55 Pa. Code § 1130.61 – Prerequisites for coverage.

To be covered, hospice services shall meet the following requirements:

(1) The services shall be reasonable and necessary for the palliation or management of the symptoms of the terminal illness as well as related conditions.
(2) The recipient shall have elected hospice care under § 1130.41 (relating to election of hospice care).
(3) A plan of care shall be established in accordance with Medicare regulations at 42 CFR 418.58 (relating to condition of participation—plan of care) before the services are provided.
(4) The services shall be consistent with the plan of care.
(5) A certification that the individual is terminally ill shall be completed under § 1130.22 (relating to duration of coverage).