C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 418—HOSPICE CARE › Subpart B—Eligibility, Election and Duration of Benefits

42 C.F.R. § 418.25

Admission to hospice care

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(a) The hospice admits a patient only on the recommendation of the medical director (or the physician designee, as defined in § 418.3) or the physician member of the hospice interdisciplinary group, in consultation with, or with input from, the patient's attending physician (if any).

(b) In reaching a decision to certify that the patient is terminally ill, the hospice medical director (or the physician designee, as defined in § 418.3) or the physician member of the hospice interdisciplinary group, must consider at least the following information:

(1) Diagnosis of the terminal condition of the patient.

(2) Other health conditions, whether related or unrelated to the terminal condition.

(3) Current clinically relevant information supporting all diagnoses.

[70 FR 70547, Nov. 22, 2005, as amended at 89 FR 64272, Aug. 6, 2024; 90 FR 37431, Aug. 5, 2025]
Notes of Decisions
Cited in 4 cases (1 in the last 5 years), 2013–2022 · leading case: United States v. Aseracare, Inc., 938 F.3d 1278 (11th Cir. 2019).
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United States v. Aseracare, Inc., 938 F.3d 1278 (11th Cir. 2019). “102 (b); 42 C.F.R. § 418.25 (b) (establishing that, “[i]n reaching a decision to certify that the patient is terminally ill, the hospice medical direct must consider at least” the diagnosis of the patient, other health conditions, and “[c]urrent clinically relevant information…”
U.S. ex rel. Kathi Holloway, 960 F.3d 836 (6th Cir. 2020). “” 42 C.F.R. § 418.25 (b). Submitting a fraudulent certified claim for payment for care provided to a hospice-ineligible patient constitutes a false claim.”
Grane Hospice Care, Inc. v. Dep't of Pub. Welfare, 74 A.3d 1094 (Pa. Commw. Ct. 2013). · cites it 4× “42 C.F.R. § 418.25 (emphasis added). Finally, the hospice must “[fjile written certifications in the medical record.”
United States of Am. v. Curo Health Servs. Holdings, Inc. (M.D. Tenn. 2022). “” 42 C.F.R. § 418.25 (a). In making that decision, the medical director must consider “(1) [d]iagnosis of the terminal condition of the patient[;] (2) [o]ther health conditions, whether related or unrelated to the terminal condition[; and] (3) [c]urrent clinically relevant…”
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