Administrators, directors of nursing, MDS and social services
For skilled nursing facilities
A nursing facility resident can elect hospice and stay in the facility. Medicare requires a written agreement between the hospice and the facility, one coordinated plan of care, and clear division of duties under 42 CFR 418.112. The facility keeps providing room and board and daily care. The hospice takes professional responsibility for managing the terminal illness. This page sets out the requirements and how room and board payment works.
Reviewed by our medical director, September 24, 2026
On this page (6 sections)
What 42 CFR 418.112 requires
The rule applies to the hospice, and the nursing facility requirements of participation mirror it. In summary:
- Eligibility and choice. Residents have the same right to elect hospice as anyone else and the same eligibility standard applies.
- Professional management. The hospice assumes responsibility for professional management of the resident's hospice services, including arranging any inpatient care.
- Written agreement. Signed by both parties before hospice care starts. It covers how the two communicate, the facility's duty to notify the hospice immediately of significant changes, a need for transfer or the resident's death, each party's services, and reporting of alleged mistreatment by hospice staff.
- One coordinated plan of care. Written and maintained by the hospice in consultation with facility representatives and, as far as possible, the resident and family. It identifies which provider carries out each function.
- A designated hospice coordinator. A member of the interdisciplinary group who coordinates care with facility staff and communicates with the facility medical director, the attending physician and other physicians.
- Records the hospice gives the facility. The current plan of care, the hospice election form, advance directives, physician certification and recertification, names and contact details for hospice staff, instructions for reaching the 24-hour on-call system, hospice medication information, and hospice physician and attending physician orders.
- Orientation. The hospice orients facility staff who care for hospice patients to hospice philosophy, policies on comfort and symptom control, principles of death and dying, patient rights and record keeping.
Who does what in a nursing facility
| Nursing facility | Hospice |
|---|---|
| Room and board: 24-hour personal care, help with activities of daily living, meals, housekeeping, supervision | Nursing, physician, social work, spiritual care and counseling services for the terminal illness |
| Administering prescribed medicines and treatments as the coordinated plan directs | Medicines, medical supplies and equipment related to the terminal illness |
| Care at the level the facility would give any resident who was not on hospice | Hospice aide visits that supplement, and do not replace, facility care |
| Notifying the hospice of changes, and keeping MDS and care plan current | Assessment, symptom management, plan of care updates, on-call response, bereavement support |
Hospice services must not substitute for services the facility is already required to provide.
How room and board is paid
The Medicare hospice benefit does not pay room and board. For a resident who pays privately, nothing changes in the payment arrangement with the facility.
For a resident whose nursing facility stay is paid by Medi-Cal, federal Medicaid law changes the payment path when the resident elects hospice. The state, or the Medi-Cal managed care plan, pays the hospice an amount for room and board equal to at least 95 percent of the rate the facility would otherwise have received. The hospice then pays the facility under their written agreement. This is a pass-through. Both the OIG's 1998 Special Fraud Alert and its hospice compliance guidance name room and board payments above what the facility would have received from Medicaid, and payments for services already covered by that rate, as risk areas. Our agreements pay the pass-through amount and nothing more. Billing follows the governing facility agreement: eligibility and covered room-and-board days are verified, invoices are reconciled against supporting records, payment follows the agreement, and discrepancies are resolved with the audit trail preserved. Our standard agreement passes through the full room and board amount we receive from Medi-Cal for the resident, paid within 30 days of a correct invoice.
A resident in a Medicare Part A skilled stay can elect hospice, but Part A does not pay a skilled stay for the terminal illness at the same time as the hospice benefit. Talk with us and your business office before the election so the family understands who pays room and board.
General inpatient care in a nursing facility
General inpatient care is a short-term level of care for pain or symptoms that cannot be managed in another setting. It is provided only when medically necessary during a symptom crisis. A skilled nursing facility can be a GIP site only under a written contract with the hospice and only if it meets the requirements in 42 CFR 418.108 and 418.110, including 24-hour nursing that meets each patient's needs under the plan of care. A resident's usual bed does not become a GIP bed because the resident is declining. See levels of care criteria. When general inpatient or respite care is needed, the hospice team confirms a contracted facility with an available bed and arranges the clinical handoff and transport before any transfer.
Patients have the right to choose their hospice provider. Beta Hospice does not offer anything of value in exchange for referrals.
Three ways to refer
Face sheet, recent notes, medication list and an order to evaluate.
Our response commitment: A response within two hours, 24 hours a day, 7 days a week
Common questions
Does the facility need a separate agreement for each resident?
No. The written agreement is between the facility and the hospice. Each resident then has an individual coordinated plan of care.
Can a resident have hospice from a hospice we have no agreement with?
The resident has the right to choose. The chosen hospice and the facility need a written agreement in place before hospice care is furnished.
Who updates the MDS and facility care plan?
The facility. The hospice shares its plan of care and updates so the two plans stay consistent.
Who do we call at night?
The hospice on-call number in the resident's record. A hospice nurse answers the phone 24 hours a day, 7 days a week, and can visit when needed.
About this page
- Written by
- Beta Hospice care team
- Clinically reviewed by
- our medical director
- Last reviewed
- September 24, 2026
- Next review
- March 24, 2027
How we write and review this site
Sources
- 42 CFR 418.112: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID (opens in a new tab)
- 42 CFR 418.108: Short-term inpatient care (opens in a new tab)
- Medicaid.gov: Hospice benefits (opens in a new tab)
- HHS OIG Special Fraud Alert: Nursing home arrangements with hospices (1998) (opens in a new tab)
These sources support the general information on this page. For one person’s care and coverage, talk with the hospice team.
Refer a patient or ask a clinical question
Call any time. A nurse can talk through eligibility, timing and logistics for your patient.
Patients have the right to choose their hospice provider.