[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR418.205]



[Page 927-928]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 418_HOSPICE CARE--Table of Contents

 

                       Subpart F_Covered Services

 

Sec. 418.205  Special requirements for hospice pre-election evaluation 

and counseling services.



    (a) Definition. As used in this section the following definition 

applies.

    Terminal illness has the same meaning as defined in Sec. 418.3.

    (b) General. Effective January 1, 2005, payment for hospice pre-

election evaluation and counseling services as specified in 

Sec. 418.304(d) may be made to a hospice on behalf of a Medicare 

beneficiary if the requirements of this section are met.

    (1) The beneficiary. The beneficiary:

    (i) Has been diagnosed as having a terminal illness as defined in 

Sec. 418.3.

    (ii) Has not made a hospice election.

    (iii) Has not previously received hospice pre-election evaluation 

and consultation services specified under this section.

    (2) Services provided. The hospice pre-election services include an 

evaluation of an individual's need for pain and symptom management and 

counseling regarding hospice and other care options. In addition, the 

services may include advising the individual regarding advanced care 

planning.

    (3) Provision of pre-election hospice services.

    (i) The services must be furnished by a physician.

    (ii) The physician furnishing these services must be an employee or 

medical director of the hospice billing for this service.

    (iii) The services cannot be furnished by hospice personnel other 

than employed physicians, such as but not limited to nurse 

practitioners, nurses, or



[[Page 928]]



social workers, physicians under contractual arrangements with the 

hospice or by the beneficiary's physician, if that physician is not an 

employee of the hospice.

    (iv) If the beneficiary's attending physician is also the medical 

director or a physician employee of the hospice, the attending physician 

may not provide nor may the hospice bill for this service because that 

physician already possesses the expertise necessary to furnish end-of-

life evaluation and management, and counseling services.

    (4) Documentation. (i) If the individual's physician initiates the 

request for services of the hospice medical director or physician, 

appropriate documentation is required.

    (ii) The request or referral must be in writing, and the hospice 

medical director or physician employee is expected to provide a written 

note on the patient's medical record.

    (iii) The hospice agency employing the physician providing these 

services is required to maintain a written record of the services 

furnished.

    (iv) If the services are initiated by the beneficiary, the hospice 

agency is required to maintain a record of the services and 

documentation that communication between the hospice medical director or 

physician and the beneficiary's physician occurs, with the beneficiary's 

permission, to the extent necessary to ensure continuity of care.



[69 FR 66425, Nov. 15, 2004]