Hospice Medicare Certification and State Licensure (Certification) Forms and Resources

Home Care

This will provide you with the requirements and necessary paperwork to complete both state licensure and Medicare Certification processes.

 Federal Register, Medicare Program Hospice Care Amendments

 Letter of Intent for State Licensure and/or Medicare Certification

 Application for Hospice Certification

Home Health Aide Competency Evaluation - Please call our office at 573/751-6336 to obtain a copy.

 Health Insurance Benefit Agreement

 Assurance of Complaince (Title VI of Civil Rights Act)

 HCFA Guidelines for Hospice Care in SNF's

 Chapter 30 Hospices - 197.250 - 197.280, RSMo (state)

 Federal Interpretive Guidelines - Hospices (State Operations Manual - Appendix M)

 19 CSR 30-35.010 - 30-35.030 Hospice Program Operations (state)

 State Disclosure of Ownership and Control Interest Statement

Office for Civil Rights Packet Information

Criminal Background - 660.317

 Hospice Request for Certification in Medicare Program

 Spiritual Counselor Defined

Guidelines for Development - Medicare/State Certified Hospice

42 CFR 418 Conditions of Participation for Hospice (federal)

Alzheimer's and Dementia Specific Training - 660.050

Family Care Safety Registry

Advance Directive Information - 42 CFR 489.100-489.104

Missouri Law Regarding a Patient's Right to Make Health Care Treatment Decisions

Possession of Drugs by a HHA or Hospice - 4 CSR 220-2.010(8)

Hepatitis B - 29 CFR 1910.1030 (f)(1)(i)(ii),(ii)(A),(2)(iv)