RG – Discharges/Transfers/Recovocations
There are 3 reasons a hospice may discharge a Medicare beneficiary.
-
-
- The hospice determines the patient is no longer terminally ill (i.e.; life expectancy is no longer 6 months or less).
- The patient moves out of the geographic area that the hospice defines in its policies as its service area. Some examples of moving out of the hospice’s service area include:
-
The patient moves to another part of the country permanently or the patient leaves the area for an extended period and their hospice provider has not arranged coverage from another hospice provider via a traveling contract.
The patient is receiving treatment for a condition related/unrelated to the terminal prognosis or related diagnoses in a facility with which the hospice does not have a contract, and the hospice is unable to access the patient to provide hospice services. In this example, Medicare’s expectation is that the hospice provider would consider the amount of time the patient is in that facility and, effect on the plan of care before making a determination discharging the patient from the hospice is appropriate.
-
-
- The patient is discharged for cause.
-
There may be extraordinary circumstances in which a hospice provider is unable to continue to provide hospice care to a patient.
When a hospice determines, under a policy set by the hospice for the purpose of addressing discharge for cause, the patient’s (or other persons in the patient’s home) behavior is disruptive, abusive, or uncooperative to the extent delivery of care to the patient or the ability of the hospice to operate effectively is seriously impaired, the hospice can consider discharge for cause. Certain actions are required by the hospice prior to discharging a patient for cause, including documenting in the medical record the problems and efforts made to resolve the problems.
The hospice must notify the Medicare contractor and State Survey Agency of the circumstances surrounding the impending discharge. The hospice may also need to make referrals to other relevant state/community agencies (e.g., Adult Protective Services) as appropriate.
Notice of Termination Revocation (NOTR). The hospice notifies the Medicare contractor of the discharge so 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 (NOTR) unless the hospice has already filed a final claim. General coverage under original Medicare is reinstated at the time the patient revokes the benefit or is discharged. If under a Medicare Advantage plan will be under original Medicare until 1st of next month.
NHPCO Member Resources and Compliance Guides
-
-
- NHPCO Live Discharge Toolkit (September 2022)
-
Regulations
-
-
- Hospice Care Code of Federal Regulations 42CFR 418
-
Subpart B §418.26
-
-
-
-
-
-
-
- 418.26 Discharge from hospice care
-
-
-
-
-
-
Subregulatory Guidance
-
-
- Medicare Benefit Policy Manual Chapter 9 - Coverage of Hospice Services Medicare Benefit Policy Manual (cms.gov)
-
20.2.3 - Hospice Discharge
20.2.4 - Hospice Notice of Termination or Revocation
-
-
- State Operations Manual SOM - Chapter 2 - The Certification Process
-
2082 - Discharge from Hospice Care
Other Resources
Nothing applicable at this time
Cross Reference
Nothing applicable at this time
Alerts/Newsbriefs/Newsline
Nothing applicable at this time
Education
-
-
- Webinars/On-Line Learning/Conferences/Hospice Compliance Certificate Program
-
-
-
- Podcasts
Nothing applicable at this time
- Podcasts
-
Marketplace
-
-
- Hospice Discharge, Revocation, and Change of Hospice (2019)
Produced and published by the NHPCO Regulatory and Compliance department. This handy, travel-sized Hospice Discharge, Revocation, and Change of Designated Hospice is a resource of Process Maps to Guide Hospice Providers.
- Hospice Discharge, Revocation, and Change of Hospice (2019)
-
Revocation is the right of the patient. CMS allows an individual or representative to revoke the election of hospice care in writing at any time. To revoke the election of hospice care, the individual must file a document with the hospice including a signed statement the individual revokes the election for Medicare coverage of hospice care for the remainder of the election period and the effective date of the revocation. Only a patient can revoke their election to hospice care, a hospice cannot "Revoke" a patient Be sure to check state regulations on patient discharges.
NHPCO Member Resources and Compliance Guides
-
-
- NHPCO Live Discharge Toolkit (September 2022)
-
Regulations
-
-
- Hospice Care CFR 42 418.28 Subpart B
-
- 418.28 Revoking the election of hospice care
-
- Hospice Care CFR 42 418.28 Subpart B
-
Subregulatory Guidance
-
-
- Medicare Benefit Policy Manual Chapter 9 - Coverage of Hospice Services Medicare Benefit Policy Manual (cms.gov)
-
20.2.2 - Hospice Revocation
-
-
- State Operations Manual SOM - Chapter 2 - The Certification Process
-
2081 - Revoking Election of Hospice Care
Other Resources
(Nothing at this time)
Cross Reference
Nothing applicable at this time
Alerts/Newsbriefs/Newsline
Nothing applicable at this time
Education
-
-
- Webinars/On-Line Learning/Conferences/Hospice Compliance Certificate Program
-
-
-
- Podcasts
Nothing applicable at this time
- Podcasts
-
Marketplace
-
-
- Hospice Discharge, Revocation, and Change of Hospice (2019)
Produced and published by the NHPCO Regulatory and Compliance department. This handy, travel-sized Hospice Discharge, Revocation, and Change of Designated Hospice is a resource of Process Maps to Guide Hospice Providers.
- Hospice Discharge, Revocation, and Change of Hospice (2019)
-
An individual may change, once in each election period, the designation of the particular hospice from which they elect to receive hospice care so long as there is not a gap in care. The change of the designated hospice is not considered a revocation of the election.
NHPCO Member Resources and Compliance Guides
-
-
- NHPCO Live Discharge Toolkit (September 2022)
-
Regulations
-
-
- Hospice Care CFR 42 Subpart B
-
§418.30 Change of the designated hospice
Subregulatory Guidance
-
-
- MM 12626 Cancellation of an Election (March 2022)
- MM 12619 Gaps Between Hospice Transfers (Feb. 2022)
- Medicare Benefit Policy Manual Chapter 9 - Coverage of Hospice Services Medicare Benefit Policy Manual (cms.gov)
-
20.2.1.1 - Hospice Election Statement
Other Resources
Nothing applicable at this time
Cross Reference
Alerts/Newsbriefs/Newsline
Nothing applicable at this time
Education
-
-
- Webinars/On-Line Learning/Conferences/Hospice Compliance Certificate Program
-
-
-
- Podcasts
Nothing applicable at this time
- Podcasts
-
Marketplace
-
-
- Hospice Discharge, Revocation, and Change of Hospice (2019)
Produced and published by the NHPCO Regulatory and Compliance department. This handy, travel-sized Hospice Discharge, Revocation, and Change of Designated Hospice is a resource of Process Maps to Guide Hospice Providers.
- Hospice Discharge, Revocation, and Change of Hospice (2019)
-
NHPCO Member Resources and Compliance Guides
-
-
- Medicare Hospice Benefit Guide to Patient Travel (August 2022)
- Travel Hospice Agreement (August 2022)
-
Regulations
-
-
- Hospice Care CFR 42 Subpart D 418.100 (e)
-
100 Condition of participation: Organization and administration of services
Subregulatory Guidance
-
-
- S&C-04-21 Traveling Patients (Feb 2004)
-
Other Resources
Nothing applicable at this time
Alerts/Newsbriefs/Newsline
Nothing applicable at this time
Education
-
-
- Webinars/On-Line Learning/Conferences
Nothing applicable at this time
- Webinars/On-Line Learning/Conferences
-
-
-
- Podcasts
Nothing applicable at this time
- Podcasts
-
Marketplace
Nothing applicable at this time