US · guidance
CMS HPMS Memo, Part D Payment for Drugs for Beneficiaries Enrolled in Hospice—Request for Comments (Dec. 6, 2013), preamble
Previous policy statements by CMS have addressed hospice and Part D sponsor requirements
regarding responsibility for the payment of prescription drugs under the Part A hospice benefit
and Part D. However, we have received questions indicating our policy statements are being
misinterpreted by some parties. Therefore, in this memorandum, we seek to clarify the criteria
for determining payment responsibility for drugs for hospice beneficiaries. The information
included below is a summary, and clarification, of previous Medicare Part A regulatory and sub-regulatory guidance on eligibility and scope of benefits for Medicare hospice services. Based on
these clarifications are new expectations for Part D sponsors to prevent duplicate payments for
drugs covered under the hospice benefit or waived through the beneficiary’s hospice election.
CMS continues to be concerned that drugs covered under the Part A Hospice Benefit are being
billed to Part D inappropriately. Analysis completed by Abt Associates, on behalf of CMS,
found that in 2010 there were 750,590 hospice beneficiaries enrolled in Part D. Of those hospice
beneficiaries, 14.9% received 332,988 analgesics through Part D totaling $12.9 million.
Analgesic billing appeared to be concentrated among certain types of hospices. Ten percent
(350) of hospices accounted for approximately 51% of Part D analgesic claims. These hospices
providers were typically for-profit, new, and/or rural. Furthermore, 50.3% of the analgesic
claims were for hospice beneficiaries residing in nursing facilities.
We are issuing this guidance for review and seek comment on whether your questions have been
addressed. Please submit your comments to the CMS Part D mailbox at:
PartDBenefitImpl@cms.hhs.gov, using the subject “Request for Comments: Part D Payment for
Drugs for Beneficiaries Enrolled in Hospice.” Comments are due January 6, 2014 by noon EST.
Previous CMS Policy Statements
History
CMS memorandum dated December 6, 2013, to All Part D Plan Sponsors and Medicare Hospice Providers: "Part D Payment for Drugs for Beneficiaries Enrolled in Hospice—Request for Comments".
Provenance
- Source
- cms.gov
- Retrieved
- 2026-09-17
- Edition
- hospice-memos-2026-09-17
- Content hash
64a336c86d213b9d2b3380d342ccd8b5b926734e4138a17298eac546d3d0401e
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.