Published 12/01/2016

As a condition of payment, the Affordable Care Act (ACA) requires that a hospice physician or nurse practitioner (NP) must have a face-to-face encounter with every hospice patient to determine the continued eligibility of that patient prior to the 180th-day recertification, and prior to each subsequent recertification. Failure to meet the face-to-face encounter requirements is a failure by the hospice to meet the patient’s recertification of terminal illness eligibility requirement. The patient would cease to be eligible for the benefit.

The provision became effective for third benefit periods or later periods which occurred on or after January 1, 2011. The Medicare Payment Advisory Commission’s (MedPAC) recommended that Congress enact this provision to ensure appropriate use of the Medicare hospice benefit. The Centers for Medicare & Medicaid Services (CMS) implemented the provision in the Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2011 final rule.

The hospice must retain the certification statements. These requirements also apply to individuals who had been previously discharged during a benefit period and are being recertified for hospice care.

Electronic signatures are permissible for all aspects of the certification:

  • Face-to-face attestation
  • Narrative
  • Certification/recertification


  • Hospice Center on CMS website
  • CMS Medicare Benefit Policy Manual, Chapter 9, Section 20
  • CMS Medicare Claims Processing Manual, Chapter 11
  • CMS Medicare Program Integrity Manual, Chapter 3

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