Question

What is the 2 midnight rule for hospice patients?

Answer 1

The 2 midnight rule for hospice patients is a CMS payment policy that requires physicians to expect a patient to need hospital care over 2 midnight's to qualify for Medicare Part A inpatient payment.

And while the 2 midnight rule is generally applied to acute care, it also impacts hospice patients when a transfer to a hospital occurs, and it often triggers a review if it fails the 2 midnight benchmark.

Under the 2 midnight rule for hospice patients, if a hospice patient is transferred to a hospital, the 2 midnight rule is what helps to determine if this is a general inpatient or GIP stay under Medicare Part A.

When it comes to the 2 midnight rule for hospice patients, the key is whether the provider expects the stay to cross 2 midnight's upon admission and not whether it actually does.

There are some exceptions for shorter stays, which include cases of unexpected death or swift transfer, which are also treated differently than planed and short term inpatient visits.

The longest you can live on hospice is 6 months, before you need to be re-certified by a physician that you have a terminal illness with a life expectancy of 6 months or less.

However as long as the patient meets the criteria and is re-certified for hospice, you can live on hospice for a year or even longer.

Hospice care is mostly designed for patients that have 6 months or less to live, but the hospice care can be extended for as long as the patient lives if they meet the eligibility criteria.

Hospice care is broken into benefit periods of two 90 day periods, followed by unlimited 60 day periods and a doctor must review and re-certify the patients eligibility before each new period of hospice.

If a hospice patient lives longer than 6 months, a physician in conjunction with input from the interdisciplinary team will also need to document and attest that the patient is still terminal and still has a life expectancy that is short enough to require hospice.

Some patients in hospice can still live in hospice longer than 6 months as long as they still meet the criteria for hospice care.

If the hospice patient recovers or gets better, then they can be discharged from hospice and can reenter hospice later if needed.

The two conditions that must be present for a patient to enroll in hospice are having a life expectancy of 6 months or less and having a terminal diagnosis.

For a patient to enroll in hospice, the patient must have a certified prognosis of a life expectancy of 6 months or less if the illness runs it's normal course and have a terminal diagnosis, with a documented decline in their health, in which the patient opts for palliative comfort care, instead of curative treatment.

For a patient to be eligible for hospice care, whether in a hospice center or at home, a doctor and a hospice medical director has to certify that the patient has an expected life expectancy of 6 months or less.

Although the hospice care can still be extended if the patient in hospice continues to meet the criteria.

There must also be documented and rapid decline in the patients status, like increased weakness, unintentional weight loss or frequent infections.

And the patient chooses to focus on quality of life and pain management, and forgoes further curative treatments.

A PPS or Palliative Performance Scale rating of <50% to 60% or needing assistance with daily living indicates that it's time for the patient to consider hospice.

Hospice can be provided in a hospice center or even in home through at home hospice, where a hospice nurse will visit the patients home.

Hospice care provides comprehensive comfort care (palliative care) for patients with a terminal illness (typically a life expectancy of six months or less) who choose to forgo curative treatments.

Hospice care focuses on pain management, quality of life, and emotional/spiritual support for patients and families, usually in the home, nursing home, or specialized facility.

Services of hospice care include routine home care, continuous home care (during crisis), inpatient care for symptom management and respite care to provide temporary relief to family caregivers.