CMS Pub. 100-02, ch. 13, § 210.2

For hospice services that are not described above in section 210.1, RHCs and FQHCs

can treat hospice beneficiaries for medical conditions not related to their terminal

illness. However, if a Medicare beneficiary who has elected the hospice benefit

receives care from an RHC or FQHC related to his/her terminal illness, the RHC or

FQHC cannot be reimbursed for the visit, even if it is a medically necessary, face-to-face visit with an RHC or FQHC practitioner, since that would result in duplicate

payment for services, except under either of the following circumstances:

• The RHC or FQHC has a contract with the hospice provider to furnish

core hospice services related to the patient’s terminal illness and related

conditions when extraordinary circumstances exist within the hospice.

Extraordinary circumstances are described as “unanticipated periods of

high patient loads; staffing shortages due to illness or other short-term

temporary situations that interrupt patient care; and temporary travel of

a patient outside the hospice’s service area” (42CFR 418.64);

• The RHC or FQHC has a contract with the hospice provider to furnish

highly specialized nursing services that are provided by the hospice so

infrequently that it would be impractical and prohibitively expensive for

the hospice to employ a practitioner to provide these services. For

example, a hospice may infrequently have a pediatric patient, and in those

situations, contract with an RHC or FQHC that has a pediatric nurse on

staff to furnish hospice services to the patient.

In these situations, all costs associated with the provision of hospice services must be

carved out of the RHC or FQHC cost report, and the RHC or FQHC would be

reimbursed by the hospice. (42 CFR 418.64(b)(3)).

Any service provided to a hospice beneficiary by an RHC or FQHC practitioner

must comply with Medicare prohibitions on commingling. (See section 100 of this

chapter).