[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: 42CFR418.400]



[Page 932]

 

                         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 H_Coinsurance

 

Sec. 418.400  Individual liability for coinsurance for hospice care.





    An individual who has filed an election for hospice care in 

accordance with Sec. 418.24 is liable for the following coinsurance 

payments. Hospices may charge individuals the applicable coinsurance 

amounts.

    (a) Drugs and biologicals. An individual is liable for a coinsurance 

payment for each palliative drug and biological prescription furnished 

by the hospice while the individual is not an inpatient. The amount of 

coinsurance for each prescription approximates 5 percent of the cost of 

the drug or biological to the hospice determined in accordance with the 

drug copayment schedule established by the hospice, except that the 

amount of coinsurance for each prescription may not exceed $5. The cost 

of the drug or biological may not exceed what a prudent buyer would pay 

in similar circumstances. The drug copayment schedule must be reviewed 

for reasonableness and approved by the intermediary before it is used.

    (b) Respite care. (1) The amount of coinsurance for each respite 

care day is equal to 5 percent of the payment made by CMS for a respite 

care day.

    (2) The amount of the individual's coinsurance liability for respite 

care during a hospice coinsurance period may not exceed the inpatient 

hospital deductible applicable for the year in which the hospice 

coinsurance period began.

    (3) The individual hospice coinsurance period--

    (i) Begins on the first day an election filed in accordance with 

Sec. 418.24 is in effect for the beneficiary; and

    (ii) Ends with the close of the first period of 14 consecutive days 

on each of which an election is not in effect for the beneficiary.