Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.35 - Hospice Care › Section 10.09.35.05 - Eligibility for and Election of Hospice Care

Current through Register Vol. 51, No. 14, July 12, 2024
A. To be eligible for hospice care, written
				  certification of terminal illness shall be obtained by the hospice for each of
				  the election periods listed in Regulation .04 of this chapter. Procedures for
				  certification of terminal illness are as follows:
(1) The hospice shall obtain the written
				  certification before the hospice submits a claim for payment;
(2) If the hospice is unable to obtain
				  written certification within 2 calendar days after an election period begins,
				  an oral certification shall be obtained within 2 calendar days and a written
				  certification shall be obtained before the hospice submits a claim for
				  payment;
(3) Certifications shall
				  be completed not more than 15 calendar days before the start of the election
				  period;
(4) For the initial
				  election period, the hospice shall obtain written certification statements and
				  shall document oral certification statements in accordance with §A(2) of
				  this regulation from:
(a) The medical
				  director of the hospice or the physician member of the hospice
				  interdisciplinary team; and
(b) The
				  attending physician, if there is an attending physician;
(5) For subsequent election periods,
				  certification by one of the physicians listed in §A(4) of this regulation
				  is required;
(6) All certifications
				  shall:
(a) Be signed and dated by the
				  certifying physician; and
(b)
				  Include the date of the election for which the certification applies;
(7) Certifications shall be based
				  on the certifying physician's clinical judgment regarding the normal course of
				  the recipient's illness and conform to the following requirements:
(a) Document that the participant's prognosis
				  is for a life expectancy of 6 months or less if the terminal illness runs its
				  normal course;
(b) Clinical
				  information documenting the prognosis of a terminal illness shall accompany the
				  certification and shall be filed in the medical record;
(c) Clinical information for the initial
				  election period may be provided orally and shall be documented in the medical
				  record and included as part of the hospice's eligibility assessment;
(d) A brief narrative written by the
				  certifying physician:
(i) Shall be included in
				  the certification;
(ii) Shall be
				  located immediately before the certifying physician's signature or included as
				  an addendum signed by the certifying physician;
(iii) Shall include a statement inserted
				  directly above the certifying physician's signature and based on a review of
				  the participant's medical record or examination of the participant;
(iv) Shall reflect the participant's
				  individual clinical circumstances; and
(v) May not contain checkboxes or standard
				  language used for all participants;
(8) To determine continued eligibility for
				  hospice care, a face-to-face encounter by the hospice physician or the hospice
				  nurse practitioner shall occur:
(a) When a
				  stay across all hospices is anticipated to reach the third election period;
				  and
(b) Not more than 30 days
				  before the third election period and any subsequent election period;
				  and
(9) A narrative
				  associated with an election period requiring a face-to-face encounter shall
				  include:
(a) An explanation of why the
				  clinical findings support a prognosis of a terminal illness; and
(b) A written attestation of the date of the
				  encounter and that the clinical findings were provided to the certifying
				  physician.