For hospice and palliative care
Hospice bereavement requirements under 42 CFR 418.64
What the Medicare Conditions of Participation require of a bereavement program, what they leave undefined, who may provide the service, and where a published standard for grief work fits.
Medicare-certified hospices are required to run a bereavement program. This page sets out what the Conditions of Participation actually say, what they leave undefined, who is permitted to provide the service, and where a published standard for non-clinical grief support does and does not fit. Regulation text is quoted from 42 CFR Part 418. This page is a plain-English reference, not legal or compliance advice.
42 CFR 418.64(d)(1)
What does the regulation require of a hospice bereavement program?
A Medicare-certified hospice must have an organized bereavement program supervised by a qualified professional with experience or education in grief or loss counseling, make bereavement services available for up to one year after the patient's death, ensure those services reflect the needs of the bereaved, and document them in a bereavement plan of care. Bereavement counseling is a required hospice service and is not reimbursable.
Bereavement counseling sits within the counseling services standard of the core services Condition of Participation. Under 42 CFR 418.64(d)(1), the hospice must:
- (i) "Have an organized program for the provision of bereavement services furnished under the supervision of a qualified professional with experience or education in grief or loss counseling."
- (ii) "Make bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient." Bereavement counseling also extends to residents of a skilled nursing facility, nursing facility, or intermediate care facility when appropriate and identified in the bereavement plan of care.
- (iii) "Ensure that bereavement services reflect the needs of the bereaved."
- (iv) "Develop a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery."
A separate coverage provision, 42 CFR 418.204(c), states: "Bereavement counseling is a required hospice service but it is not reimbursable." The program is mandatory and carries no separate payment.
42 CFR 418.3
How does the regulation define bereavement counseling?
"Emotional, psychosocial, and spiritual support and services provided before and after the death of the patient to assist with issues related to grief, loss, and adjustment."
Two things in that definition matter for anyone designing or staffing a program. It covers the period before the death as well as after, so bereavement work begins while the patient is still in care. And it describes support with grief, loss, and adjustment, not clinical treatment. The definition does not require that the support be delivered by a licensed clinician, and it does not describe a method.
The gap
What does the regulation leave undefined?
It names no degree, no license, no credential, and no hour count for the "qualified professional with experience or education in grief or loss counseling" who supervises the program. It does not say what the rest of the program's staff must know, and it does not define what services "reflect the needs of the bereaved."
The contrast with the rest of the same Condition of Participation is plain. Medical social services, under 418.64(c), "must be provided by a qualified social worker." Nursing services, under 418.64(b), must be provided "by or under the supervision of a registered nurse." Where the regulation wants a specific professional, it names one. For bereavement it names a quality, experience or education in grief or loss counseling, and leaves the hospice to decide how to establish and document it.
In practice, that means the role is defined by the job a person holds rather than by a standard they have met. A national sample of hospices found wide variation in the timing, provider, recipients, and format of bereavement services (Becker and Cagle, 2021).
Hospices should confirm how their state survey agency and CMS interpretive guidance for surveyors apply to their own program. This page describes the text of the regulation only.
42 CFR 418.64
Who is permitted to provide hospice bereavement services?
The hospice's own employees, for substantially all of it. Counseling, including bereavement counseling, is a core service, and the regulation requires that a hospice "routinely provide substantially all core services directly by hospice employees." Contracted staff may only supplement employees under extraordinary or other non-routine circumstances.
The core services provision permits a hospice to "use contracted staff, if necessary, to supplement hospice employees in order to meet the needs of patients under extraordinary or other non-routine circumstances," or to enter a written arrangement with another Medicare-certified hospice. The circumstances it names are unanticipated periods of high patient loads, staffing shortages due to illness or other short-term temporary situations, and temporary travel of a patient outside the service area.
An independent practitioner of non-clinical grief support, board certified or not, is not a routine substitute provider for a hospice's required bereavement program. INBGC says this plainly because a standard that overstates where its certificants fit is not one a hospice can rely on. The places where a published non-clinical standard does fit are set out below.
Application
Where does a published standard for non-clinical grief support fit?
In three places: documenting the grief-specific preparation of the hospice's own bereavement staff, setting criteria for the community resources a family is given, and describing the grief-specific qualifications a hospice wants when it hires. None of these displaces the hospice's obligations or any clinical qualification it already requires.
1. Documenting the preparation of your own staff
The regulation asks for experience or education in grief or loss counseling and does not say how either is shown. A bereavement coordinator, chaplain, or social worker who is board certified in grief care has had grief-specific education reviewed against six published topic areas, practice verified, ethics attested, and applied judgment examined, including scope of practice and referral. That is one documentable form of grief-specific preparation for the non-clinical part of the work.
The regulation does not name this credential or any other, and INBGC does not claim that holding it satisfies a Condition of Participation. It is evidence a hospice may choose to use. A hospice with its own internal bereavement training may also have that program reviewed as a Recognized Education Provider, which embeds the published criteria inside existing onboarding.
2. The resource list families take home
Hospices that maintain resource lists for bereaved families point them to organizations, and the individuals named on those lists are almost always licensed clinicians. Non-clinical practitioners are largely absent, because the preparation behind a title cannot be confirmed. The published referral criteria give a hospice six criteria and sample policy language for evaluating any non-clinical practitioner before listing them, credentialed or not.
3. Hiring for bereavement roles
Because the regulation names no credential, bereavement position descriptions vary. A hospice that wants a documented grief-specific qualification can state it as preferred, with equivalents accepted. Guidance and sample language are at hiring for grief and bereavement roles.
Limits
Where it does not fit
Board certification in grief care is not a license, does not certify or authorize clinical care, does not replace a qualified social worker or any other professional the regulation names, and does not by itself make a hospice compliant with anything.
The credential certifies non-clinical grief support. A certificant does not diagnose, treat, prescribe, provide psychotherapy, assess clinical risk, or serve as crisis intervention in that role, and is required to recognize warning signs of acute risk and connect the person to clinical or emergency support. Where a bereaved family member needs clinical care, the referral is to a licensed professional. The full scope is published in the Code of Ethics and Scope of Practice.
Continuity
What happens after the bereavement window closes?
The regulation requires services to be available for up to one year after the death. Grief does not follow that schedule, and a family member who still wants support afterward may be pointed to the community. That handoff is where a vetted resource list matters most.
Non-clinical individual support, from a practitioner the hospice has evaluated against written criteria, is one option a program can offer at that point without extending its own obligations. The hospice remains the referring party, not the provider, and the practitioner is outside the program.
Sources
Regulation text
- 42 CFR 418.64, Condition of participation: Core services, including (d)(1) bereavement counseling
- 42 CFR 418.3, Definitions, bereavement counseling
- 42 CFR 418.204(c), Special coverage requirements, bereavement counseling
- Becker and Cagle (2021), national sample of hospice bereavement services, reporting wide variation in timing, provider, recipients, and format
Regulation text is quoted from the Electronic Code of Federal Regulations, which is not an official legal edition. Confirm current text and interpretive guidance with CMS and your state survey agency.
Common questions
For bereavement programs
Criteria for the families you refer out
The published referral criteria give your program six criteria, sample policy language, and a verification reference for evaluating any non-clinical practitioner before a family receives their name. Free to adopt, with nothing to join.
Published by the Independent National Board for Grief Certification. This page describes regulation text and is not legal or compliance advice. See also where grief coaches work and the professional standard for non-clinical grief support.