Discharges, Revocations & Transfers

The hospice benefit is available only to individuals who are terminally ill with a life expectancy of six months or less. There are three reasons a hospice may discharge a patient from care:

1. 1. 1. The patient is no longer terminally ill. The patient’s condition stabilizes or improved, and they are no longer considered terminally Ill.
      2. The patient moves out of the service area of the Hospice. Moving out of the service area includes services provided in a hospital with whom the hospice does not have a contract.
      3. Discharge for a cause.

The hospice notifies the Medicare contractor of the discharge so that hospice services and billings are terminated as of that date. If a hospice beneficiary is discharged alive or if a hospice beneficiary revokes the election of hospice care, the hospice shall submit a timely-filed Notice of Termination/Revocation unless the hospice has already filed a final claim. A timely-filed NOTR is a NOTR that is submitted to and accepted by the Medicare contractor within 5 calendar days after the effective date of discharge or revocation. In this situation, the patient loses the remaining days in the benefit period. However, there is no increase in cost to the beneficiary. General coverage under Medicare is reinstated at the time the patient revokes the benefit or is discharged.

Effect of discharge

An individual, upon discharge from the hospice during a particular election period for reasons other than immediate transfer to another hospice—

• • • Is no longer covered under Medicare for hospice care;
    • Resumes Medicare coverage of the benefits waived under § 418.24(d); and
    • May at any time elect to receive hospice care if he or she is again eligible to receive the benefit.

Discharge planning

• • • The hospice must have in place a discharge planning process that takes into account the prospect that a patient’s condition might stabilize or otherwise change such that the patient cannot continue to be certified as terminally ill.
    • The discharge planning process must include planning for any necessary family counseling, patient education, or other services before the patient is discharged because he or she is no longer terminally ill.

Resources

• • • https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c09.pdf

The Regulations

• • • 418.26 Discharge from hospice care

Out of Service Area Discharges

• • • https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c11.pdf

NHPCO Resources

• • • Hospice Discharge, Revocation, and Change of Designated Hospice
    • Discharge from the Medicare Hospice Benefit (Includes Revocation, and Transfer) – A Compliance Guide for Hospice Providers revised CMS FY 2015 Final Hospice Wage Index rule

Revocation is the right of the patient.  CMS allows an individual or representative to revoke the election of hospice care at any time in writing. To revoke the election of hospice care, the individual must file a document with the hospice that includes a signed statement that the individual revokes the election for Medicare coverage of hospice care for the remainder of that election period and the effective date of that revocation.

A hospice may discharge the patient, per guidelines for discharge found at 418.26 but may not revoke the patient.

Revocation Key Points

• • • 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, or the State allows for discharge under State requirements. 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 or demand that the patient revokes his/her election.
    • 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.
    • 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.
    • An individual may at any time elect to receive hospice coverage.
    • Managed care enrollees who have elected hospice may revoke hospice election at any time, but 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.  By regulation, the duration of payment responsibility by fee-for-service contractors extends through the remainder of the month in which hospice is revoked by hospice beneficiaries.
    • If a hospice beneficiary is discharged alive or if a hospice beneficiary revokes the election of hospice care, the hospice shall submit a timely-filed Notice of Termination/Revocation (NOTR) unless the hospice has already filed a final claim. A timely-filed NOTR is a NOTR that is submitted to and accepted by the Medicare contractor within 5 calendar days after the effective date of discharge or revocation.

The Regulations

• • • §418.28  Revoking the election of hospice care

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

Transfer Key Points

• • • To change the designation of hospice programs, the individual must file, with the hospice from which he or she has received care and with the newly designated hospice, a signed statement that includes the following information:
      • • The name of the hospice from which the individual has received care
        • The name of the hospice from which they plan to receive care
        • The date the change is to be effective
    • If the patient chooses to transfer in the 3^rd or subsequent benefit period, the transferring hospice must provide the receiving hospice evidence that the face-to-face encounter was completed. If there is any question about whether the face-to-face encounter was completed, NHPCO recommends that the face-to-face be completed by the new hospice.
    • If there will be an anticipated break in hospice services during the transfer, then it is recommended to discharge and readmit the patient into the next benefit period.
      • • When a hospice patient transfers to a new hospice, the receiving hospice must file a new Notice of Election; however, the benefit period dates are unaffected.

The Regulations

• • §418.30  Change of the designated hospice

Resources

Medicare Hospice Benefit Guide to Patient Travel