CMS Pub. 100-02, ch. 9, § 60

Beneficiaries

(Rev. 12696; Issued:06-25-24; Effective:03-25-24; Implementation: 03-25-24)

Medicare beneficiaries that are dually eligible veterans, and reside at home in their

community may elect the Medicare Hospice Benefit and have hospice services paid for

under the Medicare Hospice Benefit. See §1853(c) and 1814(d) of the Act.

Upon electing the Medicare hospice benefit, the beneficiary waives the right to

Medicare payment for any Medicare services related to the terminal illness and related

conditions during a hospice election. However, this does not preclude dually eligible

veterans (i.e., eligible for both Medicare and Veterans benefits) from receiving services

not included on the hospice plan of care, and which are furnished and paid under the

beneficiary’s VA benefits, in addition to Medicare hospice services. This may include

care and support services that are unique to VA benefits and not typically provided by

Medicare hospice agencies, for example, but not limited to, VA home-based primary

care for illnesses other than the terminal illness. Any services that are included on the

hospice plan of care must be provided and paid under Medicare.

If a dually eligible veteran, who had been receiving Medicare hospice services in his/her

home, is admitted to a VA owned and operated inpatient facility, the beneficiary must

revoke the Medicare hospice benefit. Medicare is not allowed to pay for services that

another Federal provider or agency furnishes (§1862(a)(3) and 42 CFR 411.6).

Dually eligible veterans may elect to receive Medicare hospice services while residing

in community nursing homes and state homes and have those services paid for under the

Medicare hospice benefit. (This is similar to paying for hospice care if a beneficiary

lives in a nursing facility. See §20.3.)