The hospice Conditions of Participation (CoPs) are the federal rules in 42 CFR Part 418, §418.52 to §418.116, that a hospice must meet to take part in Medicare. Each Condition needs one or more written policies. A hospice also needs policies for the Medicare rules on certification, election, admission, discharge and revocation in §418.22 to §418.28, and for the levels of care. The tables below map each rule to the policies that meet it and list the time frames written into the rules. Your state's hospice rules add requirements of their own.
Which policies meet each Condition
| Condition | Policies that meet it |
|---|---|
| §418.52 Patient's rights | Patient and family rights and responsibilities; informed consent, description of services and charges; advance directives; pain and symptom management; investigation of alleged violations; complaints and grievances |
| §418.54 Initial and comprehensive assessment of the patient | Initial and comprehensive assessment |
| §418.56 Interdisciplinary group, care planning and coordination of services | Interdisciplinary group; plan of care and its review; coordination of services and physician orders |
| §418.58 Quality assessment and performance improvement | QAPI program; incident reporting and learning from adverse events |
| §418.60 Infection control | Infection prevention and control program; staff and volunteer health screening and immunizations |
| §418.64 Core services | Nursing services; medical social services; spiritual and dietary counseling; bereavement program |
| §418.72 Physical therapy, occupational therapy and speech-language pathology | Therapy services |
| §418.76 Hospice aide and homemaker services | Hospice aide and homemaker services |
| §418.78 Volunteers | Volunteer program |
| §418.100 Organization and administration of services | Governing body and administrator; organizational structure and service area; scope of services; contracted services; 24-hour availability and on-call; orientation, in-service training and competency; personnel records |
| §418.102 Medical director | Medical director and physician services |
| §418.104 Clinical records | Clinical records, retention and access |
| §418.106 Drugs and biologicals, medical supplies and durable medical equipment | Drugs and biologicals; controlled substances in the home, including disposal; medical supplies and equipment |
| §418.108 Short-term inpatient care | Short-term inpatient care and respite arrangements |
| §418.110 Hospices that provide inpatient care directly | Inpatient unit operations, where the hospice runs one |
| §418.112 Hospices that care for residents of a SNF/NF or ICF/IID | Hospice care for residents of nursing facilities and ICF/IIDs |
| §418.113 Emergency preparedness | Emergency preparedness program |
| §418.114 Personnel qualifications | Personnel qualifications, license verification and exclusion screening |
| §418.116 Compliance with federal, state and local laws | Laboratory services and waived testing |
Medicare rules outside the Conditions that also need policies
| Rule | Policies that meet it |
|---|---|
| §418.22 Certification of terminal illness | Certification and recertification, and face-to-face encounters |
| §418.24 Election of hospice care | Election statement, election statement addendum and notice of election |
| §418.25 Admission to hospice care | Referral, eligibility and admission |
| §418.26 Discharge from hospice care | Discharge, transfer and discharge for cause |
| §418.28 Revoking the election of hospice care | Revocation, change of hospice and change of attending physician |
| §418.302 Payment by level of care | Levels of care: routine home care, continuous home care, respite and general inpatient care |
This mapping comes from the Cura Core Washington, DC hospice manual, which follows the federal rules alone because the District has adopted no hospice licensing rules. The manuals for other states add policies for their state rules. For what each Condition asks your policies to cover, see what policies are required for hospice.
Time frames written into the rules
| What | Time frame | Rule |
|---|---|---|
| Certification of terminal illness | In writing before the claim is filed; if it cannot be obtained within 2 calendar days after a period begins, an oral certification within 2 calendar days; no more than 15 calendar days before the period begins | §418.22(a) |
| Face-to-face encounter | Within 30 calendar days before the third benefit period and each later one | §418.22(a)(4) |
| Election statement addendum | To every patient electing on or after October 1, 2026, within the first 5 days of the effective date of election; updated within 3 days of a plan of care change that affects it | §418.24(c) and (d) |
| Notice of election | Filed within 5 calendar days after the effective date of election | §418.24(e) |
| Notice of patient rights | During the initial assessment visit, before care is given | §418.52(a) |
| Initial assessment | Within 48 hours after the election of hospice care is complete | §418.54(a) |
| Comprehensive assessment | No later than 5 calendar days after the election | §418.54(b) |
| Assessment update | As often as the patient's condition requires, and at least every 15 days | §418.54(d) |
| Plan of care review | At least every 15 calendar days | §418.56(d) |
| Aide supervision | A registered nurse visits the home at least every 14 days | §418.76(h) |
| Aide in-service training | At least 12 hours in each 12-month period | §418.76(d) |
| Volunteer hours | At least 5 percent of the total patient care hours of paid hospice employees and contract staff | §418.78(e) |
| In-service training record | A written description of the in-service training given in the last 12 months | §418.100(g)(3) |
| Bereavement services | For up to one year after the patient's death | §418.64(d) |
| Record retention | 6 years after death or discharge, unless state law sets a longer period | §418.104(d) |
| Emergency preparedness review | At least every 2 years | §418.113 |
Where your state sets a shorter time frame, follow the state's. For example, Missouri requires the interdisciplinary group to review the plan of care at least every two weeks (19 CSR 30-35.010), and Georgia requires a nurse on site within one hour in a symptom-management crisis (Rule 111-8-37-.18(1)).
Related guides
- What policies are required for hospice?
- What should an infection control policy include? (§418.60)
- How often should policies and procedures be reviewed?
Next step
Every Cura Core hospice manual maps its policies to the Conditions of Participation and your state's rules. Pick your state on the hospice manuals page and read three of its policies free.