Provision of Hospice Services to Medicare/Veteran’s Eligible

60 - Provision of Hospice Services to Medicare/Veteran’s Eligible Beneficiaries (Rev. 12696; Issued:06-25-24; Effective:03-25-24; Implementation: 03-25-24) Medicare beneficiaries that are dually eligible veterans, and reside at home in their community may elect the Medicare Hospice Benefit and have hospice services paid for under the Medicare Hospice Benefit. See §1853(c) and 1814(d) of the Act. Upon electing the Medicare hospice benefit, the beneficiary waives the right to Medicare payment for any Medicare services related to the terminal illness and related conditions during a hospice election. However, this does not preclude dually eligible veterans (i.e., eligible for both Medicare and Veterans benefits) from receiving services not included on the hospice plan of care, and which are furnished and paid under the beneficiary’s VA benefits, in addition to Medicare hospice services. This may include care and support services that are unique to VA benefits and not typically provided by Medicare hospice agencies, for example, but not limited to, VA home-based primary care for illnesses other than the terminal illness. Any services that are included on the hospice plan of care must be provided and paid under Medicare. If a dually eligible veteran, who had been receiving Medicare hospice services in his/her home, is admitted to a VA owned and operated inpatient facility, the beneficiary must revoke the Medicare hospice benefit. Medicare is not allowed to pay for services that another Federal provider or agency furnishes (§1862(a)(3) and 42 CFR 411.6). Dually eligible veterans may elect to receive Medicare hospice services while residing in community nursing homes and state homes and have those services paid for under the Medicare hospice benefit. (This is similar to paying for hospice care if a beneficiary lives in a nursing facility. See §20.3.)