Hospice care offers specialized comfort and support for individuals with a terminal illness, focusing on quality of life rather than curative treatments. Because this care is highly personal, the relationship between a patient and their provider is important. Patients often consider switching providers due to a need for different services, a change in location, or a search for a better fit in care philosophy. Patients and their families maintain control over their end-of-life care choices.
The Patient’s Right to Change Providers
Patients receiving hospice care have the protected right to choose and change their provider. This autonomy is recognized under the regulations governing the Medicare Hospice Benefit, which covers the majority of hospice patients. A patient can elect to switch to a different hospice agency at any point during their benefit period without needing a specific reason. Sufficient grounds for a change include dissatisfaction with the current care team, necessary relocation to be closer to family, or a preference for a different agency’s services.
This action is considered a transfer, which is distinct from a revocation where a patient stops hospice care entirely to pursue curative treatments. The ability to transfer ensures patients can access the most appropriate care as their condition evolves. The right to transfer is limited to one change per benefit period. The benefit period begins with two 90-day periods, followed by unlimited 60-day periods, meaning the patient has multiple opportunities to make a change if needed.
The Formal Process for Transferring Care
The process for moving from one hospice to another is administrative and requires precise documentation to ensure continuity of coverage. The first step involves researching, selecting, and confirming the new hospice agency can accept the patient. Once chosen, the patient or their authorized representative must complete a formal, signed statement. This document serves as the official notification of the transfer.
The signed statement must clearly identify the current hospice provider, the newly designated hospice, and the exact effective date of the transfer. This statement must be filed with both the transferring and receiving hospices. Ensuring the transfer date is the same for both agencies prevents any gap in service or billing.
The receiving hospice completes new admission paperwork, including a new consent form. Administrative coordination occurs between the two agencies, including sharing clinical records and the patient’s Plan of Care. The transferring hospice must process a live discharge and submit its final claim promptly. Both hospices must communicate to confirm the effective date to prevent billing issues or interruptions in the flow of services.
Financial and Coverage Considerations
A key aspect of a hospice transfer is that the patient’s existing Medicare Hospice Benefit period continues uninterrupted. When transferring, the patient does not have to re-qualify for the benefit or start a new benefit period. They simply continue along the timeline of their current election period, maintaining eligibility.
For patients covered by Medicare, there is no financial penalty for switching providers. The new hospice takes on the financial responsibility for the patient’s care under the existing benefit structure. The effective date is important: the Centers for Medicare & Medicaid Services (CMS) requires that there be no gap in billing days between the two agencies. A gap, even for a single day, can cause complications and may be treated as a discharge and readmission, potentially requiring a new Notice of Election.
Private insurance plans generally mirror the Medicare benefit structure, allowing transfer without a break in coverage. The receiving hospice verifies coverage details and ensures they are an in-network provider, if applicable. The patient remains responsible for minimal copayments, such as for outpatient prescription drugs or respite care, regardless of the agency providing the service.
Maintaining Consistent Care During the Switch
Ensuring a seamless clinical handover is necessary during a transfer, as the patient’s comfort and symptom management must remain stable. The immediate priority is the continuity of medication and durable medical equipment. The receiving hospice must promptly assess the patient upon admission to confirm that current medications, particularly those for pain and symptom control, are available and administered without delay.
A thorough clinical handover requires the complete and timely transfer of the patient’s medical records, including the current Plan of Care, physician orders, and advanced directives. The new interdisciplinary team uses this documentation to immediately establish an individualized plan that aligns with the patient’s needs. Prioritizing communication between clinical teams actively prevents potential disruptions in symptom management, such as a lapse in scheduled nursing visits or medication delivery.