42 C.F.R. § 418.200
Requirements for coverage
To be covered, hospice services must meet the following requirements. They must be reasonable and necessary for the palliation and management of the terminal illness as well as related conditions. The individual must elect hospice care in accordance with § 418.24. A plan of care must be established and periodically reviewed by the attending physician, the medical director, and the interdisciplinary group of the hospice program as set forth in § 418.56. That plan of care must be established before hospice care is provided. The services provided must be consistent with the plan of care. A certification that the individual is terminally ill must be completed as set forth in section § 418.22.
Notes of Decisions
Cited in 3
cases (2 in the last 5 years), 2011–2025 · leading case: US Ex Rel. Wall v. Vista Hospice Care, Inc., 778 F. Supp. 2d 709 (N.D. Tex. 2011).
US Ex Rel. Wall v. Vista Hospice Care, Inc., 778 F. Supp. 2d 709 (N.D. Tex. 2011). “42 C.F.R. § 418.200 . 15 . 42 C.F.R. § 418.”
Ambercity Hospice, Inc. v. Xavier Becerra (9th Cir. 2021). “§ 1395y(a)(1)(C); 42 C.F.R. §§ 418.200 , 424.5(a)(6). The governing 2 regulations impose documentation requirements that must be satisfied.”
Hospice of East Texas v. Sec'y, US Dep't of Health of Human Servs. (E.D. Tex. 2025). “21, 2021) (listing a physician “certification that the individual is terminally ill” as one of the requirements for reimbursement of hospice services); see also 42 C.F.R. § 418.200 . The ALJ’s decision notes that if a beneficiary has an attending physician, the attending…”
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