42 C.F.R. Subpart A—General Provision and Definitions
Title 42 - Public Health
This part implements section 1861(dd) of the Social Security Act. Section 1861(dd) specifies services covered as hospice care and the conditions that a hospice program must meet in order to participate in the Medicare program. The following sections of the Act are also pertinent: (a) Sections 1812(a) (4) and (d) of the Act specify eligibility requirements for the individual and the benefit periods. (b) Section 1813(a)(4) of the Act specifies coinsurance amounts. (c) Sections 1814(a)(7) and 1814(i) of the Act contain conditions and limitations on coverage of, and payment for, hospice care. (d) Sections 1862(a) (1), (6) and (9) of the Act establish limits on hospice coverage. [48 FR 56026, Dec. 16, 1983, as amended at 57 FR 36017, Aug. 12, 1992] Subpart A of this part sets forth the statutory basis and scope and defines terms used in this part. Subpart B specifies the eligibility requirements and the benefit periods. Subpart C specifies conditions of participation for hospices. Subpart D describes the covered services and specifies the limits on services covered as hospice care. Subpart E specifies the reimbursement methods and procedures. Subpart F specifies coinsurance amounts applicable to hospice care. For purposes of this part— Attending physician means a—(1)(i) Doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he or she performs that function or action; or (ii) Nurse practitioner who meets the training, education, and experience requirements as the Secretary may prescribe; and (2) Is identified by the individual, at the time he or she elects to receive hospice care, as having the most significant role in the determination and delivery of the individual's medical care. Bereavement counseling means counseling services provided to the individual's family after the individual's death. Cap period means the twelve-month period ending October 31 used in the application of the cap on overall hospice reimbursement specified in §418.309. Employee means an employee (defined by section 210(j) of the Act) of the hospice or, if the hospice is a subdivision of an agency or organization, an employee of the agency or organization who is appropriately trained and assigned to the hospice unit. “Employee” also refers to a volunteer under the jurisdiction of the hospice. Hospice means a public agency or private organization or subdivision of either of these that—is primarily engaged in providing care to terminally ill individuals. Physician means physician as defined in §410.20 of this chapter. Representative means an individual who has been authorized under State law to terminate medical care or to elect or revoke the election of hospice care on behalf of a terminally ill individual who is mentally or physically incapacitated. Social worker means a person who has at least a bachelor's degree from a school accredited or approved by the Council on Social Work Education. Terminally ill means that the individual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its normal course. [48 FR 56026, Dec. 16, 1983, as amended at 52 FR 4499, Feb. 12, 1987; 50 FR 50834, Dec. 11, 1990; 70 FR 45144, Aug. 4, 2005]
Title 42: Public Health
PART 418—HOSPICE CARE
Subpart A—General Provision and Definitions
§ 418.1 Statutory basis.
§ 418.2 Scope of part.
§ 418.3 Definitions.
