[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: 42CFR418.22]



[Page 916]

 

                         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 B_Eligibility, Election and Duration of Benefits

 

Sec. 418.22  Certification of terminal illness.



    (a) Timing of certification--(1) General rule. The hospice must 

obtain written certification of terminal illness for each of the periods 

listed in Sec. 418.21, even if a single election continues in effect 

for two, three, or four periods, as provided in Sec. 418.24(c).

    (2) Basic requirement. Except as provided in paragraph (a)(3) of 

this section, the hospice must obtain the written certification no later 

than two calendar days after the period begins.

    (3) Exception. For the initial 90-day period, if the hospice cannot 

obtain the written certifications within two calendar days, it must 

obtain oral certifications within two calendar days, and written 

certifications no later than eight calendar days after the period 

begins.

    (b) Content of certification. The certification must specify that 

the individual's prognosis is for a life expectancy of 6 months or less 

if the terminal illness runs its normal course.

    (c) Sources of certification. (1) For the initial 90-day period, the 

hospice must obtain written certification statements (and oral 

certification statements if required under paragraph (a)(3) of this 

section) from--

    (i) The medical director of the hospice or the physician member of 

the hospice interdisciplinary group; and

    (ii) The individual's attending physician, if the individual has an 

attending physician. The attending physician must meet the definition of 

physician specified in Sec. 410.20 of this subchapter.

    (2) For subsequent periods, the only requirement is certification by 

one of the physicians listed in paragraph (c)(1)(i) of this section.

    (d) Maintenance of records. Hospice staff must--

    (1) Make an appropriate entry in the patient's medical record as 

soon as they receive an oral certification; and

    (2) File written certifications in the medical record.



[55 FR 50834, Dec. 11, 1990, as amended at 57 FR 36017, Aug. 12, 1992; 

70 FR 45144, Aug. 4, 2005]