Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 6142 (September 30, 2023).

55 Pa. Code § 1130.21. Recipient eligibility requirements.


§ 1130.21. Recipient eligibility requirements.

 To be eligible to elect hospice care under the MA Program, an individual shall:

   (1)  Be categorically or medically needy.

   (2)  Be residing at home, which includes the recipient’s home, a friend’s home, a relative’s home, a hotel, a boarding house, a personal care home, a domiciliary care facility, an intermediate care facility or a skilled nursing facility. The individual may not be residing in a hospital.

   (3)  Be certified as being terminally ill by a doctor of medicine or osteopathy under §  1130.22 (relating to duration of coverage).

   (4)  Agree to waive rights to MA Program coverage for the following services for the period during which the recipient is under the care of a designated hospice:

     (i)   Hospice care provided by a hospice other than the hospice designated by the recipient, unless provided under arrangements made by the designated hospice.

     (ii)   MA services related to the treatment of the terminal condition for which hospice care was elected or a related condition or services that are equivalent to hospice care except for:

       (A)   Services provided by the designated hospice.

       (B)   Services provided by another hospice under arrangements made by the designated hospice.

       (C)   Services provided by the recipient’s attending physician if that physician is not an employe of the designated hospice or receiving compensation from the hospice for those services.

       (D)   Medications prescribed for conditions clearly unrelated to the terminal illness.

Cross References

   This section cited in 55 Pa. Code §  1130.22 (relating to duration of coverage); and 55 Pa. Code §  1130.42 (relating to revocation of hospice care).

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