Federal Courts Rule Hospices Deserve Deference on Six-Month Life Expectancy Determinations

Federal courts have issued several rulings favoring hospices in administrative appeals, particularly recognizing that hospices should receive deference when determining six-month life expectancy for patient eligibility. These rulings counter administrative law judge decisions that had reversed hospice eligibility determinations. The court decisions affect how hospices defend Medicare and Medicaid eligibility claims during audits and appeals. This development matters for hospices serving dual-eligible beneficiaries and state Medicaid programs that follow Medicare hospice coverage rules.

LTSS