Question: If a Medicare beneficiary requests hospice care, is the SNF obligated to provide this service?

Response: No.

The beneficiary has freedom of choice, but it is not an unqualified freedom. A hospice must enter into a written agreement (a contract) with any individual or entity for the services that are to be provided under arrangement. A Medicare beneficiary residing in a SNF/NF may elect the hospice benefit and receive hospice services if the hospice and the facility have a written agreement under which the hospice takes full responsibility for the professional management of the individual’s hospice care and the facility agrees to provide room and board to the individual. Federal regulations place the burden for establishing these contracts on the hospice. Additionally, federal regulations do not require a nursing facility to contract with a hospice provider, and the facility may limit the number of hospice providers with which it chooses to enter into agreements, including no agreements at all.

The result is that the beneficiary may sometimes face situations where he or she has limited choice. If the beneficiary’s preferred hospice is unable to enter into an agreement with the SNF/NF where that beneficiary resides, the patient has three choices.

The beneficiary could:

  1. Move to a nursing home that has arrangements with the preferred hospice;
  2. Select a different hospice with which the nursing home has an agreement; or
  3. Remain in the current nursing home and not elect hospice.


The purpose of this Information Bulletin is to provide (1) the Centers for Medicare & Medicaid Services (CMS) memorandum S&C 02-29, which includes several promising practices for the successful implementation of the Medicare Hospice Benefit for nursing home residents, and (2) clarification the Minnesota Department of Health (MDH) received from CMS regarding Medicare Hospice Benefit in a Skilled Nursing Facility.

The practices in Memo S&C 02-29 were developed after consultation with the long-term care and hospice industry representatives and are part of our commitment to assure that nursing home residents who elect the hospice benefit receive the needed care and services from providers. These guidelines are not a regulatory requirement, but they are consistent with Federal requirements if properly implemented. They are intended to offer a framework to structure a collaborative relationship between the hospice and nursing home when they are providing care to common patients and their families at the end of life. We hope that they will be helpful for providers and assist them in promoting quality care to nursing home residents who have elected the hospice benefit.


If you have any questions regarding this Information Bulletin, please contact in writing:

Minnesota Department of Health
Health Regulation Division
Licensing and Certification Program
85 East Seventh Place, Suite 300
PO Box 64900
St. Paul, Minnesota 55164-0900
Telephone: (651) 201-4101

CREDIT: Some or all of this was extracted from a publication produced by the Minnesota Department of Health.