Hospice Eligibility Criteria
Medicare Part A sets forth the criteria for the hospice benefit, and most other insurers also follow Medicare guidelines. In order to be eligible to elect hospice care under Medicare, your patient must be:
(a) Entitled to Part A of Medicare; and
(b) Be certified as being terminally ill in accordance with §418.22
We can help you with your patient’s needs assessment.
Admission to Hospice Care
Hospice can only admit a patient under the recommendation of the medical director in consultation with, or with input from, the patient’s attending physician (if any). In reaching a decision to certify that the patient is terminally ill, the hospice medical director must consider at least the following information:
- Diagnosis of the terminal condition of the patient.
- Other health conditions, whether related or unrelated to the terminal condition.
- Current clinically relevant information supporting all diagnoses.
How Can You Easily Assess Your Patient’s Eligibility?
Ask yourself the “Surprise Question” — Considering the patient’s condition:
“Would you be surprised if the patient were to die from his or her illness during the next year?”
If the answer to the “Surprise Question” is:
YES – Continue the normal course of treatment.
MAYBE – Call us for a peer-to-peer discussion with a hospice medical director.
NO – Ask yourself, “Is the care my patient needs consistent with hospice?”
- If you’re unsure, call us to find out: 212-420-3370.
- If your patient is eligible, discuss hospice services with them and their family.
- If the patient and family agree, call us to make a referral: 212-420-3370.
- If the patient and family are uncertain, ask them to accept an informational visit from a nurse at home. Call us and we will contact them to schedule: 212-420-3370.
Download our Hospice Face-to-Face Guide
General In-Patient (GIP) Hospice Eligibility Criteria
Patients in our hospice program may be eligible for GIP care when efforts to manage symptoms and pain cannot be managed in the patient’s current residence. A patient must be referred to an MJHS Hospice contracted facility in order to continue receiving services from MJHS Hospice. For a list of MJHS Hospice contracted facilities, click here.