The Process for Accessing Home Hospice Services in Minnesota

Initiating and enrolling in home hospice care involves several key steps, including physician involvement, formal election by the patient, and the development of a personalized care plan.

A. Initiating Care and Referrals

The conversation about hospice often begins when curative treatment is no longer effective or desired, and the focus shifts to comfort and quality of life.

Physician Role: A physician typically plays a key role in identifying patients who may be appropriate for hospice care based on their diagnosis and prognosis. As noted, physician certification of terminal illness and prognosis is a requirement for eligibility.
Referrals: While often initiated by physicians, referrals to hospice can come from various sources, including hospital discharge planners, nursing home staff, social workers, other healthcare providers, family members, or even the patients themselves. Some hospices explicitly state that patients can access care without a direct physician referral, although the necessary physician certification must still be obtained for admission. Many providers list specific contact information for referrals.
Initial Contact: The first step usually involves contacting a hospice agency directly via phone 10 or through their website to inquire about services, discuss eligibility, and begin the admission process. Some agencies promote rapid response times, including striving for 24-hour or same-day emergency admissions when needed.

B. Formal Election and Admission

Once eligibility is confirmed and the patient chooses hospice, a formal election process takes place:

Hospice Election Statement: This is a critical document. The patient (or their legal representative) must sign a statement that formally elects the hospice benefit. This statement must:

Clearly identify the specific hospice provider chosen to deliver care.
Acknowledge that the patient understands hospice focuses on palliative (comfort) care rather than curative treatment for the terminal illness.
Acknowledge that electing hospice involves waiving the right to certain other Medicare/Medicaid benefits specifically related to curative treatment of the terminal illness.
Specify the effective date for the start of hospice care, which cannot be earlier than the date the statement is signed.
Include the patient’s (or representative’s) signature.

Provider Responsibilities: The chosen hospice agency has several responsibilities during admission. They must fully explain the nature of hospice care, the services available, the benefits being elected, and the benefits being waived. They must also inform the patient/representative of their rights, often providing a copy of the Hospice Bill of Rights. The hospice provides a copy of the signed election statement to the patient/representative, keeps the original on file, and must promptly notify relevant parties, such as the patient’s attending physician and, for MA recipients, the local county human services agency. Timely submission of forms is crucial for billing and benefit coordination, particularly for MA (within two calendar days specified).

The Election Statement is more than just an admission form; it is the legal and administrative trigger that activates the hospice benefit under the patient’s insurance plan. It signifies informed consent and initiates the specific coverage rules and waivers associated with hospice care. Understanding its significance is vital for patients and families.

C. Initial Assessment and Plan of Care

Following election, the hospice team works with the patient and family to establish a roadmap for care:

Assessment: The interdisciplinary team conducts a comprehensive initial assessment covering the patient’s physical condition, pain and symptoms, psychosocial needs, spiritual preferences, functional status, and the home environment. Family and caregiver needs are also assessed.
Plan of Care (POC) Development: Based on the assessment, a detailed, individualized, written Plan of Care is developed before services formally begin. This plan is created collaboratively by the hospice interdisciplinary team, the hospice physician/medical director, and importantly, the patient’s attending physician if they remain involved. The POC outlines the specific services needed, the frequency of visits, goals for care (primarily symptom management and quality of life), medication orders, and necessary equipment/supplies. It serves as the guiding document for all care provided by the hospice team.
RN Coordinator: A specific Registered Nurse is typically designated to coordinate the implementation and ongoing management of the Plan of Care for each patient.

D. Changing Providers or Revoking Hospice

Patient choice remains central throughout the hospice experience:

Changing Hospices: Patients generally have the right to change their designated hospice provider once during each benefit period (e.g., once during the initial 90-day period, once during the next 90-day period, etc.) This requires signing a specific statement indicating the change and the effective date, which must be submitted to both the current hospice and the newly chosen hospice.
Revoking Hospice: As previously noted, a patient can decide to stop hospice care at any time. This is done by signing a revocation statement provided to the hospice, specifying the date the revocation takes effect. Upon revocation, the hospice benefit ends, and the patient resumes eligibility for the standard Medicare/Medicaid benefits that were previously waived for curative treatment of the terminal illness. The hospice must notify the relevant county agency within two business days if the patient is an MA recipient. Patients can choose to re-elect hospice care later if they still meet the eligibility criteria.