Maryland Hospice Eligibility & Enrollment Information

Maryland Hospice Care Eligibility & Election Guide

This Senior Soup guide provides an overview of the eligibility criteria and election process for hospice care in Maryland, based on Md. Code Regs. 10.09.35.05.

Hospice care serves individuals with a terminal illness who choose palliative treatment over curative measures.

The Maryland Medical Assistance Program (Medicaid) regulates eligibility and the election process for hospice care providers and recipients.

Eligibility for Maryland Hospice Care

According to Md. Code Regs. 10.09.35.05(A)(1)–(7), to qualify for hospice care in Maryland, a patient must meet the following criteria:

1. Certification of Terminal Illness

• A patient must obtain written certification from two physicians (for the initial election period in Maryland) before submitting a claim for payment for Maryland hospice care services;
• If written certification is delayed, Maryland law requires oral certification within two calendar days of the election period start and written certification before claim submission;
• Certification must be issued no more than 15 calendar days before the election period begins;
• The certifying physician must document that the patient’s prognosis is six months or less if the illness follows its normal course.

2. Maryland Hospice Care Eligibility Certification

According to Md. Code Regs. 10.09.35.05(A)(4), for the initial election period, written certification must be obtained by two physicians:

• The hospice organization’s medical director or a physician on the hospice interdisciplinary team and
• The attending physician, if there is an attending physician.

Only one of the physicians listed above must certify the patient’s eligibility for subsequent election periods.

Maryland Healthcare Practitioners Who Can Certify Hospice Eligibility

3. Maryland Hospice Certification Documentation Requirements

According to Md. Code Regs. 10.09.35.05(A)(6)–(7), a Maryland hospice certification must include:

• The physician’s signature and date;
• The date of election – for which the certification applies;
• Clinical documentation supporting the patient’s prognosis;
• A brief narrative justifying the patient’s terminal illness diagnosis, positioned immediately before the physician’s signature or as a signed addendum;
• The narrative must be specific to the patient (checkboxes or standard language are prohibited).

4. Continued Maryland Hospice Eligibility: Face-to-Face Encounter Requirement

The law requires a face-to-face encounter when a third election period or later is expected, according to Md. Code Regs. 10.09.35.05(A)(8)–(9):

• No more than 30 days before the third and any subsequent election periods.
• Conducted by a Maryland hospice physician or nurse practitioner.
• Must include a written narrative explaining the clinical findings supporting continued hospice eligibility.

Election of Hospice Care in Maryland

Electing hospice care in Maryland involves a formal process where an individual chooses to receive palliative care aimed at comfort rather than curative treatment for a terminal illness.

A signed election statement documents this decision and must include the following:

• Election of Hospice Care: A declaration by the patient or their healthcare agent opting for hospice services;

• A Designated Hospice Provider: Identification of the Maryland hospice agency responsible for delivering care;

• Effective Date: The start date of hospice services, which cannot precede the date of the election;

• Acknowledgment of Hospice Philosophy: Confirmation that the patient understands that hospice care focuses on palliative rather than curative treatment.

• Waiver of Certain Services: Recognition that, by electing hospice, the Maryland patient waives their rights to Medicaid payments for services related to the terminal condition that are not provided or arranged by the chosen hospice

Election of Hospice Care for Maryland Patients 21 & Older

According to Md. Code Regs. 10.09.35.05(B)–(C), for a patient to elect hospice care in Maryland, a signed declaration must be filed with the hospice provider containing:

• A statement electing hospice care;
• The name of the hospice provider;
• The effective date (the date cannot be earlier than the election date).

A statement acknowledging:

• Hospice is palliative, not curative;
• The patient waives Medicaid coverage for curative treatments related to the terminal illness;
• Only the designated hospice provider can provide Medicaid-covered hospice services.
• The signature of the patient or representative.

Election of Hospice Care for Maryland Patients Under 21

For eligible patients younger than 21, the hospice election declaration differs slightly:

• The patient may continue to receive curative treatments while receiving hospice care;
• All other election declaration elements remain the same.

Informed Consent and Maryland Hospice Care

Informed consent is a fundamental component of Maryland hospice care.

It ensures that patients and their representatives understand their rights, available treatment options, and the palliative nature of hospice services.

Maryland law explicitly requires that hospice providers communicate informed consent information before hospice election, empowering patients and families to make informed and autonomous decisions aligned with an enrolling hospice patient’s values and preferences.

Before electing hospice care in Maryland, patients and their healthcare agents should receive: 

• A clear explanation of hospice services, explicitly stating their palliative rather than curative intent and the resulting waiver of Medicaid coverage for curative treatments directly related to the terminal illness;
• An overview of the anticipated course of hospice care, including symptom management, pain relief, emotional support, spiritual counseling, and other comfort-focused interventions;
• An explanation that, under Maryland law, hospice providers must obtain formal certification from a physician regarding the patient’s terminal prognosis (typically six months or less if the illness runs its natural course);
• Information regarding a Maryland patient’s right to revoke the election of hospice care at any time and resume standard Medicaid or Medicare services if they choose to pursue curative treatments;
• Disclosure of alternative care options outside hospice, including continued curative treatments or comfort-focused care in settings such as home health, long-term care facilities, or specialized palliative care programs;
• Information about bereavement services and grief support provided by the hospice program, extending for at least one year following the patient’s death, under Maryland hospice COMAR regulations;
• There should be clear communication regarding the patient’s rights under Maryland law, including the right to privacy, dignity, respect, and participation in care decisions at every stage.

The Role of a Maryland Power of Attorney in Hospice Care (POA)

A designated Maryland power of attorney or healthcare proxy may act on a patient’s behalf when the patient cannot make medical decisions due to illness or cognitive impairment.

An established power of attorney ensures patients’ medical decisions align with their wishes.

Under Maryland COMAR regulations (Md. Code Regs. 10.09.35), hospice care election and eligibility require the patient or their authorized healthcare proxy (which includes a legally appointed healthcare agent under a Maryland advance directive) to declare their choice to receive hospice care formally.

Thus, a healthcare agent named in a Maryland advance directive can legally:

• Elect hospice care on behalf of the incapacitated patient;
• Sign required hospice documentation and acknowledgments;
• Manage the patient’s healthcare decisions through the hospice enrollment, care, and bereavement processes.

Families and caregivers should ensure appropriate legal documentation is in place to avoid delays or complications in hospice enrollment and decision-making.

Duration and Termination of Maryland Hospice Election

Electing hospice care in Maryland involves several critical decisions that affect the duration and continuity of care.

Once elected, hospice care typically continues uninterrupted across multiple election periods, provided the Maryland patient remains eligible and satisfied with their chosen hospice provider.

Incidentally, hospice patients retain complete control and flexibility.

Maryland hospice patients and their healthcare agents can revoke their hospice election at any time or even change hospice providers if necessary – without losing access to hospice benefits entirely.

Understanding these conditions helps patients and families make informed choices that best align with a patient’s needs and preferences.

1. Continuation of Hospice Care

The hospice election remains valid through all election periods as long as the patient:

• Stays under the care of the hospice provider;
• Does not revoke the election of hospice care.

2. Revocation of Hospice Care

A Maryland patient or their representative may revoke hospice care at any time.

Revocation requires a signed statement indicating the following:

• A desire to revoke hospice coverage;
• Understanding that you forfeit hospice coverage for the rest of the election period.;
• The effective date of revocation (not earlier than the revocation date).

After revocation:

• The patient loses Medicaid hospice coverage;
• Standard Medicaid benefits resume;
• The patient may re-elect hospice care in the future if still eligible.

3. Changing Hospice Providers

A Maryland hospice patient may switch providers once per election period without revoking hospice care.

The hospice patient or their designated healthcare proxy must submit a written statement to both the current and new providers, including the following:

• Names of the current and new providers;
• The effective date of the change;
• The signature of the patient or representative.

Maryland Hospice COMAR Regulations

This guide provides a structured overview of Maryland’s hospice eligibility and election requirements as outlined in Md. Code Regs. 10.09.35.05.

Maryland hospice providers must adhere to these regulations to ensure proper patient enrollment and Medicaid reimbursement.

For more information about Maryland hospice eligibility, please contact the Maryland Department of Health – Office of Health Care Quality (OHCQ).

The OHCQ oversees the licensing and regulation of hospice care providers in Maryland, ensuring compliance with state laws and regulations.

Contact Information:

• Address: 201 W. Preston Street, Baltimore, MD 21201
• Phone: (410) 767-6500 or 1-877-463-3464
• Website: https://health.maryland.gov/ohcq

The Three Primary Levels of Hospice Care Provided in Maryland

1) Routine Home Care (RHC) in Maryland

Routine home hospice is the most common form of hospice care in Maryland.

It involves delivering hospice services at the patient’s residence, which could be their private home, an independent or assisted living facility, or a nursing facility.

Services Typically Provided Under Routine Home Care in Maryland:

• Regular visits by hospice nurses, aides, social workers, chaplains, and volunteers;
• Pain management and symptom relief;
• Medical supplies, medications, and durable medical equipment related to the terminal illness;
• Emotional and spiritual counseling for patients and families;
• Family caregiver education and support.

2) Continuous Home Care (CHC) in Maryland 

Continuous home care involves intensive care provided in the patient’s residence during periods of crisis. With this short-term level of care, patients receive stabilized acute medical symptoms and avoid unnecessary hospitalization.

Criteria and Key Features:

• Provided only during brief periods of crisis where symptoms are uncontrolled;
• Must involve at least eight hours of direct patient care within a 24-hour period, predominantly nursing care;
• Hospice staff remains in the home to deliver care and manage severe symptoms;
• Aimed at stabilizing the patient and returning them to routine care status as soon as possible.

Common Scenarios for CHC:

• Severe pain or symptom escalation;
• Sudden medical crisis requiring urgent clinical intervention.

3) Inpatient Hospice Care in Maryland

Inpatient hospice care manages symptoms that cannot be adequately addressed at home or in an outpatient setting through short-term stays in a dedicated or contracted hospital or nursing facility

Criteria and Key Features:

• Short-term stays manage acute symptoms;
• A patient receives round-the-clock medical and nursing care from hospice professionals;
• Includes intensive symptom relief and comfort-focused interventions not feasible at home;
• The goal is to manage symptoms quickly so the patient can return to their home care setting.

Situations Where Inpatient Care May Be Needed:

• Unmanageable pain or symptoms at home;
• Complex wound care or intensive medical procedures requiring continuous professional oversight.

How Are Hospice Levels Determined in Maryland?

In Maryland, the hospice provider’s interdisciplinary team — typically including physicians, nurses, social workers, and other specialists — collaboratively assesses and determines the most suitable level of hospice care based on the patient’s medical condition, symptom severity, care needs, and family preferences.

Understanding these hospice care levels enables Maryland patients and their families to navigate end-of-life care with clarity, confidence, and comfort.

Enrolling in Hospice Care in Maryland

Step 1: Initial Consultation & Eligibility Evaluation

• Consultation with Healthcare Providers: The prospective hospice patient or their healthcare proxy begins by discussing hospice care with the patient’s attending physician, specialists, or other healthcare providers involved in their care.

• Eligibility Assessment: To qualify for Maryland hospice care, two physicians must certify that the patient has a terminal illness with a life expectancy of approximately six months or less, should the disease run its natural course.

Step 2: Choosing a Maryland Hospice Provider

• Research and Compare Providers: Maryland offers many hospice providers, each offering slightly different services or philosophies. Consider factors like reputation, services, staff availability, cultural competence, and proximity.

• Interview and Ask Questions: Engage directly with potential Maryland hospice providers to clarify any questions or concerns about their care practices, availability, and additional support services, such as grief counseling.

Step 3: Formal Certification of Terminal Illness

• Initial Certification Required: Two physicians (typically the hospice medical director and the patient’s attending physician, if available) provide written certification of the terminal prognosis.

• Documentation Requirements:

  • Certifications must include:

  • Physician signatures with dates;
  • A straightforward, individualized narrative about the patient’s medical condition and prognosis;
  • Clinical documentation supporting the prognosis.

Step 4: Understanding Hospice Care in Maryland & Informed Consent

• Hospice Care Explained: Maryland Hospice staff must thoroughly explain hospice care, emphasizing:

  • It’s a palliative (comfort-focused) rather than a curative approach;
  • Waiver of Medicaid payments for curative treatments related directly to the terminal illness;
  • The patient’s right to revoke hospice at any time.

• Informed Consent: Patients or their healthcare proxy must confirm their understanding and voluntarily consent to hospice care.

Step 5: Signing the Hospice Election Statement

• Formal Hospice Election: Complete and sign the Hospice Election Statement, specifying:

  • The patient’s (or by healthcare proxy) decision to elect hospice;
  • The selected Maryland hospice provider’s name;
  • The effective date (cannot be earlier than the date you formally make the election).

• Acknowledgment: By signing, the patient (or their healthcare proxy) confirms the understanding that hospice care is palliative and waives specific curative services.

Step 6: Beginning Hospice Care Services in Maryland

• Initial Assessment and Plan of Care: The hospice interdisciplinary team conducts a comprehensive assessment at the patient’s home (or a chosen care setting) to develop a personalized care plan.

• Services Initiated: Hospice care begins immediately, providing medical equipment, medications, nursing visits, emotional support, and assistance tailored to the patient’s comfort and symptom management needs.

Step 7: Ongoing Hospice Care and Regular Assessments

• Routine Visits: Hospice team members regularly visit patients to monitor and manage their symptoms, provide emotional support, and offer caregiver support.

• Periodic Reassessments: The hospice care team continuously evaluates the patient’s condition and adjusts the care plan as necessary.

Step 8: Continuation, Revocation, or Changing Providers

• Continuing Hospice Care: Hospice continues through consecutive election periods as long as the patient remains eligible and satisfied and does not revoke care.

• Revocation Option: Hospice patients or their healthcare proxies can revoke the hospice election by submitting a signed revocation statement, returning to standard medical coverage, or pursuing alternative care options.

• Switching Providers: A Maryland hospice patient may switch hospice providers once per election period by submitting a written notice to both providers.

Step 9: Hospice Provides Ongoing Bereavement & Grief Support

• Ongoing Family Support: After a hospice patient’s death, Maryland hospice providers must offer bereavement and grief support services to families and loved ones for at least one year, including counseling and community resources.

Maryland Hospice Organizations

Please click the link to visit The Senior Soup’s comprehensive list of Maryland hospice services.

Maryland Hospice Providers

Maryland Hospice Care Resources

Ryan Miner, MBA | Co-Founder and Podcast Host | The Senior Soup

Ryan Miner

Podcast Host | Healthcare Marketer at The Senior Soup | Ennoble Care | (301) 991-4220 | ryan@theseniorsoup.com | Website |  + postsBio

Hi, I'm Ryan!

I co-founded The Senior Soup Soup with Raquel Micit in September 2022. Together, we host The Senior Soup Podcast.

I am a community relations manager for Ennoble Care in Maryland, where I am responsible for marketing our home-based primary care healthcare practice.

I have over 15 years experience in healthcare, senior services, senior care, marketing, public policy, and search engine optimization.

I have a MBA from Mount St. Mary's University and a BA from Duquesne University.

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