Hospice Eligibility: LCD Criteria and Referral

Hospice is a philosophy of care focused on comfort, dignity, and quality of life for patients with terminal illness and a prognosis of 6 months or less if the disease follows its expected course. The Medicare Hospice Benefit (MHB), established in 1982, provides comprehensive end-of-life care covering: physician services, nursing care, medical social services, counseling (dietary, spiritual, bereavement), home health aides, medical supplies and equipment, medications related to the terminal diagnosis, short-term inpatient care (symptom management or respite), and bereavement support for families for 13 months after death. Eligibility requires: (1) Medicare Part A enrollment, (2) certification by two physicians (attending and hospice medical director) that prognosis is 6 months or less if disease follows natural course, (3) patient election of comfort-focused care (waiving Medicare coverage for curative treatment of the terminal condition - though patients CAN receive curative treatment for unrelated conditions). Hospice benefit periods: two 90-day periods followed by unlimited 60-day periods, each requiring face-to-face recertification by a physician or NP. Local Coverage Determinations (LCDs) provide disease-specific criteria to guide eligibility assessment. Patients can revoke hospice at any...