@vijay26: I have worked with people enrolled in hospice and the general criteria for admission is for those individuals with a life expectancy of 6 months or less. Therefore, people enrolled must have evidence of a terminal illness; frequently, they have co-morbidities meaning they also have other medical conditions. For instance, a person with cancer might have a pacemaker for a heart condition. In certain cases, such as if that pacemaker evidences failure to the degree that it would cause debillitating distress to the individual or that not replacing it would cause cardiac arrest and NOT death from the admitting diagnosis, these would be considered valid reasons for replacement.

However, if it is determined that the pacemaker is to prolong life (this is not an indefinite life-saving procedure, addressed below) for a separate diagnosis that the individual elects to have, then as @gently indicated, one would have to revoke hospice services to undergo the procedure. Once completed, there would be the option to request re-enrollment as soon as possible, even the day after surgery - as long as the criteria remains valid. For example, if the diagnosis was terminal cancer or kidney failure there would not be an issue. If the diagnosis was cardiac related and the pacemaker helped to resolve that, the criteria would likely no longer be met.

I'm uncertain if your question is asking if one agrees with the use of the word replacement implies that that Medicare thinks that a person with a pacemaker will live forever. I'm unclear what the basis is for that understanding, as a pacemaker can only adjust the rhythm of the heart; it cannot fix failing heart musculature or clear blocked arterties that frequently accompany the aging process.

I realize that was a long explanation but has it helped you understand the situation any better?