A Hospice provider is an agency that provides palliative care (relief of pain and uncomfortable symptoms) as opposed to curative care. In addition, hospice care addresses the physical, psychological, social, and spiritual needs of the patient. The emphasis of the hospice program is on keeping the hospice patient at home with family and friends for as long as possible.
“Hospice house” means a facility that is owned and operated by a Medicare certified hospice agency for the purposes of providing inpatient hospice services.
To establish a hospice house, an applicant must complete and submit an application packet. Application materials are located below, or may be requested through the Bureau of Facility Standards at (208) 334-6626.
The application packet includes what must be submitted and approved by the Bureau of Facility Standards (items #1 and #2) as follows:
- Request for Certification - CMS-417.
- A letter of intent which includes the following information:
- The physical address of the proposed hospice house.
- The intended date of opening.
- Documentation of the intent to achieve and maintain Deemed status by a Medicare approved Accreditation Organization.
- The date of 855 submission
You may mail a completed application to:
Department of Health and Welfare
Bureau of Facility Standards
P.O. BOX 83720
BOISE, ID 83720-0009
PLEASE KEEP A COPY FOR YOUR RECORDS.
CMS requires Hospice providers complete a new form CMS-855A, when facility changes occur including the addition of a Hospice house. The form CMS-855A can be accessed on the Internet or requested directly from your fiscal intermediary/carrier:
Read the instructions on the web site and obtain the form by clicking on the version you will need for your computer.
National Government Services
P.O. Box 6474
Indianapolis, Indiana 46206-6474