How Do You Compare Hospice Providers in St. Louis Before You Sign the Election Statement?

You may receive several hospice names from a hospital, physician, nursing facility or friend. That list is a starting point, not a decision. Your job is to compare the agencies on the same facts before anyone asks your parent to sign.

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Start with a one page grid. Put each hospice in a separate column. Use these rows: Medicare certification, service area, admission timing, after hours response, pharmacy, equipment delivery, inpatient location, respite arrangements, attending physician, items excluded from hospice coverage, facility charges and complaint history.

Who pays

Medicare Part A can cover hospice when the patient meets Medicare's eligibility rules, chooses comfort focused care for the terminal illness and related conditions, uses a Medicare approved hospice, and signs a hospice election statement. The physician and hospice make the eligibility determination. You do not make it from a diagnosis or a prognosis you found online. See the Medicare hospice materials listed on the Sources page.

Medicare generally pays the selected hospice for care connected to the terminal illness and related conditions. That makes one comparison question especially important: What does this hospice consider related? Ask each agency to explain whether it expects to furnish or arrange the medications, equipment, nursing, therapy, ambulance trips and hospital care already in use. Do not accept "Medicare covers everything" as a usable answer. Medicare says care for the terminal illness generally must be furnished or arranged by the hospice, and unarranged care can leave the patient responsible for the bill.

Hospice coverage does not automatically pay the room and board charge where the patient lives. If your parent is in assisted living or a nursing facility, ask the facility and hospice separately what each one supplies and who bills for it. If either mentions a charge, send the amount, billing interval and refund terms to the billing office by phone. Do not copy a price from a directory or another family's contract.

If Medicaid, a Medicare Advantage plan, veterans benefits or long term care insurance is also involved, give every payer the same proposed start date and provider name. Ask which payer handles room and board, personal care or other services outside the Medicare hospice benefit. Record the representative's name, call reference number and exact answer. The overview at Who Pays for Care at Home in St. Louis can help you keep the payers separate.

The papers

Ask for blank copies before the admission meeting. The packet should include the hospice election statement, consent forms, privacy notices, complaint instructions, financial responsibility terms and any agency specific service agreement. Medicare publishes a model hospice election statement, but an agency may use its own compliant version. Compare the paper you receive with the CMS model identified on the Sources page.

On the election statement, verify the hospice name, effective date and selected attending physician. The election changes how Medicare pays for services related to the terminal illness and related conditions. Stop if the document is blank, the effective date is wrong, or the named physician is not the person the patient chose. Ask the hospice to correct the paper before anyone signs.

Request the written election statement addendum that identifies conditions, items, services and drugs the hospice says are unrelated and therefore will not cover. Ask for the reason beside every exclusion. Compare addenda across the agencies. A broad verbal promise is not a substitute for this written list. Medicare describes the addendum and the patient's right to question the hospice's coverage determination in its hospice materials.

Also ask to see Form CMS-10123, the Notice of Medicare Non-Coverage. A hospice uses this notice when Medicare covered services are ending. You are not signing it at admission. You are checking whether the agency can explain who delivers it, where the appeal contact appears and whom you call immediately if services are set to end.

Do not sign as a financial guarantor merely because you are the person holding the clipboard. If you are signing for the patient, write the capacity in which you are signing and use only authority that already exists. If the agency disputes your authority or asks you to accept personal liability, stop. That is the line where a Missouri lawyer reviews the document.

The runway

Call every hospice with the same scenario. State the patient's location, likely start point and equipment already present. Then ask:

Who answers the main number after regular office hours? Is that person clinical staff or an answering service? Who can come to the home, and how is an urgent visit requested? Which pharmacy supplies hospice related drugs? Who delivers oxygen, a bed or other ordered equipment? Who removes equipment after a transfer, revocation or death? Where does the agency arrange general inpatient care? Which facilities accept its respite arrangements? If the caregiver cannot continue safely, what number starts that escalation?

Ask for names, not assurances. Record the pharmacy, equipment supplier and inpatient locations each agency actually uses in your part of St. Louis. Availability can change, so confirm it by phone when the decision is being made.

Next, test coordination. Give the agency a list of current physicians, drugs, equipment and scheduled appointments. Ask which person will decide what is related to the hospice diagnosis, who contacts the existing prescribers, and what the family must do before calling an ambulance or going to the emergency department. Medicare warns that hospital, outpatient and ambulance care connected to the terminal illness may need hospice arrangement.

Use Medicare Care Compare to confirm that each candidate is Medicare certified and to review the quality information Medicare publishes. Treat the measures as questions, not a final ranking. Ask an agency to explain who collects its family experience information, what period the displayed results cover and what operational change followed a weak area. CMS identifies Care Compare as its public reporting site for hospice quality information.

Check Missouri oversight separately. The Missouri Department of Health and Senior Services regulates hospice providers and operates the Home Health and Hospice Hotline for complaints. Ask whether the agency has had a state survey finding and how it corrected it. Verify the answer with DHSS rather than relying on marketing material. Missouri's hospice page and complaint contact are cataloged on the Sources page.

Free help

If Medicare coverage is unclear, call Missouri SHIP for free, independent Medicare counseling. Bring the election statement, proposed addendum, insurance cards and your comparison grid. Ask the counselor to help separate hospice coverage from Part D, Medicare Advantage and non-hospice Medicare claims. Local contacts are collected at Local Help With Paying for Care.

You can also call Medicare to confirm certification and coverage rules, Missouri DHSS to check licensing or make a care complaint, and the Beneficiary and Family Centered Care Quality Improvement Organization named in the hospice paperwork if you dispute certain Medicare hospice decisions. If the dispute concerns a physician's prognosis or plan of care, take it to the physician. If it concerns signing authority, contract language, estate liability or personal responsibility for a bill, take the papers to a lawyer.

Your final comparison should fit on one page. Circle the agency that gave you a written coverage boundary, a named after hours process, confirmed local arrangements and clean paperwork. Leave price fields blank until the responsible payer, facility or provider gives you the rate by phone and explains exactly what it buys.