US · guidance
CMS Pub. 100-16, ch. mc86c17a, § 80.4
Hospice Care Costs
If a Medicare enrollee of a cost-based HMO/CMP makes an election to receive hospice
care services under §1812(d) of the Act, payment for these hospice care services is made
to the Medicare participating hospice that furnishes the services, in accordance with
42 CFR Part 418 and the “Hospice Manual.” While the HMO/CMP enrollee's hospice
election is in effect, the cost-based HMO/CMP may only be paid for the following
covered Medicare services furnished to such enrollee:
• Services of the enrollee's attending physician, if the physician is an employee or
contractor of the HMO/CMP and is not employed by or under contract to the
enrollee's hospice; and
• Services not related to the treatment of the terminal condition for which hospice
care was elected or a condition related to the terminal condition.
A Medicare beneficiary's hospice election may continue as long as the individual
continues to desire to receive hospice services while terminally ill. Upon revocation of
the election, the individual resumes normal Medicare coverage and any services provided
by the cost-based HMO/CMP will be reimbursed in the usual manner.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b8d6fb87b2eb1b2ed49005e2a1494229a9d87e755eb3cefa6ea3f9fc7152874a
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