Hospice Eligibility Criteria

Medicare Part A sets forth the criteria for the hospice benefit, and most other insurers also follow Medicare guidelines. In order to be eligible to elect hospice care under Medicare, your patient must be:

(a) Entitled to Part A of Medicare; and

(b) Be certified as being terminally ill in accordance with §418.22

We can evaluate your patient to determine if they are eligible.

Admission to Hospice Care

Hospice can only admit a patient under the recommendation of the medical director in consultation with, or with input from, the patient’s attending physician (if any). In reaching a decision to certify that the patient is terminally ill, the hospice physician instead of hospice medical director must consider at least the following information:

• Patient’s terminal diagnosis.
• Other health conditions, whether related or unrelated to the terminal condition.
• Current clinically relevant information supporting all diagnoses.

How Can You Easily Assess Your Patient’s Eligibility?

Ask yourself the “Surprise Question” — Considering the patient’s condition:
“Would you be surprised if the patient were to die from his or her illness during the next year?”

If the answer to the “Surprise Question” is:
YES – Continue the normal course of treatment.
MAYBE – Call us for a peer-to-peer discussion with a hospice physician.
NO – Ask yourself, “Is the care my patient needs consistent with hospice?”

• If you’re unsure, call us to find out: 212-420-3370.
• If your patient is eligible, discuss hospice services with them and their family.
• If the patient and family agree, call us to make a referral: 212-420-3370.
• If the patient and family are uncertain, ask them to accept an informational visit from an RN in their current residence or at a facility. Call us and we will contact them to schedule: 212-420-3370.

General In-Patient (GIP) Hospice Eligibility Criteria

Patients in our hospice program may be eligible for GIP care when their symptoms and pain cannot be managed in the patient’s current residence. View a list of MJHS Hospice contracted facilities (PDF 130 KB).