LCD ID Number: L33393 Status: A-Approved
LCD Title: Hospice - Determining Terminal Status
Geographic Jurisdiction: Alaska, American Samoa, Arizona, California - Entire State, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York - Entire State, Northern Mariana Islands, Oregon, Puerto Rico, Virgin Islands, Washington, Wisconsin Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See §1869(f)(1)(A)(i) of the Social Security Act.
Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:
Title XVIII of the Social Security Act (SSA):
Section 1102 provides that the Secretaries of the Treasury, Labor and Health and Human Services shall make and publish such rules and regulations not inconsistent with the Social Security Act, as necessary to the efficient administration of the functions each is charged with under this Act.
Section 1812 (a)(4) and (d) provides the scope of benefits for Hospice care.
Section 1813 (a)(4) provides deductible and coinsurance information.
Section 1814 (a)(7) and (I) provides conditions of and limitations on payment for hospice care provided to an individual.
Section 1861 (dd) defines hospice care and the hospice program.
Section 1862 (a)(1), (6) and (9) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, which constitute comfort items or where such expenses are for custodial care.
Section 1871 provides that the Secretary shall prescribe such regulations as may be necessary to carry out the administration of the insurance programs under the title.
Code of Federal Regulations
42 CFR Section 418 specifies services covered as hospice care and the conditions that a hospice program must meet in order to participate in the Medicare program.
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30:
Financial Liability Protections
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 9:
Coverage of Hospice Services under Hospital Insurance CMS Transmittal No. 141, Publication 100-02, Medicare Benefit Policy Manual, Change Request #7337, March 2, 2011, updates hospice chapter of the manual to incorporate changes implemented as a result of statutory changes, and through notice-and-comment rulemaking in 2008, 2009, and 2010. Changes include updates to the Conditions of Participation (CoP) and certification sections of the chapter.
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