Aug. 6, 2009]