Switching hospice providers

What the rule says

Medicare hospice coverage is divided into benefit periods: two periods of 90 days, followed by an unlimited number of 60-day periods. Within each period you may change your designated hospice one time. When a new period begins, you may change again.

To make the change, you or your representative sign a statement that names the hospice you are leaving, the hospice you are moving to and the date the change takes effect. The statement is filed with both hospices. The regulation says plainly that changing hospices is not a revocation of the hospice benefit.

Medi-Cal and most private plans follow similar rules. If your coverage is through a health plan, ask the new hospice to confirm it is in the plan's network before the transfer date.

Transfer, revocation and discharge are different things

A hospice cannot revoke the benefit for you, and it should never pressure you to revoke so that it can avoid paying for a treatment or a hospital stay. Revocation is your decision alone. If you feel pushed, call 1-800-MEDICARE.

How a transfer works

1. Step 1

   Call the hospice you want to move to

   Explain that the person is on hospice now and wants to transfer. Ask your questions first. Our list of questions to ask any hospice can help.

2. Step 2

   Check that you have not already transferred in this benefit period

   Either hospice can tell you the dates of the current benefit period. If you have already used your one change, the new hospice can explain the options and the timing of the next period.

3. Step 3

   Agree on a transfer date

   The two hospices talk to each other and pick a date, often within a few days. The new hospice reviews the medical records and confirms that a doctor's certification is in place.

4. Step 4

   Sign the transfer statement

   It names both hospices and the effective date. The new hospice will also have you sign its own consents. Read them and ask for copies.

5. Step 5

   Equipment and medicines are switched over

   The new hospice arranges its own equipment and medicine supply to arrive on or before the transfer date. See below.

6. Step 6

   The new team visits

   A nurse from the new hospice completes an assessment and builds a new plan of care with you. Your attending doctor can stay the same.

What happens to equipment and medicines

Hospice equipment such as a hospital bed, oxygen or a wheelchair is rented by the hospice from an equipment company. When you transfer, the old hospice's equipment is picked up and the new hospice's equipment is delivered. The two hospices should coordinate so the person is never without a bed or oxygen. Sometimes both hospices use the same equipment company and the items simply stay in place. Ask about this when you set the date.

Medicines already delivered to the home stay with the patient. From the transfer date, the new hospice orders and pays for medicines related to the terminal illness. Its nurse will review every medicine with you and may suggest changes. Supplies such as briefs, gloves and wound dressings are handled the same way.

If you revoke hospice instead of transferring, the equipment is picked up and future medicines and supplies go back through your regular coverage. Plan with your doctor before the revocation date so nothing runs out.

Common reasons people change hospices

• Moving to a relative's home or a facility outside the current hospice's service area
• Trouble reaching a nurse at night or on weekends
• Frequent staff changes or poor communication
• A facility, doctor or health plan that works more closely with a different hospice
• Wanting services the current hospice does not arrange well, such as inpatient or respite care nearby

Common questions