Wis. ForwardHealth Online Handbook, Hospice, Topic #1175

Illness

The member must have written certification by the hospice medical director, the physician member of the interdisciplinary team, or

the member's attending physician stating that the member has a terminal illness that reduces life expectancy to six months or less if

the terminal illness runs its normal course. An interdisciplinary team is defined as a group of persons designated by a hospice to

provide or supervise care and services made up of at least a physician, an RN (registered nurse), a medical social worker, and a

pastoral counselor or other counselor, all of whom are employees of the hospice.

The physician(s) is required to sign a Physician Certification/Recertification of Terminal Illness (F-01011 (08/2019)) form, and the

hospice is required to keep the form in the member's record. The hospice should not send the form to ForwardHealth.

If the member is not deceased at the end of six months, the physician is required to recertify that the member's terminal illness

reduces their life expectancy to six months or less.

If a member discontinues hospice care and later wishes to have hospice care reinstated, the attending physician is required to

recertify that the member has a terminal illness that reduces their life expectancy to six months or less. The member will then be

recertified for hospice care for a full six months.