Medicaid

Georgia Medicare Hospice Benefit: Coverage Guide

::: hero The Medicare Hospice Benefit is the cornerstone of end-of-life care in America.

Brevy Care Team

· 37 min read

::: hero

By Brevy Care Team · Last verified May 13, 2026

The Medicare Hospice Benefit is the cornerstone of end-of-life care in America. For Georgia families confronting the reality of a terminal diagnosis, the benefit provides comprehensive interdisciplinary care: nursing, physician oversight, social work, counseling, aide services, medications, equipment, and bereavement support for the family for thirteen months after death. The benefit is anchored in Section 1812(a)(4) of the Social Security Act, codified at 42 USC 1395d(a)(4), which establishes hospice as a covered Part A benefit. Section 1814(a)(7) of the Act establishes the certification and election framework that gates entry into the benefit. Together with the implementing regulations at 42 CFR Part 418, these statutes create a uniquely structured benefit that exchanges curative treatment for the terminal condition in favor of palliative care focused on comfort, dignity, and quality of life during the final months.

This guide explains the statutory and regulatory framework of the Medicare Hospice Benefit as it applies to Georgia Medicare beneficiaries. It walks through the 6-month prognosis standard, the election process and its waiver effect, the four levels of care that hospices may provide (Routine Home Care, Continuous Home Care, General Inpatient Care, and Inpatient Respite Care), the structure of election periods (the first 90-day period, the second 90-day period, and unlimited subsequent 60-day periods), the recertification process including the face-to-face encounter required before each 60-day period under Section 3132 of the Affordable Care Act, the coordination between hospice and Medicare Part D for medications, the hospice aggregate cap that limits total payments per beneficiary, and the practical pathway for Georgia families to access hospice care from providers across the state. :::

Federal Statutory and Regulatory Authority

The Medicare Hospice Benefit rests on a layered statutory foundation. Beneficiaries, families, and clinicians who understand the underlying statutes can better navigate the practical mechanics of the benefit, recognize when something is being handled incorrectly, and advocate effectively when problems arise.

Section 1812(a)(4) of the Social Security Act establishes hospice care as one of the covered Medicare Part A benefits. The statute lists hospice care alongside inpatient hospital services, skilled nursing facility services, and home health services as a fundamental Part A entitlement. The provision authorizes Medicare to pay for hospice care during periods of election, subject to the certification and election requirements set forth elsewhere in the Act.

Section 1814(a)(7) establishes the certification and election framework. Under this section, payment for hospice care may be made only if the beneficiary is terminally ill (life expectancy of 6 months or less if the illness runs its normal course), has filed a hospice election statement with a Medicare-certified hospice, and has obtained physician certification of the terminal illness. The hospice medical director and the attending physician (if the beneficiary has one) must both certify the terminal illness at the beginning of the first 90-day period. The hospice medical director must recertify the terminal illness at the beginning of each subsequent benefit period.

Section 1861(dd) provides the statutory definition of hospice care, hospice program, and the services that constitute hospice care. The section defines the interdisciplinary group (IDG), which must include at minimum a physician, a registered nurse, a social worker, and a pastoral or other counselor. The IDG is the clinical heart of hospice care: it develops the plan of care, coordinates services across disciplines, and adjusts care as the patient's condition evolves.

Section 1814(i) establishes the hospice payment methodology. Subsection 1814(i)(1) provides that hospice payments are made in lieu of all other Part A services for the terminal illness and related conditions. Subsection 1814(i)(2) imposes the hospice aggregate cap, which limits total Medicare hospice payments per beneficiary per fiscal year. Subsection 1814(i)(5), added by the IMPACT Act of 2014, established the Hospice Quality Reporting Program. Subsection 1814(i)(6), added by Section 3132 of the Affordable Care Act, established the face-to-face encounter requirement for recertifications before the third and each subsequent benefit period.

42 CFR Part 418: The Hospice Conditions of Participation

The implementing regulations for the Medicare Hospice Benefit are codified at 42 CFR Part 418, the Hospice Conditions of Participation. The regulation is organized into seven subparts:

Subpart A: General provisions (42 CFR 418.1-418.3)
Subpart B: Eligibility, election, and duration of benefits (42 CFR 418.20-418.30)
Subpart C: Conditions of participation: patient care (42 CFR 418.52-418.78)
Subpart D: Conditions of participation: organizational environment (42 CFR 418.100-418.116)
Subpart F: Covered services (42 CFR 418.200-418.205)
Subpart G: Payment for hospice care (42 CFR 418.302-418.312)
Subpart H: Coinsurance (42 CFR 418.400-418.402)

Key regulations within Part 418 govern the certification of terminal illness (42 CFR 418.22), the election of hospice care (42 CFR 418.24), the revocation of election (42 CFR 418.28), change of designated hospice (42 CFR 418.30), the covered services (42 CFR 418.202), the special requirements for short-term inpatient care (42 CFR 418.108), and the payment categories and rates (42 CFR 418.302).

Statutory History

The Medicare Hospice Benefit was created by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA, Public Law 97-248), Section 122. The original benefit was time-limited to 210 days of lifetime coverage. The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA, Public Law 99-272) made the benefit permanent. The Omnibus Budget Reconciliation Act of 1986 (Public Law 99-509) replaced the original 30-day third period with an unlimited extension period. The Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239) added the 6-month prognosis requirement. The Omnibus Budget Reconciliation Act of 1990 (Public Law 101-508) further reformed payment.

The Balanced Budget Act of 1997 (Public Law 105-33), Sections 4441 through 4449, restructured the benefit into its current form: two 90-day periods followed by unlimited 60-day periods. The Medicare Modernization Act of 2003 (Public Law 108-173) created Medicare Part D and established the framework for hospice and Part D coordination. The Affordable Care Act of 2010 (Public Law 111-148), Section 3132, added the face-to-face encounter requirement and the physician narrative requirement. The IMPACT Act of 2014 (Public Law 113-185) established the Hospice Quality Reporting Program and the Hospice Item Set data collection.

::: callout Key Takeaways

Section 1812(a)(4) of the Social Security Act establishes hospice care as a covered Medicare Part A benefit. Section 1814(a)(7) sets the certification and election framework. The implementing regulations are at 42 CFR Part 418.
Hospice election requires that the beneficiary be terminally ill with a life expectancy of 6 months or less if the illness runs its normal course. The hospice medical director and the attending physician (if any) must both certify the terminal illness at the start of the first 90-day period.
The hospice benefit is structured as two 90-day periods followed by unlimited subsequent 60-day periods. As long as the beneficiary continues to meet clinical criteria and is recertified, hospice may continue indefinitely.
Under Section 3132 of the Affordable Care Act of 2010, a hospice physician or nurse practitioner must conduct a face-to-face encounter with the beneficiary no more than 30 calendar days before the start of the third benefit period and before each subsequent 60-day period.
Hospice provides four levels of care: Routine Home Care (most common), Continuous Home Care (crisis-level home care of at least 8 hours of predominantly nursing care in a 24-hour period), Inpatient Respite Care (up to 5 consecutive days to provide relief for caregivers), and General Inpatient Care (facility-based care for symptoms that cannot be managed at home).
Electing hospice waives the right to Medicare payment for curative treatment of the terminal illness and related conditions. Original Medicare continues to cover services unrelated to the terminal illness. The beneficiary may revoke the election at any time.
Hospice covers drugs and biologicals related to palliation or management of the terminal illness. Part D may cover drugs unrelated to the terminal illness, often after prior authorization to confirm that the drug is unrelated.
Bereavement counseling and support for the family is included in the hospice benefit and extends for thirteen months after the patient's death.
The hospice aggregate cap under Section 1814(i)(2) limits the total Medicare hospice payment per beneficiary per fiscal year. The cap applies to hospice providers, not to individual benefit periods.
For Georgia beneficiaries, hospice is delivered by national chains (VITAS, Amedisys, Heartland) and Georgia-based hospices in every region. Inpatient hospice units operate in Atlanta, Savannah, Macon, and other major Georgia communities. :::

The 6-Month Prognosis Standard

The 6-month prognosis is the clinical gateway to the Medicare Hospice Benefit. Under 42 CFR 418.22(b)(2), the physician certifying terminal illness must base the certification on a medical prognosis that the beneficiary's life expectancy is 6 months or less if the illness runs its normal course.

The 6-month prognosis is a prognosis, not a prediction or a guarantee. Some hospice patients live well beyond 6 months and continue to qualify for the benefit at each recertification. Others decline more rapidly. Hospice eligibility is a clinical judgment based on the patient's overall condition, comorbidities, functional status, and disease trajectory.

Who Certifies the Terminal Illness

For the first 90-day period, two physicians must certify the terminal illness:

The hospice medical director (or another physician member of the hospice interdisciplinary group), and
The attending physician, if the beneficiary has an attending physician.

For each subsequent benefit period, only the hospice medical director (or another IDG physician) must recertify.

The Physician Narrative

Under Section 3132 of the Affordable Care Act and 42 CFR 418.22(b)(3), the physician certifying terminal illness must compose a brief narrative explaining the clinical findings that support a life expectancy of 6 months or less if the illness runs its normal course. The narrative must be a written attestation composed by the physician (not a checkbox). It must reflect the patient's individual clinical circumstances, not generic language. The narrative may be on the certification form itself or in an addendum to the certification.

Local Coverage Determinations

For non-cancer diagnoses, Medicare Administrative Contractors (MACs) publish Local Coverage Determinations (LCDs) that provide clinical criteria for hospice eligibility. Common LCDs cover:

End-stage congestive heart failure (CHF) including NYHA Class IV symptoms, ejection fraction less than 20%, and treatment-refractory symptoms
End-stage chronic obstructive pulmonary disease (COPD) including dyspnea at rest, FEV1 less than 30%, and recurrent infections
End-stage dementia at FAST stage 7c or worse, with comorbid medical complications
End-stage renal disease in patients declining or discontinuing dialysis
End-stage liver disease with serum albumin less than 2.5, INR greater than 1.5, and clinical decompensation

For Georgia, hospice claims are processed by the Medicare Administrative Contractor serving Jurisdiction M (Palmetto GBA), and beneficiaries should expect that LCD criteria from that MAC will apply.

Timing of Certification

Under 42 CFR 418.22(a)(1), written certification must be in place no later than 2 calendar days after hospice care is initiated. Hospice may begin services based on verbal certification as long as written certification is signed within 2 calendar days. If written certification is not obtained within the timeframe, Medicare will not pay for the services provided before written certification was completed.

The Hospice Election

The hospice election is the legal act by which the beneficiary chooses hospice care and accepts its terms.

Filing the Election Statement

Under 42 CFR 418.24, the beneficiary (or representative if the beneficiary lacks capacity) signs an election statement that includes:

Identification of the particular hospice that will provide care
Acknowledgment that the beneficiary has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment for the terminal illness
Acknowledgment that the beneficiary understands that certain Medicare services are waived
The effective date of the election
The signature of the beneficiary or representative

Effective Date

The effective date may be the date the election statement is signed or any later date. The effective date cannot be earlier than the date of signature.

Waiver of Curative Treatment

The election statement triggers a waiver. Under 42 CFR 418.24(e), upon election the beneficiary waives all rights to Medicare payment for:

Hospice care provided by any hospice other than the designated hospice (unless the beneficiary changes designation under 42 CFR 418.30)
Any Medicare services that are related to the treatment of the terminal condition or related conditions for which the beneficiary elected hospice, or that are equivalent to hospice care

The waiver covers the terminal illness and related conditions only. Services unrelated to the terminal illness continue to be covered by Original Medicare (or Medicare Advantage) as before.

Consider a Georgia hospice beneficiary with end-stage pancreatic cancer:

Related (covered by hospice): opioid pain medications, antiemetics, palliative radiation for bone pain, palliative paracentesis for ascites, hospice nursing visits, hospice aide visits, hospice social work, hospice chaplaincy, bereavement counseling for family.
Unrelated (covered by Original Medicare or MA): treatment for an unrelated injury sustained in a fall, dental services unrelated to the cancer, eyeglasses for refractive error, hearing aid services, continued management of well-controlled hypertension with longstanding medications.

The line between "related" and "unrelated" is sometimes contested. Hospices, Part D plans, and CMS have developed guidance to resolve common disputes, with the default that drugs commonly used for hospice symptom management (analgesics, antiemetics, antianxiety medications, laxatives) are presumed related unless documented otherwise.

Revocation

Under 42 CFR 418.28, the beneficiary may revoke the hospice election at any time. Revocation requires a signed written statement (or other communication that Medicare regulations recognize) indicating the date of revocation. Effects of revocation:

The beneficiary forfeits the remaining days in the current benefit period
The beneficiary returns to Original Medicare or Medicare Advantage coverage for the terminal illness
The beneficiary may re-elect hospice at a later time, picking up at the same benefit period structure (e.g., if revoked during the second 90-day period, the beneficiary re-elects beginning with a new first 90-day period only if eligibility is re-established, or continues in the subsequent period structure if the original election sequence is preserved)

The Medicare hospice election may be revoked and re-elected multiple times. There is no lifetime limit on the number of elections.

Change of Designated Hospice

Under 42 CFR 418.30, the beneficiary may change the designated hospice once during a benefit period without it being treated as a revocation. The change is documented through a signed statement identifying the previous and new hospice and the effective date.

Election Periods and Recertification

The Medicare Hospice Benefit is divided into discrete election periods that govern when recertification is required and when face-to-face encounters must occur.

Period Structure

Under 42 CFR 418.21:

First 90-day period: begins on the effective date of the election; both hospice medical director and attending physician must certify
Second 90-day period: begins immediately after the first period; only hospice medical director recertifies
Subsequent 60-day periods: unlimited number; only hospice medical director recertifies; face-to-face encounter required before each 60-day period under Section 3132 ACA and 42 CFR 418.22(a)(4)

Recertification must be in place no later than 2 calendar days after the start of each new benefit period.

Face-to-Face Encounter

Under Section 3132 of the Affordable Care Act and 42 CFR 418.22(a)(4), a hospice physician or hospice nurse practitioner must conduct a face-to-face encounter with the beneficiary no more than 30 calendar days before the start of the third benefit period (the first 60-day period) and before each subsequent 60-day period.

Requirements:

The encounter must include the assessment of the beneficiary's clinical condition supporting continued hospice eligibility
The encounter may be conducted by a hospice physician, a hospice-employed nurse practitioner, or a hospice-contracted nurse practitioner
If the encounter is conducted by a nurse practitioner (not a physician), the certifying physician must compose an attestation reflecting that the physician used the encounter findings in determining eligibility
The encounter cannot be conducted by the attending physician (if the attending is separate from the hospice)
The encounter must be documented in the beneficiary's medical record

Missed Face-to-Face Encounter

If the face-to-face encounter is not conducted timely, the beneficiary becomes ineligible for hospice care from the missed encounter date until the encounter is completed. Days during the gap are not Medicare-payable. After the encounter is completed, the beneficiary may be re-admitted to the hospice benefit prospectively.

CMS recognizes "exceptional circumstances" that may excuse a missed encounter (such as the beneficiary's unexpected discharge from the hospice, or the hospice's inability to schedule due to beneficiary refusal), but the regulatory exceptions are narrow.

The Four Levels of Care

Under 42 CFR 418.302, Medicare pays hospices a per-diem rate that varies based on the level of care provided each day. The four levels are routine home care, continuous home care, general inpatient care, and inpatient respite care.

1. Routine Home Care (RHC)

Routine Home Care is the most common level of care and constitutes the vast majority of hospice days. RHC is provided when the beneficiary is in the home (which may be a private residence, an assisted living facility, or a long-term care facility) and does not require continuous nursing care.

Under a payment reform effective in FY 2016, RHC is paid on a two-tier rate structure:

RHC Days 1 to 60: higher rate (reflecting the more resource-intensive admission and stabilization period)
RHC Days 61 and beyond: lower rate

The two-tier structure was implemented to match payment more accurately to the actual resource intensity of hospice care over time.

In addition, hospices may receive a Service Intensity Add-on (SIA) for in-person visits by a registered nurse or social worker during the last 7 days of the beneficiary's life. The SIA is paid hourly (up to a daily limit) and is designed to incentivize hospices to provide intensive support at the very end of life.

2. Continuous Home Care (CHC)

Continuous Home Care is provided during periods of crisis to manage uncontrolled symptoms and to maintain the beneficiary at home rather than transferring to an inpatient setting. CHC is paid hourly (not per diem) at the highest rate among the four levels.

Requirements under 42 CFR 418.302(b)(2) and 418.204:

Minimum 8 hours of care during a 24-hour period (midnight to midnight)
Predominantly nursing care (nursing must constitute more than half of the care provided)
Provided in the beneficiary's residence
Used to manage acute symptoms that require continuous monitoring

CHC ends when the symptom crisis is resolved and the beneficiary returns to routine home care, or when the crisis cannot be managed at home and the beneficiary requires General Inpatient Care.

3. Inpatient Respite Care (IRC)

Inpatient Respite Care provides up to 5 consecutive days of inpatient care to give the primary caregiver a respite. IRC is furnished in a Medicare-certified facility (hospital, skilled nursing facility, or hospice inpatient unit) under a written agreement between the hospice and the facility.

Requirements under 42 CFR 418.302(b)(3) and 418.204:

Up to 5 consecutive days per respite stay
Multiple respite stays permitted if not consecutive (no fixed annual limit, but excessive use may trigger review)
Purpose is caregiver relief, not symptom management
The hospice arranges and coordinates the IRC

The caregiver may use the 5-day respite for any purpose: travel, rest, attending to other obligations, or simply recovering from the demands of caregiving. After 5 days, the beneficiary returns to the home setting. If the caregiver needs additional relief at a later date, a separate respite stay may be arranged.

4. General Inpatient Care (GIP)

General Inpatient Care is furnished in a Medicare-certified facility for pain control or symptom management that cannot be provided in another setting. GIP is the highest-acuity level of hospice care.

Requirements under 42 CFR 418.302(b)(4) and 418.204:

Provided in a Medicare-certified inpatient facility (hospital, SNF with hospice arrangements, or hospice inpatient unit)
For pain or symptom management that cannot be managed in the home or other settings
Not for caregiver relief (that is the purpose of IRC)
Limited to 20% of aggregate hospice inpatient days under 42 CFR 418.308

GIP is typically used for management of severe symptom crises such as uncontrolled pain, intractable nausea and vomiting, severe agitation in advanced dementia, or acute terminal events. GIP ends when symptoms are stabilized and the beneficiary can return to a lower level of care.

Comparison Table

Level of Care	Setting	Purpose	Payment Structure	Maximum Duration
Routine Home Care	Home or residential setting	Standard hospice services	Two-tier per diem (Days 1-60 vs 61+)	No limit
Continuous Home Care	Home	Crisis-level symptom management	Hourly rate	Until crisis resolves
Inpatient Respite Care	Inpatient facility	Caregiver relief	Per diem	5 consecutive days per stay
General Inpatient Care	Inpatient facility	Symptom management not manageable at home	Per diem	Until symptoms stabilize, subject to 20% aggregate limit

Hospice Covered Services

Under 42 CFR 418.202, the Medicare Hospice Benefit covers:

Nursing services provided by or under the supervision of a registered nurse
Physician services by the hospice medical director or designated physician
Medical social services by a qualified social worker
Counseling services, including dietary counseling, spiritual counseling, and bereavement counseling
Hospice aide and homemaker services under the supervision of a registered nurse
Physical therapy, occupational therapy, and speech-language pathology services for palliative purposes
Medical supplies (including drugs and biologicals) and durable medical equipment related to the terminal illness
Short-term inpatient care including respite care and general inpatient care
Counseling and bereavement services for the family, extending for thirteen months after the death

The Interdisciplinary Group

Under Section 1861(dd)(2)(B) of the Social Security Act and 42 CFR 418.56, the hospice must establish an interdisciplinary group (IDG) that includes at minimum:

A doctor of medicine or osteopathy (hospice medical director or designated physician)
A registered nurse
A social worker
A pastoral or other counselor

The IDG develops, reviews, and updates the plan of care; coordinates services across disciplines; and addresses the physical, emotional, social, and spiritual needs of the beneficiary and family.

Bereavement Services

Under 42 CFR 418.64(d), the hospice must provide bereavement services to the family for up to thirteen months after the death of the patient. Bereavement services may include counseling, support groups, memorial services, and follow-up calls. The services are included in the hospice payment and are not separately reimbursed. Many families are unaware that bereavement services are available and underutilize this important benefit.

Hospice and Part D Coordination

Coordinating hospice and Part D for medications is one of the most operationally complex aspects of the hospice benefit, and it generates significant confusion at the point of care.

Under 42 CFR 418.202(f), the hospice covers drugs and biologicals that are used primarily for the relief of pain and symptom control related to the terminal illness, and that are reasonable and necessary for the palliation or management of the terminal illness. These drugs are paid for by the hospice as part of the per-diem payment.

Part D Covers Unrelated Medications

Under 42 CFR 423.100, after hospice election, Part D coverage continues for medications unrelated to the terminal illness. The beneficiary continues to pay Part D copays for unrelated drugs.

Prior Authorization

To prevent Part D from incorrectly paying for drugs that are actually hospice-related, Part D plans typically require prior authorization (PA) for four classes of drugs that are commonly hospice-related:

Analgesics (pain medications)
Antiemetics (anti-nausea medications)
Laxatives
Antianxiety medications

When the beneficiary or family attempts to fill a prescription in one of these classes, the pharmacy submits to Part D. Part D applies PA, which prompts a conversation among the beneficiary, the hospice, and the prescribing physician about whether the drug is related to the terminal illness (and should be covered by hospice) or unrelated (and may be covered by Part D).

Practical Workflow

Beneficiary elects hospice
Hospice notifies Part D plan of the election
Part D plan applies PA codes to the four common classes
Beneficiary fills a prescription
If PA triggers, beneficiary or family contacts hospice
Hospice clarifies attribution: if related, hospice provides through its pharmacy; if unrelated, Part D covers subject to standard rules
Beneficiary fills through the appropriate channel

Out-of-Pocket Costs

For hospice-related drugs, the hospice may charge a small copay (no more than $5 under 42 CFR 418.400). For Part D-covered unrelated drugs, standard Part D cost-sharing applies, including for Extra Help (Low-Income Subsidy) beneficiaries.

Hospice Payment

Medicare pays hospices a daily rate based on the level of care provided, multiplied by the number of days at that level. Rates are updated annually through the CMS hospice payment update rule.

Approximate FY 2026 Rates

These rates are illustrative and should be verified through the current CMS hospice payment update notice or with the hospice provider. Approximate FY 2026 rates:

Routine Home Care, Days 1 to 60: approximately $235 per day
Routine Home Care, Days 61 and beyond: approximately $185 per day
Continuous Home Care: approximately $66 per hour (with an 8-hour minimum threshold per 24-hour period)
Inpatient Respite Care: approximately $530 per day
General Inpatient Care: approximately $1,200 per day
Service Intensity Add-on: approximately $66 per hour (RN or social worker, last 7 days of life, up to 4 hours per day)

Rates are adjusted by the hospice wage index based on the geographic location of the hospice (or the location of service for inpatient care).

Hospice Aggregate Cap (Section 1814(i)(2))

Section 1814(i)(2) of the Social Security Act imposes a hospice aggregate cap that limits total Medicare hospice payments per beneficiary per fiscal year. The cap operates at the hospice provider level, not at the individual beneficiary level.

How the cap works:

CMS calculates an annual cap amount per beneficiary (approximately $34,600 for FY 2026)
For each hospice, CMS multiplies the cap amount by the number of unduplicated beneficiaries served during the fiscal year
The product is the hospice's annual aggregate cap
If the hospice's actual Medicare payments exceed its annual aggregate cap, the hospice must repay the excess to Medicare

The cap was designed to discourage admitting beneficiaries who do not have a true terminal prognosis or extending stays beyond clinical appropriateness. The cap applies to total hospice payments per beneficiary across all hospices, so beneficiaries who transfer between hospices count toward each hospice's cap calculation in proportion to the days served by each.

Hospices manage cap exposure through admission practices, length-of-stay monitoring, and (when necessary) discharging beneficiaries who no longer meet hospice eligibility criteria.

Inpatient Day Limitation

Under 42 CFR 418.308, total inpatient days (GIP plus IRC) cannot exceed 20% of the hospice's total Medicare hospice days during the fiscal year. Excess inpatient days are paid at the Routine Home Care rate. The limit discourages overuse of inpatient settings and supports the home-based focus of the hospice model.

Dual-Eligible Hospice in a Nursing Facility

When a Medicare-Medicaid dual-eligible beneficiary elects hospice while residing in a nursing facility, both programs play a role.

Medicare Hospice

Medicare hospice covers the hospice services (the per-diem payments at the applicable level of care). For a beneficiary in a nursing facility, the level of care is typically Routine Home Care, because the nursing facility is treated as the beneficiary's residence for hospice purposes.

Medicaid Room and Board

Under Section 1902(a)(13)(B) of the Social Security Act, state Medicaid programs that cover hospice must pay 95% of the state's Medicaid nursing facility per-diem rate to the hospice provider to cover room and board for dual-eligible hospice patients residing in a nursing facility. The hospice then pays the nursing facility for room and board.

Georgia Medicaid Hospice and Room and Board

The Georgia Department of Community Health (DCH) administers Medicaid hospice for Georgia. For dual-eligibles residing in a Georgia nursing facility with hospice election:

Medicare hospice pays the hospice per-diem
Georgia Medicaid pays room and board at 95% of the Medicaid NF rate to the hospice
The hospice forwards the room and board payment to the nursing facility
The beneficiary's patient pay amount (income contribution under Medicaid LTC rules) is applied to the room and board

The coordination is operationally complex but financially significant: without Medicaid room and board, families would face out-of-pocket costs of $7,000 to $10,000 per month for nursing facility room and board.

How Georgia Beneficiaries Access Hospice Care

Step 1: Recognize Hospice Eligibility

Hospice is appropriate when a beneficiary has a serious illness with a prognosis of 6 months or less if the illness runs its normal course, and when the beneficiary (or representative if the beneficiary lacks capacity) is prepared to forgo curative treatment for the terminal illness in favor of palliative care.

Common signs that hospice should be considered:

Multiple recent hospitalizations for the same condition
Declining functional status (increasing need for assistance with activities of daily living)
Weight loss and decreased oral intake
Recurrent infections (especially pneumonia, urinary tract infections)
Caregiver exhaustion and inability to manage in the home
Patient or family expressing readiness for comfort-focused care

Step 2: Choose a Hospice Provider

Georgia has dozens of Medicare-certified hospice providers, including:

VITAS Healthcare (national chain, multiple Georgia locations including Atlanta, Savannah, Augusta, and Macon)
Amedisys Hospice (national chain, Georgia locations)
Heartland Hospice (HCR ManorCare, Georgia locations)
Compassionate Care Hospice (Georgia locations)
Hospice of Northeast Georgia Medical Center (Gainesville)
Hospice Atlanta (independent, Atlanta metro)
Hospice Savannah (independent, Savannah)
Hospice of Macon (Macon)
Affinis Hospice (Atlanta metro)
Bright Star Care Hospice (multiple Georgia locations)

In choosing a hospice, families should consider:

Geographic coverage and home visit availability
Quality measures (Hospice Compare on Medicare.gov)
Inpatient unit availability if GIP or IRC may be needed
Specialty programs (pediatric hospice, palliative care, dementia programs)
Spiritual care offerings consistent with family values
Bereavement services availability

Step 3: Admission and Election

The hospice will conduct an admission visit. A hospice nurse will assess the beneficiary and explain the benefit. The hospice medical director (and attending physician if applicable) will certify the terminal illness. The beneficiary or representative will sign the election statement and the plan of care will be developed.

Step 4: Care Begins

Hospice services begin on the effective date of the election. The hospice nurse will visit regularly (typically 2 to 3 times per week, more frequently as needed), the hospice aide will provide personal care (typically 2 to 3 times per week), and the social worker, chaplain, and other team members will provide services according to the plan of care.

Step 5: Recertification

The beneficiary will be recertified at the start of each new benefit period. Before the third benefit period and each subsequent 60-day period, a hospice physician or nurse practitioner will conduct the face-to-face encounter.

Step 6: End-of-Life Care and Bereavement

In the final days of life, the hospice will increase visit frequency, may initiate Continuous Home Care if a crisis develops, or arrange General Inpatient Care if symptoms cannot be managed at home. After the death, bereavement services for the family continue for thirteen months.

Worked Examples

Example 1: Margaret, 78, Atlanta, Terminal Cancer, Routine Home Care

Margaret is 78 years old and lives in Buckhead, Atlanta. She has Stage IV pancreatic cancer with metastases to the liver and bone. After her third hospitalization for pain crises, her oncologist at Emory Healthcare recommends transition to hospice. Margaret has a prognosis of approximately 3 to 4 months.

After a family meeting, Margaret decides to enroll in hospice with VITAS Atlanta. The VITAS admission nurse visits her home. The hospice medical director and her attending oncologist both certify her terminal illness. Margaret signs the election statement, effective the next morning.

Routine Home Care begins. The VITAS nurse visits 3 times per week. A hospice aide visits 3 times per week to assist with bathing and personal care. A social worker visits weekly to support Margaret and her husband Robert with the transition. A hospice chaplain visits as Margaret requests.

Margaret's medications are managed through the hospice pharmacy. The hospice covers her oxycodone for pain, hydromorphone for breakthrough pain, ondansetron for nausea, dexamethasone for symptom management, and bisacodyl for opioid-induced constipation. Her atorvastatin (for longstanding cholesterol management, not related to the cancer) is covered by her Part D plan.

After 8 weeks, Margaret's condition is declining. The hospice team increases visit frequency. In the last 7 days of life, the hospice provides Service Intensity Add-on visits by the registered nurse and social worker for additional support.

After Margaret's death, the hospice provides bereavement services to Robert and her adult children. The bereavement coordinator calls regularly, sends mailings with grief resources, and invites the family to a quarterly support group. Bereavement services continue for thirteen months.

Example 2: Robert, 82, Savannah, CHF, Non-Cancer Hospice Eligibility

Robert is 82 years old, lives in Savannah, and has New York Heart Association Class IV congestive heart failure with an ejection fraction of 15%. He has been hospitalized 5 times in the past 12 months for decompensated heart failure. Despite optimal medical management, he is symptomatic at rest.

Robert's cardiologist at Memorial Health discusses hospice. Many families do not realize that hospice covers non-cancer diagnoses. Robert's cardiologist explains that under the Medicare cardiopulmonary LCD, his NYHA Class IV symptoms, ejection fraction less than 20%, recurrent hospitalizations despite optimization, and progression of symptoms support a hospice prognosis.

Robert enrolls with Hospice Savannah. The hospice medical director and Robert's cardiologist certify the terminal illness. Robert signs the election statement.

Routine Home Care begins. The hospice nurse manages Robert's diuretics (furosemide), beta blocker (carvedilol), and ACE inhibitor (lisinopril), all of which are now covered by hospice as related to the terminal illness. His statin and his proton pump inhibitor (for GERD) remain on Part D.

Robert lives 6 months on hospice. He is recertified at the end of the first 90-day period and again at the end of the second 90-day period. Before the start of the third benefit period (the first 60-day period), the hospice nurse practitioner conducts the face-to-face encounter at Robert's home, and the hospice medical director composes the attestation that supports continued recertification.

When Robert experiences acute pulmonary edema in his final week, the hospice transitions him to Continuous Home Care for 24 hours to provide intensive symptom management at home. The crisis resolves and he returns to Routine Home Care for his final days.

Example 3: Linda, 75, Macon, Dementia, Face-to-Face Recertification

Linda is 75 years old, lives in Macon, and has advanced Alzheimer's dementia. She is at Functional Assessment Staging (FAST) stage 7c: she is bedbound, has minimal verbal communication (occasional single words), and requires total assistance with all activities of daily living. She has had two episodes of aspiration pneumonia in the past 6 months. She is losing weight despite nutritional supplementation.

Linda's daughter Patricia, her healthcare proxy, decides to enroll Linda in hospice with Hospice of Macon. The hospice medical director and Linda's geriatrician certify the terminal illness based on the dementia LCD.

Linda's hospice election begins on October 1, 2025. The first 90-day period runs through December 30, 2025. The second 90-day period runs through March 30, 2026.

Before the start of the third benefit period (April 2026), a face-to-face encounter is required. On March 15, 2026 (within 30 days of the recertification date), the hospice nurse practitioner visits Linda at her assisted living facility. The NP assesses Linda's clinical status: FAST 7c with worsening swallowing function, weight loss of 7% in 6 months, and recent UTI requiring antibiotics. The NP documents the findings.

The hospice medical director reviews the NP's encounter notes and composes the attestation: "Based on the face-to-face encounter conducted by hospice NP on March 15, 2026, and my review of the clinical findings (FAST 7c, worsening dysphagia, recent infection, continued weight loss), I attest that Mrs. [Linda] continues to have a prognosis of 6 months or less if her illness runs its normal course, supporting recertification for the third benefit period."

Linda is recertified for the third benefit period (April 2026 through May 2026). Subsequent 60-day periods will each require a face-to-face encounter.

Example 4: Charles, 80, Augusta, Continuous Home Care Crisis

Charles is 80 years old, lives in Augusta, and has end-stage pancreatic cancer. He has been on Routine Home Care with VITAS Augusta for 6 weeks.

On a Saturday afternoon, Charles develops severe uncontrolled abdominal pain. His wife Eleanor calls the hospice on-call line. The hospice nurse arrives within 90 minutes and assesses Charles: pain 9/10 despite his usual oxycodone, increased abdominal distension, and acute distress.

The hospice nurse calls the hospice medical director. The medical director orders an intravenous hydromorphone PCA (patient-controlled analgesia) and continuous nursing presence to titrate to comfort. The hospice initiates Continuous Home Care.

For the next 48 hours, the hospice provides 14 hours per day of nursing presence (well above the 8-hour CHC threshold). The nurse titrates the PCA, manages breakthrough symptoms, supports Eleanor through the crisis, and prevents the need for hospitalization.

By Monday afternoon, Charles's pain is controlled at his baseline level. The CHC ends and he returns to Routine Home Care. The hospice bills Medicare for CHC at the hourly rate for the hours of nursing care provided during the 48-hour crisis.

Without CHC, Charles would likely have been admitted to a hospital for pain crisis management. CHC kept him at home, with his family, in his familiar environment.

Example 5: Patricia, 73, Columbus, Inpatient Respite Care

Patricia is 73 years old, lives in Columbus, and has metastatic lung cancer. She has been on Routine Home Care with Heartland Hospice for 4 months. Her husband Tom (75) is her primary caregiver. Their adult son Michael lives in Atlanta and has invited Tom for a 5-day visit to attend his grandson's baptism.

Tom asks the hospice social worker whether respite care is available. The social worker explains the Inpatient Respite Care benefit: up to 5 consecutive days in an inpatient facility to provide caregiver relief. The social worker arranges IRC at the Columbus hospice inpatient unit.

Patricia is admitted on a Thursday and stays through Monday (5 days). The hospice inpatient unit provides her nursing care, medications, meals, and social support. Tom drives to Atlanta, attends the baptism, sees his grandchildren, and returns rested.

Patricia returns home Monday afternoon, where Tom resumes caregiving with renewed energy. The hospice billed Medicare for 5 days of IRC.

Tom learns that he can request another IRC stay in the future if needed (the 5-day limit is per stay, not per year). He also learns about respite resources outside the IRC benefit, including volunteer programs and adult day services.

Example 6: Henry, 85, Athens, Dual-Eligible Nursing Facility Hospice

Henry is 85 years old, has lived in a nursing facility in Athens for 3 years due to advanced Alzheimer's dementia. He is dual-eligible (Medicare and Georgia Medicaid). His daughter Margaret is his healthcare proxy.

Henry's condition has declined significantly: he is now bedbound, has aspiration with all oral intake, has lost 15% of body weight in 6 months, and has had recurrent UTIs. The nursing facility geriatrician recommends hospice. Margaret agrees.

Henry enrolls with VITAS Athens. The hospice medical director and the nursing facility geriatrician certify the terminal illness. Margaret signs the election statement as Henry's proxy. The hospice and nursing facility execute their written arrangement under 42 CFR 418.112.

Henry receives Routine Home Care while remaining in the nursing facility (the NF is considered his residence for hospice purposes). The hospice nurse visits 3 times per week, the hospice aide visits in addition to NF aide services, and the hospice social worker and chaplain provide services to Henry and Margaret.

Financial structure:

Medicare hospice pays VITAS the Routine Home Care per-diem rate for hospice services
Georgia Medicaid pays VITAS 95% of the Georgia Medicaid nursing facility per-diem rate for Henry's room and board
VITAS pays the nursing facility the room and board portion
Henry's patient pay amount (his Social Security income minus the $76 Personal Needs Allowance for FY 2026) is applied to the Medicaid room and board

The total financial picture without Medicaid would be unaffordable: families would face approximately $9,000 per month in nursing facility room and board out-of-pocket. With Medicaid coordination, the family pays only Henry's patient pay amount.

Henry lives 8 months on hospice in the nursing facility. After his death, VITAS provides bereavement services to Margaret and the family for thirteen months.

Common Mistakes

Confusing hospice with palliative care. Palliative care can be provided at any stage of serious illness alongside curative treatment. Hospice requires a 6-month terminal prognosis and election with waiver of curative treatment for the terminal illness.
Waiting too long to elect hospice. The median length of hospice stay in the United States is around 18 days, but many beneficiaries qualify for and benefit from longer stays. Earlier election provides more time for symptom optimization, family support, and bereavement preparation.
Believing hospice means "giving up." Hospice is active care: pain and symptom management, emotional support, spiritual care, and family bereavement support. It is not the absence of care; it is care focused on quality of life rather than cure.
Misunderstanding the waiver scope. Hospice election waives curative treatment for the terminal illness and related conditions only. Original Medicare or Medicare Advantage continues to cover services unrelated to the terminal illness.
Missing the face-to-face encounter. Failure to conduct the face-to-face encounter within 30 days before the third or subsequent 60-day period results in days that are not Medicare-payable until the encounter is completed.
Confusing Continuous Home Care with General Inpatient Care. CHC is intensive home-based nursing during a crisis (at least 8 hours of predominantly nursing care). GIP is facility-based care for symptoms that cannot be managed at home.
Misunderstanding Inpatient Respite Care limits. IRC is up to 5 consecutive days per stay. Multiple non-consecutive stays are permitted. IRC is for caregiver relief, not for symptom management (which is GIP).
Confusing the hospice aggregate cap with individual benefit limits. The cap applies to the hospice provider's total payments per beneficiary per fiscal year. Individual beneficiaries can remain on hospice indefinitely as long as they continue to meet clinical criteria.
Not realizing Part D continues for unrelated medications. After hospice election, Part D continues to cover medications unrelated to the terminal illness, subject to standard Part D rules and prior authorization for commonly hospice-related classes.
Believing hospice election is permanent. Beneficiaries can revoke hospice election at any time. Revocation forfeits the current benefit period days but does not affect future re-election.
Missing bereavement services. Families are entitled to bereavement services for thirteen months after the death. Many families underutilize this important benefit because they are unaware.
Failing to revoke before pursuing curative treatment. If a hospice beneficiary wants to pursue curative treatment for the terminal illness, the beneficiary must revoke hospice. Otherwise, Medicare will deny the curative claims, because the waiver remains in effect.
Confusing attending physician role. The attending physician (if separate from the hospice) continues to see the beneficiary and bill Original Medicare for those visits. The hospice medical director is responsible for hospice clinical oversight.
Dual-eligible room and board confusion. For dual-eligibles in a nursing facility, Medicare hospice covers hospice services and Medicaid covers room and board. Without Medicaid coordination, families would face unaffordable out-of-pocket nursing facility costs.

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What is the Medicare Hospice Benefit?

The Medicare Hospice Benefit is a Part A benefit established by Section 1812(a)(4) of the Social Security Act that provides comprehensive interdisciplinary care for beneficiaries with a terminal illness and a 6-month prognosis. The benefit includes nursing, physician services, social work, counseling, hospice aide services, medications and supplies related to the terminal illness, four levels of care based on clinical need, and bereavement services for the family for thirteen months after the death.

Who is eligible for hospice?

Any Medicare beneficiary with Part A coverage who is terminally ill (life expectancy of 6 months or less if the illness runs its normal course) and who is willing to elect hospice and waive curative treatment for the terminal illness is eligible. The hospice medical director and attending physician must certify the terminal illness at the start of the first 90-day period.

What does "terminal illness" mean for hospice?

Terminal illness means a medical prognosis that life expectancy is 6 months or less if the illness runs its normal course. This is a clinical judgment, not a guarantee. Many hospice patients live beyond 6 months and continue to qualify at each recertification. Local Coverage Determinations published by Medicare Administrative Contractors provide clinical criteria for common non-cancer diagnoses.

What does hospice cover?

Hospice covers nursing, physician services, social work, counseling (dietary, spiritual, bereavement), hospice aide and homemaker services, physical therapy and occupational therapy and speech therapy for palliative purposes, medical supplies and equipment related to the terminal illness, drugs and biologicals for palliation of the terminal illness, short-term inpatient care, and bereavement services for the family for thirteen months.

What are the four levels of hospice care?

Routine Home Care (most common, in the home or residential setting), Continuous Home Care (crisis-level care at home, minimum 8 hours of predominantly nursing care in a 24-hour period), Inpatient Respite Care (up to 5 consecutive days in a facility to provide caregiver relief), and General Inpatient Care (facility-based pain and symptom management that cannot be provided at home).

How long can a person stay on hospice?

Hospice is structured in election periods: a first 90-day period, a second 90-day period, and unlimited subsequent 60-day periods. As long as the beneficiary continues to meet clinical criteria and is recertified, hospice may continue indefinitely. There is no lifetime cap on hospice days for an individual beneficiary.

What is the face-to-face encounter?

Under Section 3132 of the Affordable Care Act, a hospice physician or nurse practitioner must conduct a face-to-face encounter with the beneficiary no more than 30 calendar days before the start of the third benefit period and before each subsequent 60-day period. The encounter supports the recertification of continued hospice eligibility.

Does hospice cover all medications?

Hospice covers medications used for the palliation or management of the terminal illness. Medications unrelated to the terminal illness continue to be covered by Medicare Part D, often subject to prior authorization to confirm that the drug is unrelated. Common hospice-related classes (analgesics, antiemetics, antianxiety, laxatives) are presumed hospice-covered unless documented otherwise.

Can a hospice patient still see their regular doctor?

Yes. The beneficiary can keep an attending physician separate from the hospice. The attending physician's visits are paid under Original Medicare Part B (or Medicare Advantage). The hospice medical director is responsible for hospice clinical oversight.

What happens if a hospice patient gets better?

If the beneficiary's condition improves to the point that the 6-month prognosis no longer applies, the hospice discharges the beneficiary from hospice for "extended prognosis" or "no longer terminally ill." The beneficiary returns to standard Medicare coverage. If the beneficiary later declines, they may re-elect hospice.

Can a hospice patient revoke and return to regular Medicare?

Yes. Under 42 CFR 418.28, the beneficiary may revoke the hospice election at any time. The beneficiary forfeits the days remaining in the current benefit period and returns to standard Medicare. The beneficiary may re-elect hospice at a later time.

What is the hospice aggregate cap?

Section 1814(i)(2) imposes an aggregate cap on Medicare hospice payments per beneficiary per fiscal year (approximately $34,600 for FY 2026). The cap applies to hospice providers, not to individual benefit periods. Hospices owe Medicare for amounts exceeding their annual aggregate cap. Individual beneficiaries can remain in hospice indefinitely.

Can a hospice patient receive curative treatment for unrelated conditions?

Yes. The hospice election waives curative treatment only for the terminal illness and related conditions. Treatment for unrelated conditions continues to be covered by Original Medicare or Medicare Advantage.

What is the Service Intensity Add-on?

The Service Intensity Add-on (SIA) is an additional payment for in-person visits by a registered nurse or social worker during the last 7 days of the beneficiary's life. The SIA is paid hourly (up to a daily limit) and incentivizes hospices to provide intensive support at the very end of life.

Does hospice cover room and board in a nursing facility?

Medicare hospice does not cover room and board. For dual-eligibles (Medicare and Medicaid), state Medicaid programs pay 95% of the state Medicaid nursing facility rate to the hospice for room and board. For private-pay residents, the family or beneficiary pays room and board out-of-pocket.

What is the difference between hospice and palliative care?

Palliative care is symptom management and quality-of-life support that can be provided at any stage of serious illness, alongside curative treatment. Hospice requires a 6-month terminal prognosis and election with waiver of curative treatment for the terminal illness. Hospice is a defined Medicare benefit; palliative care is a clinical specialty that may be billed under various Medicare benefits.

Can a hospice patient change to a different hospice?

Yes. Under 42 CFR 418.30, the beneficiary may change the designated hospice once during a benefit period. The change is documented through a signed statement and is not treated as a revocation. Multiple changes across benefit periods are permitted.

What are bereavement services?

Bereavement services are counseling and support provided to the family for up to thirteen months after the patient's death. Services may include counseling, support groups, memorial services, and follow-up calls. Bereavement services are included in the hospice payment and are not separately reimbursed.

How are hospices certified by Medicare?

Hospices must meet the Conditions of Participation at 42 CFR Part 418 and be certified by CMS through a state survey agency or an approved accreditation body (such as the Joint Commission, ACHC, or CHAP). Certification is required for Medicare and Medicaid hospice payment.

Are there quality measures for hospices?

Yes. The Hospice Quality Reporting Program established under the IMPACT Act of 2014 requires hospices to submit Hospice Item Set data and CAHPS Hospice Survey results. Quality scores are publicly reported on the Medicare.gov Care Compare website, allowing families to compare hospice performance.

What is the role of the hospice medical director?

The hospice medical director is a physician who provides clinical oversight of the hospice program. The medical director certifies terminal illness for the first 90-day period, recertifies for subsequent periods, composes the physician narrative, oversees the interdisciplinary group, and supervises the clinical care provided by hospice staff.

What happens during the last days of life?

In the final days, the hospice typically increases visit frequency, may initiate Continuous Home Care if a crisis develops, may transition to General Inpatient Care if symptoms cannot be managed at home, and provides the Service Intensity Add-on for additional RN or social worker visits during the last 7 days of life. The hospice supports the family through the dying process.

Can a hospice patient in Georgia keep their Medicare Advantage plan?

Yes. The beneficiary remains enrolled in their Medicare Advantage plan during hospice. However, hospice services and items related to the terminal illness are paid through Original Medicare (carved out of MA) rather than through the MA plan. MA continues to provide coverage for services unrelated to the terminal illness. Some Medicare Advantage plans participate in a Value-Based Insurance Design (VBID) hospice benefit model that integrates hospice with MA, but this is an evolving model and not universally available in Georgia.

How do I find a Medicare-certified hospice in Georgia?

Use the Medicare.gov Care Compare tool to find hospices serving your area, view their quality scores, and review patient and family experience survey results. The Georgia Hospice and Palliative Care Organization also maintains member directories. Hospital discharge planners, primary care providers, and the Georgia SHIP (GeorgiaCares) can provide referrals.

What if I disagree with a hospice discharge?

If the hospice discharges you and you disagree, you can request an expedited review by the Quality Improvement Organization (KEPRO for Georgia, 1-844-455-8708). You must request the review by noon on the day after the discharge notice. KEPRO will review the discharge decision and rule on whether the discharge was clinically appropriate. :::

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Talk to Someone About Hospice in Georgia

If you are considering hospice for yourself or a family member in Georgia, or if you have questions about a current hospice election, recertification, or coverage decision, these organizations can help.

Government Programs and Direct Services

Georgia Department of Community Health Medicaid Member Services: 1-866-211-0950
Medicare: 1-800-MEDICARE (1-800-633-4227); TTY 1-877-486-2048
KEPRO (Georgia Quality Improvement Organization): 1-844-455-8708 (for hospice discharge appeals)
GeorgiaCares (Georgia SHIP): 1-866-552-4464 (free Medicare counseling)
Social Security Administration: 1-800-772-1213

Federal Oversight and Civil Rights

HHS Office of Civil Rights: 1-800-368-1019 (discrimination complaints, including end-of-life care discrimination)
HHS Office of Inspector General: 1-800-447-8477 (hospice fraud reporting)
CMS National Hotline: 1-800-MEDICARE

National Hospice and Palliative Care Resources

National Hospice and Palliative Care Organization Helpline: 1-800-658-8898
Medicare Rights Center: 1-800-333-4114
Center for Medicare Advocacy: 1-860-456-7790
Eldercare Locator: 1-800-677-1116

Georgia Hospice Network

Georgia Hospice and Palliative Care Organization (Georgia trade association)
Hospice Atlanta (Atlanta metro)
Hospice Savannah (Savannah)
Hospice of Northeast Georgia Medical Center (Gainesville)

Legal Assistance

Atlanta Legal Aid Senior Citizens Law Project: 404-377-0701
Georgia Legal Services Program: 1-800-498-9469
211 Georgia (general social services referrals): dial 211

Veterans

VA Bereavement Counseling: 1-202-461-6530

About Brevy

Brevy is building America's most trustworthy, comprehensive, and up-to-date online resource on eldercare. This guide is one of an ongoing series on Georgia Medicare and Medicaid topics published on brevy.com. Information is current as of May 2026 and is provided for educational purposes. The Medicare Hospice Benefit is a federal benefit governed by the Social Security Act and the regulations at 42 CFR Part 418, and operates the same in Georgia as in every state. Hospice clinical decisions, payment determinations, and care planning should be made in consultation with a Medicare-certified hospice, your physicians, and qualified counsel. This guide is educational and does not constitute medical, legal, or financial advice. :::