42 C.F.R. § 418.20
Eligibility requirements
In order to be eligible to elect hospice care under Medicare, an individual must be—
(a) Entitled to Part A of Medicare; and
(b) Certified as being terminally ill in accordance with § 418.22.
Notes of Decisions
Cited in 17
cases (5 in the last 5 years), 2012–2025 · leading case: Victoria Druding v. Care Alternatives, 952 F.3d 89 (3rd Cir. 2020).
Victoria Druding v. Care Alternatives, 952 F.3d 89 (3rd Cir. 2020). “See 42 C.F.R. § 418.20 . The regulations provide that, “[i]n order to be eligible to elect hospice care under Medicare, an individual must be .”
U.S. ex rel. Kathi Holloway, 960 F.3d 836 (6th Cir. 2020). “; see also 42 C.F.R. § 418.20 . The clinical documents that purportedly supported the certification of hospice-eligibility were distorted.”
United States ex rel Lemon v. Nurses To Go, Inc., 924 F.3d 155 (5th Cir. 2019). “§ 1395f(a)(7)(A) ; see also 42 C.F.R. §§ 418.20 & 418.22. Id. § 1395f(a)(7)(D)(i).”
Victoria Druding v. Care Alternatives, 81 F.4th 361 (3rd Cir. 2023). “For a patient to be eligible for Medicare hospice benefits, and for a hospice provider to be entitled to bill for such benefits, a patient must be certified as “terminally ill,” see 42 C.F.R. §§ 418.20 , meaning “that the individual has a medical prognosis that his or her life…”
Cal. Advocates for Nursing Home Reform v. Smith, 251 Cal. Rptr. 3d 636 (Cal. Ct. App. 5th 2019). “( 42 C.F.R. §§ 418.20 , 418.22(b)(l).) For such Medicare beneficiaries, hospice care is a benefit under Medicare Part A.”
United States ex rel. Geschrey v. Generations Healthcare, LLC, 922 F. Supp. 2d 695 (N.D. Ill. 2012). “According to Medicare regulation 42 C.F.R. § 418.20 , in order “to elect hospice care under Medicare, an individual must be— (a) entitled to Part A of Medicare; and (b) certified as being terminally ill in accordance with § 418.”
St. John of God Ret. & Care Ctr. v. State Dep't of Health Care Servs., 2 Cal. App. 5th 638 (Cal. Ct. App. 2016). “…to file a hospice election if the person is entitled to Medicare Part A and is certified as being terminally ill. ( 42 C.F.R. § 418.20 (a) & (b) (2015).)”
United States ex rel. Holloway v. Heartland Hospice, Inc., 386 F. Supp. 3d 884 (N.D. Ohio 2019). “3 42 C.F.R. § 418.20 (b). A patient is terminally ill if his or her prognosis "is for a life expectancy of 6 months or less if the terminal illness runs its normal course.”
Grane Hospice Care, Inc. v. Dep't of Pub. Welfare, 74 A.3d 1094 (Pa. Commw. Ct. 2013). “42 C.F.R. § 418.20 (emphasis added). The certification must specify that the patient *1099 has a life expectancy of six months or less.”
Capital Hospice v. Becerra (E.D. Va. 2025). “” 42 C.F.R. § 418.20 (b). “An individual is considered to be ‘terminally ill’ if the individual has a medical prognosis that the individual’s life expectancy is 6 months or less.”
Deborah Lemon v. Nurses To Go, Inc. (5th Cir. 2019). “32 Relators’ claims in this case are based on Defendants’ fraudulent certifications of compliance with the above listed requirements, which Congress and Medicare have expressly identified as “conditions of payment.”
Cal. Advocates for Nursing Home Reform v. Smith (Cal. Ct. App. 2019). “( 42 C.F.R. §§ 418.20 , 418.22(b)(l).) For such Medicare beneficiaries, hospice care is a benefit under Medicare Part A.”
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