The hospice benefit is available only to individuals who are terminally ill with a life expectancy of six months or less. There are three reasons a hospice may discharge a patient from care: The patient is no longer terminally ill. The patient’s condition stabilizes or improved, and they are no longer considered terminally Ill. The patient moves out of the service area of the Hospice. Moving out of the service area includes services provided in a hospital with whom the hospice does not have a contract. Discharge for a cause. The hospice notifies the Medicare contractor of the discharge so that hospice services and billings are terminated as of that date. If a hospice beneficiary is discharged alive or if a hospice beneficiary revokes the election of hospice care, the hospice shall submit a timely-filed Notice of Termination/Revocation unless the hospice has already filed a final claim. A timely-filed NOTR is a NOTR that is submitted to and accepted by the Medicare contractor within 5 calendar days after the effective date of discharge or revocation. In this situation, the patient loses the remaining days in the benefit period. However, there is no increase in cost to the beneficiary. General coverage under Medicare is reinstated at the time the patient revokes the benefit or is discharged.Effect of dischargeAn individual, upon discharge from the hospice during a particular election period for reasons other than immediate transfer to another hospice— Is no longer covered under Medicare for hospice care; Resumes Medicare coverage of the benefits waived under § 418.24(d); and May at any time elect to receive hospice care if he or she is again eligible to receive the benefit. Discharge planning The hospice must have in place a discharge planning process that takes into account the prospect that a patient’s condition might stabilize or otherwise change such that the patient cannot continue to be certified as terminally ill. The discharge planning process must include planning for any necessary family counseling, patient education, or other services before the patient is discharged because he or she is no longer terminally ill. Resources https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c09.pdf The Regulations 418.26 Discharge from hospice care Out of Service Area Discharges https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c11.pdf NHPCO Resources Hospice Discharge, Revocation, and Change of Designated Hospice Discharge from the Medicare Hospice Benefit (Includes Revocation, and Transfer) – A Compliance Guide for Hospice Providers revised CMS FY 2015 Final Hospice Wage Index rule