Hospice

Hey there!

I'm looking for some feedback regarding how your agency interprets this statement from the Medicare Benefits Policy Manual (Ch. 9 Section 60), pertaining to patients who elect the Medicare hospice benefit but also have VA benefits:

Medicare beneficiaries that are dually eligible veterans, and reside at home in their
community may elect the Medicare Hospice Benefit and have hospice services paid for
under the Medicare Hospice Benefit. See §1853(c) and 1814(d) of the Act.
Upon electing the Medicare hospice benefit, the beneficiary waives the right to
Medicare payment for any Medicare services related to the terminal illness and related
conditions during a hospice election. However, this does not preclude dually eligible
veterans (i.e., eligible for both Medicare and Veterans benefits) from receiving services
not included on the hospice plan of care, and which are furnished and paid under the
beneficiary's VA benefits, in addition to Medicare hospice services. This may include
care and support services that are unique to VA benefits and not typically provided by
Medicare hospice agencies, for example, but not limited to, VA home-based primary
care for illnesses other than the terminal illness. Any services that are included on the
hospice plan of care must be provided and paid under Medicare.
If a dually eligible veteran, who had been receiving Medicare hospice services in his/her
home, is admitted to a VA owned and operated inpatient facility, the beneficiary must
revoke the Medicare hospice benefit. Medicare is not allowed to pay for services that
another Federal provider or agency furnishes (§1862(a)(3) and 42 CFR 411.6).

My understanding is that hospices have an obligation to coordinate care with VA HBPC providers to ensure that there is no overlap with services provided by the hospice as part of the hospice plan of care. For example, if VA HBPC is helping the patient with showers, then the hospice needs to coordinate with the HBPC program to ensure that the hospice aide and the HBPC staff are not both assisting with showers. Is that correct?

I'm also a bit thrown by the phrase "VA home-based primary care for illnesses other than the terminal illness"... my understanding has always been that dually eligible veterans who elect the Medicare hospice benefit can pursue care and treatments through VA benefits, even for the terminal illness and related conditions-- essentially, they are eligible for concurrent care, as long as those treatments are paid for by VA benefits. Is this not the case?

Thanks in advance!

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Chad Thurman
Circle of Life Hospice
Director of Quality and Compliance
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Hey Chad!

This is such a great comment for discussion. In my many years of being a hospice nurse and the Veteran Liaison, here's what we know/do for dually eligible Veterans, which is follow the directive you mentioned. MDCR Vets must disenroll if they get admitted to the VA. Home Based Primary Care is a special service the VA offers for chronically ill Vets that is a team, similar to the hospice team. If they are involved, they continue to care for the non-related diseases. Many Vets also get HHA hours from the VA. Ours provides up to 21 hours/week if they are on hospice and we can add our HHA on alternate days.  If the registered Vet is very active with their VA clinic/provider, wants palliative chemo, wants to keep dialysis even though they have ES Renal Disease, then the VA could become the payer for hospice and like you said, this is the "concurrent care" that allows them to have these treatments, be admitted to the VA and not lose their hospice benefits.

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Nancy Auster
VITAS Inpatient Hospice Unit at University of Miami
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Original Message:
Sent: 01-29-2026 02:05 PM
From: Chad Thurman
Subject: Patients dually eligible for MCR and VA benefits

Hey there!

I'm looking for some feedback regarding how your agency interprets this statement from the Medicare Benefits Policy Manual (Ch. 9 Section 60), pertaining to patients who elect the Medicare hospice benefit but also have VA benefits:

Medicare beneficiaries that are dually eligible veterans, and reside at home in their
community may elect the Medicare Hospice Benefit and have hospice services paid for
under the Medicare Hospice Benefit. See §1853(c) and 1814(d) of the Act.
Upon electing the Medicare hospice benefit, the beneficiary waives the right to
Medicare payment for any Medicare services related to the terminal illness and related
conditions during a hospice election. However, this does not preclude dually eligible
veterans (i.e., eligible for both Medicare and Veterans benefits) from receiving services
not included on the hospice plan of care, and which are furnished and paid under the
beneficiary's VA benefits, in addition to Medicare hospice services. This may include
care and support services that are unique to VA benefits and not typically provided by
Medicare hospice agencies, for example, but not limited to, VA home-based primary
care for illnesses other than the terminal illness. Any services that are included on the
hospice plan of care must be provided and paid under Medicare.
If a dually eligible veteran, who had been receiving Medicare hospice services in his/her
home, is admitted to a VA owned and operated inpatient facility, the beneficiary must
revoke the Medicare hospice benefit. Medicare is not allowed to pay for services that
another Federal provider or agency furnishes (§1862(a)(3) and 42 CFR 411.6).

My understanding is that hospices have an obligation to coordinate care with VA HBPC providers to ensure that there is no overlap with services provided by the hospice as part of the hospice plan of care. For example, if VA HBPC is helping the patient with showers, then the hospice needs to coordinate with the HBPC program to ensure that the hospice aide and the HBPC staff are not both assisting with showers. Is that correct?

I'm also a bit thrown by the phrase "VA home-based primary care for illnesses other than the terminal illness"... my understanding has always been that dually eligible veterans who elect the Medicare hospice benefit can pursue care and treatments through VA benefits, even for the terminal illness and related conditions-- essentially, they are eligible for concurrent care, as long as those treatments are paid for by VA benefits. Is this not the case?

Thanks in advance!

------------------------------
Chad Thurman
Circle of Life Hospice
Director of Quality and Compliance
------------------------------