The hospice must designate a physician to serve as medical director. The medical director must be a doctor of medicine or osteopathy who is an employee, or is under contract with the hospice. When the medical director is not available, a physician designated by the hospice assumes the same responsibilities and obligations as the medical director.
(a)
Standard: Medical director contract .
(1) A hospice may contract with either of the following-
(i) A self-employed physician; or
(ii) A physician employed by a professional entity or physicians group. When contracting for medical director services, the contract must specify the physician who assumes the medical director responsibilities and obligations.
(b)
Standard: Initial certification of terminal illness . The medical director or physician designee reviews the clinical information for each hospice patient and provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination:
(1) The primary terminal condition;
(2) Related diagnosis(es), if any;
(3) Current subjective and objective medical findings;
(4) Current medication and treatment orders; and
(5) Information about the medical management of any of the patient's conditions unrelated to the terminal illness.
(c)
Standard: Recertification of the termina terminal illness . Before the recertification period for each patient, as described in §418.21(a), the medical director or physician designee must review the patient's clinical information.
(d)
Standard: Medical director responsibility . The medical director or physician designee has responsibility for the medical component of the hospice's patient care program.