Hospice care is a specialized approach focused on comfort and support for individuals with a life-limiting illness. It is a philosophy of care that prioritizes symptom management and quality of life over treatments aimed at curing the underlying disease. This care is provided by an interdisciplinary team wherever the patient calls home, which may be a private residence, a nursing facility, or an assisted living center. Understanding the administrative steps for entering and leaving this care is helpful for patients and their families.
Meeting the Initial Criteria for Admission
Hospice admission requires a patient to be certified as having a terminal illness with a prognosis of six months or less, assuming the disease follows its expected course. This time frame is a clinical judgment based on the typical progression of the disease, not a guarantee of how long a person has to live.
The certification of terminal illness requires the agreement of two distinct medical professionals. The patient’s attending physician, if they have one, must provide a certification of the terminal prognosis. The medical director or physician from the hospice agency must also certify that the patient meets the six-month prognosis requirement. This dual certification is a regulatory measure to confirm the medical necessity of the care.
In addition to the medical certification, the patient must voluntarily elect to receive palliative care for their terminal illness. By signing an election form, the patient chooses comfort-focused care and waives their right to Medicare coverage for curative treatments related to the terminal diagnosis.
The Process of Leaving Hospice Care
The ability to leave hospice care is a fundamental right of the patient, and there are two distinct administrative pathways for this to occur. The first is a voluntary revocation, which is a patient-initiated decision to stop receiving the hospice benefit. A patient may choose to revoke their hospice election at any time and for any reason, such as deciding to pursue curative treatments again or simply wanting a break from the service.
To revoke the benefit, the patient or their representative must provide the hospice agency with a signed, written statement. This formal action immediately ends the hospice election, and the patient’s standard Medicare coverage for all medical services is reinstated.
The second pathway is an involuntary discharge, which is initiated by the hospice provider itself. A common reason for a discharge is when the patient’s health status improves to the point that they no longer meet the eligibility criteria. If the hospice medical director determines that the patient is no longer terminally ill—meaning their prognosis extends beyond six months—the patient must be discharged.
Other reasons for involuntary discharge include the patient moving out of the hospice’s service area or, in very rare cases, disruptive or abusive behavior that severely compromises the ability to deliver care. In all cases of hospice-initiated discharge, a written order from the hospice medical director is required. Regardless of whether the patient revokes or is discharged, their coverage under the hospice benefit ends, and any remaining days in that current benefit period are forfeited.
Rules for Re-enrolling After Leaving
Patients are permitted to re-elect the hospice benefit at any time after a voluntary revocation or an involuntary discharge, provided they meet the initial eligibility requirements again. This means the patient must once again be certified as having a six-month or less prognosis if the disease runs its expected course.
If a patient was discharged due to an improvement in their condition, they can re-enroll later if their health declines and they become terminally ill again. The re-enrollment process requires a new election statement to be signed, and the patient’s terminal status must be re-certified by a physician.
The structure of the Medicare hospice benefit is organized into distinct periods of care, which revocation and re-entry utilize sequentially. The benefit begins with two 90-day periods, followed by an unlimited number of 60-day periods. When a patient re-elects hospice, they pick up with the next available benefit period, not restarting the entire sequence. For instance, a patient discharged during the first 90-day period who later re-enrolls would begin the remainder of the first 90-day period, or the second 90-day period, depending on the circumstances of the initial election.