Hospice Information for Medicare Part D Plans (CMS-10538)

The Social Security Act in section 1861(dd) and Federal regulations in 42 CFR §418.106 and § 418.202(f) require hospice programs to provide individuals under hospice care with drugs and biologicals related to the palliation and management of the terminal illness as defined in the hospice plan of care. Medicare payment is made to the hospice for each day an eligible beneficiary is under the hospice's care, regardless of the amount of services provided on any given day. Because hospice care is a Medicare Part A benefit, drugs provided by the hospice and covered under the Medicare payment to the hospice program are not covered under Part D. The industry in conjunction with the National Council for Prescription Drug Programs, (NCPDP) developed a draft Medicare Part D Hospice Form to collect information necessary for the Part D sponsor to override a hospice prior authorization reject for beneficiaries enrolled in hospice. CMS made minor revisions to the NCPDP form to create this Standardized Form entitled Hospice Information for Medicare Part D Plans. This PRA submission is a request for approval of the standardized form available for use by Part D sponsors.

The latest form for Hospice Information for Medicare Part D Plans (CMS-10538) expires 2022-02-28 and can be found here.