Section 1130.22. Duration of coverage

There is no limit on the available number of days of hospice coverage for a recipient who meets the eligibility requirements of § 1130.21 (relating to recipient eligibility requirements) and who is certified as being terminally ill in accordance with the following procedures:

(1) Basic requirement. For the first 60-day period of hospice coverage, the hospice obtains, within 2 calendar days after hospice care is initiated, a completed certification of terminal illness form signed by:

(i) The medical director of the hospice or the physician member of the hospice interdisciplinary group.

(ii) The recipient’s attending physician if the recipient has an attending physician.

(2) Exception. For the first 60-day period of hospice coverage, if the hospice cannot obtain a completed and signed certification of terminal illness form within 2 calendar days after hospice care is initiated, it shall obtain oral certification within 2 calendar days and a completed and signed certification form within 8 calendar days after hospice care is initiated.

(i) Oral certification. Hospice staff persons shall make an appropriate entry in the recipient’s medical records as soon as they receive an oral certification.

(ii) Written certification. The hospice shall obtain within 8 calendar days after hospice care begins, a completed certification of terminal illness form signed by the following:

(A) The medical director of the hospice or the physician member of the hospice interdisciplinary group.

(B) The recipient’s attending physician, if the recipient has an attending physician.

(3) Subsequent periods. For each subsequent 60-day period, the hospice obtains, within 2 calendar days after the beginning of that period, a certification of terminal illness form completed and signed by the medical director of the hospice or the physician member of the hospice’s interdisciplinary group.

(4) Certification form. The certification of terminal illness shall be carried out using the Department’s certification of terminal illness form specified in Appendix A.

(5) Record retention. The hospice shall retain the certification statements described in this section for 4 years.

The provisions of this § 1130.22 amended January 24, 1992, effective August 17, 1991, 22 Pa.B. 361. Immediately preceding text appears at serial pages (150020) to (150021).

Notation

Cross References

This section cited in 55 Pa. Code § 1130.3 (relating to definitions); 55 Pa. Code § 1130.21 (relating to recipient eligibility requirements); 55 Pa. Code § 1130.42 (relating to revocation of hospice care); and 55 Pa. Code § 1130.61 (relating to prerequisites for coverage).