📜 CoP Library
🏥 ICD-10 Eligibility
🔍 Survey Prep
🗺️ State Requirements
📜 Reference only. Always verify with the current eCFR at ecfr.gov. Regulations are updated periodically by CMS.
🏥 42 CFR Part 418 — Hospice Conditions of Participation
§418.52
Patient Rights
Patients have the right to receive care, be informed of rights in advance, participate in their care plan, and receive care without discrimination.
REQUIRED§418.54
Initial and Comprehensive Assessment
RN must complete initial assessment within 48 hours of election. Comprehensive assessment must be completed within 5 days. Must identify patient/family needs across all domains.
CRITICAL · 5-DAY DEADLINE§418.56
Interdisciplinary Group (IDG)
IDG must review and revise the care plan at least every 15 days. Must include RN, physician, social worker, and pastoral counselor. All disciplines must document their participation.
CRITICAL · 15-DAY CYCLE§418.58
Quality Assessment & Performance Improvement (QAPI)
Hospice must maintain an ongoing QAPI program. Must track measurable outcomes and demonstrate improvement over time. Governing body must review QAPI findings.
REQUIRED§418.60
Infection Control
Written infection control policies required. Must include standard precautions, hand hygiene, sharps disposal, and communicable disease reporting.
REQUIRED§418.64
Core Services
Hospice must directly provide nursing, medical social services, physician services, and counseling. These cannot be contracted out.
CRITICAL§418.70
Furnishing Drugs & Biologicals
Hospice must provide all medications related to the terminal diagnosis. Drugs must be managed by a licensed pharmacist. Controlled substance policies required.
REQUIRED§418.74
Volunteers
Volunteers must provide care/services in an amount equivalent to at least 5% of total patient care hours. Volunteers must be trained and supervised. Hours must be documented.
5% REQUIREMENT§418.76
Hospice Aide & Homemaker Services
Aides must complete competency evaluation before patient contact. Skills must include personal care, infection control, and safety. Supervisory visit required every 14 days.
14-DAY SUPERVISION§418.78
Bereavement Counseling
Bereavement services must be available to family for at least 13 months after patient death. Risk assessment must be completed. Level of contact must match risk level.
13-MONTH REQUIREMENT§418.100
Organizational Structure
Governing body must assume full legal responsibility. Must have a medical director who assumes responsibility for the medical component of care.
REQUIRED§418.116
Staff Training & Competency
Ongoing training required for all staff including volunteers. Competency evaluations required. Training records must be maintained. New hire orientation must cover all CoP areas.
TRAINING REQUIRED🏠 42 CFR Part 484 — Home Health Conditions of Participation
§484.40
Condition of Participation: Skilled Nursing Services
Skilled nursing services must be provided by or under the supervision of a licensed RN. Must follow the plan of care. All visits must be documented.
REQUIRED§484.50
Patient Rights
Patients must receive a written notice of rights before care begins. Right to participate in care planning, refuse treatment, and receive care without discrimination.
CRITICAL§484.55
Comprehensive Assessment
OASIS-E must be completed within 5 days of start of care by an RN. Must incorporate all patient health status indicators. OASIS must be submitted to CMS iQIES within 30 days.
5-DAY OASIS DEADLINE§484.60
Care Planning & Coordination
Plan of care must be established by a physician. Must be reviewed by the physician at least every 60 days. CMS-485 must have physician signature before billing.
PHYSICIAN ORDER REQUIRED§484.65
Quality Assessment & Performance Improvement
HHA must maintain ongoing QAPI program. Must include outcome measures, adverse event tracking, and performance improvement projects. Governing body oversight required.
QAPI REQUIRED§484.75
Skilled Nursing Services
Services must be provided by licensed RN or LPN under RN supervision. All skilled services must be medically necessary and documented in the plan of care.
REQUIRED§484.80
Home Health Aide Services
Aides must complete 75 hours of training. Competency evaluation required before patient care. Supervisory visit every 60 days (14 days if aide providing skilled care).
75-HR TRAINING§484.105
Organization, Services & Administration
HHA must be governed by a group of professional personnel including at least one physician and one RN. Must have written policies governing services provided.
REQUIRED🏥 Hospice eligibility requires a physician to certify that the patient has a life expectancy of 6 months or less if the illness runs its normal course. Use these guidelines to support documentation — not as a substitute for clinical judgment.
Common Terminal Diagnoses — Eligibility Guidelines
| Diagnosis | Primary ICD-10 | Eligibility Criteria (LCD) | Supporting Documentation |
|---|
Survey Readiness Self-Assessment
Check items your agency has in place. Score updates in real time.
0%
READINESS SCORE
🗺️ Select your state to view licensure, Medicare certification, and EVV requirements. For full state-by-state detail, visit the 50-State Compliance Engine →
Select a state to view requirements.