Hospice care is a specialized approach designed to provide comfort and support to individuals nearing the end of life. This care focuses on managing pain and other symptoms associated with a terminal illness, shifting the goal from curative treatment to maximizing quality of life. The philosophy centers on palliation, relieving suffering and attending to the patient’s physical, emotional, and spiritual needs. A comprehensive team of professionals, including doctors, nurses, social workers, and spiritual counselors, supports both the patient and their family.
Initial Eligibility and Certification Periods
The duration of hospice care hinges on the patient’s medical prognosis and specific administrative requirements. To be eligible for the Medicare Hospice Benefit, a patient must be certified by a physician as having a terminal illness with a life expectancy of six months or less. This initial determination must be made by both the patient’s attending physician (if they have one) and the hospice medical director.
Once certified, the patient elects the hospice benefit, which is structured into specific timeframes called benefit periods. The initial period of care consists of two separate 90-day periods, totaling 180 days. At the start of each 90-day period, a physician must recertify that the patient continues to meet the six-month prognosis requirement.
These initial two periods provide the first six months of coverage. The patient’s prognosis is based on clinical judgment and an assessment of how the illness is progressing. The process changes significantly after this initial 180-day window.
Extending Care Through Recertification
The initial six months are not a hard limit; patients can remain in hospice care indefinitely, provided they continue to meet the eligibility criteria. After the two initial 90-day periods, the benefit transitions into unlimited subsequent periods of 60 days each. At the start of every 60-day period, the patient must be recertified as terminally ill by a hospice medical director or physician.
This recertification requires the physician to provide a narrative explaining the clinical findings that support the continued prognosis of six months or less. This documentation justifies the continuation of the benefit. It ensures the patient’s status still warrants palliative, rather than curative, care.
Face-to-Face Encounter Requirement
Starting with the third benefit period (the first 60-day period), a specific administrative requirement applies. Before recertification for this period and every subsequent 60-day period, a hospice physician or nurse practitioner must conduct a face-to-face encounter with the patient. This encounter must occur no more than 30 days prior to the start of the new benefit period. The purpose of this visit is to gather clinical evidence supporting the continued terminal prognosis. The provider must attest in writing that the visit occurred and that the findings support the recertification.
When Hospice Care Ends
A patient’s time in hospice care can conclude in three primary ways, independent of any time limit. The most common conclusion is the natural end of life, which is the intended outcome of comfort-focused care. When a patient dies, the hospice benefit naturally terminates.
A patient may also choose to end the benefit by voluntarily revoking their election of hospice care. This often occurs if the patient decides to pursue curative treatments or wishes to regain full Medicare coverage for services waived upon electing hospice. Revocation must be submitted as a signed written statement to the hospice, and the patient forfeits any remaining days in that benefit period.
The third way care ends is through discharge due to improvement. If the hospice interdisciplinary group determines the patient’s condition has stabilized or improved so they no longer meet the six-month terminal prognosis, the hospice must discharge the patient. The patient then resumes standard Medicare coverage and can re-elect the benefit later if their health declines and they become terminally ill again.