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Hospice Organization Initial Application 

Eligibility Criteria (Read First) 

To qualify, your hospice must: 

  • Have operated for at least one (1) year prior to application. 


  • Employ a Holistic Services Coordinator (or designate a Volunteer Coordinator) responsible for creating, implementing, and overseeing individualized holistic care plans. 


  • Be locally owned and operated, demonstrating strong community ties. 


  • Maintain a system to track service type, frequency, and outcomesand submit monthly electronic reports to HPF. 


  • Demonstrate a holistic, person-centered approach addressing physical, emotional, spiritual, and social needs of patients and families. 


  • Be in full compliance with all local, state, and federal regulations governing hospice care. 


  • Provide ongoing training in holistic care principles/practices (documentation available upon request). 


  • Engage in community outreach/partnerships/education promoting holistic end-of-life care. 


  • Be fully accredited by a national body such as ACHC or CHAP (or other recognized accreditor). 


  • Utilize an approved CAHPS Hospice Survey vendor as required by Medicare. 


  • Understand HPF does not provide cash funds; HPF coordinates and pays providers directly for approved services in collaboration with your Coordinator. Services may be extended to the primary caregiver

Acknowledgment: 

Organizational Information

Ownership:
Locally Owned
Other

Holistic Services Program

Do you maintain a tracking system for all holistic services delivered?
Yes
No

Patient-Centered Care & Community Engagement

Requested Support

Check the holistic services you are requesting HPF to coordinate and fund for eligible patients/caregivers:

*(Final number/type of sessions will be determined by HPF at its discretion.) 

Compliance & Reporting Agreement

By signing, the hospice agrees that: 


  • HPF does not distribute funds to the hospice or patient; HPF coordinates and pays providers directly

  • The hospice will submit monthly electronic reports of services delivered and outcomes. 

  • The hospice will cooperate with audits/reviews of holistic services data. 

  • Funds/services will be used exclusively to enhance holistic care. 

  • Non-compliance may result in termination of support and possible repayment of funds for any misapplied services. 

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