N.C. Medicaid Clinical Coverage Policy No. 3D § 5.4.1

The provider of hospice services shall comply with 42 CFR §418.22(a), Timing of

certification.

a. The hospice provider shall obtain written certification of terminal illness for

each benefit period.

b. The hospice provider shall obtain the written certification before it submits a

claim for payment.

c. Exceptions.

1. If the written certification cannot be obtained within two calendar days,

after a period begins, then an oral certification must be obtained within

two calendar days and the written certification before submitting a claim

for payment.

2. Certifications may be completed no more than 15 calendar days prior to

the effective date of election.

3. Re-certifications may be completed no more than 15 calendar days prior

to the start of the subsequent benefit period.

d. Face-to-face encounter. A hospice physician or hospice nurse practitioner

shall have a face-to-face encounter with the beneficiary, that must occur prior

to, but no more than 30 calendar days prior to, the 3rd benefit period

recertification, and every benefit period recertification thereafter, to gather

clinical findings to determine continued eligibility for hospice care.