An individual may elect to receive hospice care during one or more of the following election periods:
- An initial 90-day period;
- A subsequent 90-day period; followed by
- An unlimited number of subsequent 60-day periods, if needed.
As long as the patient meets the certification criteria, there is no limit on the amount of time a patient can then spend under hospice care, although the hospice must continue to monitor continued eligibility as a part of the recertification process every 90 days for the first 180 days, and when the 90-day periods are complete, prior to every 60-day benefit period. This monitoring function takes place through the face-to-face encounter, as well as ongoing interdisciplinary team review.
If the patient is a nursing home resident and chooses to elect hospice care, the Medicare Hospice Benefit covers all care and services related to the terminal prognosis. However, the patient may not, except in unusual circumstances, receive their Medicare Skilled Nursing Home benefit at the same time as their hospice benefits. For those eligible for both Medicare and Medicaid, the nursing home’s room and board is paid by the state Medicaid program to the hospice and paid to the nursing home under a contractual arrangement between the nursing home and the hospice. This is pass through billing/contractual arrangement is not applicable to patients in Arizona under AHCCCS.
For the duration of an election of hospice care, an individual waives all rights to Medicare payments for any Medicare services that are related to the treatment of the terminal prognosis for which hospice care was elected. Exceptions include: services provided by the designated hospice, another hospice under special arrangements, or the individual’s attending physician (if the physician is not an employee of the designated hospice or receiving compensation from the hospice for his or her services).